Pharyngeal Sites Research Articles

Jailed Artery Ostia Modifications After Flow-Diverting Stent Deployment at Arterial Bifurcations: A Scanning Electron Microscopy Translational Study.

Even though flow-diverting stents are being increasingly used to treat intracranial aneurysms, the fate of jailed side branches remains controversial, with recent clinical data contradicting finding of earlier animal studies that reported patency. To quantify the surface area of the ostia after 3 months of jailing by flow-diverting stents as a more accurate means of patency evaluation. Ten large white swine were stented by flow-diverting stents placed at common carotid-ascending pharyngeal arterial bifurcation sites. A dual antiplatelet regimen was initiated 72 hours before stenting and maintained during follow-up. Optical coherence tomography was used to search for per-procedural thrombus formation. Selective control digital subtraction angiography was performed 12 weeks post-stenting. Subsequently, the stented arterial segments were harvested en bloc and observed under scanning electron microscopy, photographed, and quantified. The absence of per-procedural thrombus formation was confirmed. All ostia were patent at 12 weeks (or 3 months) post stenting, with no angiographic or scanning electron microscopy-evident thrombus formation. The mean initial ostium surface was 2 048 617 ± 731 625 μm. At 3 months, the mean nonendothelialized ostium surface was 229 218 ± 140 172 μm, and mean endothelialized ostium surface was 1 819 399 ± 672 632 μm. A statistically significant difference (reduction) was observed between the initial and 12-week ostium surfaces (P < .001), with an significant statistical power (1.000). Jailed side branches remained patent after stenting, but the surface quantifications showed significant endothelial coverage, with a significant reduction of patent ostium surfaces at 12 weeks post-stenting. APhA, ascending pharyngeal arteryCI, confidence interval3DRA, 3-dimensional rotational angiographyDSA, digital subtraction angiographyFDS, flow-diverting stentOCT, optical coherence tomographyOS, ostium surfaceSEM, scanning electron microscopy.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections detected by real-time PCR among individuals reporting sexual assaults in the Paris, France area

BackgroundNeisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are the most common bacteria involved in sexually transmitted infections (STIs). In France, combined screening for CT and NG using nucleic acid amplification tests is recommended in populations that are considered at risk. However, no data have been published about victims of sexual assaults. The aim of this retrospective study was to assess the usefulness of real-time PCR for the rapid detection of CT and NG genomic DNA, and the prevalence of CT/NG infections in a sample of sexual assault victims examined at a department of forensic medicine. MethodsBetween July 2012 and July 2013, 326 adults and adolescents aged over 12 years reported a sexual assault and they were referred to the Department of Forensic Medicine for a medical and forensic examination. Secretions from urogenital (cervix or vagina), anorectal, or pharyngeal sites were collected for CT/NG assays. ResultsCT and NG were detected in 48/326 (15%) and 16/326 patients (5%), respectively, where 10 (3%) had a CT/NG co-infection. Among 48 patients with CT infection, 13 (27.1%) patients had co-occurring genital and anorectal infections. For the pharyngeal sites, 3/21 men (14.3%) were NG-positive. ConclusionsGiven the high prevalence of CT and NG infections, systematic screening of both pathogens at the time of forensic examination should provide an opportunity for the early treatment of diagnosed STIs.

High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima, Peru

ObjectivesThis study aimed to characterise the epidemiology of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) and transgender women (TW) in Lima,...

How to get away from the cold: body temperature during surgery.

How to get away from the cold: body temperature during surgery.

003.3 The prevalence ofmycoplasma genitaliumandchlamydia trachomatisat various anatomical sites of men who have sex with men in five cities of china

Introduction To determine the prevalence of Mycoplasma genitalium and Chlamydia trachomatis in urethra, rectum and pharynx of men who have sex with men (MSM) in China, and to analyse the association between the agents detection and clinical manifestations. Methods 388 MSM were recruited at gay bars in five cities of China from September 2007 to November 2008. Rectal and pharyngeal swabs and first void urine were tested for M. genitalium and C trachomatis by PCR. Bivariate and multivariable analyses were performed to determine the association between the infections and clinical manisfestations. Results The prevalence of M. genitalium infection at urethral, rectal and pharyngeal sites was 17.2% (95% CI: 13.4% to 21.0%), 11.8% (95% CI: 8.4% to 15.2%), and 13.5% (95% CI: 9.9% to 17.1%), respectively. C trachomatis was more commonly detected in rectum (16.0%, 95% CI: 12.2% to 19.8%) than in urethra (9.4%, 95% CI: 6.4% to 12.3%) and in pharynx (0.8%, 95% CI: 0.1% to 1.6%). Urethral M. genitalium infection was significantly associated with urethral discomfort in the past 3 months (AOR: 2.22, 95% CI: 1.09–4.52) and polymorphonuclear leucocyte (PMNL) counts per high-power microscope field (AOR: 2.40, 95% CI: 1.02–5.62). Rectal M. genitalium infection was independently associated with rectal discharge in the past 3 months (AOR: 6.06, 95% CI: 1.59–23.11). For C trachomatis infection, PMNL counts per high-power microscope field (AOR: 4.66, 95% CI: 1.80–12.07) and having receptive anal intercourse with a male in the past 3 months (AOR: 2.27, 95% CI: 1.14–4.54) were associated with urethral and rectal C trachomatis infection, respectively. Conclusion High prevalence of M. genitalium infection was observed among MSM in China at urethral, rectal and pharyngeal sites. M. genitalium infection was significantly associated with urethral and rectal symptoms. C trachomatis was more commonly detected in rectum and more likely to be asymptomatic. Disclosure of interest statement No potential conflicts of interest.

003.5 Clinician-taken extra-genital samples for gonorrhoea and chlamydia in women compared with self-taken samples analysed separately and self-taken pooled samples:

Background Extra-genital sampling (rectum and pharynx) using nucleic acid amplification tests is becoming increasingly important in women as vulvovaginal swabs (VVS) alone may miss infections. We compared clinician-taken extra-genital samples in women with self-taken samples analysed both separately and as pooled samples for accuracy and cost-effectiveness. Methods Women attending a sexual health clinic were invited into a ‘swab yourself’ trial. Clinician and two self-samples (analysed separately and pooled) were taken from vulvovaginal, pharyngeal and rectal sites for gonorrhoea (NG) and chlamydia (CT) using AC2. Sampling order was randomised. Patient infected status was defined as at least two positive confirmed samples. Results 402 women recruited January–March 2015. Overall prevalence: gonorrhoea 3.2% (rectal 2.7%, pharyngeal 1.5%), chlamydia 13.7% (rectal 12.9%, pharyngeal 3.2%). One NG case (7.7%) and 7 CT cases (12.7%) were VVS negative. McNemar test showed no difference between clinician-taken and self-taken rectal or pharyngeal samples, or between self-taken samples analysed separately or pooled. Conclusion This on-going work is the first randomised study showing women’s self-taken extra-genital samples are comparable to clinician-taken and can be analysed accurately as a pooled sample. High levels of extra-genital infections were found with 12.7% of CT infections being missed on VVS. Trebling diagnostic costs with rectal, pharyngeal, and VVS samples would be unaffordable for many health systems but a pooled sample has the same laboratory cost as the current VVS. Disclosure of interest statement Dr Janet Wilson has received honoraria and travel and accommodation expenses from BD Diagnostics, and research grants in the form of diagnostic kits from Hologic/Gen-Probe.

P11.14 Pharyngeal and anogenital chlamydia in men who have sex with men: temporal trends and characteristics among attendees at a sydney metropolitan sexual health clinic 2011–2014

Introduction Australian STI testing guidelines recommend regular Chlamydia trachomatis (CT) testing at pharyngeal and anogenital sites among asymptomatic men who have sex with men (MSM). Our aim was to investigate temporal trends and characteristics of clinic-diagnosed pharyngeal and anogenital CT among MSM. Methods Testing was performed using Aptima Combo 2 (Hologic, US). Data were extracted from the laboratory database and medical records. Statistical analyses were performed using STATA13 (Statcorp, College Station, TX). Results During the study period 2919 MSM were tested on 6850 occasions, and 556 (8.2%) episodes of CT were diagnosed. Pharyngeal (PCT), urethral (UCT) and rectal (RCT) positivity rates were 1.2%, 2.3% and 6.2%, respectively. From 2011–2014, there was a significant increase in number of tests performed, (999–2834, p-trend Conclusion CT positivity remained stable despite substantially increased testing. The temporal decline in symptomatic infections likely reflects a recent policy shift towards regular asymptomatic testing for MSM. Despite a relatively low prevalence of PCT, men with PCT had more sexual partners than men with anogenital CT and close to half the pharyngeal infections would have remained untreated without pharyngeal testing. There may be valuable public health benefits of regular PCT testing among MSM. Disclosure of interest statement No disclosures of interest.

P13.11 Self-taken extragenital sampling for chlamydia and gonorrhoea in women – is it acceptable? feedback from a self-swab and clinician-swab trial

Introduction Self-taken vulvovaginal swabs analysed by nucleic acid amplification tests (NAATs) for chlamydia and gonorrhoea are standard practice worldwide. Extra-genital sampling (rectum and pharynx) is becoming increasingly important in women, with evidence that urogenital sampling alone may miss infections. Yet, little is known about women’s views of extra-genital sampling. We explored the acceptability of self-taken extra-genital samples for women as part of a clinician versus self-taken extra-genital sampling study. Methods Women attending a sexual health clinic were invited to participate in a ‘swab yourself’ trial. After randomisation, both clinician and self-taken samples for chlamydia and gonorrhoea NAATs from vulvovaginal, pharyngeal and rectal sites were taken. Participants were then invited to complete a questionnaire about the extra-genital sampling. Results 400 surveys were returned from 402 women recruited (response rate >99%), age range 17–57 (mean 25.2) years. 75% disagreed/strongly disagreed with the statement ‘taking my own samples was difficult’. 72% agreed/strongly agreed that they felt confident taking their own swabs but 30.5% agreed/strongly agreed they felt uncomfortable taking their own swabs; of these 53 (43%) stated they had never had anal sex. 42% agreed/strongly agreed that they would prefer to take their own samples compared to 34% who agreed/strongly agreed they would prefer clinician-taken swabs. 66% agreed/strongly agreed they would be happy to take the samples themselves in a non-clinic setting. Free comments covered themes of ‘more confidence if had clinician samples taken before’, ‘concerns if self-swabbing would give correct results’. Nine commented specifically on discomfort, but none disagreed with the statement ‘I would be happy to take my own swabs in a non-clinic environment’. Conclusion Extra-genital sampling was highly acceptable to the majority of women, with high levels of confidence and low reports of discomfort. This has positive implications for the future of extra-genital testing in women, especially in non-clinic settings. Disclosure of interest statement Dr Janet Wilson has received honoraria and travel and accommodation expenses from BD Diagnostics, and research grants in the form of diagnostic kits from Hologic/Gen-Probe.

O11.1 Patient-delivered partner therapy (pdpt) increases the frequency of partner notification among msm in lima, peru: a randomised clinical trial

Background Patient-Delivered Partner Therapy (PDPT) improves treatment outcomes among sexual partners of individuals with curable STIs. Although use of PDPT with MSM has been questioned due to the high prevalence of undiagnosed HIV and syphilis in MSM networks, increasing partner notification (PN) through PDPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of PDPT on self-reported partner notification (PN) among Peruvian MSM with gonorrheal (GC) and/or chlamydial (CT) infection. Methods We screened 898 MSM in Lima, Peru for GC and/or CT between 2012–2014. Screening included syndromic management of urethritis/proctitis and nucleic acid testing for GC/CT at urethral, pharyngeal, and rectal sites (Aptima Combo-2 TMA). Enrollment was limited to participants with symptomatic urethritis/proctitis (n = 44) and/or laboratory-diagnosed GC/CT infection (n = 263). 173 eligible participants were randomly assigned to receive either standard PN counselling (n = 84) or counselling and PDPT (Cefixime 400 mg/Azithromycin 1 g) for up to 5 recent partners (n = 89). Self-reported notification of recent partners was assessed by CASI with 155 participants who returned for 14-day follow-up. Results The median age of all enrolled participants was 26 (IQR: 23–31), with a median of 3 (IQR: 2–4) partners reported during the previous 30-day period. Among all participants completing follow-up, 111/155 (71.6%) notified at least one partner, with a median of 1 partner notified per participant (IQR: 0–2). For participants randomised to receive PDPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (p = 0.001). The proportion of all recent partners notified was significantly greater in the PDPT than the Control arm (53.5% vs. 36.4%; p = 0.004). Conclusions Provision of PDPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of PDPT on biological outcomes of HIV/STI transmission in MSM sexual networks.

P9 Low false positive rate of gonorrhoea cases referred to gum from a low prevalence chlamydia screening population

<h3>Background/introduction</h3> Recent national guidance for the detection of gonorrhoea (GC) has raised concerns that the majority of initial positive GC test results are likely to be false positives when a low prevalence population is screened using a nucleic acid amplification test (NAAT). Our local chlamydia screening programme uses a dual NAAT for chlamydia and GC and has a low reactive GC rate &lt;1%. All GC reactive cases are referred to GUM for further investigation. <h3>Aim(s)/objectives</h3> To determine whether GC reactive cases referred from our local chlamydia screening programme were true GC infections or likely to be false positive cases. <h3>Methods</h3> A retrospective case notes review of 13 consecutive GC reactive cases seen at our clinic referred from the local chlamydia screening programme. <h3>Results</h3> 10/13 were women. 10/13 cases were confirmed as true GC infections by positive genital GC cultures. In 1 case genital culture was negative but screening and supplementary NAAT with a different target confirmed a true GC infection. In 1 case genital cultures were negative however pharyngeal culture was positive indicating a true GC infection. In 1 case GC cultures were all negative but NAAT tests were reactive from genital and pharyngeal sites and equivocal from the rectum. <h3>Discussion/conclusion</h3> Only 1/13 GC reactive cases seen in our GU referred from a low prevalence screening population might have been a false positive. Contrary to recent publications, in our area, using a dual NAAT is unlikely to lead to high numbers of false positive GC results.

Making teeth to order: conserved genes reveal an ancient molecular pattern in paddlefish (Actinopterygii).

Ray-finned fishes (Actinopterygii) are the dominant vertebrate group today (+30 000 species, predominantly teleosts), with great morphological diversity, including their dentitions. How dental morphological variation evolved is best addressed by considering a range of taxa across actinopterygian phylogeny; here we examine the dentition of Polyodon spathula (American paddlefish), assigned to the basal group Acipenseriformes. Although teeth are present and functional in young individuals of Polyodon, they are completely absent in adults. Our current understanding of developmental genes operating in the dentition is primarily restricted to teleosts; we show that shh and bmp4, as highly conserved epithelial and mesenchymal genes for gnathostome tooth development, are similarly expressed at Polyodon tooth loci, thus extending this conserved developmental pattern within the Actinopterygii. These genes map spatio-temporal tooth initiation in Polyodon larvae and provide new data in both oral and pharyngeal tooth sites. Variation in cellular intensity of shh maps timing of tooth morphogenesis, revealing a second odontogenic wave as alternate sites within tooth rows, a dental pattern also present in more derived actinopterygians. Developmental timing for each tooth field in Polyodon follows a gradient, from rostral to caudal and ventral to dorsal, repeated during subsequent loss of teeth. The transitory Polyodon dentition is modified by cessation of tooth addition and loss. As such, Polyodon represents a basal actinopterygian model for the evolution of developmental novelty: initial conservation, followed by tooth loss, accommodating the adult trophic modification to filter-feeding.

143. The State of Sexual Health Services at U.S. Colleges & Universities

143. The State of Sexual Health Services at U.S. Colleges & Universities

Infection with neisseria gonorrhoeae and association between rising ceftriaxone minumum inhibitory concentration and men who have sex with men

Objectives The aim of this study was to review patients presenting with Neisseria gonorrhoeae over a 5 year period. Methods We performed a retrospective cohort study, using a prospective database and retrospective review of medical records, of patients with gonorrhoea infection presenting between January 2008 and November 2013. Results 215 patients screened positive by NAAT and treatment failure occurred in 2 patients after both initially received treatment with ciprofloxacin. of the 106 culture positive Neisseria gonorrhoeae isolates, 37 had ceftriaxone MIC >0.008. In addition, there were 4 penicillinase producing Neisseria gonorrhoeae (PPNG) isolates, 30 quinolone resistant Neisseria gonorrhoeae (QRNG) isolates, 9 tetracycline resistant Neisseria gonorrhoeae (TRNG) isolates and 4 isolates resistant to azithromycin. On a multivariate model, an association was seen between ceftriaxone MIC >0.008 and a history of men who have sex with men (MSM, OR 11.81, 95% CI 2.51–55.59, p = 0.02). Univariate analysis was statistically significant for infection involving either rectal or pharyngeal sites (OR 3.02, 95 CI 1.24–7.34, p = 0.02). Conclusion Screening for Neisseria gonorrhoea in rectal and pharyngeal sites is important amongst patients presenting with a history of MSM. Rising ceftriaxone MIC is associated with MSM and infection in rectal or pharyngeal sites.

Einfluss verschieden starker Unterkiefervorverlagerungen und Bissanhebungen durch Protrusionsschienen auf die sagittale Atemwegsfläche von bezahnten Apnoepatienten

Despite numerous studies investigating the dimensional and therapeutic effects of mandibular advancement splints (MASs), data regarding the effects of differently designed individual and non-adjustable MASs on the upper airway in fully dentate apneic subjects in the sagittal plane including comparison of these effects with a placebo device are sparse. The present study aimed to determine the dimensional changes in the sagittal plane created by differently designed MASs in the upper airway in fully dentate apneic subjects and to compare these changes with the effects of a placebo device. Magnetic resonance (MR) images of 9 dentate apneic subjects with 5 differently designed MASs and without a MAS were obtained. We measured the area of the entire pharynx (velopharynx, oropharynx, hypopharynx) on these MR images and compared the dimensional changes. The dimensional changes triggered by two specific MASs (75% of the maximum mandibular protrusion with 5 mm vertical opening, and 75% of the maximum mandibular protrusion with 10 mm of vertical opening) in the entire pharynx in the sagittal plane were statistically significant compared to the other MASs (p < 0.05). The MAS effecting 75% of the maximum mandibular protrusion and 10 mm of vertical opening created a significant dimensional increase only in the velopharyngeal area among the three pharyngeal sites (p ≤ 0.003). While the degree of mandibular protrusion created by the MAS affects the dimensions of the upper airway, the degree of the vertical opening exerts no significant dimensional effect in the sagittal plane in fully dentate apneic patients. The mandibular protrusion effect is comparatively larger in the velopharyngeal region.

Oral and vaginal epithelial cell lines bind and transfer cell-free infectious HIV-1 to permissive cells but are not productively infected.

The majority of HIV-1 infections worldwide are acquired via mucosal surfaces. However, unlike the vaginal mucosa, the issue of whether the oral mucosa can act as a portal of entry for HIV-1 infection remains controversial. To address potential differences with regard to the fate of HIV-1 after exposure to oral and vaginal epithelium, we utilized two epithelial cell lines representative of buccal (TR146) and pharyngeal (FaDu) sites of the oral cavity and compared them with a cell line derived from vaginal epithelium (A431) in order to determine (i) HIV-1 receptor gene and protein expression, (ii) whether HIV-1 genome integration into epithelial cells occurs, (iii) whether productive viral infection ensues, and (iv) whether infectious virus can be transferred to permissive cells. Using flow cytometry to measure captured virus by HIV-1 gp120 protein detection and western blot to detect HIV-1 p24 gag protein, we demonstrate that buccal, pharyngeal and vaginal epithelial cells capture CXCR4- and CCR5-utilising virus, probably via non-canonical receptors. Both oral and vaginal epithelial cells are able to transfer infectious virus to permissive cells either directly through cell-cell attachment or via transcytosis of HIV-1 across epithelial cells. However, HIV-1 integration, as measured by real-time PCR and presence of early gene mRNA transcripts and de novo protein production were not detected in either epithelial cell type. Importantly, both oral and vaginal epithelial cells were able to support integration and productive infection if HIV-1 entered via the endocytic pathway driven by VSV-G. Our data demonstrate that under normal conditions productive HIV-1 infection of epithelial cells leading to progeny virion production is unlikely, but that epithelial cells can act as mediators of systemic viral dissemination through attachment and transfer of HIV-1 to permissive cells.

Patients with HPV-related tonsil squamous cell carcinoma rarely harbour oncogenic HPV infection at other pharyngeal sites

Patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) have a reduced risk of developing second primary upper aerodigestive tract (UADT) tumours compared to patients with HPV-negative primary tumours at the same site. To determine whether this finding might be explained by a lack of viral-induced field cancerisation or multifocal infection, we investigated whether there was epithelial dysplasia and/or evidence of HPV infection at other pharyngeal mucosal sites in patients presenting with the disease. Sixty-three patients with primary tonsil SCC and 108 pharyngeal endoscopic biopsies, representing at least one pharyngeal subsite from each patient, were included in this study. Tissue samples were tested using HPV PCR (GP5+/6+), p16 immunohistochemistry (IHC) and high risk HPV DNA in situ hybridisation (ISH). There were 46 patients with HPV-related SCC and 17 patients with HPV-negative disease. PCR detected HPV DNA in a fifth of pharyngeal endoscopic biopsies and was equally likely to be from a patient with HPV-related SCC as from a patient with HPV negative disease. All PCR positive cases were tested using p16 IHC and high risk HPV ISH and only three biopsies were positive. Significantly, these three biopsies all showed evidence of epithelial dysplasia and were from patients with an HPV positive index tumour. Our data suggest that virus-induced field cancerisation and/or multifocal oncogenic HPV infection of the pharynx is uncommon in OPSCC and supports the concept that these patients have a lower risk of developing second primary tumours of the UADT.

High rates of sexually transmissible infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study

Background In HIV-positive people, sexually transmissible infections (STIs) probably increase the infectiousness of HIV. In 2010, we established a cohort of individuals (n=554) from clinics in the Australian HIV Observational Database (AHOD). We calculated retrospective rates for four STIs for 2005-10 and prospective incidence rates for 2010-11. At baseline (2010), patient characteristics were similar to the rest of AHOD. Overall incidence was 12.5 per 100 person-years. Chlamydial infections increased from 3.4 per 100 person-years (95% confidence interval (CI): 1.9-5.7) in 2005 to 6.7 per 100 person-years (95% CI: 4.5-9.5) in 2011, peaking in 2010 (8.1 per 100 person-years; 95% CI: 5.6-11.2). Cases were distributed among rectal (61.9%), urethral (34%) and pharyngeal (6.3%) sites. Gonococcal infections increased, peaking in 2010 (4.7 per 100 person-years; 95% CI: 5.6-11.2; Ptrend=0.0099), distributed among rectal (63.9%), urethral (27.9%) and pharyngeal (14.8%) sites. Syphilis showed several peaks, the largest in 2008 (5.3 per 100 person-years; 95% CI: 3.3-8.0); the overall trend was not significant (P=0.113). Genital warts declined from 7.5 per 100 person-years (95% CI: 4.8-11.3) in 2005 to 2.4 per 100 person-years (95% CI: 1.1-4.5) in 2011 (Ptrend=0.0016). For chlamydial and gonococcal infections, incidence was higher than previous Australian estimates among HIV-infected men who have sex with men, increasing during 2005-2011. Rectal infections outnumbered infections at other sites. Syphilis incidence remained high but did not increase; that of genital warts was lower and decreased.

Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography

Introduction When CPAP intolerance is present in obstructive sleep apnea (OSA) patients, the assessment of pharyngeal obstruction areas is critical in order to increase surgical success rate. Drug-induced sleep endoscopy (DISE) allows visual pharynx evaluation of patients under sedation, artificially reproducing natural sleep. Although consensus has not yet been established on the sedation method, propofol and midazolam are the drugs most frequently used. The object of the present study is to compare pharyngeal and polysomnographical (PSG) findings during DISE performed either with propofol or midazolam as a single sedative in the same patient. Materials and methods Sixteen patients with sleep breathing disorders were sedated and endoscopically evaluated, under propofol sedation first, followed by midazolam, after confirmation of complete arousal. Simultaneous PSG was performed during sedation. Comparison of pharyngeal obstruction and vibration sites under each of the drugs is performed using the VOTE classification. PSG findings were also compared. Results There were 15 men and one woman; mean age 42.7 years old, mean body mass index (BMI) 26.9 Kg/m2. Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam. The induced-sleep stage obtained was N2 with both drugs. There was a good correlation between DISE results with both drugs (p 0.001). A high level of agreement was found when evaluating tongue base and epiglottic collapse (97% and 87% respectively), and lower at the vellum (84.4%). There was a good correlation of the AHI and minimal O2 saturation with both drugs. (ICC 0.7 and 0.67). Conclusion A high level of agreement is found when DISE is performed with propofol and midazolam, under continuous perfusion. Acknowledgement To Juan Vinoles.

Abstract C14: Type of insurance affects risk of late-stage oral and pharyngeal cancer diagnosis

Abstract Differences in stage of diagnosis for oral and pharyngeal cancer OPC based on race, ethnicity, and socioeconomic status have been documented with poor and Blacks having the poorest outcomes. To understand points of intervention, we examined how stage at diagnosis is influenced by gender, race, ethnicity, 3rd party payer, and marital status separately for oral sites and pharyngeal sites. Oral sites include squamous cell carcinomas of tongue, floor of mouth, and palate; Pharyngeal sites include squamous cell carcinomas of base of tongue, tonsil, hypopharynx, and oropharynx. Our rationale for separating these sites is the dramatic difference in stage of diagnosis between oral and pharyngeal (1). In this analysis, we add a modeling component to our previous work and focus on the effect of insurance on stage of diagnosis. Methods: OPC cancer patients diagnosed between 2000 and 2008 were examined using data from the Florida Cancer Data System. A total of 12938 patients with OPC cancers were identified, with 4531 oral cavity cases and 8407 pharynx cases. Overall, 72.2% of patients were male, 92% were white, and 8.5% were Hispanic. The primary outcome variable stage of diagnosis was dichotomized into: localized versus late (regional and distant) stage diagnosis. Two logistic regression models, separated for oral SCC and pharyngeal SCC, were built with predictor variables including gender, race, ethnicity, insurance used, and marital status. Categories of insurance coverage were: 1) No insurance, 2) Private insurance, 3) Medicaid, 4) Medicare, and 5) Other. Age at diagnosis and year of diagnosis were controlled for the models. Results: Compared to Whites, Blacks were less likely to have private insurance (19.47% versus 30.64% for Whites) but more likely to have no insurance (12.46% versus 7.06% for Whites) and Medicaid coverage (20.74% versus 6.31% for Whites). Compared to Non-Hispanics, Hispanics were more likely to have no insurance (12.49% versus 7.01% for Non-Hispanics) and Medicaid coverage (15.11% versus 6.74% for Non-Hispanics). However, the percentages covered by private insurance were similar for Hispanics (28.87%) and Non-Hispanics (29.83%). The percentage with Medicare coverage were similar across groups ranging from 33%-39%. Insurance Race Ethnicity White Black Non-Hispanic Hispanic No insurance 7.06% 12.46% 7.01% 12.49% Private 30.64% 19.47% 29.83% 28.87% Medicaid 6.31% 20.74% 6.74% 15.11% Medicare 39.9% 33.01% 39.91% 33.48% other 16.09% 14.31% 16.50% 10.05% Based on the regression analysis, having private insurance (OR=0.48, p&amp;lt;0.001; OR=0.66, p=0.004) or Medicare (OR=0.46, p&amp;lt;0.001; OR=0.54, p&amp;lt;0.001) coverage were protective compared to no insurance in having a late-stage diagnosis at either oral or pharyngeal sites. On the other hand, being enrolled in Medicaid was no different than having no insurance in stage of diagnosis for both oral and pharyngeal cancer. Many of the other observed relationships were as expected: being male was a risk factor for late stage dx for both oral and pharyngeal cancer (OR=1.52, p&amp;lt;0.001; OR=1.54, p&amp;lt;0.001) as was being Hispanic (OR=1.27, p=0.021; OR=1.29, p=0.027). Being Black was a risk factor for late stage oral cancer diagnosis (OR=2.00, p&amp;lt;0.001) but not pharyngeal cancer (OR=1.18, p=0.1596). Being married was protective for oral and pharyngeal sites (OR=.74, p&amp;lt;0.001; OR=0.80, p&amp;lt;0.001, respectively). Conclusions: Medicare and private insurance were protective against late stage diagnosis. Benefits associated with Medicaid coverage provide no additional protection for late stage diagnosis compared to having no insurance pointing to a clear need for a review of the diagnostics services available. 1. Guo Y, McGorray SP, Riggs CE, Jr., Logan HL. Racial disparity in oral and pharyngeal cancer in Florida in 1991-2008: mixed trends in stage of diagnosis. Community Dentistry and Oral Epidemiology 2012;72(1):68-74. Citation Format: Henrietta L. Logan. Type of insurance affects risk of late-stage oral and pharyngeal cancer diagnosis. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C14.

Self-collected versus clinician-collected sampling for sexually transmitted infections: a systematic review and meta-analysis protocol

BackgroundThree meta-analyses and one systematic review have been conducted on the question of whether self-collected specimens are as accurate as clinician-collected specimens for STI screening. However, these reviews predate 2007 and did not analyze rectal or pharyngeal collection sites. Currently, there is no consensus on which sampling method is the most effective for the diagnosis of genital chlamydia (CT), gonorrhea (GC) or human papillomavirus (HPV) infection. Our meta-analysis aims to be comprehensive in that it will examine the evidence of whether self-collected vaginal, urine, pharyngeal and rectal specimens provide as accurate a clinical diagnosis as clinician-collected samples (reference standard).Methods/DesignInclusion and exclusion criteria: Eligible studies include both randomized and non-randomized controlled trials, pre- and post-test designs, and controlled observational studies. Search strategy: The databases that will be searched include the Cochrane Database of Systematic Reviews, Web of Science, Database of s of Reviews of Effects (DARE), EMBASE and PubMed/Medline. Data collection and analysis: Data will be abstracted independently by two reviewers using a standardized pre-tested data abstraction form. Heterogeneity will be assessed using the Q2 test. Sensitivity and specificity estimates with 95% confidence intervals as well as negative and positive likelihood ratios will be pooled and weighted using random effects meta-analysis, if appropriate. A hierarchical summary receiver operating characteristics curve for self-collected specimens will be generated.DiscussionThis synthesis involves a meta-analysis of self-collected samples (urine, vaginal, pharyngeal and rectal swabs) versus clinician-collected samples for the diagnosis of CT, GC and HPV, the most prevalent STIs. Our systematic review will allow patients, clinicians and researchers to determine the diagnostic accuracy of specimens collected by patients compared to those collected by clinicians in the detection of chlamydia, gonorrhea and HPV.