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Saroul N, Loukine M, Durand M, Pereira B, Rozand I, Becaud J, Martinez Q, Mom T, Gilain L, Evrard B, Puechmaille M, Bonnet B. Early detection of pharyngocutaneous fistulae after total laryngectomy by cytokine in drainage: A pilot study (DEFILAC). Head Neck 2023; 45:3067-3074. [PMID: 37815200 DOI: 10.1002/hed.27535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The determination of cytokines in the postoperative drainage (POD) fluid could be a method for early detection of the development of a pharyngocutaneous fistula (PCF). MATERIALS AND METHODS We conducted a prospective two-center study involving 28 patients. PODs were collected on Day 1 (D1) and Day 2 (D2) postoperatively for determination of a cytokine panel and cytobacteriological examination. RESULTS Eleven (39%) patients presented with PCF on average 13 ± 5.5 days after surgery. Patients with PCF had higher IL-10 (121 vs. 40.3, p = 0.04, effect size (ES) = 0.98 [0.16, 1.79]) and TNFα level (21.2 vs. 2.2, p = 0.02, ES = 0.83 [0.03, 1.63]) on D2. An IL-10 threshold of 72 pg/mL on D2 was diagnostic of the occurrence of PCF with a sensibility of 70%, specificity of 88%. CONCLUSION The determination of cytokines in POD fluid on D2 is a reliable tool for predicting the development of a PCF after total laryngectomy.
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Affiliation(s)
- Nicolas Saroul
- Department of Otolaryngology - Head and Neck Surgery, CHU-Clermont-Ferrand, Clermont-Ferrand, France
- University of Clermont Auvergne, CHU-Clermont-Ferrand, INRAE, UNH, Clermont-Ferrand, France
| | - Margaux Loukine
- Department of Otolaryngology - Head and Neck Surgery, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Durand
- Department of Otolaryngology - Head and Neck Surgery, CH Emile Roux, Le Puy-en-Velay, France
| | - Bruno Pereira
- Department of Biostatistics, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Rozand
- Department of Biochemistry, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Justine Becaud
- Department of Otolaryngology - Head and Neck Surgery, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Quentin Martinez
- Department of Otolaryngology - Head and Neck Surgery, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Thierry Mom
- Department of Otolaryngology - Head and Neck Surgery, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Gilain
- Department of Otolaryngology - Head and Neck Surgery, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Bertrand Evrard
- Department of Clinical Immunology, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathilde Puechmaille
- Department of Otolaryngology - Head and Neck Surgery, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Bonnet
- Department of Clinical Immunology, CHU-Clermont-Ferrand, Clermont-Ferrand, France
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Leppäpuska IM, Rannikko EH, Laukka M, Peuhu E, Veemaa R, Viitanen T, Koskivuo I, Hartiala P. Low TGF-β1 in Wound Exudate Predicts Surgical Site Infection After Axillary Lymph Node Dissection. J Surg Res 2021; 267:302-308. [PMID: 34175584 DOI: 10.1016/j.jss.2021.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Surgical site infection (SSI) after axillary lymph node dissection (ALND) for breast cancer increases morbidity and delays the onset of adjuvant treatment. Only a few studies have investigated the feasibility of wound exudate analysis in SSI prediction. This study assessed changes in cytokine levels in postsurgical wound exudate after ALND and examined their predictive value for the early diagnosis of SSI. METHODS An observational prospective pilot study was conducted in 47 patients with breast cancer undergoing ALND. Wound exudate samples were collected on the first and sixth postoperative days (POD). Interleukin (IL)-1α, IL-1β, IL-4, IL-10, IL-13, tumor necrosis factor alpha (TNF-α), transforming growth factor beta1 (TGF-β1) and vascular endothelial growth factor (VEGF) C and D levels were measured by immunoassay. Patients were followed to detect SSI. RESULTS SSI was diagnosed in 8/47 (17.0%) patients. Four SSI patients were hospitalized and treated with intravenous antibiotics. The concentration of TGF-β1 in wound exudate was significantly lower on POD#1 in the SSI group compared to the no SSI group (p=0.008). The receiving operator characteristics (ROC) curve for TGF-β1 showed an area under curve of 0.773 (p=0.0149) indicating good diagnostic potential. On POD#6, the concentration of TGF-β1 remained significantly lower (p=0.043) and the concentrations of IL-10 (p=0.000) and IL-1β (0.004) significantly higher in the SSI group compared to the no SSI group. CONCLUSION To our knowledge, this is the first study suggesting a predictive role of wound exudate TGF-β1 levels for SSI. Our results suggest that the risk for SSI can be detected already on POD#1 and that the assessment of TGF-β1 levels in the wound exudate after ALND can provide a usefull method for the early detection of SSI. The key findings of this pilot study warrant verification in a larger patient population.
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Affiliation(s)
- Ida-Maria Leppäpuska
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Eeva H Rannikko
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Mervi Laukka
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Institute of Biomedicine, University of Turku, Turku, Finland
| | - Emilia Peuhu
- Institute of Biomedicine, University of Turku, Turku, Finland; Cancer Research Laboratory FICAN West, University of Turku, Turku, Finland; Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Raili Veemaa
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Tiina Viitanen
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Ilkka Koskivuo
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Pauliina Hartiala
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Institute of Biomedicine, University of Turku, Turku, Finland; Cancer Research Laboratory FICAN West, University of Turku, Turku, Finland.
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Shi M, Han Z, Qin L, Su M, Liu Y, Li M, Cheng L, Huang X, Sun Z. Risk factors for surgical site infection after major oral oncological surgery: the experience of a tertiary referral hospital in China. J Int Med Res 2021; 48:300060520944072. [PMID: 32841576 PMCID: PMC7463046 DOI: 10.1177/0300060520944072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To identify risk factors associated with surgical site infection (SSI) after
major oral oncological surgery. Methods This retrospective study reviewed data from patients that underwent major
surgery for oral cancer at a tertiary referral hospital in China between
January 2005 and July 2016. SSI was diagnosed within 30 days. Demographic,
cancer-related, preoperative, perioperative and postoperative data were
analysed using descriptive statistics and univariate and multivariate
analyses of the risk factors for SSI. Results A total of 786 patients were enrolled, of whom 125 had SSI (15.9%), which
were all incisional. Independent risk factors for SSI, identified by
multivariate analysis, were diabetes mellitus (odds ratio [OR] 2.147, 95%
confidence interval [CI] 1.240, 3.642), prior radiotherapy (OR 4.595, 95% CI
1.293, 17.317) and oral–neck communication (OR 2.838, 95% CI 1.263, 7.604);
and factors reflecting large extent resections were tracheostomy (OR 2.235,
95% CI 1.435, 3.525), anterolateral thigh flap (OR 1.971, 95% CI 1.103,
3.448) and latissimus dorsi flap (OR 4.178, 95% CI 1.325, 13.189). Conclusions Multiple risk factors were associated with SSI after major oral oncological
surgery. To minimize SSI risk, surgeons managing oral cancer patients should
have a better understanding of the risk factors, including diabetes
mellitus, prior radiotherapy, tracheostomy, oral–neck communication and flap
reconstruction.
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Affiliation(s)
- Menghan Shi
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China.,Department of Oral Medicine, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Lizheng Qin
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Ming Su
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Yanbin Liu
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Man Li
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Long Cheng
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Xin Huang
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Zheng Sun
- Department of Oral Medicine, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
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Bi X, Li Y, Lin J, Li C, Li J, Cao Y. Concentration standardization improves the capacity of drainage CRP and IL-6 to predict surgical site infections. Exp Biol Med (Maywood) 2020; 245:1513-1517. [PMID: 32715784 DOI: 10.1177/1535370220945290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPACT STATEMENT The ability to predict surgical site infections (SSIs) early would be advantageous. Previous studies have investigated the use of inflammatory factors in fluids drained from surgical sites to predict SSI, but the diagnostic efficacy of this method requires improvement. Baseline levels of inflammatory factors vary between individuals, but this variation tends to differ in patients with and without SSIs. Therefore, we standardized subsequently acquired concentrations of interleukin 6 and C-reactive protein in fluids drained from surgical sites by dividing them by the concentrations determined at day 1 to preclude the confounding effects of differences in baseline levels. The standardized concentrations had higher predictive efficacy than the absolute concentrations. Standardizing the data rendered SSI prediction more precise and practical in a diverse group of real patients. This translational study suggests that inflammatory factors in fluid drained from injury sites are promising tools for the prediction of SSI in the clinic.
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Affiliation(s)
- Xiaoqin Bi
- West China School of Nursing, Sichuan University, Chengdu 610041, China.,Department of Nursing, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yan Li
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu 610041, China.,National Engineering Laboratory for Oral Regenerative Medicine, West China College of Stomatology, Sichuan University, Chengdu 610041, China.,Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jie Lin
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu 610041, China.,Department of Dental Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu 610041, China.,Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jiping Li
- West China School of Nursing, Sichuan University, Chengdu 610041, China.,Department of Nursing, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu 610041, China.,Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Bao X, Chen F, Qiu Y, Shi B, Lin L, He B. Log Odds of Positive Lymph Nodes is Not Superior to the Number of Positive Lymph Nodes in Predicting Overall Survival in Patients With Oral Squamous Cell Carcinomas. J Oral Maxillofac Surg 2019; 78:305-312. [PMID: 31705864 DOI: 10.1016/j.joms.2019.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/26/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE It is unclear whether the log odds of positive lymph nodes (LODDS) outperforms the number of positive lymph nodes (LN+) in predicting the overall survival (OS) of oral squamous cell carcinoma (OSCC) patients. The specific aim of this study was to compare the prognostic predictive performance of LN+ with LODDS in OSCC patients. MATERIALS AND METHODS This prospective cohort study was conducted in Fujian, China, from December 2005 to January 2017. Patients' characteristics and clinicopathologic data were obtained through medical records, and follow-up data were obtained by telephone interviews. Cox proportional hazards models were used to evaluate the association between LN+ or LODDS and OS in OSCC. Finally, the Harrell concordance index, Akaike information criterion, and area under the receiver operating characteristic curve were adopted as criteria for assessing the predictive performance of lymph node models. RESULTS For all 706 patients, the 5-year survival rate was 65.69% (95% confidence interval, 0.61 to 0.70) and the mean age at diagnosis was 57.32 ± 11.80 years. Of the patients, 456 were men and 250 were women (ratio of 1.82:1). LN+ and LODDS were significantly associated with a poor prognosis of OSCC patients (all P values for trend < .001). Furthermore, the prognostic value of LODDS was not better than that of LN+. An interesting finding was that there was a J-shaped relationship between the number of negative lymph nodes and OS. The hazard ratio was reduced with each additional negative lymph node dissected up to 24 negative lymph nodes, with no improvement in prognosis beyond this number. Moreover, when the number of negative lymph nodes was greater than 40, the negative lymph nodes suggested a worse prognosis for OSCC patients. CONCLUSIONS Our study suggests that the discriminatory capability of LODDS was not superior to that of LN+. An interesting finding was that, when the number of negative lymph nodes was greater than 40, the predictive power of LODDS was reduced tremendously.
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Affiliation(s)
- Xiaodan Bao
- Master Degree Candidate, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fa Chen
- Lecturer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yu Qiu
- Physician, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bin Shi
- Physician, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lisong Lin
- Physician, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Baochang He
- Associate Professor, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
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6
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Saleh K, Strömdahl AC, Riesbeck K, Schmidtchen A. Inflammation Biomarkers and Correlation to Wound Status After Full-Thickness Skin Grafting. Front Med (Lausanne) 2019; 6:159. [PMID: 31355202 PMCID: PMC6640317 DOI: 10.3389/fmed.2019.00159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background: A surgical site infection (SSI) is believed to be the result of an exaggerated inflammatory response. Objective: Examine the relationship between clinical status and inflammation biomarkers in full-thickness skin grafting wounds. Methods: Twenty patients planned for facial full-thickness skin grafting were enrolled. A week after surgery, all graft wounds were clinically assessed using a 3-step scale for inflammation (low, moderate, high). All wounds were swabbed for routine microbiological analysis and assessment of numbers of aerobic bacteria. Tie-over dressings from all patients were collected and used for wound fluid extraction and subsequent analysis of MMPs, cytokines, and NF-κB inducing activity. Results: Wounds with a high degree of inflammation contained increased total MMP activity (P ≤ 0.05) in their corresponding fluids. Likewise, the level of the cytokines IL-1ß, IL-8, IL-6, TNF-α was analyzed, and particularly IL-1ß was discriminatory for highly inflamed wounds (P ≤ 0.01). Moreover, bacterial loads were increased in highly inflamed wounds compared to wounds with a low degree of inflammation (P ≤ 0.01). NF-κB activation in the monocytic cell line THP-1 was significantly higher when these cells were stimulated by wound fluids with a high degree of inflammation (P ≤ 0.01). Growth of S. aureus in wounds did not vary between wounds with different degrees of inflammation (chi-square 3.8, P = 0.144). Conclusion: Biomarkers analyzed from tie-over dressings correlated to clinical wound healing in full-thickness skin grafting.
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Affiliation(s)
- Karim Saleh
- Division of Dermatology, Department of Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Ann-Charlotte Strömdahl
- Division of Dermatology, Department of Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Artur Schmidtchen
- Division of Dermatology, Department of Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.,Department of Biomedical Sciences, Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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7
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Guo Z, Zhang J, Gong Z, Jing S. Correlation of factors associated with postoperative infection in patients with malignant oral and maxillofacial tumours: a logistic regression analysis. Br J Oral Maxillofac Surg 2019; 57:460-465. [DOI: 10.1016/j.bjoms.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/04/2019] [Indexed: 11/25/2022]
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8
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Lassig AAD, Joseph AM, Lindgren BR, Yueh B. Association of Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid With Patient Outcomes. JAMA Otolaryngol Head Neck Surg 2017; 143:670-678. [PMID: 28418447 DOI: 10.1001/jamaoto.2016.3595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Survival rates for head and neck cancer have been relatively stable for several decades. Individualized prognostic indicators are needed to identify patients at risk for poorer outcomes. Objective To determine whether biomarker levels in surgical drain fluid of patients with head and neck cancer are associated with poor cancer outcomes. Design, Setting, and Participants This prospective cohort study enrolled patients with squamous cell carcinoma (SCC) of the oral cavity and oropharynx who required surgical treatment from April 1, 2011, to February 1, 2016, at a tertiary or academic care center. Twenty patients, including 14 with stage IV disease, had complete specimen collection. Differences in cytokine and MMP levels by disease outcomes were evaluated. Interventions Patients underwent surgical treatment with drain placement as dictated by the standard of care. Drain fluid samples were collected every 8 hours postoperatively until drains were removed because of clinical criteria. Levels of cytokines and matrix metalloproteinases (MMPs) were measured using electrochemiluminescent, patterned array, multiplex technology. Main Outcomes and Measures The primary clinical outcome measures were survival outcome and recurrence. The biomarkers measured included the cytokines basic fibroblastic growth factor, vascular endothelial growth factor isoform A, soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PIGF) and MMP-1, MMP-3, and MMP-9. Other clinical and pathologic cancer characteristics were recorded. Results In this cohort of 20 patients with SCC (15 men and 5 women; mean [SD] age, 63.5 [9.9] years), a significant association with recurrence was found for levels of MMP-1 (relative difference between groups, 2.78; 95% CI, 1.23-6.29), MMP-3 (relative difference between groups, 5.29; 95% CI, 2.14-13.05), and sFlt-1 (relative difference between groups, 3.75; 95% CI, 1.84-7.65). No biomarkers were associated with disease outcome. Vascular endothelial growth factor isoform A was associated with nodal metastasis (relative difference between groups, 1.98; 95% CI, 1.12-3.51), and basic fibroblastic growth factor was associated with lymphovascular invasion (relative difference between groups, 1.74; 95% CI, 1.02-2.97). Conclusions and Relevance In this pilot sample of patients with SCC of the oral cavity and oropharynx, MMP-1, MMP-3, and sFlt-1 levels in wound fluid were associated with poor clinical cancer outcomes in the form of recurrence. This finding is consistent with the literature of tumor microenvironment in saliva, serum, and tumor tissue biomarkers. To our knowledge, this report is the first of such findings in surgical drain fluid, an easily accessible means of cytokine measurement. Measurement of these biomarkers in surgical fluid potentially represents a novel means of assessing cancer prognosis in this population.
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Affiliation(s)
- Amy Anne D Lassig
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis2Department of Otolaryngology-Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Anne M Joseph
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, Minneapolis
| | - Bruce R Lindgren
- Division of Biostatistics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Bevan Yueh
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
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Cytokines as Biomarkers and Their Respective Clinical Cutoff Levels. Int J Inflam 2017; 2017:4309485. [PMID: 28487810 PMCID: PMC5401738 DOI: 10.1155/2017/4309485] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/30/2017] [Indexed: 12/20/2022] Open
Abstract
Cytokines, including interleukins, interferons, tumor necrosis factors, and chemokines, have a variety of pro- and anti-inflammatory effects in the body through a number of biochemical pathways and interactions. Stimuli, actions, interactions, and downstream effects of cytokines have been investigated in more depth in recent years, and clinical research has also been conducted to implicate cytokines in causal patterns in certain diseases. However, particular cutoffs of cytokines as biomarkers for disease processes have not been well studied, and this warrants future work to potentially improve diagnoses for diseases with inflammatory markers. A limited number of studies in this area are reviewed, considering diseases correlated with abnormal cytokine profiles, as well as specific cutoffs at which cytokines have been deemed clinically useful for diagnosing those diseases through Receiver Operator Characteristics modeling. In light of studies such as those discussed in this review, cytokine testing has the potential to support diagnosis due to its lack of invasiveness and low cost, compared to other common types of testing for infections and inflammatory diseases.
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Wen Z, Wu C, Cui F, Zhang H, Mei B, Shen M. The role of osmolality in saline fluid nebulization after tracheostomy: time for changing? BMC Pulm Med 2016; 16:179. [PMID: 27938371 PMCID: PMC5148908 DOI: 10.1186/s12890-016-0342-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022] Open
Abstract
Background Saline fluid nebulization is highly recommend to combat the complications following tracheostomy, yet the understandings on the role of osmolality in saline solution for nebulization remain unclear. Objectives To investigate the biological changes in the early stage after tracheostomy, to verify the efficacy of saline fluid nebulization and explore the potential role of osmolality of saline nebulization after tracheostomy. Methods Sprague-Dawley rats undergone tracheostomy were taken for study model, the sputum viscosity was detected by rotational viscometer, the expressions of TNF-α, AQP4 in bronchoalveolar lavage fluid were assessed by western blot analysis, and the histological changes in endothelium were evaluated by HE staining and scanning electron microscopy (SEM). Results Study results revealed that tracheostomy gave rise to the increase of sputum viscosity, TNF-α and AQP4 expression, mucosa and cilia damage, yet the saline fluid nebulization could significantly decrease the changes of those indicators, besides, the hypertonic, isotonic and hypertonic saline nebulization produced different efficacy. Conclusions Osmolality plays an important role in the saline fluid nebulization after tracheostomy, and 3% saline fluid nebulization seems to be more beneficial, further studies on the role of osmolality in saline fluid nebulization are warranted.
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Affiliation(s)
- Zunjia Wen
- Nursing School of Soochow University, Su Zhou, People's Republic of China
| | - Chao Wu
- Nursing School of Soochow University, Su Zhou, People's Republic of China
| | - Feifei Cui
- Neurosurgery Department of First Hospital Affiliated to Soochow University, No. 188 Shizi Street, Gusu District, Su Zhou, Jiangsu Province, People's Republic of China
| | - Haiying Zhang
- Neurosurgery Department of First Hospital Affiliated to Soochow University, No. 188 Shizi Street, Gusu District, Su Zhou, Jiangsu Province, People's Republic of China
| | - Binbin Mei
- Nursing School of Soochow University, Su Zhou, People's Republic of China
| | - Meifen Shen
- Neurosurgery Department of First Hospital Affiliated to Soochow University, No. 188 Shizi Street, Gusu District, Su Zhou, Jiangsu Province, People's Republic of China.
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