首页 > 最新文献

JAMA otolaryngology-- head & neck surgery最新文献

英文 中文
Intraoperative Parathyroid Hormone Monitoring Criteria in Primary Hyperparathyroidism: A Network Meta-Analysis of Diagnostic Test Accuracy. 原发性甲状旁腺功能亢进术中甲状旁腺激素监测标准:诊断测试准确性的网络meta分析。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-26 DOI: 10.1001/jamaoto.2024.4453
Phillip Staibano, Michael Au, Han Zhang, Sheila Yu, Winnie Liu, Jesse D Pasternak, Xing Xing, Carolyn D Seib, Lisa Orloff, Nhu-Tram Nguyen, Michael K Gupta, Eric Monteiro, Sameer Parpia, Tyler McKechnie, Alex Thabane, J E M Ted Young, Mohit Bhandari
<p><strong>Importance: </strong>Intraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy.</p><p><strong>Objective: </strong>To evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT.</p><p><strong>Data sources: </strong>A bayesian diagnostic test accuracy network meta-analysis (DTA-NMA) was performed, in which peer-reviewed citations from January 1, 1990, to July 22, 2023, were searched for in MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL.</p><p><strong>Study selection: </strong>All full-text study designs that evaluated any IOPTH monitoring criteria as a diagnostic test were included in this meta-analysis. Any studies evaluating adult patients diagnosed with PHPT undergoing parathyroidectomy were also included. The reference standard used in this study was normalization of calcium and/or parathyroid hormone levels within 1 year of surgery.</p><p><strong>Data extraction and synthesis: </strong>This DTA-NMA was reported in accordance with the applicable Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two reviewers evaluated all abstracts and full-text articles using a piloted extraction form. A third author resolved any conflicts. There are no published Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) resources for DTA-NMA. The following conventional monitoring criteria were included: Halle, Miami, Rome, Vienna, and PTH normalization, and the following modified criteria were included: Miami and PTH normalization, modified Miami, and modified Vienna. A bayesian hierarchical DTA-NMA model with corresponding 95% credible intervals (CrIs) was used to describe the pooled diagnostic characteristics of the evaluated IOPTH monitoring criteria.</p><p><strong>Main outcomes and measures: </strong>Main outcomes included pooled diagnostic test properties, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio.</p><p><strong>Results: </strong>A total of 72 studies, which included 19 072 patients, met the inclusion criteria. Sixty-nine studies (95.8%) investigated classic PHPT. In PHPT, the Miami criteria were investigated most often and had the best diagnostic properties (diagnostic odds ratio, 60.00 [95% CrI, 32.00-145.00]) when compared to other conventional criteria. Moreover, the modified Miami criteria, which measures a postexcision IOPTH level 15 minutes or more postexcision of all hyperfunctioning parathyroid tissue, were the overall best criteria (diagnostic odds ratio, 79.71 [95% CrI, 22.46-816.67]). There was a low risk of study bias and no publication bias.</p><p><strong>Conclusions and relevan
重要性:美国内分泌外科医生协会推荐在原发性甲状旁腺功能亢进(PHPT)患者进行甲状旁腺切除术时使用术中甲状旁腺激素(IOPTH)监测,但临床医生对优化诊断准确性的IOPTH监测标准尚无共识。目的:对PHPT患者手术中使用的IOPTH监测标准的诊断特性进行评价和排序。数据来源:在MEDLINE、Embase、Web of Science、CENTRAL和CINAHL中检索1990年1月1日至2023年7月22日的同行评审引文,进行贝叶斯诊断测试准确性网络元分析(DTA-NMA)。研究选择:所有评估任何IOPTH监测标准作为诊断测试的全文研究设计都包括在本荟萃分析中。任何评估诊断为PHPT并行甲状旁腺切除术的成年患者的研究也被纳入。本研究使用的参考标准是手术后1年内钙和/或甲状旁腺激素水平的正常化。数据提取和综合:本DTA-NMA按照适用的系统评价和荟萃分析(PRISMA)报告指南的首选报告项目进行报告。两名审稿人评估了所有的摘要和全文文章使用试点提取形式。第三位作者解决了任何冲突。DTA-NMA没有公开的推荐、评估、发展和评估分级(GRADE)资源。包括以下常规监测标准:Halle、Miami、Rome、Vienna和PTH正常化;包括以下修改标准:Miami和PTH正常化、修改Miami和修改Vienna。采用具有相应95%可信区间(CrIs)的贝叶斯分层DTA-NMA模型来描述所评估的IOPTH监测标准的汇总诊断特征。主要结局和测量指标:主要结局包括合并诊断试验特性,包括敏感性、特异性、阳性似然比、阴性似然比和诊断优势比。结果:共有72项研究,19 072例患者符合纳入标准。69项研究(95.8%)调查经典PHPT。在PHPT中,与其他常规标准相比,Miami标准被研究得最多,并且具有最好的诊断特性(诊断优势比为60.00 [95% CrI, 32.00-145.00])。此外,改良后的Miami标准是总体最佳标准(诊断优势比为79.71 [95% CrI, 22.46-816.67]),该标准测量切除后所有功能异常的甲状旁腺组织在切除后15分钟或更长时间内的IOPTH水平。研究偏倚风险低,无发表偏倚。结论和相关性:本荟萃分析的结果表明,外科医生在对PHPT患者进行iopth引导手术时应使用改良的Miami标准,因为这些标准通过减少不必要的颈部探查和翻修手术率来优化术中诊断的准确性。
{"title":"Intraoperative Parathyroid Hormone Monitoring Criteria in Primary Hyperparathyroidism: A Network Meta-Analysis of Diagnostic Test Accuracy.","authors":"Phillip Staibano, Michael Au, Han Zhang, Sheila Yu, Winnie Liu, Jesse D Pasternak, Xing Xing, Carolyn D Seib, Lisa Orloff, Nhu-Tram Nguyen, Michael K Gupta, Eric Monteiro, Sameer Parpia, Tyler McKechnie, Alex Thabane, J E M Ted Young, Mohit Bhandari","doi":"10.1001/jamaoto.2024.4453","DOIUrl":"10.1001/jamaoto.2024.4453","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Intraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;A bayesian diagnostic test accuracy network meta-analysis (DTA-NMA) was performed, in which peer-reviewed citations from January 1, 1990, to July 22, 2023, were searched for in MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;All full-text study designs that evaluated any IOPTH monitoring criteria as a diagnostic test were included in this meta-analysis. Any studies evaluating adult patients diagnosed with PHPT undergoing parathyroidectomy were also included. The reference standard used in this study was normalization of calcium and/or parathyroid hormone levels within 1 year of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;This DTA-NMA was reported in accordance with the applicable Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two reviewers evaluated all abstracts and full-text articles using a piloted extraction form. A third author resolved any conflicts. There are no published Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) resources for DTA-NMA. The following conventional monitoring criteria were included: Halle, Miami, Rome, Vienna, and PTH normalization, and the following modified criteria were included: Miami and PTH normalization, modified Miami, and modified Vienna. A bayesian hierarchical DTA-NMA model with corresponding 95% credible intervals (CrIs) was used to describe the pooled diagnostic characteristics of the evaluated IOPTH monitoring criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Main outcomes included pooled diagnostic test properties, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 72 studies, which included 19 072 patients, met the inclusion criteria. Sixty-nine studies (95.8%) investigated classic PHPT. In PHPT, the Miami criteria were investigated most often and had the best diagnostic properties (diagnostic odds ratio, 60.00 [95% CrI, 32.00-145.00]) when compared to other conventional criteria. Moreover, the modified Miami criteria, which measures a postexcision IOPTH level 15 minutes or more postexcision of all hyperfunctioning parathyroid tissue, were the overall best criteria (diagnostic odds ratio, 79.71 [95% CrI, 22.46-816.67]). There was a low risk of study bias and no publication bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevan","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient-Reported Distress in Individuals With Head and Neck Cancer. 头颈癌患者报告的痛苦。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-19 DOI: 10.1001/jamaoto.2024.4357
Melissa C White, Cheyenne Corbett, Trinitia Y Cannon, Tammara L Watts, Rong Jiang, Nosayaba Osazuwa-Peters
<p><strong>Importance: </strong>Distress is common among patients with cancer, and evidence of disparities associated with distress has been mixed. Head and neck cancer (HNC) is one of the most emotionally distressing cancers and is also a highly disparate disease. However, it is unknown whether there are disparities associated with patient-reported distress in HNC.</p><p><strong>Objective: </strong>To examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study analyzed data from a single tertiary institution at a National Cancer Institute-designated comprehensive cancer center in the Southeastern US. Participants included adult patients from January 2017 to December 2022 with confirmed diagnoses of head and neck squamous cell carcinoma who received radiation therapy up to 5 weeks from initial diagnosis.</p><p><strong>Main outcomes and measures: </strong>The outcome of interest was clinically meaningful distress (score of at least 4 on the distress thermometer). The distress thermometer is a single-item, self-reported tool used to measure a person's level of psychological distress over the past week, represented on a scale from 0 (no distress) to 10 (extreme distress). Patients were included in the study if they had visits with clinicians in the radiation oncology department within 5 weeks of diagnosis. Sociodemographic factors were race and ethnicity, age, sex, marital status, and health insurance status. Clinical variables (stage of presentation, anatomical subsites, smoking, and alcohol history) and problem list domain items were included in the adjusted model. Using multivariable logistic regression analysis, odds of meaningful distress by sociodemographic factors were estimated, adjusting for clinical factors and problem list domains.</p><p><strong>Results: </strong>A total of 507 patients met the inclusion criteria. The study population included 389 male patients (76.7%). The median (IQR) age of participants was 63 (56-71) years, with a racial distribution of 89 Black patients (17.6%), 385 White patients (75.9%), and 33 patients of other categories (6.9%), including Asian, Native American, multiracial, declined to respond, and unknown. Overall, 232 patients (45.8%) had meaningful distress. The median (IQR) DT score for the entire cohort was 3 (0-6). Black patients had the highest rate of physical concerns (n = 31 [34.8%]) compared to the other racial groups (78 White patients [20.3%] and 7 persons of other race [21.2%]). However, in the final multivariable model, race was not significantly associated with clinically meaningful distress (Black compared with White: adjusted odds ratio [aOR], 0.76 [95% CI, 0.45-1.28]; other compared with White: aOR, 0.85 [95% CI, 0.37-1.94]). Compared to those married, unmarried patients were significantly more likely to report distress (aOR, 1.61 [95% CI, 1
重要性:痛苦在癌症患者中很常见,与痛苦相关的差异证据是混合的。头颈癌(HNC)是最令人痛苦的癌症之一,也是一种高度不同的疾病。然而,尚不清楚在HNC中是否存在与患者报告的窘迫相关的差异。目的:研究HNC患者队列中与临床意义窘迫相关的种族和社会人口学因素。设计、环境和参与者:本回顾性队列研究分析了来自美国东南部国家癌症研究所指定的综合癌症中心的一所高等院校的数据。参与者包括2017年1月至2022年12月确诊为头颈部鳞状细胞癌的成年患者,他们在初次诊断后接受放射治疗长达5周。主要结局和测量:感兴趣的结局是临床有意义的痛苦(在痛苦温度计上得分至少为4)。压力温度计是一种单项自我报告的工具,用于测量一个人过去一周的心理压力水平,范围从0(无压力)到10(极度压力)。如果患者在诊断后5周内与放射肿瘤科的临床医生进行了访问,则将其纳入研究。社会人口因素包括种族和民族、年龄、性别、婚姻状况和健康保险状况。临床变量(表现阶段、解剖亚位、吸烟和酗酒史)和问题列表域项目被纳入调整后的模型。使用多变量逻辑回归分析,估计社会人口因素造成有意义的痛苦的几率,调整临床因素和问题列表域。结果:507例患者符合纳入标准。研究人群包括389例男性患者(76.7%)。参与者的中位(IQR)年龄为63(56-71)岁,种族分布为89名黑人患者(17.6%),385名白人患者(75.9%),33名其他类别患者(6.9%),包括亚洲人,印第安人,多种族,拒绝回应和未知。总的来说,232名患者(45.8%)有意义的痛苦。整个队列的中位(IQR) DT评分为3(0-6)。黑人患者的身体问题发生率最高(n = 31[34.8%]),而其他种族(78名白人患者[20.3%]和7名其他种族患者[21.2%])。然而,在最后的多变量模型中,种族与临床意义上的痛苦没有显著相关(黑人与白人相比:调整优势比[aOR], 0.76 [95% CI, 0.45-1.28];other与White比较:aOR为0.85 [95% CI, 0.37-1.94])。与已婚患者相比,未婚患者更有可能报告痛苦(aOR, 1.61 [95% CI, 1.05-2.50])。此外,有情绪问题的患者报告有临床意义的痛苦的几率是其他患者的两倍(aOR, 2.03 [95% CI, 1.02-4.08])。其他与显著临床困扰相关的因素包括吸烟(aOR, 2.14 [95% CI, 1.02-4.50])和报告的实际问题(aOR, 2.08 [95% CI, 1.17-3.69])。结论和相关性:独立于种族或社会人口因素,这项回顾性队列研究的结果强调了社会和情感支持在减轻患者痛苦和优化精神卫生保健方面的必要性。进一步的研究应该探索整个HNC连续体的痛苦轨迹及其对HNC结果的影响。
{"title":"Patient-Reported Distress in Individuals With Head and Neck Cancer.","authors":"Melissa C White, Cheyenne Corbett, Trinitia Y Cannon, Tammara L Watts, Rong Jiang, Nosayaba Osazuwa-Peters","doi":"10.1001/jamaoto.2024.4357","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4357","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Distress is common among patients with cancer, and evidence of disparities associated with distress has been mixed. Head and neck cancer (HNC) is one of the most emotionally distressing cancers and is also a highly disparate disease. However, it is unknown whether there are disparities associated with patient-reported distress in HNC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study analyzed data from a single tertiary institution at a National Cancer Institute-designated comprehensive cancer center in the Southeastern US. Participants included adult patients from January 2017 to December 2022 with confirmed diagnoses of head and neck squamous cell carcinoma who received radiation therapy up to 5 weeks from initial diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The outcome of interest was clinically meaningful distress (score of at least 4 on the distress thermometer). The distress thermometer is a single-item, self-reported tool used to measure a person's level of psychological distress over the past week, represented on a scale from 0 (no distress) to 10 (extreme distress). Patients were included in the study if they had visits with clinicians in the radiation oncology department within 5 weeks of diagnosis. Sociodemographic factors were race and ethnicity, age, sex, marital status, and health insurance status. Clinical variables (stage of presentation, anatomical subsites, smoking, and alcohol history) and problem list domain items were included in the adjusted model. Using multivariable logistic regression analysis, odds of meaningful distress by sociodemographic factors were estimated, adjusting for clinical factors and problem list domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 507 patients met the inclusion criteria. The study population included 389 male patients (76.7%). The median (IQR) age of participants was 63 (56-71) years, with a racial distribution of 89 Black patients (17.6%), 385 White patients (75.9%), and 33 patients of other categories (6.9%), including Asian, Native American, multiracial, declined to respond, and unknown. Overall, 232 patients (45.8%) had meaningful distress. The median (IQR) DT score for the entire cohort was 3 (0-6). Black patients had the highest rate of physical concerns (n = 31 [34.8%]) compared to the other racial groups (78 White patients [20.3%] and 7 persons of other race [21.2%]). However, in the final multivariable model, race was not significantly associated with clinically meaningful distress (Black compared with White: adjusted odds ratio [aOR], 0.76 [95% CI, 0.45-1.28]; other compared with White: aOR, 0.85 [95% CI, 0.37-1.94]). Compared to those married, unmarried patients were significantly more likely to report distress (aOR, 1.61 [95% CI, 1","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Symptoms, Quality of Life, and Executive Function in Children Who Snore. 儿童打鼾的症状、生活质量和执行功能
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-19 DOI: 10.1001/jamaoto.2024.4373
Phoebe K Yu, Kaitlyn Cook, Ignacio E Tapia, Kristie R Ross, Sally Ibrahim, Raouf Amin, Stacey L Ishman, Fauziya Hassan, Ronald D Chervin, Christopher Liu, Ron B Mitchell, Laura Stone, H Gerry Taylor, Jerilynn Radcliffe, Susan Redline, Cristina M Baldassari

Introduction: Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction.

Objective: To assess associations among executive function, QOL, and symptom burden in children with mSDB.

Design, setting, and participants: This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024.

Exposure: Pediatric mSDB.

Main outcomes and measures: Quality of life was assessed using the Obstructive Sleep Apnea-18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function.

Results: The sample included 459 children (mean [SD] age, 6.1 [2.3] years; 230 female [50.1%]). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 (r = 0.58 [95% CI, 0.51-0.64] and 0.59 [95% CI, 0.52-0.64], respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 [95% CI, 0.36-0.47] and 3.66 [95% CI, 3.17-4.15], respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = -0.04 [95% CI, -0.08 to -0.01]) and sustained attention (β = -0.05 [95% CI, -0.10 to -0.01]).

Conclusions and relevance: In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.

儿童轻度睡眠呼吸障碍(mSDB)与神经行为发病率和生活质量(QOL)降低有关。然而,症状负担和生活质量与执行功能之间的关系尚不清楚,尚不清楚生活质量和症状负担是否有助于识别神经认知功能障碍儿童。目的:探讨mSDB患儿执行功能、生活质量与症状负担的关系。设计、环境和参与者:本横断面研究是对多中心儿童打鼾腺扁桃体切除术试验的二次分析,该试验包括3至12岁的儿童,随机分为观察等待或腺扁桃体切除术治疗mSDB(打鼾和阻塞性呼吸暂停低通气指数)。主要结局和测量方法:使用阻塞性睡眠呼吸暂停-18 (OSA-18)评估生活质量,使用儿童睡眠问卷-睡眠相关呼吸障碍量表(PSQ-SRBD)评估症状负担。执行功能包括自我控制和工作记忆,采用执行功能全球执行复合行为评定量表(BRIEF GEC)测量,抑制控制和持续注意采用GoNoGo警觉性测试测量。采用偏Pearson相关和多元线性回归模型评估生活质量、症状和执行功能之间的关系。结果:纳入459例儿童,平均[SD]年龄6.1[2.3]岁;230名女性[50.1%])。BRIEF GEC与PSQ-SRBD和OSA-18存在中度相关性(r分别为0.58 [95% CI, 0.51-0.64]和0.59 [95% CI, 0.52-0.64])。在调整了年龄、性别、种族和民族、体重指数百分位数、家庭收入、母亲教育程度、注意缺陷/多动障碍、测试特征和疾病严重程度后,OSA-18和PSQ-SRBD评分与BRIEF GEC相关(β = 0.41 [95% CI, 0.36-0.47]和3.66 [95% CI, 3.17-4.15])。在完全调整后的模型中,PSQ-SRBD还与GoNoGo抑制控制(β = -0.04 [95% CI, -0.08至-0.01])和持续注意力(β = -0.05 [95% CI, -0.10至-0.01])相关。结论及意义:在本研究中,疾病特异性生活质量和症状负担与mSDB患儿的执行功能相关。这些发现可能有助于识别那些有神经认知功能障碍风险的儿童。
{"title":"Symptoms, Quality of Life, and Executive Function in Children Who Snore.","authors":"Phoebe K Yu, Kaitlyn Cook, Ignacio E Tapia, Kristie R Ross, Sally Ibrahim, Raouf Amin, Stacey L Ishman, Fauziya Hassan, Ronald D Chervin, Christopher Liu, Ron B Mitchell, Laura Stone, H Gerry Taylor, Jerilynn Radcliffe, Susan Redline, Cristina M Baldassari","doi":"10.1001/jamaoto.2024.4373","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4373","url":null,"abstract":"<p><strong>Introduction: </strong>Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction.</p><p><strong>Objective: </strong>To assess associations among executive function, QOL, and symptom burden in children with mSDB.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024.</p><p><strong>Exposure: </strong>Pediatric mSDB.</p><p><strong>Main outcomes and measures: </strong>Quality of life was assessed using the Obstructive Sleep Apnea-18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function.</p><p><strong>Results: </strong>The sample included 459 children (mean [SD] age, 6.1 [2.3] years; 230 female [50.1%]). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 (r = 0.58 [95% CI, 0.51-0.64] and 0.59 [95% CI, 0.52-0.64], respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 [95% CI, 0.36-0.47] and 3.66 [95% CI, 3.17-4.15], respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = -0.04 [95% CI, -0.08 to -0.01]) and sustained attention (β = -0.05 [95% CI, -0.10 to -0.01]).</p><p><strong>Conclusions and relevance: </strong>In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Frequency-to-Place Mismatch and Cochlear Implant Outcomes by Electrode Type. 频率-位置不匹配与电极类型的人工耳蜗植入结果。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-12 DOI: 10.1001/jamaoto.2024.4158
Andrea DeFreese, Katelyn Berg, Jack Noble, Benoit Dawant, Jourdan Holder, Susan Amberg, Christine Brown, Emily Burg, Nichole Dwyer, Allyson Sisler-Dinwiddie, Tayler Sparrow, Linsey Sunderhaus, Stephanie Yaras, Marc Bennett, Taha Jan, Aaron Moberly, Matthew O'Malley, Ankita Patro, Elizabeth Perkins, Kareem Tawfik, David Haynes, René Gifford
<p><strong>Importance: </strong>Speech recognition outcomes with a cochlear implant (CI) are highly variable. One factor suggested to correlate with CI-aided speech recognition is frequency-to-place mismatch, or the discrepancy between the natural tonotopic organization of the cochlea and the electric frequency allocation of the CI electrodes within the patient's cochlea.</p><p><strong>Objective: </strong>To evaluate the association between frequency-to-place mismatch and speech recognition outcomes in a large cohort of postlingually deafened adult CI users, while controlling for various clinical factors known to be associated with those outcomes.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used data from a CI program at a tertiary medical center and included CIs from postlingually deafened adult CI users. After excluding patients whose data were not logged, patients with implantations occurring between 2016 and 2023 were included in the analysis. The data were extracted in November 2023.</p><p><strong>Main outcomes and measures: </strong>Results of the Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition test measured in the CI-aided alone condition 1 month, 3 months, 6 months, and 12 months after activation served as the main outcome. The independent variables included frequency-to-place mismatch, electrode array type, mean modiolar distance, electrode position, age at implantation, biological sex, contralateral hearing abilities, time since CI activation (test interval), and daily device use.</p><p><strong>Results: </strong>In 498 CIs from 447 postlingually deafened adults (mean [SD] age, 63.1 [17.1] years; 271 [54.4%] CIs with male users), frequency-to-place mismatch was negatively correlated with CI-aided speech recognition outcomes, but the association was only significant for precurved electrode arrays and not straight electrode arrays. In the linear mixed effects model for straight electrode arrays, only test interval (β = 1.14 [95% CI, 0.90-1.38]) and daily device use (β = 0.90 [95% CI, 0.42-1.38]) were correlated with the improvement of word recognition over the first year of device use. In the model for precurved electrode arrays, mismatch at 1500 Hz (β = -0.011 [95% CI, -0.011 to -0.006]), scalar location (β = 16.37 [95% CI, 9.01 to 23.74]), test interval (β = 1.18 [95% CI, 1.18-1.41]) and daily device use (β = 1.65 [95% CI, 1.15-2.14]) all were significantly associated with the improvement of word recognition over the first year of device use.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of postlingually deafened adult CI users, including both straight and precurved electrode arrays, daily device use and time since CI activation were found to be significantly associated with improved CI-aided speech recognition outcomes. Frequency-to-place mismatch at 1500 Hz and scalar location were associated with word recognition only for precurved arrays. These fin
重要性:人工耳蜗(CI)的语音识别结果是高度可变的。与人工耳蜗辅助语音识别相关的一个因素是频率-位置不匹配,即耳蜗的自然张力组织与患者耳蜗内人工耳蜗电极的电频率分配之间的差异。目的:在控制已知与这些结果相关的各种临床因素的情况下,评估大量语后聋成人CI使用者中频率-位置不匹配与语音识别结果之间的关系。设计、环境和参与者:本回顾性队列研究使用来自三级医疗中心CI项目的数据,包括来自语后失聪成人CI使用者的CI。在排除了未记录数据的患者后,将2016年至2023年期间植入的患者纳入分析。这些数据是在2023年11月提取的。主要观察指标:激活后1个月、3个月、6个月、12个月的ci辅助单独条件下的辅音-核-辅音(CNC)单音节单词识别测试结果为主要观察指标。自变量包括频率与位置不匹配、电极阵列类型、平均模摩尔距离、电极位置、植入年龄、生物性别、对侧听力、CI激活时间(测试间隔)和日常设备使用情况。结果:447例语后聋成人498例ci(平均[SD]年龄63.1[17.1]岁;271[54.4%]男性用户),频率-位置不匹配与ci辅助语音识别结果呈负相关,但这种关联仅对预弯曲电极阵列显著,而对直电极阵列不显著。在直线电极阵列的线性混合效应模型中,只有测试间隔(β = 1.14 [95% CI, 0.90-1.38])和每日设备使用(β = 0.90 [95% CI, 0.42-1.38])与设备使用一年内单词识别的改善相关。在预弯曲电极阵列模型中,1500 Hz的失配(β = -0.011 [95% CI, -0.011至-0.006])、标量位置(β = 16.37 [95% CI, 9.01至23.74])、测试间隔(β = 1.18 [95% CI, 1.18至1.41])和日常设备使用(β = 1.65 [95% CI, 1.15至2.14])都与设备使用第一年的单词识别改善显著相关。结论和相关性:在这项对语后失聪成人CI使用者的队列研究中,包括直电极和预弯曲电极阵列,发现日常设备使用和CI激活后的时间与CI辅助语音识别结果的改善显着相关。1500 Hz频率与位置不匹配和标量位置仅与预弯曲阵列的单词识别有关。这些发现表明,对于使用直线阵列的患者,任何由频率与位置不匹配产生的干扰都可以通过适应来克服,这可以通过日常设备使用来支持。然而,对于使用预弯曲阵列的患者,日常设备使用可能不足以完全克服电极放置因素,包括标量位置和不匹配。
{"title":"Frequency-to-Place Mismatch and Cochlear Implant Outcomes by Electrode Type.","authors":"Andrea DeFreese, Katelyn Berg, Jack Noble, Benoit Dawant, Jourdan Holder, Susan Amberg, Christine Brown, Emily Burg, Nichole Dwyer, Allyson Sisler-Dinwiddie, Tayler Sparrow, Linsey Sunderhaus, Stephanie Yaras, Marc Bennett, Taha Jan, Aaron Moberly, Matthew O'Malley, Ankita Patro, Elizabeth Perkins, Kareem Tawfik, David Haynes, René Gifford","doi":"10.1001/jamaoto.2024.4158","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4158","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Speech recognition outcomes with a cochlear implant (CI) are highly variable. One factor suggested to correlate with CI-aided speech recognition is frequency-to-place mismatch, or the discrepancy between the natural tonotopic organization of the cochlea and the electric frequency allocation of the CI electrodes within the patient's cochlea.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the association between frequency-to-place mismatch and speech recognition outcomes in a large cohort of postlingually deafened adult CI users, while controlling for various clinical factors known to be associated with those outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study used data from a CI program at a tertiary medical center and included CIs from postlingually deafened adult CI users. After excluding patients whose data were not logged, patients with implantations occurring between 2016 and 2023 were included in the analysis. The data were extracted in November 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Results of the Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition test measured in the CI-aided alone condition 1 month, 3 months, 6 months, and 12 months after activation served as the main outcome. The independent variables included frequency-to-place mismatch, electrode array type, mean modiolar distance, electrode position, age at implantation, biological sex, contralateral hearing abilities, time since CI activation (test interval), and daily device use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 498 CIs from 447 postlingually deafened adults (mean [SD] age, 63.1 [17.1] years; 271 [54.4%] CIs with male users), frequency-to-place mismatch was negatively correlated with CI-aided speech recognition outcomes, but the association was only significant for precurved electrode arrays and not straight electrode arrays. In the linear mixed effects model for straight electrode arrays, only test interval (β = 1.14 [95% CI, 0.90-1.38]) and daily device use (β = 0.90 [95% CI, 0.42-1.38]) were correlated with the improvement of word recognition over the first year of device use. In the model for precurved electrode arrays, mismatch at 1500 Hz (β = -0.011 [95% CI, -0.011 to -0.006]), scalar location (β = 16.37 [95% CI, 9.01 to 23.74]), test interval (β = 1.18 [95% CI, 1.18-1.41]) and daily device use (β = 1.65 [95% CI, 1.15-2.14]) all were significantly associated with the improvement of word recognition over the first year of device use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of postlingually deafened adult CI users, including both straight and precurved electrode arrays, daily device use and time since CI activation were found to be significantly associated with improved CI-aided speech recognition outcomes. Frequency-to-place mismatch at 1500 Hz and scalar location were associated with word recognition only for precurved arrays. These fin","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Misinformation and Readability of Social Media Content on Pediatric Ankyloglossia and Other Oral Ties. 儿童强直性咬合和其他口头联系的社交媒体内容的错误信息和可读性。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-12 DOI: 10.1001/jamaoto.2024.4211
Lindsay Booth, Abdullah Aldaihani, Jacob Davidson, Claire Wilson, Claire Lawlor, Paul Hong, M Elise Graham

Importance: Diagnosis of pediatric ankyloglossia and other oral ties is increasing in part due to social media, leading to more frenotomies and excess medicalization of often normal anatomy.

Objective: To assess the accuracy and readability of social media content on pediatric ankyloglossia and other oral ties.

Design, setting, and participants: In this cross-sectional study, the top 200 posts on an image-based social media platform tagged with #tonguetie, #liptie, or #buccaltie were collected using a de novo account on March 27, 2023. Post metadata and caption and content text were extracted.

Main outcomes and measures: Misinformation was judged by a 30-point scoring sheet based on clinical practice guidelines and expert consensus that was developed by 3 fellowship-trained pediatric otolaryngologist-head and neck surgeons. Readability was assessed using the Flesch-Kincaid Grade Level, Flesch Reading Ease, and Simple Measure of Gobbledygook scales. Quality was scored using the JAMA Benchmark Criteria.

Results: After removing duplicates and irrelevant content, 71 unique posts from 68 unique accounts were included in the analysis. Business and practice accounts made up most of the account types (60 [84.5%]) compared with individual and personal accounts (11 [15.5%]). Most accounts (49 [69.0%]) were run by individuals who self-identified as health care practitioners, and 21 posts (29.6%) originated from accounts of individuals who self-identified as International Board Certified Lactation Consultants (IBCLCs). On average, the content corresponded to a ninth-grade reading level per Flesch-Kincaid Grade Level. Quality of posts as rated by the JAMA Benchmark Criteria corresponded to a median score of 3.0 (IQR, 2.0-4.0). Of the 71 posts, only 8 (11.3%) contained no misinformation. There was a significant difference in misinformation prevalence between accounts run by IBCLCs vs non-IBCLCs, with posts from IBCLCs less likely to contain over 50% misinformation (odds ratio, 0.22; 95% CI, 0.06-0.81), compared with posts from non-IBCLCs.

Conclusions and relevance: This study found a high frequency of misinformation in social media content on ankyloglossia. Most content was generated by self-identified health care practitioners but not physicians. Furthermore, the grade level of the content reviewed was above that recommended for the public. As the public increasingly looks to social media for medical information, health care practitioners should correct medical misinformation.

重要性:儿童强直性咬合和其他口腔联系的诊断正在增加,部分原因是社交媒体,导致更多的舌骨切开术和对通常正常解剖的过度医疗化。目的:评价社交媒体内容对小儿强直性咬合及其他口腔关系的准确性和可读性。设计、设置和参与者:在这项横断面研究中,使用一个新账户收集了2023年3月27日在一个以图片为基础的社交媒体平台上标记为# tongutie、#liptie或#buccaltie的前200条帖子。提取帖子元数据、标题和内容文本。主要结果和措施:根据临床实践指南和专家共识,由3名接受过奖学金培训的儿科耳鼻喉科-头颈外科医生制定的30分计分表来判断错误信息。可读性采用Flesch- kinkaid等级水平、Flesch阅读难度和简单测量的官样书量表进行评估。使用JAMA基准标准对质量进行评分。结果:在删除重复和不相关内容后,68个独立账户的71个独立帖子被纳入分析。商业和执业账户占比最高(60个[84.5%]),个人和个人账户占比最高(11个[15.5%])。大多数账户(49个[69.0%])由自认为是卫生保健从业人员的个人运营,21个帖子(29.6%)来自自认为是国际委员会认证哺乳顾问(ibclc)的个人账户。平均而言,内容对应于每个flesch - kinkaid年级的九年级阅读水平。根据JAMA基准标准评价的帖子质量对应的中位数得分为3.0 (IQR, 2.0-4.0)。在71篇帖子中,只有8篇(11.3%)没有错误信息。ibclc账户与非ibclc账户之间的错误信息流行率存在显著差异,来自ibclc的帖子不太可能包含超过50%的错误信息(优势比,0.22;95% CI, 0.06-0.81),与非ibclc的帖子相比。结论和相关性:本研究发现,社交媒体内容中关于强直性咬合的错误信息频率很高。大多数内容是由自我认定的卫生保健从业人员而不是医生生成的。此外,审查内容的等级水平高于公众建议的等级。随着公众越来越多地从社交媒体上获取医疗信息,医疗从业人员应该纠正医疗错误信息。
{"title":"Misinformation and Readability of Social Media Content on Pediatric Ankyloglossia and Other Oral Ties.","authors":"Lindsay Booth, Abdullah Aldaihani, Jacob Davidson, Claire Wilson, Claire Lawlor, Paul Hong, M Elise Graham","doi":"10.1001/jamaoto.2024.4211","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4211","url":null,"abstract":"<p><strong>Importance: </strong>Diagnosis of pediatric ankyloglossia and other oral ties is increasing in part due to social media, leading to more frenotomies and excess medicalization of often normal anatomy.</p><p><strong>Objective: </strong>To assess the accuracy and readability of social media content on pediatric ankyloglossia and other oral ties.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, the top 200 posts on an image-based social media platform tagged with #tonguetie, #liptie, or #buccaltie were collected using a de novo account on March 27, 2023. Post metadata and caption and content text were extracted.</p><p><strong>Main outcomes and measures: </strong>Misinformation was judged by a 30-point scoring sheet based on clinical practice guidelines and expert consensus that was developed by 3 fellowship-trained pediatric otolaryngologist-head and neck surgeons. Readability was assessed using the Flesch-Kincaid Grade Level, Flesch Reading Ease, and Simple Measure of Gobbledygook scales. Quality was scored using the JAMA Benchmark Criteria.</p><p><strong>Results: </strong>After removing duplicates and irrelevant content, 71 unique posts from 68 unique accounts were included in the analysis. Business and practice accounts made up most of the account types (60 [84.5%]) compared with individual and personal accounts (11 [15.5%]). Most accounts (49 [69.0%]) were run by individuals who self-identified as health care practitioners, and 21 posts (29.6%) originated from accounts of individuals who self-identified as International Board Certified Lactation Consultants (IBCLCs). On average, the content corresponded to a ninth-grade reading level per Flesch-Kincaid Grade Level. Quality of posts as rated by the JAMA Benchmark Criteria corresponded to a median score of 3.0 (IQR, 2.0-4.0). Of the 71 posts, only 8 (11.3%) contained no misinformation. There was a significant difference in misinformation prevalence between accounts run by IBCLCs vs non-IBCLCs, with posts from IBCLCs less likely to contain over 50% misinformation (odds ratio, 0.22; 95% CI, 0.06-0.81), compared with posts from non-IBCLCs.</p><p><strong>Conclusions and relevance: </strong>This study found a high frequency of misinformation in social media content on ankyloglossia. Most content was generated by self-identified health care practitioners but not physicians. Furthermore, the grade level of the content reviewed was above that recommended for the public. As the public increasingly looks to social media for medical information, health care practitioners should correct medical misinformation.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musicality as a Health-Relevant Factor for Hearing Outcomes. 音乐性是听力结果的健康相关因素。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-05 DOI: 10.1001/jamaoto.2024.4157
Srishti Nayak, Aaron C Moberly, Terrin N Tamati
{"title":"Musicality as a Health-Relevant Factor for Hearing Outcomes.","authors":"Srishti Nayak, Aaron C Moberly, Terrin N Tamati","doi":"10.1001/jamaoto.2024.4157","DOIUrl":"10.1001/jamaoto.2024.4157","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clarification Regarding the Association of Cannabis Use and Head and Neck Cancer. 关于大麻使用与头颈癌关系的澄清。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-05 DOI: 10.1001/jamaoto.2024.4168
Joseph Katz
{"title":"Clarification Regarding the Association of Cannabis Use and Head and Neck Cancer.","authors":"Joseph Katz","doi":"10.1001/jamaoto.2024.4168","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4168","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clarification Regarding the Association of Cannabis Use and Head and Neck Cancer. 关于大麻使用与头颈癌关系的澄清。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-05 DOI: 10.1001/jamaoto.2024.4165
Donald P Tashkin
{"title":"Clarification Regarding the Association of Cannabis Use and Head and Neck Cancer.","authors":"Donald P Tashkin","doi":"10.1001/jamaoto.2024.4165","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4165","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clarification Regarding the Association of Cannabis Use and Head and Neck Cancer-Reply. 关于大麻使用与头颈部癌症关系的澄清:回复。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-05 DOI: 10.1001/jamaoto.2024.4162
Tyler J Gallagher, Niels C Kokot
{"title":"Clarification Regarding the Association of Cannabis Use and Head and Neck Cancer-Reply.","authors":"Tyler J Gallagher, Niels C Kokot","doi":"10.1001/jamaoto.2024.4162","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4162","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Cancer. 人乳头瘤病毒相关口咽癌的新辅助化疗和经口机器人手术
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-05 DOI: 10.1001/jamaoto.2024.3303
Nader Sadeghi, Thavakumar Subramaniam, Keith Richardson, Marco Mascarella, Anthony Zeitouni, George Shenouda, Khalil Sultanem, Alex Mlynarek, Derin Caglar, Khashayar Esfahani, Arjun Joshi, Robert Siegel, Joseph Goodman, Punam Thakkar, Esther Lee, Nahid Golabi, Agnihotram V Ramanakumar, Michael Hier, Nathaniel Bouganim
<p><strong>Importance: </strong>Distant metastasis (DM) remains the leading cause of death in patients treated for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). An effective treatment strategy needs to address DM while reducing treatment-related toxic effects.</p><p><strong>Objective: </strong>To assess DM-free survival in patients with HPV-OPSCC treated with neoadjuvant chemotherapy followed by transoral robotic surgery (NECTORS) and neck dissection compared with standard of care, concurrent chemoradiation (CCRT).</p><p><strong>Design, setting, and participants: </strong>This multicenter retrospective cohort study compares prospective data from the NECTORS treatment group with a historical cohort of patients treated with CCRT. Patients with American Joint Committee on Cancer seventh edition stage III and IVa HPV-OPSCC treated with NECTORS and CCRT between February 2010 and September 2021 were included. Data were analyzed in September 2024.</p><p><strong>Exposures: </strong>Patients in the NECTORS arm were treated with 3 cycles of neoadjuvant docetaxel and cisplatin followed by TORS and neck dissection. Patients in the radiation therapy arm were treated with concurrent high-dose cisplatin and radiotherapy.</p><p><strong>Main outcomes and measures: </strong>DM-free survival was analyzed with Kaplan-Meier and Cox regression after adjusting for age, sex, tobacco and alcohol use, site, and cancer stage.</p><p><strong>Results: </strong>Of 342 included patients, 282 (82.5%) were male, and the mean (SD) age was 61.4 (9.4) years. A total of 232 patients were treated with CCRT and 110 patients were treated with NECTORS. Within the CCRT arm, 11 patients (4.7%) had locoregional recurrence (LRR), 5 (2.2%) had LRR and DM, and 28 (12.1%) developed distant-only metastasis. For patients treated with NECTORS, 5 (4.5%) developed LRR, 1 (0.9%) developed LRR plus DM, and no patients developed distant-only metastasis. With pseudorandomization matching for T and N stages, 209 patients were matched between the 2 treatment groups for further analysis (105 in the CCRT treatment arm and 104 in the NECTORS arm). The median (range) follow-up period for the CCRT and NECTORS groups were 5.8 (3.8-7.5) years and 5.1 (4.0-5.9) years, respectively. The hazard ratio of developing distant recurrence in the CCRT group was 10.77 (95% CI, 1.40-82.90) in univariate analysis and 9.98 (95% CI, 1.29-77.29) in multivariable analysis. In Kaplan-Meier survival analysis, the risk of developing DM was higher in the CCRT group. The hazard ratio for failure anywhere in the CCRT group was 3.32 (95% CI, 1.23-8.97) in univariate analysis and 3.21 (95% CI, 1.18-8.72) in multivariable analysis.</p><p><strong>Conclusions and relevance: </strong>In this study, neoadjuvant chemotherapy followed by transoral robotic surgery and neck dissection was an effective treatment option for patients with stage III and IVa HPV-OPSCC. Findings from our study suggest lower rates of
重要性:在接受人乳头瘤病毒(HPV)相关口咽鳞状细胞癌(OPSCC)治疗的患者中,远处转移(DM)仍然是死亡的主要原因。有效的治疗策略需要解决糖尿病,同时减少治疗相关的毒性作用。目的:比较新辅助化疗后经口机器人手术(NECTORS)和颈部清扫治疗的HPV-OPSCC患者与标准护理同步放化疗(CCRT)的无dm生存率。设计、环境和参与者:这项多中心回顾性队列研究比较了NECTORS治疗组与CCRT治疗的历史队列患者的前瞻性数据。2010年2月至2021年9月期间,美国癌症联合委员会第七版III期和IVa期HPV-OPSCC患者接受了nector和CCRT治疗。数据分析于2024年9月进行。暴露:NECTORS组患者接受3个周期的新辅助多西他赛和顺铂治疗,随后进行TORS和颈部清扫。放疗组患者同时接受高剂量顺铂和放疗。主要结局和测量指标:在调整年龄、性别、吸烟和饮酒、部位和癌症分期后,采用Kaplan-Meier和Cox回归分析无dm生存。结果:342例患者中,282例(82.5%)为男性,平均(SD)年龄为61.4(9.4)岁。共有232例患者接受CCRT治疗,110例患者接受nector治疗。在CCRT组中,11例(4.7%)有局部复发(LRR), 5例(2.2%)有LRR和DM, 28例(12.1%)仅发生远处转移。在接受NECTORS治疗的患者中,5例(4.5%)发生LRR, 1例(0.9%)发生LRR合并DM,没有患者发生远处转移。通过T期和N期的伪随机匹配,209例患者在两个治疗组之间进行匹配以进一步分析(CCRT治疗组105例,NECTORS治疗组104例)。CCRT组和NECTORS组的中位(范围)随访期分别为5.8(3.8-7.5)年和5.1(4.0-5.9)年。CCRT组发生远处复发的风险比单因素分析为10.77 (95% CI, 1.40 ~ 82.90),多因素分析为9.98 (95% CI, 1.29 ~ 77.29)。Kaplan-Meier生存分析显示,CCRT组发生糖尿病的风险更高。CCRT组任何地方失败的风险比在单因素分析中为3.32 (95% CI, 1.23-8.97),在多变量分析中为3.21 (95% CI, 1.18-8.72)。结论及相关性:在本研究中,新辅助化疗后经口机器人手术和颈部清扫是III期和IVa期HPV-OPSCC患者的有效治疗选择。我们的研究结果表明,较低的糖尿病发生率值得在前瞻性随机试验中进一步研究。
{"title":"Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Cancer.","authors":"Nader Sadeghi, Thavakumar Subramaniam, Keith Richardson, Marco Mascarella, Anthony Zeitouni, George Shenouda, Khalil Sultanem, Alex Mlynarek, Derin Caglar, Khashayar Esfahani, Arjun Joshi, Robert Siegel, Joseph Goodman, Punam Thakkar, Esther Lee, Nahid Golabi, Agnihotram V Ramanakumar, Michael Hier, Nathaniel Bouganim","doi":"10.1001/jamaoto.2024.3303","DOIUrl":"10.1001/jamaoto.2024.3303","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Distant metastasis (DM) remains the leading cause of death in patients treated for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). An effective treatment strategy needs to address DM while reducing treatment-related toxic effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess DM-free survival in patients with HPV-OPSCC treated with neoadjuvant chemotherapy followed by transoral robotic surgery (NECTORS) and neck dissection compared with standard of care, concurrent chemoradiation (CCRT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This multicenter retrospective cohort study compares prospective data from the NECTORS treatment group with a historical cohort of patients treated with CCRT. Patients with American Joint Committee on Cancer seventh edition stage III and IVa HPV-OPSCC treated with NECTORS and CCRT between February 2010 and September 2021 were included. Data were analyzed in September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Patients in the NECTORS arm were treated with 3 cycles of neoadjuvant docetaxel and cisplatin followed by TORS and neck dissection. Patients in the radiation therapy arm were treated with concurrent high-dose cisplatin and radiotherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;DM-free survival was analyzed with Kaplan-Meier and Cox regression after adjusting for age, sex, tobacco and alcohol use, site, and cancer stage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 342 included patients, 282 (82.5%) were male, and the mean (SD) age was 61.4 (9.4) years. A total of 232 patients were treated with CCRT and 110 patients were treated with NECTORS. Within the CCRT arm, 11 patients (4.7%) had locoregional recurrence (LRR), 5 (2.2%) had LRR and DM, and 28 (12.1%) developed distant-only metastasis. For patients treated with NECTORS, 5 (4.5%) developed LRR, 1 (0.9%) developed LRR plus DM, and no patients developed distant-only metastasis. With pseudorandomization matching for T and N stages, 209 patients were matched between the 2 treatment groups for further analysis (105 in the CCRT treatment arm and 104 in the NECTORS arm). The median (range) follow-up period for the CCRT and NECTORS groups were 5.8 (3.8-7.5) years and 5.1 (4.0-5.9) years, respectively. The hazard ratio of developing distant recurrence in the CCRT group was 10.77 (95% CI, 1.40-82.90) in univariate analysis and 9.98 (95% CI, 1.29-77.29) in multivariable analysis. In Kaplan-Meier survival analysis, the risk of developing DM was higher in the CCRT group. The hazard ratio for failure anywhere in the CCRT group was 3.32 (95% CI, 1.23-8.97) in univariate analysis and 3.21 (95% CI, 1.18-8.72) in multivariable analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, neoadjuvant chemotherapy followed by transoral robotic surgery and neck dissection was an effective treatment option for patients with stage III and IVa HPV-OPSCC. Findings from our study suggest lower rates of","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
JAMA otolaryngology-- head & neck surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1