Primary Head Research Articles

Constructing heterogeneous single-cell landscape and identifying microenvironment molecular characteristics of primary and lymphatic metastatic head and neck squamous cell carcinoma

BackgroundHead and neck squamous cell carcinoma (HNSCC) accounts for more than half of head and neck tumors, roughly 90%. This study focused on constructing the heterogeneous landscape using single-cell and bulk transcriptomic data to identify molecular characteristics of the microenvironment in primary and lymphatic metastatic head and neck squamous carcinomas. MethodThe study enrolled 23 HNSCC samples with scRNA-seq data and 546 HNSCC samples from TCGA. We used Monocle to sort the cells and used CellPhoneDB to explore the cell-cell interactions. Infercnv, which was used to infer cells with apparent copy number variation based on single-cell sequencing transcriptome data. We re-evaluated HNSCC bulk RNA transcriptome data to characterize the functions of different cell types in shaping the immune microenvironment of HNSCC. ResultsWe combined genealogical reconstruction, CNV inference, and cellular interactions to uncover the characteristics of distinct cell populations in different disease states, differences in cancer and immune cell lineages of differentiation trajectories, and interactions between non-immune and immune cell. PD-1 and PD-L1/PD-L2 expressed extremely rare in T cells, the immune checkpoint molecule KLRB1-CLEC2D achieved a high-level expression. We identified three microenvironment-based HNSCC subtypes associated with the prognosis of HNSCC patients. ConclusionsIn summary, the present study dissected the intratumoral heterogeneity and immune microenvironment of primary and metastatic HNSCC, which is crucial to reveal the mechanisms of resistance to immunotherapy in HNSCC in different disease states and is expected to assist in the further investigation of the mechanism of HNSCC cell metastasis and guide the treatment of clinical patients.

Critical Appraisal of Histologic Grading for Mucoepidermoid Carcinoma of Salivary Gland: Is an Objective Prognostic 2-tiered Grading System Possible?

Multiple 3-tiered grading systems exist for mucoepidermoid carcinoma (MEC), leading to controversial results on the frequency and prognostic values of each grade. We aimed to identify prognostic histologic factors and to evaluate grading schemes in this retrospective study of 262 resected primary head and neck MECs. The rate of nodal metastasis was 8.4%. Large tumor size, tumor fibrosis, infiltrative border, lymphovascular invasion, perineural invasion, atypical mitosis, mitotic index (MI) ≥4/2mm 2 (4/10HPFs), necrosis, and pT4 stage were associated with increased risk of nodal metastasis. The 5-year recurrence-free survival (RFS) was 95%. Significant prognostic factors for RFS included infiltrative border, tumor-associated lymphoid stroma, architectural patterns (macrocystic, microcystic, and noncystic), anaplasia, atypical mitosis, MI, necrosis, lymphovascular invasion, margin, pT stage, and tumor size. Nuclear anaplasia, high mitotic rate, and ≥25% microcystic component were significant independent prognostic factors on multivariate survival analysis. There was no significant difference between low-grade (LG) and intermediate-grade (IG) MECs in terms of risk of nodal metastasis and outcomes using all 4 known grading systems. Rather, high-grade MEC was consistently associated with an increased risk of nodal metastasis at presentation and decreased RFS and distant metastasis-free survival (DMFS) compared with the LG/IG MECs. We therefore recommend simplifying MEC grading to a 2-tiered grading scheme using MI and/or tumor necrosis. Using a 2-tiered grading, high-grade histology independently predict RFS, and is associated with a 25% risk of nodal metastasis, a 5-year RFS of 76%, and a 5-year DMFS of 76%, whereas LG MEC has a nodal metastasis rate of 7.0%, 5-year RFS of 97% and 5-year DMFS of 99%.

Impact of hyperfractionated re-irradiation on quality of life in patients with recurrent or second primary head and neck cancer, a prospective single institutional study.

Describe the clinical outcome of hyperfractionated re-irradiation (HFRT) in patients with recurrent or second primary (SP) head and neck cancer (HNC). This prospective observational study included HNC patients eligible for HFRT. Inclusion criteria: age ≥18years, recurrent or SP HNC, planned re-irradiation and ability to respond to questionnaires. Patients received 1.5Gy twice daily, five days a week for three (palliative) or four (curative/local control) weeks, total dose 45/60Gy. Toxicity was scored with CTCAE v3 at baseline, end of treatment, at three, six, 12 and 36months follow-up. Health-related quality of life (HRQoL) was measured with EORTC QLQ-C30 and EORTC QLQ-H&N35, pre-treatment and eight times until 36months. In the main outcome (Global quality of life and H&N Pain), a change score of ≥10 was considered clinically significant, and p-values<0.05 (two-sided) statistically significant. The Kaplan-Meier method was used for survival analyses. Over four years from 2015, 58 patients were enrolled (37 recurrent and 21SP). All, but two patients completed treatment as planned. Toxicity (≥grade 3) increased from pre-treatment to end of treatment with improvement in the follow-up period. The mean Global quality of life (QoL) and H&N Pain scores were stable from pre-treatment to three months. Maintained/ improved Global QoL was reported by 60% of patients at three months and 56% of patients at 12months. For patients with curative, local control and palliative intent, the median survival (range) was 23 (2-53), 10 (1-66) and 14 (3-41) months respectively. Of those alive, the proportion of disease-free patients at 12 and 36months, were 58% and 48%, respectively. Most HNC patients reported maintained HRQoL at three and 12months after HFRT despite serious toxicity observed in many patients. Long-term survival can be achieved in a limited proportion of the patients.

Is there still a place for anatomic hemiarthroplasty in patients with high functional demands in primary, nonreconstructable proximal humeral fractures? A clinical and radiographic assessment.

Vitality-threatening proximal humerus fractures often provide an indication for prosthetic treatment. We investigated the issue of how anatomic hemiprostheses perform in younger, functionally challenging patients with the use of a specific fracture stem and systematic tuberosity management in medium-term follow-up. Thirteen skeletally mature patients with a mean age of 64±9years and a minimum follow-up of 1year after primary open-stem hemiarthroplasty for 3- and 4-part proximal humeral fractures were included. All patients were followed up regarding their clinical course. Radiologic follow-up included fracture classification, healing of tuberosities, proximal migration of the humeral head, evidence of stem loosening, and glenoid erosion. Functional follow-up included range of motion, pain, objective and subjective performance scores, complications, and return to sports rates. We statistically compared treatment success based on the Constant score between the cohort with proximal migration and the cohort with regular acromiohumeral distance by means of the Mann-Whitney U test. After an average follow-up period of 4.8years, satisfactory results were obtained. The absolute Constant-Murley score was 73.2±12.4 points. The disabilities of the arm, shoulder, and hand score was 13.2±13.0 points. Patients reported their mean subjective shoulder value as 86.6%±8.5%. Pain was reported as 1.1±1.3 points on a visual analog scale. Flexion, abduction, and external rotation values were 138±31°, 134±34°, and 32±17°, respectively. 84.6% of the referred tuberosities healed successfully. Proximal migration was observed in 38.5% of cases and was associated with worse Constant score results (P=.065). No patient showed signs of loosening. Mild glenoid erosion was apparent in 4 patients (30.8%). All patients who were interviewed and participated in sports before surgery were able to return to their primary sport after surgery and continued to do so during the final follow-up. With narrow indications, use of a specific fracture stem and adequate tuberosity management, successful radiographic and functional results are presented after a mean follow-up of 4.8years after hemiarthroplasty for primary nonreconstructable humeral head fractures. Accordingly, open-stem hemiarthroplasty appears to remain a possible alternative to reverse shoulder arthroplasty in younger, functionally challenging patients with primary 3- or 4-part proximal humeral fractures.

Two CcCCL19bs orchestrate an antibacterial immune response in Yellow River carp (Cyprinus carpio haematopterus).

Chemokines are a group of chemotactic cytokines with an essential role in homeostasis as well as immunity via specific G protein-coupled receptors and atypical receptors. In our study, two Yellow River carp (Cyprinus carpio haematopterus) CCL19b genes (CcCCL19bs), tentatively named CcCCL19b_a and CcCCL19b_b, were cloned. The open reading frames (ORFs) of CcCCL19b_a and CcCCL19b_b were both 333 bp that encoded a 12kDa protein with 110 amino acid residues. CcCCL19bs contained a signal peptide and a SCY domain with four typical conserved cysteine residues. The two CcCCL19b proteins shared high similarities with each other in both secondary and three-dimensional structure. Phylogenetic analysis showed that CcCCL19bs and other CCL19bs from tetraploid cyprinid fish were clustered into one clade. CcCCL19bs were highly expressed in gill and intestine in healthy fish, and a significant up-regulation of gene expression after Aeromonas hydrophila infection and poly(I:C) stimulation was observed in gill, liver, and head kidney. Furthermore, chemotaxis and antibacterial activity of CcCCL19bs were studied. The results indicated that recombinant CcCCL19b_a and CcCCL19b_b protein (rCcCCL19b_a and rCcCCL19b_b) exhibited significant attraction to primary head kidney leukocytes (HKLs). Meanwhile, both of rCcCCL19bs could promote the proliferation of HKLs, and significantly up-regulate the expressions of IL-1β, CCR7, and IL-6, and down-regulate the expression of IL-10 in primary HKLs. In vitro, rCcCCL19bs could bind and aggregate A. hydrophila and Staphylococcus aureus. The rCcCCL19bs exhibited significant antibacterial activity against A. hydrophila, but not S. aureus. Moreover, they inhibited the growth of A. hydrophila and S. aureus. In vivo, overexpression of CcCCL19bs contributed to the bacterial clearance. These studies suggested that CcCCL19bs orchestrate an antibacterial immune response.

Influence of Primary School Head Teachers’ Instructional Leadership on Teachers’ Professional Practices in Musanze District, Rwanda

The purpose of this study was to assess the influence of head teachers’ instructional leadership on teachers’ professional practices in primary schools of Musanze district in Rwanda. The study employed the correlational research design. A questionnaire made of close-ended items was used to collect data related to head teachers’ instructional leadership as well as teachers’ professional practices. Descriptive statistics including mean and standard deviation were used to describe head teachers’ leadership practices and teachers’ professional practices. Furthermore, regression analysis was used to determine the influence of head teachers’ instructional leadership on teachers’ professional practices. Based on the findings, the study concludes that head teachers in primary schools of Musanze District rarely implement practices related to instructional leadership. Furthermore, professional practices were not satisfactory as teachers rarely or sometimes acted professionally. Finally, poor professional practices are explained by the poor instructional leadership practices of their head teachers. The following recommendations have been made: Policymakers should build the capacity of primary school head teachers in terms of instructional leadership in order to improve the quality of teaching and learning. Furthermore, head teachers should make more use of instructional leadership to improve professional practices of teachers.

The Prospects of Effective Management of Educational Data in Primary School at Mbarali District, Tanzania

In recent years, the use of education data has increased attention. They are important in education planning and development in general. This study assessed the prospects of effective management of educational data in Mbarali District. Our study employed a Cross sectional research design. A quantitative research methodology was used. The population of the study included data managers in primary schools. The study's sample included data managers 285 in primary schools from Mbarali district. Questionnaires were used to gather data. Multiple regression analyses were used to analyse the data. The study revealed that all the four independent variables (effective decision making, minimization of errors, cost effectiveness and efficient operations) uniquely, significantly and positively were influenced by effective data management model (β=0.257 P=0.00), (β=0.301 P=0.00), (β=-0.632 P=0.00) and (β=-0.614 P=0.00) respectively. Therefore, an effective data management support efficiency in decision-making, leads to cost-effective, minimize errors, and support operational effectiveness.&#x0D; Generally the appropriate investment in education is largely determines the success of the implementation of any education policy in a country. The government of Tanzania has given primary school heads power as a primary source of education data in order to ensure that the data submitted to various education authorities are accurate, dependable, and secured. Computers and data storage facilities should be among the data management tools and systems that should be available in schools.&#x0D; Our study then recommends that the government through the Ministry of Education, Science and Technology should make sure current technology is used to manage data in education institutions through updating data management systems and data management tools such as computers, hard drives and data storage facilities to ensure data security and reliability.

Prognostic Value of Hematological Markers in Head and Neck Cancer Patients With a History of Hematological Malignancy

Background and Objectives Head and neck cancer can occur as a second primary tumor in patients with a history of hematological malignancy, and the pathological features of those are more aggressive than de novo primary head and neck cancer. However, research related to the prognostic value of hematological markers in the head and neck cancer patients with a history of hematological malignancy is scarce, so we performed this study.Subjects and Method We reviewed a total of 89 head and neck cancer patients with hematological malignancy diagnosed at a single tertiary hospital between 1997 and 2021, and enrolled 29. The analyzed hematological parameters included pre- and post-treatment hemoglobin, hematocrit, lactate dehydrogenase, absolute neturophil count (ANC), absolute platelet count, absolute leukocyte count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio.Results Hematological malignancy was diagnosed almost 62.14±96.10 months before head and neck cancer. The most common hematological malignancy was acute myeloid leukemia. The overall survival (OS) rate was lower in patients with second primary tumor than in those with de novo primary head and neck cancer. The cox-proportional hazard ratio analysis showed that the post-treatment absolute neutrophil count was significantly correlated with disease-free survival but not with OS.Conclusion The post-treatment hematological profile, particularly ANC, can be considered a useful prognostic marker in the head and neck cancer patients with a history of hematological malignancy.

House modifications as a malaria control tool: how does local context shape participants’ experience and interpretation in Uganda?

BackgroundEvidence that house design can provide protection from malaria is growing. Housing modifications such as screening windows, doors, and ceilings, and attaching insecticide-impregnated materials to the eaves (the gap between the top of the wall and bottom of the roof), can protect against malaria. To be effective at scale, however, these modifications must be adopted by household residents. There is evidence that housing modifications can be acceptable, but in-depth knowledge on the experiences and interpretation of modifications is lacking. This qualitative study was carried out to provide a holistic account of the relationship between experiences and interpretations of four types of piloted housing modifications and the local context in Jinja, Uganda.MethodsQualitative research was conducted between January to June 2021, before and during the installation of four types of housing modifications. The methods included nine weeks of participant observations in two study villages, nine focus group discussions with primary caregivers and heads of households (11–12 participants each), and nine key informant interviews with stakeholders and study team members.ResultsMost residents supported the modifications. Experiences and interpretation of the housing modifications were shaped by the different types of housing in the area and the processes through which residents finished their houses, local forms of land and property ownership, and cultural and spiritual beliefs about houses.ConclusionsTo maximize the uptake and benefit of housing modifications against malaria, programme development needs to take local context into account. Forms of local land and house ownership, preferences, the social significance of housing types, and religious and spiritual ideas shape the responses to housing modifications in Jinja. These factors may be important in other setting.Trial registration Trial registration number is NCT04622241. The first draft was posted on November 9th 2020.

Curative high-dose reirradiation for patients with recurrent head and neck adenoid cystic carcinomas: outcomes and analysis of patterns of failure

Background To investigate the outcomes of patients who underwent curative reirradiation (reRT), with intensity-modulated radiation therapy (IMRT) or proton therapy (PT) for unresectable recurrent or second primary head and neck adenoid cystic carcinoma (HNACC). Methods Ten patients, mostly KPS 90%, were reirradiated (3/10 with IMRT and 7/10 with PT) at a median maximum dose to the CTV of 64.2 Gy from July 2011 to November 2021. Locations at the time of reRT were mainly the sinus (4/10) and the salivary glands (including the parotid and submandibular gland, 3/10). CTCAEv5 was used to assess acute and late toxicities. Follow-up was the time between the end of reRT and the date of last news. Results The median time between the two irradiations was 53.5 months (IQR: 18–84). After a median follow-up of 26 months (range, 12.5–51.8 months), six patients had developed a locoregional recurrence (LR), of which four occurred within the previously irradiated volume. Two and three-year locoregional failure-free survival (LFFS) and overall survival (OS) were 55.6% [95%CI: 31–99.7%], and 41% [18.5–94%] and 66.7% [42–100%] and 44.4% [21.4–92.3%], respectively. LFFS and OS were significantly better in the subgroup of sinus tumors (p = .013) and the subgroup of patients re-irradiated more than two years after the first course of irradiation (p = .01). Seven patients had impairments before the start of reRT, including hearing impairment (3/10) and facial nerve impairment (3/10). The most severe late toxicities were brain necrosis (2/10), osteoradionecrosis (1/10) and vision decreased (1/10). Conclusion Curative reRT for HNACC is possible for selected cases, but the LR rate in the irradiated field and the risk of severe toxicity remain high. Improved selection criteria and more carefully defined target volumes may improve outcome in these patients. A further study including larger cohort of patients would be useful to confirm these results.

The Pedagogical Role of the Primary-School Headteacher: Insights From Greece

&lt;p style="text-align:justify"&gt;The pedagogical and didactic guidance of teachers has been linked, in the relevant literature, to the school management’s adoption of the model of pedagogical leadership as well as to the assurance of a series of factors that influence it. This study aims at investigating the pedagogical role of the principal in Greek primary schools. Data were collected through an anonymous questionnaire completed by 133 Greek primary school head teachers. Results show that head teachers consider that their pedagogical role has mainly to do with the pedagogical climate, psychosocial and pedagogical guidance of the school unit. Additionally, the research results show that head teachers carry out their pedagogical role cooperating and communicating mainly with the members of the educational community of the school. Another noteworthy finding of the present study is that the factors that support head teachers in their pedagogical leadership role, are hard to exist in hierarchical educational realities such as Greece. The originality of the paper draws attention to the school's socio-economic environment, which significantly influences school leadership. Conclusions on the implications of the study are made and directions for future research are suggested.&lt;/p&gt;

Ofsted suicides: who is responsible for suicide prevention?

PurposeThe purpose of this paper is to discuss the response of the relevant authorities to evidence that female primary schoolteachers have an elevated suicide risk in the UK. The paper situates the recent tragic death of a primary school head teacher, following an Ofsted inspection at her school, within the wider context of teacher suicide deaths and asks what, if any, action the authorities have taken to prevent avoidable suicide deaths from occurring.Design/methodology/approachThe paper examines a recent case of suicide by a primary head teacher within the wider context of statistical data on suicides by primary schoolteachers and in relation to previous cases of suicide linked to a school inspection.FindingsThe paper suggests that the relevant authorities have failed to act in relation to evidence of high suicide risk amongst female primary schoolteachers and to previous suicide deaths linked to the impact of a school inspection. Without learning from suicide deaths and acting on available evidence, there is a risk that preventable suicide deaths will continue to occur.Originality/valueThe paper draws together case study evidence and statistical data to make the case for regulatory reform to ensure that work-related suicides are investigated, monitored and prevented.

PANDANGAN KEPALA KANTOR URUSAN AGAMA (KUA) MELAWI TERHADAP FENOMENA PERNIKAHAN BEDA AGAMA DI KABUPATEN MELAWI

The purpose of this study was to find out: 1) To find out the views of the head of the office of religious affairs (kua) melawi on interfaith marriages between Muslim men and non-Muslim women. 2) To find out the views of the head of the office of religious affairs (kua) Melawi on interfaith marriages of non-Muslim men and Muslim women. Primary data source Head of Religious Affairs Office (KUA) Melawi. This study uses interview data collection techniques. Meanwhile, data analysis by reducing the very basic things is then summarized to be presented in the form of a narrative. So that it can be concluded, the data is also checked for validity by triangulating sources. The results showed: 1) The views of the head of the Office of Religious Affairs (KUA) Melawi on interfaith marriages, where Muslim men marry non-Muslim women, namely that there are those who state that it is not permissible based on QS Al-Baqarah 221, Law Number 16 of 2019 Amendments to Law Number 1 of 1974, the Compilation of Islamic Law, and the 2005 MUI Fatwa concerning interfaith marriages. In addition, there are also those who say that marriage is permissible as long as it is with an ahlul Kitab based on QS Al-Maidah 5, and the jurists of 4 schools of law allow interfaith marriages with an ahlul Kitab. 2) The view of the head of the Office of Religious Affairs (KUA) melawi on interfaith marriages for non-Muslim men marrying Muslim women. All heads of KUA Melawi agree that interfaith marriages for Muslim men marrying non-Muslim women are illegal and unlawful based on QS Al-Baqarah 221, QS Al-Mumtahanah 10, Law No. 16 of 2019 Amendments to Law No. 1 of 1974, the Compilation of Islamic Law, and the 2005 MUI Fatwa on interfaith marriages.

Detection of Cancer Recurrence Using Systemic Inflammatory Markers and Machine Learning after Concurrent Chemoradiotherapy for Head and Neck Cancers.

Pretreatment values of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are well-established prognosticators in various cancers, including head and neck cancers. However, there are no studies on whether temporal changes in the NLR and PLR values after treatment are related to the development of recurrence. Therefore, in this study, we aimed to develop a deep neural network (DNN) model to discern cancer recurrence from temporal NLR and PLR values during follow-up after concurrent chemoradiotherapy (CCRT) and to evaluate the model's performance compared with conventional machine learning (ML) models. Along with conventional ML models such as logistic regression (LR), random forest (RF), and gradient boosting (GB), the DNN model to discern recurrences was trained using a dataset of 778 consecutive patients with primary head and neck cancers who received CCRT. There were 16 input features used, including 12 laboratory values related to the NLR and the PLR. Along with the original training dataset (N = 778), data were augmented to split the training dataset (N = 900). The model performance was measured using ROC-AUC and PR-AUC values. External validation was performed using a dataset of 173 patients from an unrelated external institution. The ROC-AUC and PR-AUC values of the DNN model were 0.828 ± 0.032 and 0.663 ± 0.069, respectively, in the original training dataset, which were higher than the ROC-AUC and PR-AUC values of the LR, RF, and GB models in the original training dataset. With the recursive feature elimination (RFE) algorithm, five input features were selected. The ROC-AUC and PR-AUC values of the DNN-RFE model were higher than those of the original DNN model (0.883 ± 0.027 and 0.778 ± 0.042, respectively). The ROC-AUC and PR-AUC values of the DNN-RFE model trained with a split dataset were 0.889 ± 0.032 and 0.771 ± 0.044, respectively. In the external validation, the ROC-AUC values of the DNN-RFE model trained with the original dataset and the same model trained with the split dataset were 0.710 and 0.784, respectively. The DNN model with feature selection using the RFE algorithm showed the best performance among the ML models to discern a recurrence after CCRT in patients with head and neck cancers. Data augmentation by splitting training data was helpful for model performance. The performance of the DNN-RFE model was also validated with an external dataset.

The Incidence, Risk, and Overall Survival of First and Second Primary Head and Neck Malignancies in the Eastern Province, Saudi Arabia

Abstract Background: The mean survival time of head and neck cancers (HNC) differs according to patient and tumor characteristics. Treatment with radiotherapy or chemotherapy, genetic susceptibility, and environmental factors can contribute to the risk of developing second primary malignancy (SPM). Objective: Our purpose is to determine the rate of first primary malignancy and SPM among HNC patients, identify risk factors that may lead to the development of SPM, and analyze predictors of overall survival. Subjects and Methods: This is a single-center, retrospective study that included patients who were diagnosed with a head and neck and nonhead and neck SPM and visited the head and neck clinic between 2010 and 2020. Patients diagnosed with thyroid cancer or head and neck lymphoma, treated outside the facility, or lost to follow-up were excluded from the study. Data about demographics, diagnosis-related information, therapeutic approach, tumor recurrence, and the status of the patient and the tumor after the latest hospital visit were collected. Results: Thirty-seven (6.13%) cases were diagnosed with SPM with a median age of 61 years and a median time to diagnosis of 30.1 months from the first malignancy. Nearly half of the SPM patients were males (54.05%), smokers (51.35%), and underwent radiotherapy to treat the first cancer (51.35%). Laryngeal cancer carries the highest risk of the development of SPM of all SPM cases, followed by oral cavity cancers. The overall survival in patients with metachronous SPM is better than synchronous malignancies, with a median survival time of 149 months. Conclusion: The development of an SPM in patients with HNC is associated with decreased overall survival. Male gender, hypertension, and primary cancer site were significant risk factors for SPM.

Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database.

Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded. The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0-1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis. Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection.

Transoral Laser Resection of the Tongue Base in the Workup of Unknown Primary Head and Neck Squamous Cell Carcinoma.

Objective Failure to localize the primary tumor site in head and neck carcinoma of unknown origin after imaging and endoscopic evaluation leads to increased treatment-related morbidity. The use of transoral laser microsurgery to improve the detection of unknown primary carcinoma site identification is described in this article. Methods A retrospective cohort of 71 consecutive cases of cervical carcinoma of an unknown primary source from 2006 until 2012 from a single academic institution was analyzed. Of these, 10 patients were excluded based on our exclusion criteria. All patients underwent endoscopy with biopsies performed by fellowship-trained head and neck cancer surgeons. Results The primary detection rate was 76% for patients who underwent laser tongue base resection versus 34% for traditional operative examination. There were no complications or prolonged recovery times in either group. Operative time was increased by the addition of the transoral base of tongue resection by 30 minutes. Conclusions Laser tongue base excision offers improved sensitivity in primary site detection without a significant increase in morbidity and only a modest increase in operative time.

State of Instructional Educational Facilities of Primary Education at Upazila Level

Primary education is a basic education for all, which depends on different agencies and factors to ensure its quality. The study assessed the state of instructional facilities in primary education at the Upazila level in Bangladesh. An explanatory sequential design and mixed methods have been used in this study. The researcher has collected quantitative data by surveying primary school head teachers and selected schools from two upazilas: Charghat in Rajshahi and Sundargonj in Gaibandha District. The sample for the study was determined by stratified and simple random sampling. The total schools were 12 and 42 in both study areas. Through different interviews, questionnaire surveys, and document reviews, the researcher has explored the scenario of instructional educational facilities and provided suggestions to ensure quality primary education. The study finds that the Upazila Education Office should be at the vanguard of achieving quality primary education by ensuring the excellence of the school environment through instructional facilities with the help of the government, School Management Committee (SMC), Parent-Teacher Association (PTA), and communities. Overall, the government should prioritize investing in the improvement of instructional facilities in primary schools, as it directly impacts the quality of education and the ultimate academic performance of the students.

Challenges to the Quality of Early Childhood Education Delivery at Pre-Primary Level at Five Schools in the Zambezi Region (Namibia)

Objective. The primary purpose of this study was to document the nature of challenges faced by pre-primary teachers when delivering quality early childhood education at pre-primary schools in the Zambezi Region. The quality of delivery of early childhood education is crucial for the cognitive, emotional, physical and social wellbeing of children (Ministry of Education, Arts, and Culture [MEAC], 2016). The researcher envisaged that a high standard of delivery of early childhood education will potentially equip young children with skills and knowledge that will be important to their success during primary schooling. The study should prove essential for policy makers and other stakeholders to help them deliver early childhood education in pre-primary schools of a high standard in five schools that were purposefully selected for the study. &#x0D; Materials &amp; Methods. The case study collected qualitative data using face-to-face interviews with pre-primary teachers and junior primary heads of department. Observations were conducted in pre-primary classrooms during the lessons. In addition, the documents were reviewed, which included ministerial documents, journals and newspaper articles, to gather data that could be used to facilitate the improvement of early childhood education in pre-primary schools.&#x0D; Results. The central question of study was: What are the challenges of quality delivery in early childhood education at the selected pre-primary schools? In order to answer this primary question, the following supporting questions were formulated: What are the challenges faced by pre-primary teachers in order to implement a curriculum that will provide quality early childhood education at the five schools in the Zambezi Region of Namibia? How does the classroom environment influence the delivery of quality early childhood education at the five selected pre-primary schools? &#x0D; Conclusions. The findings of the research revealed that several challenges inhibit the quality of delivery of early childhood education at the five pre-primary schools selected for the study in the Zambezi Region. These challenges included: the use of SiLozi as a medium of instruction, a discrepancy between learning objectives as presented in teacher’s manual and in the curriculum, the lack of educational corners, the lack of teaching materials, the lack of recreational facilities and a deficiency in parental involvement in their children’s schooling.

Radial Head Arthroplasty for Fracture: Implant Survivorship and Outcomes at Mean Follow-up of 8 Years

The purpose of this study was to evaluate implant survivorship and clinical outcomes following radial head arthroplasty for fracture at long-term follow-ups. A retrospective analysis was conducted on adult patients who underwent primary uncemented radial head arthroplasty for radial head or neck fractures between 2012 and 2015. Medical records were reviewed to collect information regarding demographics, injury characteristics, reoperations, and revisions requiring implant removal. A bivariate analysis was conducted to identify potential risk factors for reoperation. A Kaplan-Meier curve was created to determine implant survival rates. Eligible patients were contacted to confirm any reoperations and obtain Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups. A total of 89 patients were eligible for analysis and assessed at a mean of 97 months after surgery (range, 81-128). Reoperation rate was 16% (14 of 89 patients), including 5% of patients requiring implant removal or revision. However, 93% of reoperations occurred within the first 12 months of the index surgery. Fracture dislocations of the elbow had a higher rate of reoperation. A Kaplan-Meier curve demonstrated an implant survival rate of 96% at 10-year follow-up. Of the patients who responded, the mean Quick Disability of the Arm, Shoulder, and Hand score was 8.7 ± 10.3, with none requiring additional reoperations or revisions. There were otherwise similar outcome scores among patients requiring reoperation versus those who did not. Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. Fractures with associated elbow dislocation may be at a higher risk for reoperation, and it is important to provide this prognostic information to patients who are likely to require arthroplasty for more extensive injuries. Therapeutic IV.