Head Version Research Articles

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

ObjectiveOsteoradionecrosis of the jaws (ORNJ) is among the most serious oral complications of head and neck cancer treatment with radiation therapy. This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China. MethodsA cross-sectional study was conducted to profile patient reported symptom severity. Ninety-five hospitalized ORNJ patients were recruited. Participants completed the MD Anderson Symptom Inventory–Head and Neck Module-Chinese version. ResultsThe percentage of participants who reported that they experienced at least one type of symptom was 97.9%, and 85.2% patients reported interference. The 10 most severe symptoms were as follows: limited mouth opening, problem with teeth/gums, difficulty swallowing/chewing, dry mouth, oral malodor, difficulty with voice/speech, dental ulcer, tinnitus/ear obstruction, skin pain/burning/rash, and difficulty hearing. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. The interference of patients positively correlated with core symptoms (r = 0.612), head and neck symptoms (r = 0.709), and ORNJ symptoms (r = 0.440) (P < 0.01). The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress (r = 0.479, P < 0.001), and mouth opening correlated negatively with symptom distress (r = −0.298, P = 0.003). ConclusionsORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. ORNJ patients commonly had symptom distress, which influenced their quality of life.

Prophylactic gabapentin decreases fatigue and swallowing difficulty in patients undergoing concurrent chemo-radiation (CCR) for head and neck cancer (HNC): Interim results from a randomized controlled trial.

6059 Background: Preliminary data suggest that gabapentin (G) administered during HNC radiation may decrease treatment associated pain. To confirm this, we undertook a prospective, randomized trial in HNC patients undergoing CCR. Primary outcomes: pain severity (scale of 0-10) and opioid use. Exploratory outcomes: local and systemic symptoms measured by the Vanderbilt Head and Neck Symptom Survey version 2 plus the general symptom survey (VHNSSv2/GSS). We report results of the exploratory endpoints from the interim analysis. Methods: Measures: VHNSSv2 - 50 items, demonstrated reliability/validated, captures acute/chronic local HNC specific symptoms; GSS – 11 item checklist, demonstrated content validity, captures acute/chronic systemic symptoms. Population: HNC patients (≥ stage 2) undergoing primary or adjuvant CCR. Procedures: Randomized to standard pain management (SPM) or SPM + G dose escalated to 900mg tid. VHNSSv2/GSS completed weekly during treatment beginning week 1 and ending the last week of radiation therapy. Results were analyzed using a mixed-effects regression analysis adjusting for baseline levels of each symptom. Results: 71 patients completed a mean of 5.5 surveys. Patients on G experienced a reduction in overall systemic symptoms as measured by the GSS (11-items, p = 0.0073), fatigue (two-items, p = 0.013 ) sleep disturbance (five items, p &lt; 0.0001) , neurosensory eating (3 items, p = 0.026), phlegm-related symptoms (4 items, p = 0.004), and trend to better smell (2 items, p = 0.055). No impact on swallow, xerostomia, voice, dental or musculoskeletal symptoms was noted. Conclusions: This exploratory analysis suggests that G may moderate neurological and neuropsychiatric toxicities in HNC patients undergoing CCR. Further studies are warranted.

Gyratory seizures as a presentation of temporal encephalocele.

Gyratory seizures (GS) are rare and have been reported in focal (frontal and temporal) as well as generalized epilepsies. The exact neuroanatomical substrate of gyration during a seizure is not clearly understood, but is thought to be due to the involvement of the basal ganglia. The direction of gyration occurring without head version is thought to have ipsilateral cerebral origins, while gyrational seizures preceded by forced head version are suggestive of seizure onset contralateral to the direction of gyration or the presence or absence of forced head version is thought to have important implications for lateralization of seizure origins from the direction of gyration. This case describes gyratory seizures in a young boy with a temporal encephalocele. Report of MRI brain initially indicated no abnormalities, but careful review revealed a left temporal encephalocele. PET scan showed left temporal hypometabolism. The patient underwent a left anterior temporal resection with amygdalohippocampectomy (ATL + AH) and is seizure‐free for 18 months. Temporal encephalocele is the most commonly iatrogenic but may also be spontaneous, post‐traumatic, or in relation to chronic otitis media. This case suggests that gyratory seizures may be a unique presentation of temporal encephalocele and this possibility warrants investigation in patients with medically refractory epilepsy.

Epileptic ictal strabismus: a case report and review of the literature

Ictal strabismus, sometimes associated with epileptic nystagmus, is an extremely rare epileptic phenomenon, suggestive of cortical involvement in monocular eye movement control. We describe a patient with ictal disconjugate contraversive horizontal eye deviation of cortical origin as the main clinical feature of a focal seizure. A 17-year-old, previously healthy woman had a seizure characterized by initial rightward conjugate eye deviation, followed by convergent strabismus due to adduction of the right eye towards the nose without conjugate left eye abduction (esotropia), forced leftward head deviation with impaired awareness, and subsequent evolution into a bilateral tonic-clonic seizure. Postictal and interictal neurological status were unremarkable; more specifically, neuro-ophthalmological examination revealed no nystagmus or altered eye motility. Ictal EEG showed a rhythmic theta activity over the right posterior temporal region, involving fronto-central regions when strabismus appeared. MRI showed cortical dysplasia in the right temporal lobe. Due to the low spatial resolution of scalp EEG, we could not identify with precision the symptomatogenic zone underlying ictal strabismus. However, the concomitant appearance of rhythmic theta activity over the right fronto-central region and the leftward head version with MRI perfusion sequences, showing cerebral blood flow increase in the right frontal eye field area, suggest involvement of the right frontal lobe. [Published with video sequence on www.epilepticdisorders.com].

Vanderbilt head and neck symptom survey, version 2.0: Clinical and research utility for identification of symptom clusters and changes in symptoms over time

ObjectivesThe symptoms and functional defects following treatment for head and neck cancer (HNC) have been poorly defined. The purpose of this study was to examine the utility of the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0 to identify symptom clusters experienced by patients with HNC as well as assess reliability and sensitivity to change. Materials and methodsThe VHNSS 2.0 questionnaire was completed by 150 patients over three studies. Two studies utilized the survey at multiple time points. ResultsCluster analysis identified ten multi-item clusters and three single items. The internal consistency was good to excellent, with Cronbach’s alpha coefficient above 0.90 in five symptom clusters and above 0.70 in remaining clusters. Clusters demonstrated convergent and divergent validity with other measures. Symptom burden was lowest at baseline, peaked at the end of treatment then subsided over the following months. ConclusionsThe VHNSS 2.0 is a reliable and valid measure of acute and late toxicities in patients treated for HNC. The tool may be used in research and clinical practice to screen, to evaluate treatments, and to compare side effects of treatment regimens.

Three-dimensional assessment of curvature, torsion, and canal flare index of the humerus of skeletally mature nonchondrodystrophic dogs.

OBJECTIVE To assess 3-D geometry of the humerus of dogs and determine whether the craniocaudal canal flare index (CFI) is associated with specific geometric features. SAMPLE CT images (n = 40) and radiographs (38) for 2 groups of skeletally mature nonchondrodystrophic dogs. PROCEDURES General dimensions (length, CFI, cortical thickness, and humeral head offset), curvature (shaft, humeral head, and glenoid cavity), version (humeral head and greater tubercle), and torsion were evaluated on CT images. Dogs were allocated into 3 groups on the basis of the craniocaudal CFI, and results were compared among these 3 groups. The CT measurements were compared with radiographic measurements obtained for another group of dogs. RESULTS Mean ± SD humeral head version was -75.9 ± 9.6° (range, -100.7° to -59.4°). Mean mechanical lateral distal humeral angle, mechanical caudal proximal humeral angle, and mechanical cranial distal humeral angle were 89.5 ± 3.5°, 50.2 ± 4.5°, and 72.9 ± 7.8°, respectively, and did not differ from corresponding radiographic measurements. Mean humeral curvature was 20.4 ± 4.4° (range, 9.6° to 30.5°). Mean craniocaudal CFI was 1.74 ± 0.18 (range, 1.37 to 2.10). Dogs with a high craniocaudal CFI had thicker cranial and medial cortices than dogs with a low craniocaudal CFI. Increased body weight was associated with a lower craniocaudal CFI. Radiographic and CT measurements of craniocaudal CFI and curvature differed significantly. CONCLUSIONS AND CLINICAL RELEVANCE CT-based 3-D reconstructions allowed the assessment of shaft angulation, torsion, and CFI. Radiographic and CT measurements of shaft curvature and CFI may differ.

Small temporal pole encephaloceles in children with presumed nonlesional temporal lobe epilepsy

Objective: Temporal lobe epilepsy (TLE) is the one of most common form of focal epilepsy. Children with intractable TLE epilepsy undergo presurgical evaluations for resective treatment. The cases are considered “nonlesional’’ if brain magnetic resonance imaging (MRI) shows no structural abnormality and they sometimes encounter invasive procedures. We describe two patients, initially thought to have “lesion negative” refractory TLE, in whom the recognition of a small anterior temporal encephalocele by close inspection of imaging altered the follow up strategy. Case Presentation: Case 1: 12-year-old girl, focal seizures began at age 10 years, manifesting as no reduced awareness, contractions in the corner of the mouth, and head version. At the time of assessment the patient was having multiple daily attacks. Two antiepileptic drugs in various doses and combinations had failed to control seizures. Early childhood development and schooling were unremarkable. Febrile seizures had not occurred. Video–electroencephalography (EEG) monitoring captured ten typical seizures, all originating from the right temporal region. Prior imaging was reported normal. The current brain MRI has showed small right anterior temporal tip encephalocele through a congenital defect in the sphenoidal bone. She is now a epilepsy surgery candidate. Case 1: 15-year-old girl, discognitive seizures began at age 6 years characterized by a rising abdominal sensation and impaired consciousness. Seizures continued weekly with no evolving to bilateral convulsive seizures, despite trials of two anticonvulsants in various doses and combinations. Febrile seizures had not occurred. Routine EEG showed interictal epileptiform activity in left temporal region. Prior imaging was reported normal. The current brain MRI has showed bilateral temporal tip encephalocele greater on the left. She will be hospitalized for phase I epilepsy surgery evaluations. Conclusion: We would like to present this cases to emphasize the discovery of an occult lesion such as an encephalocele markedly alters treatment opinions in children.

Importance of chewing, saliva, and swallowing function in patients with advanced oral cancer undergoing preoperative chemoradiotherapy: a prospective study of quality of life

The primary objective of this study was to investigate the quality of life (QOL) of patients with oral squamous cell carcinoma (OSCC) undergoing curative neoadjuvant chemoradiotherapy followed by radical tumour resection and simultaneous oral cavity reconstruction, using two validated questionnaires. A secondary objective was to assess clinical variables predicting post-treatment dysfunction in chewing, saliva, and swallowing. Thirty-five patients with locally advanced OSCC who underwent preoperative chemoradiotherapy were recruited prospectively. All patients completed both the University of Washington Quality of Life version 4 questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy–Head & Neck version 4 questionnaire (FACT-H&N). UW-QOL and FACT-H&N items were associated with clinical variables. Nearly three-quarters of OSCC patients perceived good to excellent levels of overall QOL after preoperative chemoradiotherapy. Chewing difficulties, decreased salivary function, and swallowing dysfunction were the most frequent complaints of OSCC patients. Items related to food intake were significantly worse in OSCC patients older than 60 years and those with T4 tumours, as well as those without alcohol intake. Chewing, saliva, and swallowing are the most significant issues in patients with OSCC undergoing preoperative chemoradiotherapy. The results of this study may help guide treatment decisions for OSCC patients based on more accurate expectations of adverse effects of cancer treatment.

Febrile infection–related epilepsy syndrome (FIRES) in four patients

FIRES is an epileptic syndrome that presents with multifocal refractory status epilepticus (SE) in previously normal children following a nonspecific febrile illness and evolves into a chronic, refractory, focal epilepsy with associated cognitive and behavioral difficulties. Objective: To describe the course of FIRES in 4 patients. Methods: Two boys and two girls with FIRES were analyzed. The duration of follow-up was 1–5 years. Results: Onset of the disease was 4–14 years (median 8.75 years). All patients were with a normal development. The duration of fever prior SE was 5–10 days (median 6.75 days). In all cases, the fever was higher than 39 degrees without obvious signs of infection. Seizures manifested with head and eyes version in all patients, one patient had facial twitching and hemiclonic jerking. All patients required intensive care treatment using burst-suppression coma and ventilatory support. CSF, MRI were no significant deviations during the acute period in all patients. In one case, HSV 6 type was detected by PCR in the serum and lymphocytes. All patients were treated with AEDs, antiviral and antimicrobial drugs, steroids and IVIG. The duration of SE was 3–27 days (median 12.25 days). After SE drug-resistant focal epilepsy developed in all children. Two patients had mild cognitive impairment, the other two – heavy (especially in case with SE lasting 27 days). Light motor disturbances occurred in two children, one child had severe spastic tetraparesis. Interictal EEG revealed the rhythm slowing and independent bilateral focal IEDs, predominantly over the frontotemporal regions in all patients. Follow-up MRI was performed in 3 cases: two were normal and one had mild diffuse cortical atrophy. For epilepsy treatment have been consistently applied 3–7 AEDs without a significant effect. Conclusion: FIRES resulted in the development of drug-resistant epilepsy and cognitive impairment in all cases.

Assessment of established patient reported outcomes (PROs) instruments measuring toxicities and quality of life (QOL) for patients (pts) with head and neck cancer (HNC) treated on ECOG 1308 and 2399 studies.

6074 Background: HPV HNC pts are younger and have a higher cure rate than smoking-related pts, and therefore carry treatment toxicities longer. Dose deintensification and conformal RT may result in decreased toxicity. We report the impact of these techniques on patient outcomes in E2399 and E1308 as measured through PROs. Methods: Longitudinal data on acute and late toxicities were recorded prospectively at baseline, post-treatment, and at 6, 12, 24 and 30 months in HPV+ pts on E1308 and HIV+/- pts on E2399 using the following measures: E1308: FACT-HN, KATZ Index of Independence (ADL), Brief Fatigue Index (BFI), Instrumental Activities of Daily Living (IADL), and the Vanderbilt Head and Neck Symptom Survey Version 2 (VHNSS V2); on E2399: FACT-HN. We correlated acute and late toxicities with de-escalation of RT dose (69.3Gy to 54Gy) on E1308, and with IMRT (E1308) vs. conformal RT (E2399). Results: 38 pts on E1308 completed 12 mo VHNSS V2; 32 received low dose IMRT and 6 standard dose, and 56 E2399 pts completed 12 mo FACT-HN. Items from the VHNSS V2 showed that difficulty eating solids (40% vs. 89%, p = 0.011) and improved nutrition (10% vs 44%, p = 0.025) were statistically improved at 12 months by lowering IMRT dose from 69.3Gy to 54Gy. The FACT-HN showed an improvement in eating solids at 12 mo when comparing low dose IMRT vs. 3DRT (65% vs. 33% had no or minimal solid food problems, p = 0.057). No other statistically significant reductions in toxicity were noted on any of the other PRO instruments. Conclusions: Both FACT-HN and VHNSS V2 demonstrated an improvement in eating solids by reducing IMRT dose. FACT-HN demonstrated that IMRT is associated with an improvement in eating solids when compared to 3DRT. Analyses are exploratory and need to be validated using randomized data.Future studies should stress accurate and complete PRO data. The KATZ, BFI, and IADL were not sensitive to detecting differences in toxicities from IMRT dose reduction on E1308. The VHNSS V2 and FACT-HN instruments corroborated specific toxicities both by RT technique as well as IMRT dose, and will therefore be utilized in future ECOG-ACRIN HNC studies. Clinical trial information: NCT01084083.

Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country

This study aimed to assess changes in oral cancer patients’ health-related quality of life (HRQOL) and the impact of disease stage on HRQOL scores. HRQOL data were collected from seven hospital-based centres using the Functional Assessment of Cancer Therapy–Head and Neck (FACT-H&N) version 4.0 instrument. The independent samples t-test, χ2 test, and paired samples t-test were used to analyse the data. A total of 300 patients were recruited. The most common oral cancer sub-site was tongue and floor of mouth (42.6%). Surgical intervention (41.1%) was the most common treatment modality. Significant differences in ethnicity and treatment modality were observed between early and late stage patients. Pre-treatment HRQOL scores were significantly lower for late than early stage patients. At 1 month post-treatment, the functional and head and neck domains and the FACT-H&N (TOI) summary scores showed significant deterioration in both early and late stage patients. In contrast, the emotional domain showed a significant improvement for early and late stage patients at 1, 3, and 6 months post-treatment. Although HRQOL deterioration was still observed among early and late stage patients at 6 months post-treatment, this was not statistically significant. In conclusion, advanced disease is associated with poorer HRQOL. Although ethnic differences were observed across different disease stages, the influence of ethnicity on patient HRQOL was not evident in this study.

Assessment of quality of life of patients 1-5 years after treatment for oral cancer.

The study aims to assess the quality of life (QOL) of oral cancer survivors, 1-5 years after the treatment. The data of fifty patients concerning their QOL were gained from the Outpatient Department of K.L.E's Dr. Prabhakar Kore Hospital and Medical Research Institute, Belagavi, and Karnataka Cancer Therapy and Research Institute, Navanagar, Hubli, Karnataka, India. All the patients suffered from oral cancer (stage T2-T4) and underwent surgery with reconstruction followed by chemotherapy or radiotherapy or both. The patients completed the standard European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C-30 (version 3.0) and QLQ Head and Neck Cancer Specific (QLQ H and N-35) (version 1.0). Scoring was done according to the EORTC scoring manual. The mean age at the time of diagnosis was 45.0 (±9.0). The study population had a mean global health status (GHS) for overall QOL of 55.5 ± 13.4.The mean functional scale (FS) was 87.5 (±9.6).The mean QLQ C-30 symptom scale (SS) was 16.3 (±11.9) and the mean QLQ H and N-35 SS (H and NSS) was 26.9 ± 11.5. Location, gender, age, and time after the treatment showed very less discrepancy in the group comparisons of GHS, FS, SS, and H and NSS whereas comparison based on T-stage showed significant difference in scores. Oral cancer has a significant impact on the QOL of the patients. Assessment of QOL should receive adequate attention in treatment planning and rehabilitation. This would definitely help in delivery of better symptom directed therapies and improve the QOL of the patients.

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients.

Tumor/treatment-related internal lymphedema (IL) and/or external lymphedema (EL) are associated with functional deficits and increased symptom burden in head and neck cancer patients (HNCP). Previously, we noted association between EL/IL and patient-reported dysphagia using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 1.0. To determine the relationship between IL/EL and subjective and objective measures of swallowing function. Eighty-one HNCP completed: (1) VHNSS version 2.0, including 13 swallowing/nutrition-related questions grouped into three clusters: swallow solids (ss), swallow liquids (sl), and nutrition(nt); (2) physical assessment of EL using Foldi scale; (3) endoscopic assessment of IL using Patterson scale (n = 56); and (4) modified barium swallow study rated by dysphagia outcome and severity scale (DOSS) and in conjunction with a swallow evaluation by National Outcomes Measurement System (NOMS). Examinations were performed at varied time points to assess lymphedema spectrum, from baseline (n = 15, 18.1%) to 18 months post-therapy (n = 20, 24.1%). VHNSS swallow/nutrition items scores correlated with NOMS/DOSS ratings (p < 0.001). Highest correlation was with NOMS: ss (-0.73); sl (-0.61); nt (-0.56). VHNSS swallow/nutrition scores correlated with maximum grade of swelling for any single structure on Patterson scale: ss (0.43; p = 0.001); sl (0.38; p = 0.004); nt (0.41; p = 0.002). IL of aryepiglottic/pharyngoepiglottic folds, epiglottis, and pyriform sinus were most strongly correlated with VHNSS and NOMS ratings. NOMS/DOSS ratings correlated with EL (> = -0.34; p < 0.01). No meaningful correlations exist between VHNSS swallow/nutrition items and EL (< ± 0.15, p > 0.20). IL correlated with subjective and objective measures of swallow dysfunction. Longitudinal analysis of trajectory and impact of IL/EL on dysphagia is ongoing.

Study of glenoid and humerus head version in adult human skeleton

Background: Several researchers have investigated the angles of Glenoid version and Humerus head version worldwide, however sparsely studied in India. The purpose of the study was to determine the native angles of Glenoid and Humerus head version of adult skeletons and to compare the observation with the findings of other workers in different races while discussing our finding in light of literature. This data would prove of great assistance at the time of actual shoulder replacement surgery for proper alignment and fixation of the implants, as any variance from normal version would alter gleno-humeral mechanics and may predispose to instability and arthropathy. Materials and method: A total of sixty seven adult wet scapulae and sixty three humeri were harvested from cadavers fixed in formalin from the Department of Anatomy BJGMC, Pune. The angles of glenoid and humeral head version were measured using goniometer and compass. Correlation analysis was performed between humeral head version and glenoid version values. Result: This study finds wide distribution of glenoid version ranging from -10o to +6o the mean glenoid version of the left side (n=34) was -1.00±4.06o and on the right side (n=33) was -3.30±3.63o the average humerus version recorded on left (n=31) and the right (n=32) sides were 36.13±7.61o and 37.56±7.8o respectively. Conclusion: We report a significant difference between the mean value of the glenoid version angle of both sides; right being greatly retroverted. A significant positive. Correlation was established between Glenoid version and Humerus head version on the right side. Keywords: Humerus head Version, Glenoid Version, Arthroplasty, Retroversion, Glenoid fossa

The Vanderbilt Head and Neck Symptom Survey Brazilian Portuguese version 2.0 (VHNSS 2.0): psychometric properties for patients with head and neck cancer who have undergone radiotherapy.

BackgroundPatients who undergo radiotherapy to treat head and neck cancer can present with several symptoms, including oral ones. The symptoms are usually assessed using instruments to evaluate quality of life. However, these instruments do not really assess oral health outcomes and their functional implications. The VHNSS 2.0 instrument was developed to be used with head and neck cancer patients, and has recently been translated and culturally adapted to be used in Brazil. The purpose of the study was to evaluate the psychometric properties of the VHNSS 2.0 Brazilian Portuguese version.MethodsThree assessment instruments, the Brazilian Portuguese versions of EORTC QLQ-C30, EORTC H&N 35 and VHNSS 2.0, were answered by 241 head and neck cancer patients, of whom 47 were submitted to the test retest in 5–16 days. The construct validity was assessed through convergent validation (assuming correlations between VHNSS 2.0 and EORTC), and known group analysis (radiotherapy time, site of tumor, staging and surgery). Reliability was evaluated by means of Cronbach’s alpha and test retest using the intraclass correlation coefficient.Results241 head and neck cancer patients, median age 58.8, were included in this study. Hypothesized correlations were confirmed, the comparison among the groups showed differences in most of the domains. Reliability for the domains of swallowing solids, dry mouth, mouth pain, mucus, voice, pain and taste/smell presented Cronbach’s alpha values from 0.858 to 0.735 and for the domains of nutrition, swallowing liquids and teeth, 0.618, 0.620 and 0.670 respectively. The test–retest reliability, for the domains of the VHNSS 2.0, measured using intraclass correlation coefficient, ranged from 0.372 to 0.854.ConclusionThe VHNSS 2.0 Brazilian Portuguese version presented good results for the convergent validation and known-group analyses. It also showed reliability for the Cronbach´s alpha and test retest for most domains.

Translation and cross-cultural adaptation into Brazilian Portuguese of the Vanderbilt Head and Neck Symptom Survey version 2.0 (VHNSS 2.0) for the assessment of oral symptoms in head and neck cancer patients submitted to radiotherapy

IntroductionPatients submitted to radiotherapy for the treatment of head and neck cancer have several symptoms, predominantly oral. The Vanderbilt Head and Neck Symptom Survey version 2.0 is an American tool developed to evaluate oral symptoms in head and neck cancer patients submitted to radiotherapy. ObjectiveThe aim of the present study was to translate the Vanderbilt Head and Neck Symptom Survey version 2.0 into Brazilian Portuguese and cross-culturally adapt this tool for subsequent validation and application in Brazil. MethodsA method used for the translation and cultural adaptation of tools, which included independent translations, synthesis of the translations, back-translations, expert committee, and pre-test, was used. The pre-test was performed with 37 head and neck cancer patients, who were divided into four groups, to assess the relevance and understanding of the assessed items. Data were submitted to descriptive statistical analysis. ResultsThe overall mean of the content validity index was 0.79 for semantic and idiomatic equivalence, and it was higher than 0.8 for cultural and conceptual equivalence. The cognitive interview showed that patients were able to paraphrase the items, and considered them relevant and easily understood. ConclusionThe tool was translated and cross-culturally adapted to be used in Brazil. The authors believe this translation is suited for validation.

The eating experience in long-term survivors of head and neck cancer: a mixed-methods study.

This study explored the eating experience in long-term survivors of head and neck cancer (HNC) ≥3years post concurrent chemoradiation. Quality of life (QOL) and the meanings and perceptions survivors had as it related to the eating experience were explored. Purposive sampling was utilized; 10 long-term survivors of HNC participated in the study. A mixed-methods approach was used; exploratory qualitative research using content analysis and summary statistics was used to describe demographic and clinical characteristics and the Vanderbilt Head and Neck Symptom Survey version 2.0 scores (VHNSS 2.0). Four categories (psychological, social impact, functional status, and the current eating experience) containing 15 subthemes and 1 overarching theme (adaptation) emerged. Current health status, QOL, and QOL related to eating were viewed favorably despite the impact of treatment late effects on participants' daily lives. Adaptation and maladaptation in regard to food choice and downplaying of symptoms were recognized. Interviews as well as the VHNSS 2.0 scores indicated that xerostomia, mucosal sensitivity, swallowing difficulty, length of time required to eat, and dysgeusia remained problematic. Psychological, functional, and social losses associated with eating were identified. Participants modify or avoid foods that are challenging yet report enjoyment with eating. Challenges with eating were downplayed. Due to the potential negative nutritional and social implications of avoiding specific food/food groups, standard of care in long-term survivors of HNC should include assessment of the eating experience and functional challenges. Nutrition professional can help patients optimize dietary intake and the eating experience.

Textual research on circulation of the Ming edition of Li Heng's Xiu zhen fang (Pocket Formulary)

Xiu zhen fang (Pocket Formulary) is a recipe book of the Ming Dynasty, inspired and managed by Zhu Su, compiled by Li Heng of liangyisuo (good physician house) in Zhou wangfu (Zhou's royal palace). The book was compiled and published twice during the reigns of the Hongwu and Yongle Emperors of the Ming Dynasty. Because of its high practicability, there were some editions in circulation, and the book was published several times only in the Ming Dynasty. At present, the earliest extanteditionwas the little character version of Yongle, and the version in the 4(th) year of Zhengde Emperor of the Ming Dynasty was a reprinting edition based on the Yongle edition, sharingthe same edition system. Most of the editions appeared after the reign of Zhengtong Emperor of the Ming Dynasty, titled by "kui ben (head version)" and "da quan (complete edition)" were the editionspublished in the local bookshops, which had rather distinct differences from the Yongle edition system not only in the its format but also in its contents.

Primary Partial Humeral Head Resurfacing

Background: Humeral head defects such as degenerative disease or avascular necrosis are often treated with stemmed hemiarthroplasty or total shoulder arthroplasty. Despite its historical and clinical significance, stemmed humeral head replacement poses inherent technical challenges to placing spherical implants at the anatomically correct head height, version, and neck-shaft angle. Purpose: The aim of this study was to assess humeral head inlay arthroplasty as a joint-preserving alternative that maintains the individual head-neck-shaft anatomy. Humeral head inlay arthroplasty also allows intraoperative surface mapping and placement of a contoured articular component that is matched to the patient’s defect size, location, and individual surface geometry. Study Design: Case series; Level of evidence, 4. Methods: This retrospective case series included 19 patients (20 shoulders), with an average age of 48.9 years (range, 32-58 years; 16 men, 3 women). Preoperative diagnoses were osteoarthritis in 16 shoulders and osteonecrosis in 4 shoulders. Pre- and postoperative evaluations included physical examination, radiographic assessment, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, the Simple Shoulder Test, a pain visual analog scale, and patient satisfaction rating. Results: The mean follow-up period was 32.7 months (range, 17-66 months). The mean American Shoulder and Elbow Surgeons score improved from 24.1 to 78.8, mean Simple Shoulder Test score from 3.95 to 9.3, mean visual analog scale score from 8.2 to 2.1, mean forward flexion from 100° to 129°, and mean external rotation from 23° to 43° (P < .001 for all). Radiographic follow-up showed no evidence of periprosthetic fracture, component loosening, osteolysis, or device failure. Patient shoulder self-assessment was 90% poor before surgery and improved to 75% good to excellent at last follow-up; 20% of patients self-rated as somewhat good to somewhat poor, and 5% self-rated as poor. Ninety percent of patients were satisfied with the choice of the procedure. Three patients had postoperative complications unrelated to the implants, including a partial rotator cuff tear treated with physical therapy, preexisting glenoid wear treated with arthroscopic debridement and microfracture, and infection complicated by subscapularis rupture requiring several subsequent surgical procedures but with retention of the implant. Conclusion: Humeral head inlay arthroplasty is effective in providing pain relief, functional improvement, and patient satisfaction. Rather than delaying shoulder arthroplasty to end-stage osteoarthritis, humeral head inlay arthroplasty is a promising new direction in primary shoulder arthroplasty for younger and active patients with earlier stage disease.

Looking for complexity in quantitative semiology of frontal and temporal lobe seizures using neuroethology and graph theory

Epileptic syndromes and seizures are the expression of complex brain systems. Because no analysis of complexity has been applied to epileptic seizure semiology, our goal was to apply neuroethology and graph analysis to the study of the complexity of behavioral manifestations of epileptic seizures in human frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). We analyzed the video recordings of 120 seizures of 18 patients with FLE and 28 seizures of 28 patients with TLE. All patients were seizure-free >1year after surgery (Engel Class I). All patients' behavioral sequences were analyzed by means of a glossary containing all behaviors and analyzed for neuroethology (Ethomatic software). The same series were used for graph analysis (CYTOSCAPE®). Behaviors, displayed as nodes, were connected by edges to other nodes according to their temporal sequence of appearance.Using neuroethology analysis, we confirmed data in the literature such as in FLE: brief/frequent seizures, complex motor behaviors, head and eye version, unilateral/bilateral tonic posturing, speech arrest, vocalization, and rapid postictal recovery and in the case of TLE: presence of epigastric aura, lateralized dystonias, impairment of consciousness/speech during ictal and postictal periods, and development of secondary generalization.Using graph analysis metrics of FLE and TLE confirmed data from flowcharts. However, because of the algorithms we used, they highlighted more powerfully the connectivity and complex associations among behaviors in a quite selective manner, depending on the origin of the seizures. The algorithms we used are commonly employed to track brain connectivity from EEG and MRI sources, which makes our study very promising for future studies of complexity in this field.This article is part of a Special Issue entitled “NEWroscience 2013”.