Updates in Robotic Head and Neck Reconstructive Surgery.

The use of robotics in head and neck surgery has drastically increased over the past two decades. Transoral robotic surgery has revolutionized the surgical approach to the upper aerodigestive tract including the oropharynx and supraglottic larynx. The expanded use and improving technology of robotics have allowed for new approaches in both the ablative and reconstructive aspects of head and neck surgery.

Experiences in transitioning a testing laboratoryto the new ISO/IEC 17025:2017 standard.

Since its inception, the international quality standard ISO/IEC 17025 has been revised twice. The most recent edition adopted a new structure to align with other conformity assessment and quality management standards, harmonized the terminology with the International Vocabulary of Metrology and introduced the concept of risk-based thinking. This paper disseminates the experience of the IAEA Radiation Safety Technical Services Laboratory in successful transition and re-accreditation to ISO/IEC 17025:2017.

Internal dosimetric analyser to assist routine, confirmatory and special radiobioassays.

The IAEA Radiation Safety Technical Services Laboratory has developed and validated an Internal Dosimetric Analyser (IDA) software tool to facilitate access to dosimetric data and perform calculations related to individual monitoring for intakes of radionuclides and occupational radiation protection. IDA serves to correlate measurements from routine, confirmatory and special internal monitoring with data obtained from the Occupational Intakes of Radionuclides series of recommendations published by the International Commission on Radiological Protection. The purpose of IDA is to keep the internal dosimetry data in the background and allow the dosimetrist to make the necessary calculations to be able to decide (1) whether the bioassay method and monitoring period are appropriate for routine, confirmatory or special monitoring; (2) whether the method and period will allow the recording level to be detected; (3) whether previous intakes are contributing to the current measurement; and (4) whether measurement uncertainties affect the dose assessment.

Novel Machine Learning Model to Predict Interval of Oral Cancer Recurrence for Surveillance Stratification.

Objective(s): We aimed to develop a machine learning (ML) model to accurately predict the timing of oral squamous cell carcinoma (OSCC) recurrence across four 1-year intervals.

Methods: Patients with surgically treated OSCC between 2012-2018 were retrospectively identified from the Yale-New Haven Health system tumor registry. Patients with known recurrence or minimum follow-up of 24 months from surgery were included.

Correlations of Radiographic and Endoscopic Observations in Subglottic Stenosis.

Objective(s): Subglottic stenosis (SGS) represents a constellation of diverse pathologic processes that ultimately lead to narrowing of the subglottic region and can produce significant morbidity. Existing endoscopic and radiographic assessments may not be consistent in practice.

Methods: Severity of stenosis was evaluated and reported using the Cotton-Myer classification system from 33 endoscopic procedures from 32 unique subjects.

Global Genome Demethylation Causes Transcription-Associated DNA Double Strand Breaks in HPV-Associated Head and Neck Cancer Cells.

High levels of DNA methylation at CpG loci are associated with transcriptional repression of tumor suppressor genes and dysregulation of DNA repair genes. Human papilloma virus (HPV)-associated head and neck squamous cell carcinomas (HNSCC) have high levels of DNA methylation and methylation has been associated with dampening of an innate immune response in virally infected cells. We have been exploring demethylation as a potential treatment in HPV+ HNSCC and recently reported results of a window clinical trial showing that HNSCCs are particularly sensitive to demethylating agent 5-azacytidine (5-aza).

The role of vitamin D in head and neck cancer.

Objective: Head and neck squamous cell carcinoma (HNSCC) describes a set of malignancies of the head and neck that continue to inflict considerable morbidity and mortality. Because HNSCC often presents at an advanced stage, patients frequently undergo intensive multi-modal therapy with an intent to cure. Vitamin D is a precursor to the biologically active hormone calcitriol which governs bone and calcium physiology that is obtained from diet and UV-B exposure.

The role of bile reflux and its related NF-κB activated pathway in progression of hypopharyngeal squamous cell cancer.

Background: Prognosis for hypopharyngeal cancer is usually poor, and recurrence is common. Identifying new factors or related mechanisms that promote its progression may have clinical implications. Although, recent studies support bile reflux in hypopharyngeal carcinogenesis, it remains to be explored how bile and its related NF-κB activated pathway may further affects its progression in already established hypopharyngeal cancer.

Pediatric thyroidectomies: A surgical subspecialty comparison.

Objective: This study aims to establish the typical population, safety, and outcomes of pediatric thyroidectomies, specifically identifying surgical complication rates. Furthermore, the study compares management and complication differences between the two specialties that most often manage these patients - Pediatric General Surgery and Otolaryngology.

Methods: National Surgical Quality Improvement Program - Pediatrics (NSQIP-P) data between the years of 2012 and 2016 was reviewed and analyzed for patient characteristics, perioperative course and outcomes.

Thirty-day morbidity and mortality following otologic/neurotologic surgery: Analysis of the national surgical quality improvement program.

Objectives/hypothesis: To determine the rate and timing of, as well as risk factors for, postoperative morbidity and mortality following otologic and neurotologic surgery.

Study Design: Retrospective cohort study.

Methods: A total of 1,381 patients were identified in the American College of Surgeons National Surgical Quality Improvement Program for the years 2005 to 2010.

Demethylation Therapy as a Targeted Treatment for Human Papillomavirus-Associated Head and Neck Cancer.

DNA methylation in human papillomavirus-associated (HPV) head and neck squamous cell carcinoma (HNSCC) may have importance for continuous expression of HPV oncogenes, tumor cell proliferation, and survival. Here, we determined activity of a global DNA-demethylating agent, 5-azacytidine (5-aza), against HPV HNSCC in preclinical models and explored it as a targeted therapy in a window trial enrolling patients with HPV HNSCC. Sensitivity of HNSCC cells to 5-aza treatment was determined, and then 5-aza activity was tested using xenografted tumors in a mouse model.

Time-of-day influences on respiratory sequelae following maximal electroshock-induced seizures in mice.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in refractory epilepsy patients. Although specific mechanisms underlying SUDEP are not well understood, evidence suggests most SUDEP occurs due to seizure-induced respiratory arrest. SUDEP also tends to happen at night.

Comparing 30-Day Morbidity and Mortality in Pediatric and Adult Otologic Surgery.

Objective To determine differences in timing and rate of postoperative adverse events among pediatric and adult populations undergoing specific otologic procedures. Study Design Administrative database study. Setting Multi-institutional database.

TRAF3/CYLD mutations identify a distinct subset of human papillomavirus-associated head and neck squamous cell carcinoma.

Background: The incidence of human papillomavirus (HPV)-associated (HPV-positive) head and neck squamous cell carcinoma (HNSCC) of the oropharynx has dramatically increased over the last decade and continues to rise. Newly diagnosed HPV-positive HNSCCs in the United States currently outnumber any other HPV-associated cancers, including cervical cancer. Despite introduction of the HPV vaccine, the epidemic of HPV-positive HNSCC is expected to continue for approximately 60 years.

Selective antitumor activity of roscovitine in head and neck cancer.

Radiation and chemotherapy that are commonly used to treat human cancers damage cellular DNA. DNA damage appears to be more toxic to cancer cells than normal cells, most likely due to deregulated checkpoint activation and/or deficiency in DNA repair pathways that are characteristics of many tumors. However, unwanted side effects arise as a result of DNA damage to normal cells during the treatment.

Influence of vigilance state on physiological consequences of seizures and seizure-induced death in mice.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. SUDEP occurs more commonly during nighttime sleep. The details of why SUDEP occurs at night are not well understood.

Severe epistaxis due to aberrant vasculature in a patient with STAT-1 mutation.

Background: Signal transducer and activator 1 (STAT-1) mutations are rare and have been implicated in combined immunodeficiency, enhanced tumorigenesis, and vascular defects.

Methods: A 60-year-old woman with a novel STAT-1 mutation and resulting immunodeficiency, squamous cell carcinoma, and vascular disease presented with profuse epistaxis secondary to rupture of an aberrant artery that she developed in part because of this mutation. After unsuccessful posterior packing, embolization was initiated but subsequently aborted because of a bovine origin carotid artery and a history of multiple carotid dissections.

NUNDO: a numerical model of a human torso phantom and its application to effective dose equivalent calculations for astronauts at the ISS.

The health effects of cosmic radiation on astronauts need to be precisely quantified and controlled. This task is important not only in perspective of the increasing human presence at the International Space Station (ISS), but also for the preparation of safe human missions beyond low earth orbit. From a radiation protection point of view, the baseline quantity for radiation risk assessment in space is the effective dose equivalent.

Serotonin neurones have anti-convulsant effects and reduce seizure-induced mortality.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. Defects in central control of breathing are important contributors to the pathophysiology of SUDEP, and serotonin (5-HT) system dysfunction may be involved. Here we examined the effect of 5-HT neurone elimination or 5-HT reduction on seizure risk and seizure-induced mortality.

An infrastructure for accurate characterization of single-event transients in digital circuits.

We present the architecture and a detailed pre-fabrication analysis of a digital measurement ASIC facilitating long-term irradiation experiments of basic asynchronous circuits, which also demonstrates the suitability of the general approach for obtaining accurate radiation failure models developed in our FATAL project. Our ASIC design combines radiation targets like Muller C-elements and elastic pipelines as well as standard combinational gates and flip-flops with an elaborate on-chip measurement infrastructure. Major architectural challenges result from the fact that the latter must operate reliably under the same radiation conditions the target circuits are exposed to, without wasting precious die area for a rad-hard design.

The MATROSHKA experiment: results and comparison from extravehicular activity (MTR-1) and intravehicular activity (MTR-2A/2B) exposure.

Astronauts working and living in space are exposed to considerably higher doses and different qualities of ionizing radiation than people on Earth. The multilateral MATROSHKA (MTR) experiment, coordinated by the German Aerospace Center, represents the most comprehensive effort to date in radiation protection dosimetry in space using an anthropomorphic upper-torso phantom used for radiotherapy treatment planning. The anthropomorphic upper-torso phantom maps the radiation distribution as a simulated human body installed outside (MTR-1) and inside different compartments (MTR-2A: Pirs; MTR-2B: Zvezda) of the Russian Segment of the International Space Station.

Peer review versus editorial review and their role in innovative science.

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences.

Cosmic radiation exposure of biological test systems during the EXPOSE-E mission.

In the frame of the EXPOSE-E mission on the Columbus external payload facility EuTEF on board the International Space Station, passive thermoluminescence dosimeters were applied to measure the radiation exposure of biological samples. The detectors were located either as stacks next to biological specimens to determine the depth dose distribution or beneath the sample carriers to determine the dose levels for maximum shielding. The maximum mission dose measured in the upper layer of the depth dose part of the experiment amounted to 238±10 mGy, which relates to an average dose rate of 408±16 μGy/d.

Astronaut's organ doses inferred from measurements in a human phantom outside the international space station.

Space radiation hazards are recognized as a key concern for human space flight. For long-term interplanetary missions, they constitute a potentially limiting factor since current protection limits for low-Earth orbit missions may be approached or even exceeded. In such a situation, an accurate risk assessment requires knowledge of equivalent doses in critical radiosensitive organs rather than only skin doses or ambient doses from area monitoring.

The efficiency of various thermoluminescence dosemeter types to heavy ions.

Dose verification in heavy-ion beams using passive dosemeter systems, e.g. thermoluminescence dosemeters (TLDs), is crucial due to the changing efficiency of the dosemeters for different ion species and linear energy transfer (LET) values.