Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

The role of rapid maxillary expansion in the promotion of oral and general health

Rapid maxillary expansion (RME) is an effective orthopedic procedure that can be used to address problems concerned with the growth of the midface. This procedure also may produce positive side effects on the general health of the patient. The aim of the present consensus paper was to identify and evaluate studies on the changes in airway dimensions and muscular function produced by RME in growing patients. A total of 331 references were retrieved from a database search (PubMed). The widening of the nasal cavity base after midpalatal suture opening in growing patients allows the reduction in nasal airway resistance with an improvement of the respiratory pattern. The effects of RME on the upper airway, however, have been described as limited and local, and these effects become diminished farther down the airway, possibly as a result of soft-tissue adaptation. Moreover, limited information is available about the long-term stability of the airway changes produced by RME. Several studies have shown that maxillary constriction may play a role in the etiology of more severe breathing disorders such as obstructive sleep apnea (OSA) in growing subjects. Early orthodontic treatment with RME is able to reduce the symptoms of OSA and improve polysomnographic variables. Finally, early orthopedic treatment with RME also is beneficial to avoid the development of facial skeletal asymmetry resulting from functional crossbites that otherwise may lead to functional and structural disorders of the stomatognathic system later in life

An in situ FT-IR study of photo-oxidation of alcohols over uranyl-anchored MCM-41: Possible reaction pathways

Photosensitive uranyl ions anchored onto MCM-41 mesoporous molecular sieves serve as remarkable photocatalysts in the degradation of alcohols, under ambient conditions of light, temperature, and air. The rates of conversion of alcohols to carbon dioxide was found to decrease in the order methanol > ethanol > 2-propanol > 1-propanol, with the difference in reactivity attributed to the stability of the carbon-centered radicals formed during photo-oxidation. Kinetics revealed that the photo-oxidation of alcohols followed a first-order reaction. A detailed in situ FT-IR analysis was used to identify the transient species formed during the photo-oxidation of ethanol and 2-propanof over uranyl-anchored photocatalyst. Acetic acid, ethyl acetate, and acetaldehyde were the intermediates obtained over UO22+/MCM-41 during photo-oxidation of ethanol, whereas acetate species, methyl acetate, and acetone were detected during photo-oxidation of 2-propanol. Based on the intenriediate species formed, their growth with respect to irradiation time, and their intensities, appropriate reaction mechanisms were proposed to corroborate our observations. (c) 2007 All fiahts reserved

Uranyl-anchored MCM-41 as a highly efficient photocatalyst for the complete oxidation of methanol under sunlight

A photocatalyst that may exhibit high activity for oxidation of volatile organic compounds (VOCs) under solar radiation would offer a practical and economic means for the cleaning of air under environmental conditions. We report here for the first time that the uranyl ions anchored within the mesopores of MCM-41 may serve as an efficient heterogeneous photocatalyst for the complete destruction of methanol in vapor phase, and in the presence of sunlight and air. The uranyl-anchored MCM-41 was found to be more efficient than a TiO(2) photocatalyst in terms of CH(3)OH-->CO(2) conversion rates. The reversible and active participation of uranyl groups in the studied photocatalytic reaction was ascertained with the help of in situ fluorescence and electron paramagnetic resonance techniques, whereas the radiation-induced transient species over catalyst surface were monitored using in situ FTIR spectroscopy. The detailed reaction mechanism and the role played by uranyl ions in the photooxidation of methanol over UO(2)(2+)/MCM are elucidated on the basis of these results. (C) 200

Vapor-phase photocatalytic oxidation of volatile organic compounds over novel uranyl-anchored MCM-41 heterogeneous catalyst

In the present investigation, we exploited the visible region absorbance (lambda > 380 nm) of uranyl ions anchored onto mesoporous MCM-41 matrix for the vapor-phase photooxidation of volatile organic compounds (VOCs) such as benzene, toluene, cyclohexane, cyclohexene, and oxylene. In all cases, the only complete oxidation products, viz., carbon dioxide and water, were obtained. Further, the extent of conversion to carbon dioxide depended upon the nature of the organic compound. Under sunlight, the uranyl-anchored catalyst was found to be highly active for the degradation of a stable molecule like benzene, though longer irradiation times were needed for its complete conversion. This study signifies the potential applicability of the uranyl-anchored photocatalyst for applications related to air cleaning under ambient conditions of solar radiation and air

Gefitinb along with methotrexate as palliative therapy in PS 3 and above in metastatic esophagus squamous cell carcinoma with focus on Q-TWIST.

355 Background: Metronomic therapy is proven method for treatment of terminally ill patients with malignancy, who are not fit for chemotherapy. The median PFS was significantly superior in responders in previous Indian experiences. However most of them were done in head and neck cancers.The prognosis of patients with metastatic esophageal cancer remains poor with only option being symptomatic care. As the previous experiences show metronomic therapy is safe among various options and there is no study focusing on Quality-Adjusted Time Without Symptoms or Toxicity (Q-TWiST) in southern Indian population,we thought of evaluating the same. Methods: Details of 42 subjects with refractory or progressive metastatic squamous cell carcinoma esophagus having PS &gt; 2 were evaluated. Case records between 2017 September and 2018 September were analyzed for TWIST and QOL. Patients received Gefitinib (250 mg/day), Methotrexate 15 mg IM weekly or in combination. Patients were stratified into those with improved PS and those without. The subjects without PS improvement were continued on the single agent and those with improvement were offered additional chemotherapy based on physician/ patient preference. Metronomic therapy could be continued beyond disease progression- if there is TWIST/QOL improvement. Results: Out of 42 subjects, 29 had improvement in the PS and were continued later. 9 had stable PS and disease. 4 had worsening of PS. 34 subjects have clinically meaningful response (stable disease + complete + partial responses) and had symptomatic improvement. The median number of cycles was 6 (4–11). The median PFS was 198 days (95% CI, 174 to 214), and the median improvement in QOL was 6 points on a scale of 25. Grade II/IV toxicities were observed in 21 (50%) cases predominantly skin rash, stomatitis and diarrhea. Conclusions: Metronomic therapy is well tolerated and may have a role in the treatment of advanced cancers with poor performance status. 67% of the patients who are otherwise not eligible for any active therapy became eligible and had better QOL and longer PFS, which re-emphasizes role of metronomic therapy in advanced squamous cell carcinoma of esophagus. </jats:p