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Pimolbutr K, Lim WT, Leeson R, Hopper C, Kalavrezos N, Liew C, Schilling C, Sinha D, Jay A, Agrawal R, Porter S, Fedele S. Prognosis of oral epithelial dysplasia in individuals with and without oral lichen planus. Oral Dis 2024; 30:504-517. [PMID: 36648368 DOI: 10.1111/odi.14503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate the role of oral lichen planus (OLP) on the long-term prognosis of oral epithelial dysplasia (OED). METHODS Retrospective single-centre cohort study using the 2007-2019 database of the Head and Neck Cancer and Oral Medicine units of University College London Hospital. The exposure of interest was the presence of OLP, and the prognostic outcomes included the development of new primary episodes of OED, progression to malignancy and mortality. Cox proportional hazard and Poisson regression models were performed. RESULTS A total of 299 patients, of whom 144 had OED arising on the background of OLP (OLP/OED) and 155 had OED without underlying OLP (non-OLP/OED), were included. A pre-existing diagnosis of OLP was significantly associated with a twofold increased risk of subsequent primary OED events (HR = 2.02, p = 0.04), which also developed faster (1.46 vs. 2.96 years, p = 0.04) and with more involvement of non-cancer-prone sites (p = 0.001) than in the non-OLP/OED group. There was no difference between groups in the progression to malignancy or mortality. CONCLUSIONS Oral lichen planus/OED patients are at higher risk of multiple episodes of primary OED, which can develop faster and at non-cancer-prone sites as compared to non-OLP/OED individuals. Further research is needed to clarify the effects of OLP upon progression to OSCC and mortality.
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Affiliation(s)
- Kununya Pimolbutr
- UCL Eastman Dental Institute, University College London, London, UK
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Woei Tatt Lim
- Oral and Maxillofacial Surgery Department, Sarawak General Hospital, Kuching, Malaysia
| | - Rachel Leeson
- UCL Eastman Dental Institute, University College London, London, UK
| | - Colin Hopper
- UCL Eastman Dental Institute, University College London, London, UK
| | - Nicholas Kalavrezos
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Colin Liew
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Clare Schilling
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Deepti Sinha
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Amrita Jay
- Department of Cellular Pathology, University College London Hospitals (UCLH), London, UK
| | - Reshma Agrawal
- Department of Cellular Pathology, University College London Hospitals (UCLH), London, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
| | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
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2
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Schilling C, Collins L, Farrow A, McGurk M, Bisase B, Kerawala C, Wan S, Hall G, Thavaraj S. Incidental Thyroid Tissue in Sentinel Nodes From Oral Squamous Cell Carcinoma. Laryngoscope 2024; 134:1278-1281. [PMID: 37610258 DOI: 10.1002/lary.30996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Sentinel node biopsy (SNB) is a surgical staging test in which sentinel nodes (SNs) undergo intensive histological analysis. SNB diagnoses early cancer spread, but can also reveal unexpected findings within the SNs. We review cases of incidental thyroid cells (TC) found in SNs from patients with oral squamous cell carcinoma (OSCC) to assess the prevalence of TC, and the clinical significance of these. METHODS Multicenter retrospective review of SNB performed for cT1-T2N0 OSCC. Incidental TC were identified by TTF-1 or thyroglobulin positivity. Anatomical location of nodes containing TC, TC morphology, and ongoing management/follow up of this incidental finding was recorded. Neck dissections performed during the same period were reviewed to establish the expected incidence of TC in neck nodes without serial sectioning analysis. RESULTS 278 SNB cases were reviewed. Ten procedures detected TC in nine patients (10/278, 3.6%). During the same time period 725 neck dissections were performed, six containing TCs (6/725, 0.8%). One patient underwent SNB twice with TC identified on both occasions. Three patients had both OSCC metastasis and thyroid cells. All SNB patients with TC identified underwent thyroid USS with no primary tumours identified. Three patients underwent thyroidectomy, in all cases no primary thyroid tumour was found. CONCLUSION Prevalence of incidental TC in SNs appears to be higher than that reported in neck dissections, these are not likely to be clinically relevant and can be managed on a conservative basis in the absence of clear metastatic features. LEVEL OF EVIDENCE Multicentre retrospective cohort study, 3 Laryngoscope, 134:1278-1281, 2024.
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Affiliation(s)
- Clare Schilling
- Head and Neck Academic Centre, University College London, London, UK
- Head & Neck Surgery, University College London Hospital, London, UK
| | - Lisette Collins
- Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Adrian Farrow
- Head & Neck Surgery, University College London Hospital, London, UK
| | - Mark McGurk
- Head and Neck Academic Centre, University College London, London, UK
- Head & Neck Surgery, University College London Hospital, London, UK
| | - Brian Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Cyrus Kerawala
- Head and Neck Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Simon Wan
- Institute of Nuclear Medicine, UCLH NHS Foundation Trust, London, UK
| | - Gill Hall
- Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Selvam Thavaraj
- Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK
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Chegini S, Tahim A, Liu M, Chooi Y, Edwards E, Clarkson M, Schilling C. A training tool for clinicians in segmenting medical images to make 3D models. Ann Surg Open 2023; 4:e275. [PMID: 37342255 PMCID: PMC7614675 DOI: 10.1097/as9.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Introduction 3D models produced from medical imaging can be used to plan treatment, design prosthesis, teach and for communication. Despite the clinical benefit, few clinicians have experience of how 3D models are produced.This is the first study evaluating a training tool to teach clinicians to produce 3D models and reporting the perceived impact on their clinical practice. Method Following ethical approval, 10 clinicians completed a bespoke training tool, comprising written and video material alongside online support. Each clinician and 2 technicians (included as control) were sent 3 CT scans and asked to produce 6 fibula 3D models using an open-source software (3Dslicer). The produced models were compared to those produced by the technicians using Hausdorff distance calculation. Thematic analysis was used to study the post-intervention questionnaire. Results The mean Hausdorff distance between the final model produced by the clinicians and technicians was 0.65mm SD0.54mm. The first model made by clinicians took a mean time of 1hr 25mins and the final model took 16:04mins (5:00-46:00mins). 100% of learners reported finding the training tool useful and will employ it in future practice. Discussion The training tool described in this paper is able to successfully train clinicians to produce fibula models from CT scans. Learners were able to produce comparable models to technicians within an acceptable timeframe. This does not replace technicians. However, the learners perceived this training will allow them to use this technology in more cases, with appropriate case selection and they appreciate the limits of this technology.
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4
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Malik A, Hardman JC, Devabalan Y, Nutting C, Bhide S, Harrington K, Schilling C, Paleri V. Systematic review and meta-analysis of occult contralateral nodal metastases in patients with oropharyngeal squamous carcinoma undergoing elective neck dissection. Eur J Surg Oncol 2023; 49:316-322. [PMID: 36270881 DOI: 10.1016/j.ejso.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 02/24/2023]
Abstract
A systematic review and meta-analysis was conducted to evaluate the occult contralateral nodal metastases (OCM) in patients undergoing bilateral neck dissection for surgically treated oropharyngeal squamous cell carcinoma (OPSCC). Following PRISMA guidelines, MEDLINE, Embase and Cochrane Controlled Register of Trials databases were searched for observational and experimental studies until March 2021. Search yielded 175 articles, of which 13 were included. Overall, OCM were seen in 9.8% of patients (95% CI: [5.7, 16.4], 839 patients, 12 studies, I2 65%). For ipsilateral cN0 necks, the OCM rate was 1.7% (95% CI: [0.1, 22.4], 150 patients, 8 studies, I2 0%) and for cN + necks the OCM rate was 9.8% (95% CI: [4.4, 20.3], 429 patients, 8 studies, I2 72%). Occult contralateral nodal metastases are uncommon in OPSCC patients with clinico-radiologically negative ipsilateral necks. Occult rates are higher in the contralateral neck when the ipsilateral neck is clinico-radiologically node positive.
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Affiliation(s)
- Akshat Malik
- Department of Surgical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India.
| | - John C Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Yadsan Devabalan
- Department of Otolaryngology-Head Neck Surgery, Imperial College NHS Trust, London, United Kingdom.
| | - Christopher Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Shreerang Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Clare Schilling
- Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK.
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
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5
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Payne KFB, Higginson J, Basyuni S, Goodson AMC, Chadha A, Elledge R, Breeze J, Goodson M, Bajwa MS, Schilling C, Shaw RJ, Fan K, Dhanda J, Schache A. Academic Training in Oral and Maxillofacial Surgery - when and how to enter the pathway. Br J Oral Maxillofac Surg 2023; 61:124-130. [PMID: 36774281 DOI: 10.1016/j.bjoms.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
Entering into surgical academia can seem a daunting prospect for an oral and maxillofacial surgery (OMFS) trainee. However, the streamlining of academic training by the NIHR to create the integrated academic training (IAT) pathway has simplified academic training and more clearly defined academic positions and entry points for trainees. In this article we review the current NIHR IAT pathway and the various grades and entry points available to OMF surgeons, both pre- and post-doctoral. We highlight the unique challenges facing OMF trainees and provide advice and insight from both junior and senior OMFS academics. Finally, we focus on the planning and application for a doctoral research fellowship - discussing funding streams available to OMF surgeons.
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Affiliation(s)
- Karl F B Payne
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, UK.
| | | | - Shadi Basyuni
- Department of Oral and Maxillofacial Surgery, Addenbrookes Hospital, Cambridge University NHS Hospital Trust, Cambridge, UK; Early Cancer Institute, University of Cambridge, Cambridge, UK.
| | - Alexander M C Goodson
- University of South Wales, Pontypridd, Wales, UK; Queen Alexandra Hospital, Portsmouth, UK.
| | - Ambika Chadha
- Cleft.NET.East, Addenbrookes Hospital, Cambridge University NHS Hospital Trust, Cambridge, UK.
| | - Ross Elledge
- School of Dentistry, University of Birmingham, Birmingham, UK.
| | - John Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham, UK; The Royal British Legion Centre for Blast Injury Studies and the Department of Bioengineering, Imperial College London, London, UK.
| | | | - Mandeep S Bajwa
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - Clare Schilling
- Head and Neck Academic Centre, University College London, London, UK; Department of Head and Neck Surgery, University College London Hospital, London, UK.
| | - Richard J Shaw
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - Kathleen Fan
- King's College Hospital, Denmark Hill, London, UK; King's College London, Strand, London, UK.
| | - Jagtar Dhanda
- Queen Victoria Hospital, East Grinstead, UK; Brighton and Sussex Medical School, Brighton, UK.
| | - Andrew Schache
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK; Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK.
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6
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Schilling C. Re: Sentinel lymph node biopsy for early oral cancer - accuracy and considerations in patient selection. Br J Oral Maxillofac Surg 2023; 61:251-252. [PMID: 36764854 DOI: 10.1016/j.bjoms.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Clare Schilling
- Head and Neck Academic Centre, UCL, United Kingdom; Department of Head and Neck Surgery, UCLH, United Kingdom.
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7
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Chegini S, Edwards E, McGurk M, Clarkson M, Schilling C. Systematic review of techniques used to validate the registration of augmented-reality images using a head-mounted device to navigate surgery. Br J Oral Maxillofac Surg 2023; 61:19-27. [PMID: 36513525 DOI: 10.1016/j.bjoms.2022.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
Augmented-reality (AR) head-mounted devices (HMD) allow the wearer to have digital images superposed on to their field of vision. They are being used to superpose annotations on to the surgical field akin to a navigation system. This review examines published validation studies on HMD-AR systems, their reported protocols, and outcomes. The aim was to establish commonalities and an acceptable registration outcome. Multiple databases were systematically searched for relevant articles between January 2015 and January 2021. Studies that examined the registration of AR content using a HMD to guide surgery were eligible for inclusion. The country of origin, year of publication, medical specialty, HMD device, software, and method of registration, were recorded. A meta-analysis of the mean registration error was conducted. A total of 4784 papers were identified, of which 23 met the inclusion criteria. They included studies using HoloLens (Microsoft) (n = 22) and nVisor ST60 (NVIS Inc) (n = 1). Sixty-six per cent of studies were in hard tissue specialties. Eleven studies reported registration errors using pattern markers (mean (SD) 2.6 (1.8) mm), and four reported registration errors using surface markers (mean (SD) 3.8 (3.7) mm). Three studies reported registration errors using manual alignment (mean (SD) 2.2 (1.3) mm). The majority of studies in this review used in-house software with a variety of registration methods and reported errors. The mean registration error calculated in this study can be considered as a minimum acceptable standard. It should be taken into consideration when procedural applications are selected.
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Affiliation(s)
- Soudeh Chegini
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom.
| | - Eddie Edwards
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Mark McGurk
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Matthew Clarkson
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Clare Schilling
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
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8
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Pepper T, Spiers H, Weller A, Schilling C. Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury - Is It Safe? Radiological Simulation in a Healthy Volunteer. Craniomaxillofac Trauma Reconstr 2022; 15:312-317. [PMID: 36387322 PMCID: PMC9647385 DOI: 10.1177/19433875211053091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Study Design Observational. Objective To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations - neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. Results In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4-C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1-2) joints. Conclusions Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.
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Affiliation(s)
- Thomas Pepper
- Institute of Naval Medicine, Defence Medical
Services, UK
| | - Harry Spiers
- Department of Surgery, Addenbrooke’s Hospital, Cambridge, UK
| | - Alex Weller
- Department of Head and Neck Radiology, Northwick Park Hospital, Watford
Road, London, UK
| | - Clare Schilling
- Department of Head and Neck Surgery,
University College Hospital, Academic Head and Neck Unit, University College London, London, UK
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9
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Chegini S, Chegini S, Schilling C, Clarkson M, Edwards E. 63. A training tool for clinicians in segmenting medical images to make 3D models. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Tighe D, McMahon J, Schilling C, Ho M, Provost S, Freitas A. Machine learning methods applied to risk adjustment of cumulative sum chart methodology to audit free flap outcomes after head and neck surgery. Br J Oral Maxillofac Surg 2022; 60:1353-1361. [PMID: 36379810 DOI: 10.1016/j.bjoms.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 12/31/2022]
Abstract
We describe a risk adjustment algorithm to benchmark and report free flap failure rates after immediate reconstruction of head and neck defects. A dataset of surgical care episodes for curative surgery for head and neck cancer and immediate reconstruction (n = 1593) was compiled from multiple NHS hospitals (n = 8). The outcome variable was complete flap failure. Classification models using preoperative patient demographic data, operation data, functional status data and tumour stage data, were built. Machine learning processes are described to model free flap failure. Overall complete flap failure was uncommon (4.7%) with a non-statistical difference seen between hospitals. The champion predictive model had acceptable discrimination (AUROC 0.66). This model was used to risk-adjust cumulative sum (CuSUM) charts. The use of CuSUM charts is a viable way to monitor in a 'Live Dashboard' this quality metric as part of the quality outcomes in oral and maxillofacial surgery audit.
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11
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Chegini S, Chegini S, Patel S, Schilling C, McGurk M. 14. Neck Failure Following Sentinel Lymph Node Biopsy For Patient’s With Oral Squamous Cell Carcinoma: A Systematic Review And Meta-analysis. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Dell’Oglio P, Mazzone E, Buckle T, Maurer T, Navab N, van Oosterom MN, Schilling C, Witjes MJH, Vahrmeijer AL, Klode J, Vojnovic B, Mottrie A, van der Poel HG, Hamdy F, van Leeuwen FWB. Precision surgery: the role of intra-operative real-time image guidance - outcomes from a multidisciplinary European consensus conference. Am J Nucl Med Mol Imaging 2022; 12:74-80. [PMID: 35535122 PMCID: PMC9077167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
Developments within the field of image-guided surgery are ever expanding, driven by collective involvement of clinicians, researchers, and industry. While the general conception of the potential of image-guided surgery is to improve surgical outcome, the specific motives and goals that drive can differ between the different expert groups. To establish the current and future role of intra-operative image guidance within the field of image-guided surgery a Delphi consensus survey was conducted during the 2nd European Congress on Image-guided surgery. This multidisciplinary survey included questions on the conceptual potential and clinical value of image-guided surgery and was aimed at defining specific areas of research and development in the field in order to stimulate further advances towards precision surgery. Obtained results based on questionnaires filled in by 56 panel experts (clinicians: N=30, researchers: N=20 and industry: N=6) were discussed during a dedicated expert discussion session during the conference. The outcome of this Delphi consensus is indicative of the potential improvements offered by image-guided surgery and of the need for further research in this emerging field, that can be enriched by the identification of reliable molecular targets.
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Affiliation(s)
- Paolo Dell’Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano NiguardaMilan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical CenterLeiden, The Netherlands
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Tessa Buckle
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical CenterLeiden, The Netherlands
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-EppendorfHamburg, Germany
| | - Nassir Navab
- Computer Aided Medical Procedure, Technical University of MunichMunich, Germany
| | - Matthias N van Oosterom
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical CenterLeiden, The Netherlands
| | - Clare Schilling
- Department of Head and Neck Surgery, University College HospitalLondon, United Kingdom
| | - Max JH Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center GroningenGroningen, The Netherlands
| | | | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-EssenEssen, Germany
| | - Boris Vojnovic
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of OxfordOxford, United Kingdom
| | - Alexandre Mottrie
- ORSI, AcademyMelle, Belgium
- Department of Urology, Onze Lieve Vrouw HospitalAalst, Belgium
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdam, The Netherlands
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of OxfordOxford, United Kingdom
| | - Fijs WB van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical CenterLeiden, The Netherlands
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13
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Patel HN, Bowe C, Garg M, Tighe D, Gulati A, Norris P, Kerawala C, McGurk M, Bisase B, Thavaraj S, Schilling C. Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience. J Oral Pathol Med 2022; 51:315-321. [PMID: 35218247 DOI: 10.1111/jop.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy is an increasingly recognised option for accurate staging and subsequent management of the clinically negative neck in early stage oral cavity squamous cell carcinoma. However, the technique is currently underused due to several logistic constraints including increased burden on pathology services. Here, we describe the feasibility of an outsourced centralised pathology processing and reporting service for sentinel lymph node biopsies in oral cavity squamous cell carcinoma. PATIENTS AND METHODS The Southeast England Consortium comprises four surgical centres utilising a central pathology service. Consecutive cases between January 2016 and February 2020 were retrospectively evaluated for survival outcomes and laboratory turnaround times. RESULTS Twenty-eight per cent from a cohort of 139 patients had positive sentinel nodes. There was a trend towards greater overall, disease-free and disease-specific survival (OS, DFS and DSS, respectively) in sentinel node negative compared to sentinel node positive patients, but these differences were not statistically significant. The sensitivity, negative predictive value and false negative rate were 92.8%, 97.0% and 6.8%, respectively. The mean and mode laboratory TAT were 5 and 4 working days, respectively. CONCLUSION An outsourced centralised pathology service is a feasible option to widen the availability of sentinel node biopsy in oral cavity squamous cell carcinoma.
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Affiliation(s)
- Helina N Patel
- Head and Neck Academic Centre, University College London, London, UK
| | - Conor Bowe
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Montey Garg
- Department of Oral & Maxillofacial Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Tighe
- Department of Oral & Maxillofacial Surgery, East Kent Hospitals NHS Foundation Trust, Kent, UK
| | - Aakshay Gulati
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Paul Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Cyrus Kerawala
- Head and Neck Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Mark McGurk
- Head and Neck Academic Centre, University College London, London, UK.,Head & Neck Surgery, University College London Hospital, London, UK
| | - Brian Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Selvam Thavaraj
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK.,Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Clare Schilling
- Head and Neck Academic Centre, University College London, London, UK.,Head & Neck Surgery, University College London Hospital, London, UK
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14
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Chegini S, Schilling C, Clarkson M. Technical Note on the production of 3D anatomical models using an open access software from medical imaging. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Howells R, Nezamivand-Chegini S, Schilling C. A better way to implement the QOMS proforma for oncology and reconstruction. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Karamchandani S, Wan S, Gnanasegaran G, Dasgupta D, Schilling C, McGurk M. Single-photon emission computed tomography (SPECT/CT) images of sentinel node distribution in oral cancer. Br J Oral Maxillofac Surg 2021; 59:1313-1319. [PMID: 34742605 DOI: 10.1016/j.bjoms.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
This audit describes the lymphatic flow from oral tumours seen on single-photon emission computed tomography (SPECT/CT) to help sentinel node (SN) identification. A total of 95 consecutive sentinel node biopsies (SNB) were taken between 2010 and 2019. Eligibility criteria for SNB were patients over 18 years of age with a T1-T2 oral or oropharyngeal squamous cell carcinoma and an N0 neck. SNs collect at high-frequency sites irrespective of the primary tumour (22.7% level Ib; 64.8% levels II/III; and 7.6% level IV), but with individual variation. Radiotracer activity did not influence the number of nodes identified, and metastatic deposits were found in the hottest nodes. SNs occur at the same high-frequency locations in the neck, so familiarity with anatomical detail may reduce false-negative results.
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Affiliation(s)
- Searan Karamchandani
- Department of Surgery, Southampton University Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom.
| | - Simon Wan
- Head & Neck Academic Centre, Division of Surgery & Interventional Science, University College London, Charles Bell House, 43045 Foley St, London W1W7TS, United Kingdom
| | - Gopinath Gnanasegaran
- Head & Neck Academic Centre, Division of Surgery & Interventional Science, University College London, Charles Bell House, 43045 Foley St, London W1W7TS, United Kingdom
| | - Dhruba Dasgupta
- Nuclear Medicine Department, Guy's & St Thomas' Hospital NHS Foundation Trust, 20 St Thomas Street, London SE1 9RS, United Kingdom.
| | - Clare Schilling
- Head & Neck Academic Centre, Division of Surgery & Interventional Science, University College London, Charles Bell House, 43045 Foley St, London W1W7TS, United Kingdom
| | - Mark McGurk
- Head & Neck Academic Centre, Division of Surgery & Interventional Science, University College London, Charles Bell House, 43045 Foley St, London W1W7TS, United Kingdom.
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17
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Almhanedi H, McGurk M, Wan S, Schilling C. Novel double injection technique for sentinel lymph node biopsy in oral cancer. Br J Oral Maxillofac Surg 2021; 59:1296-1301. [PMID: 34742602 DOI: 10.1016/j.bjoms.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
The development of new lymphatic tracers and the advancement of hybrid tracers, such as indocyanine green (ICG)-Nanocoll (GE Healthcare), represent an exciting step in the future of sentinel lymph node biopsy (SLNB). These tracers aim to improve our ability to detect sentinel lymph nodes by enhancing their localisation. The aim of this study was to assess the performance of a novel dual tracer, double injection technique of ICG-'cold'-Nanocoll and radiolabelled Nanocoll, in SLNB for early-stage oral cancer. A double injection technique was performed first using 99mTc-Nancoll prior to sentinel node imaging followed by ICG-'cold'-Nanocoll injection in theatre. Analysis involved examination of the number, labelling, and location of the nodes harvested, sentinel node status, survival analysis, false negative rate, and complications associated with use of the technique. ICG 'cold' Nanocoll results showed concordance of fluorescence and radioactivity detection in 74 nodes in 24 patients. Most importantly, all nodes found positive for metastasis (6 nodes) were discovered to be both 'hot' and fluorescent; 74 nodes removed were both 'hot' and fluorescent, eight fluorescent only and six 'hot' only. Our results indicate that two sets of tracer injections given at two different time points will flow to the same sentinel nodes. This double labelling increased our confidence that the retrieved node was a sentinel node.
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Affiliation(s)
- H Almhanedi
- Head and Neck Academic Centre University College London & Head and Neck Surgery Department University College London Hospital, United Kingdom.
| | - M McGurk
- Head and Neck Academic Centre University College London & Head and Neck Surgery Department University College London Hospital, United Kingdom.
| | - S Wan
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom.
| | - C Schilling
- Head and Neck Academic Centre University College London & Head and Neck Surgery Department University College London Hospital, United Kingdom.
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18
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King C, Elsherif N, Kirwan R, Schilling C, Hall G, Morgan P, Collins L, Sandison A, Odell E, Thavaraj S. Serial step sections at narrow intervals with immunohistochemistry are required for accurate histological assessment of sentinel lymph node biopsy in oral squamous cell carcinoma. Head Neck 2021; 43:2985-2993. [PMID: 34128276 DOI: 10.1002/hed.26784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is an accurate staging modality in early oral squamous cell carcinoma (OSCC), but its accuracy relies on labor-intensive histopathology protocols. We sought to determine whether serial step sections with immunohistochemistry (SSSIHC) at narrow intervals of the entire SLN are required to accurately exclude metastasis. METHODS Consecutive SLN biopsies over a 13-year period were retrospectively evaluated. If the index section was negative for carcinoma, the entire SLN was subjected to SSSIHC at 150 μm intervals. The first section level and total number of section levels to contain carcinoma were recorded. RESULTS One hundred and eighteen SLN+ from 90 patients were included. SSSIHC upstaged the nodal status in 19.5% of patients. Metastasis was identified in 16.7% and 10.2% beyond section levels 4 and 6, respectively. Among SLNs requiring SSSIHC, 47.5% contained carcinoma in a single section level. CONCLUSION SSSIHC of the entire SLN at 150 μm intervals are required to identify occult metastasis in OSCC.
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Affiliation(s)
- Claire King
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nusaybah Elsherif
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruaidhrí Kirwan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clare Schilling
- Head & Neck Surgery, University College London Hospital, London, UK.,Head and Neck Academic Centre, University College London, London, UK
| | - Gillian Hall
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter Morgan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Lisette Collins
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ann Sandison
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Edward Odell
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Selvam Thavaraj
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
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Buckle T, Schilling C, Maurer T, Vidal-Sicart S. Image-guided surgery: from classical techniques to novel aspects and approaches. Q J Nucl Med Mol Imaging 2021; 65:187-189. [PMID: 34105340 DOI: 10.23736/s1824-4785.21.03388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands -
| | - Clare Schilling
- Head and Neck Academic Center, Department of Head and Neck Surgery, University College Hospital, London, UK
| | - Tobias Maurer
- Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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20
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Boekestijn I, Azargoshasb S, Schilling C, Navab N, Rietbergen D, van Oosterom MN. PET- and SPECT-based navigation strategies to advance procedural accuracy in interventional radiology and image-guided surgery. Q J Nucl Med Mol Imaging 2021; 65:244-260. [PMID: 34105338 DOI: 10.23736/s1824-4785.21.03361-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Nuclear medicine has a crucial role in interventional strategies where a combination between the increasing use of targeted radiotracers and intraprocedural detection modalities enable novel, but often complex, targeted procedures in both the fields of interventional radiology and surgery. 3D navigation approaches could assist the interventional radiologist or surgeon in such complex procedures. EVIDENCE ACQUISITION This review aimed to provide a comprehensive overview of the current application of computer-assisted navigation strategies based on nuclear imaging to assist in interventional radiology and image-guided surgery. This work starts with a brief overview of the typical navigation workflow from a technical perspective, which is followed by the different clinical applications organized based on their anatomical organ of interest. EVIDENCE SYNTHESIS Although many studies have proven the feasibility of PET- and SPECT-based navigation strategies for various clinical applications in both interventional radiology and surgery, the strategies are spread widely in both navigation workflows and clinical indications, evaluated in small patient groups. Hence, no golden standard has yet been established. CONCLUSIONS Despite that the clinical outcome is yet to be determined in large patient cohorts, navigation seems to be a promising technology to translate nuclear medicine findings, provided by PET- and SPECT-based molecular imaging, to the intervention and operating room. Interventional Nuclear Medicine (iNM) has an exciting future to come using both PET- and SPECT-based navigation.
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Affiliation(s)
- Imke Boekestijn
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Samaneh Azargoshasb
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Clare Schilling
- Head and Neck Academic Center, Department of Head and Neck Surgery, University College London Hospital, London, UK
| | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, Munich, Germany.,Computer Aided Medical Procedures, Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Daphne Rietbergen
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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21
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Chegini S, Schilling C, Walgama ES, Yu KM, Thankappan K, Iyer S, Cariati P, Balasubramanian D, Kanatas A, Lai SY, McGurk M. Neck failure following pathologically node-negative neck dissection (pN0) in oral squamous cell carcinoma: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 59:1157-1165. [PMID: 34281738 DOI: 10.1016/j.bjoms.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Due to the risk of occult cervical metastasis, elective neck dissection (END) is recommended in the management of patients with early oral cavity squamous cell carcinoma (OSCC) and a clinically node-negative (cN0) neck. This paper presents a systematic review and meta-analysis of studies that recorded isolated regional recurrence (RR) in the pathologically node-negative neck dissection (pN0) neck following END in order to quantify the failure rate. Pubmed and Ovid databases were systematically searched for relevant articles published between January 2009 and January 2019. Studies reporting RR following END in patients with OSCC who had no pathological evidence of lymph node metastasis were eligible for inclusion in this meta-analysis. In addition, a selection of large head and neck units were invited to submit unpublished data. Search criteria produced a list of 5448 papers, of which 18 studies met the inclusion criteria. Three institutions contributed unpublished data. This included a total of 4824 patients with median follow-up of 34 months (2.8 years). Eight datasets included patients staged T1-T4 with RR 17.3% (469/2711), 13 datasets included patients staged T1-T2 with RR 7.5% (158/2113). Overall across all 21 studies, isolated neck recurrence was identified in 627 cases giving a RR of 13.0% (627/4824) on meta-analysis. Understanding the therapeutic effectiveness of END provides context for evaluation of clinical management of the cN0 in these patients. A pathologically negative neck does not guarantee against future recurrence.
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Affiliation(s)
- S Chegini
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom.
| | - C Schilling
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
| | - E S Walgama
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Yu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Thankappan
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - S Iyer
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - P Cariati
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario de Albacete, Albacete, Spain
| | - D Balasubramanian
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - A Kanatas
- Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom
| | - S Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M McGurk
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
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22
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Cocker H, Francies O, Adams A, Sassoon I, Schilling C. Do we have a robust method for preoperative tumour depth assessment for oral cavity tumours with clinically negative necks? Int J Oral Maxillofac Surg 2020; 50:981-988. [PMID: 33358587 DOI: 10.1016/j.ijom.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Tumour depth is an important prognostic factor in head and neck cancer and has recently been included in the eighth edition of the Union for International Cancer Control TNM classification of malignant tumours for oral squamous cell carcinoma (OSCC). It is important to appraise the accuracy of depth assessments; however, there is little current evidence in the literature. Accurate depth assessment is particularly pertinent in cT1-T2N0 OSCC where it may influence neck management. A retrospective study was performed at two tertiary referral centres, in which surgically treated patients with cT1-T4N0 OSCC were audited. Preoperative tumour depth assessments from multimodality radiological staging scans were compared with the final histopathological depth. The predictive accuracy of intraoral ultrasound (IOUS), computed tomography (CT), and magnetic resonance imaging (MRI) for tumour depth was evaluated. Accuracy to within 3mm of the histopathological depth was seen in 56.7% of MRI scans and 57.1% of CT scans. IOUS appeared to have superior prediction, with 78.2% of measurements within 3mm. Over one third of CT and MRI imaging failed to detect a lesion; IOUS scans detected the lesions in all of these case. In conclusion, the reliability of preoperative imaging assessment of tumour depth should be considered when recommending treatment.
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Affiliation(s)
- H Cocker
- University College London Hospital, Bloomsbury, London, UK.
| | - O Francies
- University College London Hospital, Bloomsbury, London, UK
| | - A Adams
- University College London Hospital, Bloomsbury, London, UK
| | - I Sassoon
- University College London Hospital, Bloomsbury, London, UK
| | - C Schilling
- University College London Hospital, Bloomsbury, London, UK
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23
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Chegini S, Schilling C, McGurk M. Neck failure following a pathologically staged negative neck dissection (pN-) in oral squamous cell carcinoma (OSCC). A systematic review and meta-analysis. Br J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.bjoms.2020.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Karamchandani S, McGurk M, Schilling C, Wan S. Study of 95 lymphangiograms showing patterns of sentinel node biopsy in patients with early oral cancer. Br J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.bjoms.2020.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Basu I, Howells R, Schilling C. Complications of Neck Dissections - A local experience. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Affiliation(s)
- Clare Schilling
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
| | - Stephen Y Lai
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
| | - Soudeh Chegini
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
| | - Mark McGurk
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
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27
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Pepper T, Spiers H, Schilling C. Intraoperative positioning in maxillofacial patients with cervical spine injuries – when is it safe to remove the collar? Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Schilling C, Stoeckli SJ, Vigili MG, de Bree R, Lai SY, Alvarez J, Christensen A, Cognetti DM, D'Cruz AK, Frerich B, Garrel R, Kohno N, Klop WM, Kerawala C, Lawson G, McMahon J, Sassoon I, Shaw RJ, Tvedskov JF, von Buchwald C, McGurk M. Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer. Head Neck 2019; 41:2655-2664. [PMID: 30896058 DOI: 10.1002/hed.25739] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The eighth international symposium for sentinel node biopsy (SNB) in head and neck cancer was held in 2018. This consensus conference aimed to deliver current multidisciplinary guidelines. This document focuses on the surgical aspects of SNB for oral cancer. METHOD Invited expert faculty selected topics requiring guidelines. Topics were reviewed and evidence evaluated where available. Data were presented at the consensus meeting, with live debate from panels comprising expert, nonexpert, and patient representatives followed by voting to assess the level of support for proposed recommendations. Evidence review, debate, and voting results were all considered in constructing these guidelines. RESULTS/CONCLUSION A range of topics were considered, from patient selection to surgical technique and follow-up schedule. Consensus was not achieved in all areas, highlighting potential issues that would benefit from prospective studies. Nevertheless these guidelines represent an up-to-date pragmatic recommendation based on current evidence and expert opinion.
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Affiliation(s)
- Clare Schilling
- Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK
| | - Sando J Stoeckli
- Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Maurizio G Vigili
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale San Carlo, Rome, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephen Y Lai
- Department Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julio Alvarez
- Department of Oral and Maxillofacial Surgery, Cruces University Hospital, Bilbao, Spain
| | - Anders Christensen
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David M Cognetti
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anil K D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Renaud Garrel
- Department of Head and Neck Surgery, University Hospital, Montpellier, France
| | - Naoyuki Kohno
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Willem Martin Klop
- Department of Head and Neck Oncology/Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Cyrus Kerawala
- Department of Head and Neck Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Georges Lawson
- Department of Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Namur, Belgium
| | - Jeremy McMahon
- Department of Head and Neck Surgery, Southern General Hospital, Glasgow, Scotland
| | - Isabel Sassoon
- Department of Infomatics, Kings College London, London, UK
| | - Richard J Shaw
- Institute of Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
| | - Jesper F Tvedskov
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark McGurk
- Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK
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29
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Giammarile F, Schilling C, Gnanasegaran G, Bal C, Oyen WJG, Rubello D, Schwarz T, Tartaglione G, Miller RN, Paez D, van Leeuwen FWB, Valdés Olmos RA, McGurk M, Delgado Bolton RC. The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2018; 46:623-637. [PMID: 30564849 PMCID: PMC6351508 DOI: 10.1007/s00259-018-4235-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 01/09/2023]
Abstract
Purpose Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized oral cavity squamous cell carcinoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery, and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with early N0 oral cavity squamous cell carcinoma. Methods These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) and the International Atomic Energy Agency (IAEA) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, and national nuclear medicine societies. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). These guidelines, together with another two focused on Surgery and Pathology (and published in specialised journals), are part of the synergistic efforts developed in preparation for the “2018 Sentinel Node Biopsy in Head and Neck Consensus Conference”. Conclusion The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of early N0 oral cavity squamous cell carcinoma patients.
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Affiliation(s)
- Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria.
| | - Clare Schilling
- Department of Head and Neck Surgery, University College Hospital, 235 Euston Road, London, NW1, UK
| | - Gopinanth Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Chandrasckhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Wim J G Oyen
- Department of Nuclear Medicine, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, and Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - Thomas Schwarz
- Division of Radiology, Department of Nuclear Medicine, Medical University Graz, Graz, Austria
| | | | - Rodolfo Nuñez Miller
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - Fijis W B van Leeuwen
- Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Renato A Valdés Olmos
- Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark McGurk
- Department of Head and Neck Surgery, University College Hospital, 235 Euston Road, London, NW1, UK
| | - Roberto C Delgado Bolton
- University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
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Holden A, Sharma D, Schilling C, Gnanasegaran G, Odell E, Sassoon I, McGurk M. Biopsy of the sentinel lymph node in oral squamous cell carcinoma: analysis of error in 100 consecutive cases. Br J Oral Maxillofac Surg 2018; 56:615-620. [DOI: 10.1016/j.bjoms.2018.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 06/27/2018] [Indexed: 12/15/2022]
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Korschelt K, Schwidetzky R, Pfitzner F, Strugatchi J, Schilling C, von der Au M, Kirchhoff K, Panthöfer M, Lieberwirth I, Tahir MN, Hess C, Meermann B, Tremel W. CeO 2-x nanorods with intrinsic urease-like activity. Nanoscale 2018; 10:13074-13082. [PMID: 29961799 DOI: 10.1039/c8nr03556c] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The large-scale production and ecotoxicity of urea make its removal from wastewater a health and environmental challenge. Whereas the industrial removal of urea relies on hydrolysis at elevated temperatures and high pressure, nature solves the urea disposal problem with the enzyme urease under ambient conditions. We show that CeO2-x nanorods (NRs) act as the first and efficient green urease mimic that catalyzes the hydrolysis of urea under ambient conditions with an activity (kcat = 9.58 × 101 s-1) about one order of magnitude lower than that of the native jack bean urease. The surface properties of CeO2-x NRs were probed by varying the Ce4+/Ce3+ ratio through La doping. Although La substitution increased the number of surface defects, the reduced number of Ce4+ sites with higher Lewis acidity led to a slight decrease of their catalytic activity. CeO2-x NRs are stable against pH changes and even to the presence of transition metal ions like Cu2+, one of the strongest urease inhibitors. The low costs and environmental compatibility make CeO2-x NRs a green urease substitute that may be applied in polymer membranes for water processing or filters for the waste water reclamation. The biomimicry approach allows the application of CeO2-x NRs as functional enzyme mimics where the use of native or recombinant enzyme is hampered because of its costs or operational stability.
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Affiliation(s)
- K Korschelt
- Institut für Anorganische Chemie und Analytische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55128 Mainz, Germany.
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Puente Reyna AL, Holderied M, Jäger M, Schilling C, Grupp TM. ARTICULATION AND BACKSIDE WEAR ANALYSIS AFTER LONG-TERM IN VITRO WEAR SIMULATION OF VITAMIN E STABILIZED POLYETHYLENE ACETABULAR LINERS WITH A PRESS-FIT LOCKING MECHANISM. ACTA ACUST UNITED AC 2018. [DOI: 10.21823/2311-2905-2018-24-2-29-40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A previous retrieval study analyzed the backside wear of short-term implanted liners against in vitro tested liners of similar life in service and showed comparable results among both groups, with no significant backside wear due to micro-motion.The purpose — to obtain a picture of the overall wear (articulation and backside surfaces) of 0.1% vitamin e blended polyethylene liners, with a locking mechanism based on a press-fit cone in combination with a rough titanium conical inner surface in the fixation area, under a 20 million cycles hip wear simulation.Materials and Methods. A semi-quantitative method was used in order to assess the damage on the backside of the liners and a 3d measuring machine to assess the creep and wear at the articulation surface.Results. The total average backside wear score was 22.00±2.59 from a maximum total score of 147 after 5 million cycles (mc), increased to 31.92±5.57 after 10 mc, but showed no further increment after 15 and 20 mc. The reference liners (subjected only to axial load) showed similar wear scores and modes as the liners under wear simulation (axial load and movement). Small scratches produced during insertion and removal were clearly seen at the rim (fixation) area and no considerable abrasion was observed. The machining marks on the convex surface were always visible. Regarding the articulation surface, a steady state wear rate of 7 µm/year was measured.Conlusion. These results determined that most of the backside wear produced on the liners occurred during their insertion and removal rather than during their life in service. Moreover, the wear at the articulation surface was similar to that seen in vivo at short- and mid-term on highly cross-linked polyethylene liners with and without vitamin e content.
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Behr M, Acker J, Cohrs S, Deuschle M, Danker-Hopfe H, Göder R, Norra C, Richter K, Riemann D, Schilling C, Weeß HG, Wetter TC, Wollenburg LM, Pollmächer T. [Prevalence of sleep-related breathing disorders of inpatients with psychiatric disorders]. Nervenarzt 2018; 89:807-813. [PMID: 29876601 DOI: 10.1007/s00115-018-0545-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep-related breathing disorders seriously impair well-being and increase the risk for relevant somatic and psychiatric disorders. Moreover, risk factors for sleep-related breathing disorders are highly prevalent in psychiatric patients. The aim of this study was for the first time in Germany to study the prevalence of obstructive sleep apnea syndrome (OSAS) as the most common form of sleep-related breathing disorder in patients with psychiatric disorders. METHODS In 10 psychiatric hospitals in Germany and 1 hospital in Switzerland, a total of 249 inpatients underwent an 8‑channel sleep polygraphy to investigate the prevalence of sleep apnea in this group of patients. RESULTS With a conspicuous screening result of 23.7% of the subjects, a high prevalence of sleep-related breathing disorders was found to occur among this group of patients. Male gender, higher age and high body mass index (BMI) were identified as positive risk factors for the detection of OSAS. DISCUSSION The high prevalence indicates that sleep apnea is a common sleep disorder among psychiatric patients. Although OSAS can lead to substantial disorders of the mental state and when untreated is accompanied by serious somatic health problems, screening procedures are not part of the routine work-up in psychiatric hospitals; therefore, sleep apnea is presumably underdiagnosed in psychiatric patients. In view of the results of this and previous studies, this topic complex should be the subject of further research studies.
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Affiliation(s)
- M Behr
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - J Acker
- Klinik für Schlafmedizin, Bad Zurzach, Schweiz
| | - S Cohrs
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Rostock, Rostock, Deutschland
| | - M Deuschle
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - H Danker-Hopfe
- Kompetenzzentrum Schlafmedizin, Klinik für Psychiatrie und Psychotherapie der Charité, Berlin, Deutschland
| | - R Göder
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - C Norra
- LWL-Klinik Paderborn, Paderborn, Deutschland
| | - K Richter
- Klinik für Psychiatrie und Psychotherapie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
| | - D Riemann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Schilling
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - H-G Weeß
- Schlafzentrum am Pfalzklinikum Klingenmünster, Klingenmünster, Deutschland
| | - T C Wetter
- Schlafmedizinisches Zentrum, Klinik für Psychiatrie und Psychotherapie, Universität Regensburg am Bezirksklinikum, Regensburg, Deutschland
| | - L M Wollenburg
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - T Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland.
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Chevalier Y, Matsuura M, Krüger S, Fleege C, Rickert M, Rauschmann M, Schilling C. Micro-CT and micro-FE analysis of pedicle screw fixation under different loading conditions. J Biomech 2017; 70:204-211. [PMID: 29336820 DOI: 10.1016/j.jbiomech.2017.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
Anchorage of pedicle screw instrumentation in the elderly spine with poor bone quality remains challenging. In this study, micro finite element (µFE) models were used to assess the specific influence of screw design and the relative contribution of local bone density to fixation mechanics. These were created from micro computer tomography (µCT) scans of vertebras implanted with two types of pedicle screws, including a full region-or-interest of 10 mm radius around each screw, as well as submodels for the pedicle and inner trabecular bone of the vertebral body. The local bone volume fraction (BV/TV) calculated from the µCT scans around different regions of the screw (pedicle, inner trabecular region of the vertebral body) were then related to the predicted stiffness in simulated pull-out tests as well as to the experimental pull-out and torsional fixation properties mechanically measured on the corresponding specimens. Results show that predicted stiffness correlated excellently with experimental pull-out strength (R2 > 0.92, p < .043), better than regional BV/TV alone (R2 = 0.79, p = .003). They also show that correlations between fixation properties and BV/TV were increased when accounting only for the pedicle zone (R2 = 0.66-0.94, p ≤ .032), but with weaker correlations for torsional loads (R2 < 0.10). Our analyses highlight the role of local density in the pedicle zone on the fixation stiffness and strength of pedicle screws when pull-out loads are involved, but that local apparent bone density alone may not be sufficient to explain resistance in torsion.
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Affiliation(s)
- Y Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany.
| | - M Matsuura
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - S Krüger
- Aesculap AG, Research & Development, Tuttlingen, Germany
| | - C Fleege
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Wirbelsäulenorthopädie, Frankfurt a.M., Germany
| | - M Rickert
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Wirbelsäulenorthopädie, Frankfurt a.M., Germany
| | - M Rauschmann
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Wirbelsäulenorthopädie, Frankfurt a.M., Germany
| | - C Schilling
- Aesculap AG, Research & Development, Tuttlingen, Germany
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Holden A, Sharma D, Schilling C, Gnanasegaran G, Odell E, Sassoon I, McGurk M. Sentinel Node Biopsy in oral squamous cell carcinoma: Analysis of error in a cohort of 100 consecutive cases. Br J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.bjoms.2017.08.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schilling C, Shaw R, Schache A, McMahon J, Chegini S, Kerawala C, McGurk M. Sentinel lymph node biopsy for oral squamous cell carcinoma. Where are we now? Br J Oral Maxillofac Surg 2017; 55:757-762. [PMID: 28864148 DOI: 10.1016/j.bjoms.2017.07.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/13/2017] [Indexed: 12/16/2022]
Abstract
Recent data have confirmed that elective surgical management of the cN0 neck improves survival in patients with early (T1-T2) oral squamous cell carcinoma (SCC), and is better than watchful waiting. However, elective neck dissection (END) may not always be necessary. Sentinel node biopsy (SNB), which is a reliable staging test for patients with early disease and a radiologically N0 neck, can detect occult metastases with a sensitivity of 86%-94%. Patients with no sign of metastases on SNB could avoid neck dissection, and individual treatment should reduce both morbidity and cost. Currently, SNB for oral SCC is available at a limited number of centres in the UK, but this is likely to change as national guidelines have recommended that it is incorporated into the standard treatment pathway. It is therefore important to understand the current evidence that supports its use, its limitations and related controversies, and to plan for a validated training programme.
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Affiliation(s)
- C Schilling
- Department of Oral and Maxillofacial Surgery, St Georges Hospital, Blackshaw Road, Tooting, London, England, SW17 0QT.
| | - R Shaw
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool & Aintree University Hospitals NHS Foundation Trust, Longmoor Lane, Liverpool, Merseyside, England, L9 7AL
| | - A Schache
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool & Aintree University Hospitals NHS Foundation Trust, Longmoor Lane, Liverpool, Merseyside, England, L9 7AL
| | - J McMahon
- Department of Head and Neck Surgery, Southern General Hospital, 1345 Govan Rd, Govan, Glasgow, Scotland, G51 4TF
| | - S Chegini
- Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ
| | - C Kerawala
- Department of Head and Neck Surgery, Royal Marsden Hospital, 203 Fulham Road, Chelsea, London SW3 6JJ
| | - M McGurk
- Department of Oral and Maxillofacial Surgery, University College London Hospital, 235 Euston Road, Fitzrovia, London NW1 2BU
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Schilling C, Spiers H, Hayes E, Jones TL, Manisali M. Intraoperative neck positioning for maxillofacial procedures on patients with cervical spine injuries, is it safe to remove the collar? Br J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.bjoms.2016.11.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schilling C, Kennedy H, Messiha A. Non-flap non-graft healing of scalp defects following skin tumour resection. Br J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.bjoms.2016.11.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schilling C, Hosney N, Festy F, Cook RJ. Development of a non-invasive microvascular imaging system for oral cancer diagnosis. Br J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.bjoms.2016.11.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Profeta AC, Schilling C, McGurk M. Augmented reality visualization in head and neck surgery: an overview of recent findings in sentinel node biopsy and future perspectives. Br J Oral Maxillofac Surg 2016; 54:694-6. [PMID: 26809235 DOI: 10.1016/j.bjoms.2015.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
"Augmented reality visualisation", in which the site of an operation is merged with computer-generated graphics, provides a way to view the relevant part of the patient's body in better detail. We describe its role in relation to sentinel lymph node biopsy (SLNB), current advancements, and future directions in the excision of tumours in early-stage cancers of the head and neck.
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Affiliation(s)
- Andrea Corrado Profeta
- Guy's and St Thomas's Hospital NHS Foundation Trust, Department of Oral and Maxillofacial Surgery, Floor 23, Guy's Tower, Guy's Hospital, London, SE1 9RT, UK.
| | - Clare Schilling
- Guy's and St Thomas's Hospital NHS Foundation Trust, Department of Oral and Maxillofacial Surgery, Floor 23, Guy's Tower, Guy's Hospital, London, SE1 9RT, UK.
| | - Mark McGurk
- Guy's and St Thomas's Hospital NHS Foundation Trust, Department of Oral and Maxillofacial Surgery, Floor 23, Guy's Tower, Guy's Hospital, London, SE1 9RT, UK.
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Ryba F, Schilling C, Fan K. Maxillofacial injuries due to assault in women: a 5-year retrospective analysis in a level 1 trauma unit. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA, Bakholdt V, Krogdahl A, von Buchwald C, Bilde A, Sebbesen LR, Odell E, Gurney B, O'Doherty M, de Bree R, Bloemena E, Flach GB, Villarreal PM, Fresno Forcelledo MF, Junquera Gutiérrez LM, Amézaga JA, Barbier L, Santamaría-Zuazua J, Moreira A, Jacome M, Vigili MG, Rahimi S, Tartaglione G, Lawson G, Nollevaux MC, Grandi C, Donner D, Bragantini E, Dequanter D, Lothaire P, Poli T, Silini EM, Sesenna E, Dolivet G, Mastronicola R, Leroux A, Sassoon I, Sloan P, McGurk M. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 2015; 51:2777-84. [PMID: 26597442 DOI: 10.1016/j.ejca.2015.08.023] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/22/2015] [Accepted: 08/23/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE Optimum management of the N0 neck is unresolved in oral cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis. The object of this study was to establish whether the technique was both reliable in staging the N0 neck and a safe oncological procedure in patients with early-stage oral squamous cell carcinoma. METHODS An European Organisation for Research and Treatment of Cancer-approved prospective, observational study commenced in 2005. Fourteen European centres recruited 415 patients with radiologically staged T1-T2N0 squamous cell carcinoma. SNB was undertaken with an average of 3.2 nodes removed per patient. Patients were excluded if the sentinel node (SN) could not be identified. A positive SN led to a neck dissection within 3 weeks. Analysis was performed at 3-year follow-up. RESULTS An SN was found in 99.5% of cases. Positive SNs were found in 23% (94 in 415). A false-negative result occurred in 14% (15 in 109) of patients, of whom eight were subsequently rescued by salvage therapy. Recurrence after a positive SNB and subsequent neck dissection occurred in 22 patients, of which 16 (73%) were in the neck and just six patients were rescued. Only minor complications (3%) were reported following SNB. Disease-specific survival was 94%. The sensitivity of SNB was 86% and the negative predictive value 95%. CONCLUSION These data show that SNB is a reliable and safe oncological technique for staging the clinically N0 neck in patients with T1 and T2 oral cancer. EORTC Protocol 24021: Sentinel Node Biopsy in the Management of Oral and Oropharyngeal Squamous Cell Carcinoma.
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Affiliation(s)
- Clare Schilling
- Department of Head and Neck Surgery, Guys and St Thomas NHS Trust, London, UK
| | - Sandro J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery Kantonsspital St Gallen, Switzerland
| | - Stephan K Haerle
- Department of Head and Neck Surgery, University of Basel, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery Kantonsspital St Gallen, Switzerland
| | - Gerhard F Huber
- Department of Otolaryngology University Hospital Zurich, Switzerland
| | - Jens Ahm Sorensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark
| | - Vivi Bakholdt
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark
| | | | - Christian von Buchwald
- Department of Otolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Anders Bilde
- Department of Otolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Lars R Sebbesen
- Department of Otolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Edward Odell
- Head and Neck/Oral Pathology, King's College London, Guys and St Thomas NHS Trust, London, UK
| | - Benjamin Gurney
- Department of Head and Neck Surgery, Guys and St Thomas NHS Trust, London, UK
| | - Michael O'Doherty
- Department of Nuclear Medicine, Guys and St Thomas NHS Trust, London, UK
| | - Remco de Bree
- Department of Otolaryngology Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Department of Pathology, VU University Medical Centre and Academic Centre of Dentistry Amsterdam, The Netherlands
| | - Geke B Flach
- Department of Otolaryngology Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Pedro M Villarreal
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Julio Alvarez Amézaga
- Department of Maxillofacial Surgery, BioCruces, Hospital Universitario De Cruces, Universidad del Pais Vasco (UPV/EHU), Bilbao, Spain
| | - Luis Barbier
- Department of Maxillofacial Surgery, BioCruces, Hospital Universitario De Cruces, Universidad del Pais Vasco (UPV/EHU), Bilbao, Spain
| | - Joseba Santamaría-Zuazua
- Department of Maxillofacial Surgery, BioCruces, Hospital Universitario De Cruces, Universidad del Pais Vasco (UPV/EHU), Bilbao, Spain
| | - Augusto Moreira
- Department of Head and Neck Surgery, Instituto Portugues de Oncologia do Porto, Portugal
| | - Manuel Jacome
- Department of Head and Neck Surgery, Instituto Portugues de Oncologia do Porto, Portugal
| | | | - Siavash Rahimi
- Department of Histopathology, San Carlo Hospital Rome, Italy
| | | | - Georges Lawson
- Department of Head and Neck Surgery, CHU Dinant Godinne, Université Catholique de Louvain, Belgium
| | - Marie-Cecile Nollevaux
- Department of Head and Neck Surgery, CHU Dinant Godinne, Université Catholique de Louvain, Belgium
| | - Cesare Grandi
- Department of Otolaryngology, Ospedale S. Chiara, Trento, Italy
| | - Davide Donner
- Department of Nuclear Medicine, Ospedale S. Chiara, Trento, Italy
| | - Emma Bragantini
- Department of Surgical Pathology, Ospedale S. Chiara, Trento, Italy
| | - Didier Dequanter
- Department of Maxillofacial Surgery CHU de Charleroi Belgium, Belgium
| | - Philippe Lothaire
- Department of Maxillofacial Surgery CHU de Charleroi Belgium, Belgium
| | - Tito Poli
- Department of Maxillofacial Surgery, Azienda Ospedaliera, Universitaria of Parma, Italy
| | - Enrico M Silini
- Department of Pathology Azienda Ospedaliera Universitaria of Parma, Italy
| | - Erinco Sesenna
- Department of Maxillofacial Surgery, Azienda Ospedaliera, Universitaria of Parma, Italy
| | - Giles Dolivet
- Department of Head and Neck Surgery Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Romina Mastronicola
- Department of Head and Neck Surgery Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Agnes Leroux
- Department of Pathology Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | | | - Philip Sloan
- Department of Cellular Pathology, Newcastle University Hospital, UK
| | - Mark McGurk
- Department of Head and Neck Surgery, Guys and St Thomas NHS Trust, London, UK.
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Machts R, Reuter T, Prokop P, Schewtschenko O, Stubenrauch M, Schilling C, Witte H. Energy harvesting for active implants: powering a ruminal pH-monitoring system. Current Directions in Biomedical Engineering 2015. [DOI: 10.1515/cdbme-2015-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Energy harvesting is a feasible method to prolong service life of implanted devices. We present a thermal energy harvesting approach for a ruminal pH-monitoring probe in cattle. Thermoelectric generators utilize the temperature gradient between the probe and the ruminal fluid during water intake. The in vivo experiment yielded a maximum electric power of 32 μW.
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Affiliation(s)
- R. Machts
- fzmb GmbH, Geranienweg 7, 99947 Bad Langensalza, Germany
| | - T. Reuter
- fzmb GmbH, Geranienweg 7, 99947 Bad Langensalza, Germany
| | - P.V. Prokop
- fzmb GmbH, Geranienweg 7, 99947 Bad Langensalza, Germany
| | | | - M. Stubenrauch
- fzmb GmbH, Geranienweg 7, 99947 Bad Langensalza, Germany
| | - C. Schilling
- fzmb GmbH, Geranienweg 7, 99947 Bad Langensalza, Germany
| | - H. Witte
- fzmb GmbH, Geranienweg 7, 99947 Bad Langensalza, Germany
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Machts R, Reuter T, Prokop PV, Schewtschenko O, Stubenrauch M, Schilling C, Witte H. Track C. Nano- and Physico-Chemical Systems. BIOMED ENG-BIOMED TE 2015; 60 Suppl 1:s35-46. [DOI: 10.1515/bmt-2015-5002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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46
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Siddiqui S, Sharma D, Schilling C, McGurk M. Speech and Swallowing Outcomes for Patients following Wide Local Excision and Sentinel Node Biopsy for Oral Cancer. Br J Oral Maxillofac Surg 2014. [DOI: 10.1016/j.bjoms.2014.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Lynch M, Mulligan N, Devaney D, Schilling C, Beausang A, Lenane P. Extensive unilateral hyperkeratotic plaques in a blaschkoid distribution. Clin Exp Dermatol 2014; 39:544-6. [PMID: 24758332 DOI: 10.1111/ced.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 11/26/2022]
Affiliation(s)
- M Lynch
- Departments of Dermatology, Children's University Hospital, Dublin, Ireland
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48
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Schilling C, Gnanasegaran G, McGurk M. Three-dimensional imaging and navigated sentinel node biopsy for primary parotid malignancy: New application in parotid cancer management. Head Neck 2014; 36:E91-3. [DOI: 10.1002/hed.23560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/04/2013] [Accepted: 12/03/2013] [Indexed: 02/06/2023] Open
Affiliation(s)
- Clare Schilling
- Department of Oral and Maxillofacial Surgery; Guy's and St Thomas' NHS Foundation Trust; London United Kingdom
| | - Gopinath Gnanasegaran
- Department of Nuclear Medicine; Guy's and St Thomas NHS Foundation Trust; London United Kingdom
| | - Mark McGurk
- Department of Oral and Maxillofacial Surgery; Guy's and St Thomas' NHS Foundation Trust; London United Kingdom
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49
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Lahiff C, Schilling C, Cathcart MC, Mulligan N, Doran P, Muldoon C, Murray D, Pidgeon GP, Reynolds JV, MacMathuna P. Prognostic significance of neuroepithelial transforming gene 1 in adenocarcinoma of the oesophagogastric junction. Br J Surg 2013; 101:55-62. [DOI: 10.1002/bjs.9373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2013] [Indexed: 01/24/2023]
Abstract
Abstract
Background
Neuroepithelial transforming gene 1 (NET1) mediates tumour invasion and metastasis in a number of cancers, including gastric adenocarcinoma. It is an indicator of poor prognosis in breast cancer and glioma. This study examined NET1 expression and its prognostic significance in patients with adenocarcinoma of the oesophagogastric junction (AOG).
Methods
NET1 expression was measured by immunohistochemistry in a tissue microarray, constructed from biobanked tissue collected over a 10-year interval, and linked to a prospectively maintained clinical database.
Results
Using the Siewert classification for AOG, type I tumours expressed significantly higher levels of NET1, with lowest expression in type III and intermediate levels in type II (P = 0·001). In patients with AOG type III, NET1-positive patients were more likely to be female (P = 0·043), have advanced stage cancer (P = 0.035), had a higher number of transmural cancers (P = 0·006) and had a significantly higher median number of positive lymph nodes (P = 0·029). In this subgroup, NET1-positive patients had worse median overall (15 versus 23 months; P = 0·025) and disease-free (11 versus 36 per cent; P = 0·025) survival compared with NET1-negative patients.
Conclusion
Although existing data show differences in clinical and prognostic indices across AOG subtypes, there are no studies showing differences in tumour biology. These data suggest NET1, a known mediator of an aggressive tumour phenotype in a number of gastrointestinal cancers, is expressed differentially across AOG subtypes and may be of prognostic significance in the clinical management of this condition.
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Affiliation(s)
- C Lahiff
- Gastrointestinal Unit, Mater Misericordiae Hospital, Dublin, Ireland
| | - C Schilling
- Department of Pathology, Mater Misericordiae Hospital, Dublin, Ireland
| | - M-C Cathcart
- Department of Surgery, St James's Hospital and Trinity College, Dublin, Ireland
| | - N Mulligan
- Department of Pathology, Mater Misericordiae Hospital, Dublin, Ireland
| | - P Doran
- University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | - C Muldoon
- Department of Pathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - D Murray
- University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | - G P Pidgeon
- Department of Surgery, St James's Hospital and Trinity College, Dublin, Ireland
| | - J V Reynolds
- Department of Surgery, St James's Hospital and Trinity College, Dublin, Ireland
| | - P MacMathuna
- Gastrointestinal Unit, Mater Misericordiae Hospital, Dublin, Ireland
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50
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O'Connor R, Pezier T, Schilling C, McGurk M. The relative cost of sentinel lymph node biopsy in early oral cancer. J Craniomaxillofac Surg 2013; 41:721-7. [DOI: 10.1016/j.jcms.2013.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 10/27/2022] Open
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