Cancer Subclones Derived from the Patient's Head and Neck Squamous Cell Carcinoma Tumor Stem Cells for the Screening of Personalized Antitumor Immunotherapy and Chemotherapy

Studying on subclonal evolution of cancer stem cells can help illustrate how the immune system recognizes tumor cells, leading to subclonal treatment by immune-based therapies. Here, we discuss that cancer subclones derived from the patient's head and neck squamous cell carcinoma tumor stem cells can be used for the screening of personalized antitumor immunotherapy and chemotherapy, to maximize benefits and to minimize the adversary effects, toward personalized or precision medicine. We propose a "wait-and-watch" scheme for monitoring a lifetime cancer stem cell subclonal development evolved with local environments to cancer.

The Effects of Superoxide Dismutase in Gerbils with Bacterial Meningitis

BACKGROUND: Inflammatory products, such as oxygen radicals generated during the course of bacterial meningitis, can damage nerve endings, hair cells, and/or supporting cells in the cochlea. Superoxide dismutase (SOD), an O2-scavenger, has been shown to play an important role in the protection against radical toxicity in various animal experiments.

OBJECTIVE: To study the antioxidant effects of SOD on the inflammatory response of gerbils with bacterial meningitis.

STUDY DESIGN: Meningitis was induced in three groups of 10 gerbils by intrathecal (IT) injection of Streptococcus pneumoniae into the cisterna magna. Group 1 received IT SOD, group 2 received intramuscular (IM) SOD, and group 3, the control group, received IM normal saline. Histologic data and auditory brainstem responses (ABR) were obtained from each gerbil.

RESULTS: Fibrosis and/or neo-ossification were near absent in the IT SOD group and significantly less fibrosis occurred in the IM group (IT vs. IM: P = 0.010; IT vs. control group: P = 0.001). The amount of surviving spiral ganglion cells correlated inversely with the extent of fibrosis (r = −0.753, P < 0.00001).

CONCLUSIONS: IT injection of SOD significantly reduced cochlear fibrosis and neo-ossification, reduced the spiral ganglion cell loss, and decreased damage of the cochlear components following bacterial meningitis.

Nonmelanoma skin cancer of the head and neck II: surgical treatment and reconstruction

Surgical treatment of non-melanoma skin cancers (NMSC) is most often straight forward and can be performed as an office-based procedure by non-surgically trained professionals. However, the cases that present to an Otolaryngology practice typically will involve difficult-to-treat lesions around the face and lesions that necessitate an in depth knowledge of how to balance the need for adequate surgical margins with the reconstructive contraints imposed by aesthetic subunits of the face. This article discusses modern concepts of surgical margins for NMSC, including the Moh's micrographic surgical technique, and then reviews the most common reconstructive strategies for difficult-to-treat areas on the face. The goal of this paper is to help the general Otolaryngollogists to understand the basic principles of surgical resection and reconstruction of NMSC lesions on the face.

Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior

Non-Melanoma skin cancer (NMSC) is the most commonly encountered malignancy in almost every area of practice, but the cases that present to an Otolaryngology practice will be advanced in nature. The major subtypes of NMSC include basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, merkel cell carcinoma, and adnexal malignancies. In this review, we present the epidemiology, histology, clinical presentation and management of these major subtypes. Further, we present background on multimodality treatment for NMSC lesions that have become metastatic from their primary site and an introduction to the behavior and treatment of NMSC lesions in patients who have received organ transplants. Understanding the clinical behavior of advanced NMSC is essential knowledge for a general Otolaryngologist.

Summating potential and action potential ratio in Meniere's disease before and after treatment

OBJECTIVE

This study aimed to compare the summating potential and action potential ratio (SP:AP) in patients with Meniere's disease before and after various surgical and medical treatments as an indication of change in endolymphatic hydrops to study the progression of Meniere's disease.

STUDY DESIGN

The study design was a retrospective case review.

SETTING

The study was conducted at an otology-neurotology referral center.

PATIENTS

Eighty-eight ears of 84 patients with Meniere's disease received medical treatment in 18 ears and surgical treatments including endolymphatic shunt in 12 ears, streptomycin perfusion of the lateral semicircular canal in 9 ears, streptomycin perfusion of the middle ear in 33 ears, and dexamethasone perfusion of the middle ear in 16 ears.

INTERVENTION

Transtympanic electrocochleography (ECoG) was performed in all patients before treatment and 1-57 months after treatment (mean, 13.5 months) with a 2-year interval in 28 patients.

MAIN OUTCOME MEASURE

An enlarged SP:AP ratio (> or = 0.40) was used as the diagnostic criterion for endolymphatic hydrops.

RESULTS

Overall, an enlarged SP:AP ratio was found in 75% of ears before treatment and 78% after treatment. The SP:AP ratio, when enlarged, remained enlarged in 91% of ears. A nonenlarged SP:AP ratio before treatment became enlarged after treatment in 41% of ears. In American Academy of Otolaryngology-Head and Neck Surgery stage 1 Meniere's disease (pure-tone threshold average < or = 25 dB), an enlarged SP:AP was found in 58% of ears before treatment and 79% after. Twenty-five (89%) of 28 patients followed for 2 years were free of vestibular symptoms after treatment, and in 22 patients (79%), the SP:AP remained enlarged. The distribution of an enlarged SP:AP ratio was associated with the duration of disease (chi-square = 33.5552, p < 0.01).

CONCLUSIONS

The development of endolymphatic hydrops, as indicated by an enlarged SP:AP, is part of the progression of Meniere's disease. The longer the duration of the disease, the more likely the SP:AP ratio will be enlarged. These findings indicate that endolymphatic hydrops as detected by ECoG was not reversed in this study by the treatments used. Despite the absence of definitive spells of vertigo in most patients, endolymphatic hydrops as evidenced by an enlarged SP:AP ratio persisted.

Action potential latency shift by rarefaction and condensation clicks in Menière's disease

Transtympanic electrocochleography using rarefaction and condensation clicks was performed on 122 ears of 112 patients, including 98 ears of 89 patients with Menière's disease (MD) and 24 ears of 23 patients without Menière's disease (NMD). The mean action potential (AP) latency difference between rarefaction and condensation clicks was 0.40 +/- 0.37 msec in the MD group and 0.06 +/- 0.07 msec in the NMD group (p < .01). An AP latency shift > 0.2 msec was found more often in the MD group (62.2% vs 8.3%) and in ears with an enlarged summating potential and AP ratio (69.7% vs 36.4%). The results suggest that comparison of rarefaction and condensation latencies may serve as a useful addition to electrocochleography in the diagnosis of MD.

Cochlear microphonics in Ménière's disease

The pathophysiology of hearing deterioration in Ménière's disease (MD) is unclear. Hair cell loss has been proposed to be the cause of severe hearing loss in Ménière's disease. The cochlear microphonic (CM) is known to be the receptor potential of the outer hair cells in the cochlea. This study measured the CM in Ménière's disease and investigated its relationship with the degree of hearing impairment and endolymphatic hydrops. Transtympanic electrocochleography (ECoG) using rarefaction (RAR) and condensation (CON) tonebursts at 1 kHz was performed on 130 ears of 119 patients. Ninety six ears were diagnosed to have MD and 34 were diagnosed non-Ménière's disease (NMD). The mean amplitude of the CM was 33.10 +/- 46.04 microV in the MD group and 13.15 +/- 12.77 microV in the NMD group (p < 0.001). Enlarged negative summating potential and action potential ratios (SP:AP > 40%) were found in 81.3% of the MD group and 17.6% of the NMD group. In the MD group, the CM in the group with an enlarged negative SP was 36.98 +/- 49.78 microV, and 16.31 +/- 15.88 microV in the group without (p < 0.01). The CM was 34.33 +/- 49.28 microV in the pure-tone average (PTA) < or = 25 dB group, 46.97 +/- 58.31 microV in the 26-40 dB group, 29.12 +/- 42.62 microV in the 41-70 dB group, and 26.20 +/- 22.41 microV in the > 70 dB group (p > 0.05). The CMs in 11 pairs of MD ears and sensorineural hearing loss (SNHL) ears with matching hearing (MD 44 dB, SNHL 45 dB) were measured. They were 71.42 +/- 75.94 microV and 7.90 +/- 5.89 microV, respectively (p < 0.01). Our study shows that the CM is higher in ears with endolymphatic hydrops, evidenced by an enlarged SP:AP ratio, than ears without and the CM shows no statistical difference in groups with different levels of hearing loss. These findings suggest that hearing loss with a large CM in Ménière's disease patients may be the result of an alteration of cochlear mechanics and only severe hearing loss with a small CM is caused by hair cell loss. The CM measurement, to evaluate the hair cell status, may be helpful in identifying patients whose hearing may be recoverable if the underlying hydrops can be corrected. Our data do not permit the conclusion that an enlarged CM can be used in the diagnosis of MD.