Publications by authors named "S O Hoch"

163 Publications

UV light-based reprocessing of flexible endoscopes without working channel in Oto-Rhino-Laryngology: an effective method?

Eur Arch Otorhinolaryngol 2021 Mar 13. Epub 2021 Mar 13.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.

Background: Reprocessing of flexible endoscopes (FEs) is often expensive, time consuming, and becomes increasingly complex, due to rising demands of hygiene. After beneficial results in reprocessing of rigid endoscopes using Impelux™ UV-C light technology, we tested the same method for reprocessing of FEs without working channel.

Materials And Methods: Testing was performed on FEs without working channel after routine clinical use (transnasal flexible endoscopy). Disinfection consisted of mechanical precleaning and 60 s exposure to Impelux™ UV-C light technology. Bacterial contamination was tested on 50 FEs before and after disinfection. Further 50 FEs regarding protein residuals. The absolute effectiveness of the D60 was tested on 50 test bodies (RAMS) with a standardized contamination of 10 colony-forming units (CFU) of Enterococcus faecium.

Results: The FEs were contaminated with a high average value of 916.7 CFU (± 1057 CFU) after clinical usage. After reprocessing, an average contamination of 2.8 CFU (± 1.6) on 14% (n = 7) of the FEs was detected consisting of non-pathogenic species, the remaining FE were sterile. After reprocessing, all FEs were protein-free (< 1 μg). The artificially contaminated test bodies showed no remaining bacterial contamination after disinfection, resulting in an average absolute germ reduction of about 10 CFU.

Conclusion: Impelux™ UV-C light technology efficiently reduces bacterial contamination of FEs and might be useful in daily practice.
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http://dx.doi.org/10.1007/s00405-021-06737-1DOI Listing
March 2021

Anti-IgE: A treatment option in allergic rhinitis?

Allergol Select 2021 24;5:119-127. Epub 2021 Feb 24.

The two first authors have equally contributed to the publication.

Background: Allergic rhinitis (AR) is the most common IgE-mediated allergic disease. Multiple clinical trials have demonstrated promising results on the AR treatment with biologics, in particular with the use of omalizumab - an anti-IgE antibody. Omalizumab has also been established in the routine management of allergic asthma and chronic idiopathic urticaria. However, currently there is no approved license for the use of biologics in AR in Germany.

Materials And Methods: A systematic literature review has been completed including randomized controlled trials, meta-analyses, and reviews on the treatment of AR with omalizumab.

Results: The systematic review demonstrates strong evidence supporting the use of omalizumab in the treatment of AR with regard to symptom control, safety profile, and management of comorbidities.

Conclusion: Omalizumab is a good and safe option in the treatment of AR in terms of symptom control and the management of pre-existing comorbidities. Further clinical trials with other biologics in the management of AR are needed and are expected to follow soon.
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http://dx.doi.org/10.5414/ALX02205EDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905705PMC
February 2021

PROSS 2: a new server for the design of stable and highly expressed protein variants.

Bioinformatics 2020 Dec 26. Epub 2020 Dec 26.

Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel.

Many natural and designed proteins are only marginally stable limiting their usefulness in research and applications. Recently, we described an automated structure and sequence-based design method, called PROSS, for optimizing protein stability and heterologous expression levels that has since been validated on dozens of proteins. Here, we introduce improvements to the method, workflow and presentation, including more accurate sequence analysis, error handling and automated analysis of the quality of the sequence alignment that is used in design calculations. PROSS2 is freely available for academic use at https://pross.weizmann.ac.il.
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http://dx.doi.org/10.1093/bioinformatics/btaa1071DOI Listing
December 2020

On the turbulence structure of deep katabatic flows on a gentle mesoscale slope.

Q J R Meteorol Soc 2020 Apr 23;146(728):1206-1231. Epub 2020 Jan 23.

Department of Atmospheric Sciences, University of Utah Salt Lake City Utah.

A comprehensive analysis of the turbulence structure of relatively deep midlatitude katabatic flows (with jet maxima between 20 and 50 m) developing over a gentle (1°) mesoscale slope with a long fetch upstream of the Meteor Crater in Arizona is presented. The turbulence structure of flow below the katabatic jet maximum shows many similarities with the turbulence structure of shallower katabatic flows, with decreasing turbulence fluxes with height and almost constant turbulent Prandtl number. Still stark differences occur above the jet maximum where turbulence is suppressed by strong stability, is anisotropic and there is a large sub-mesoscale contribution to the flux. Detecting the stable boundary-layer top depends on the method used (flux- vs. anisotropy-profiles) but both methods are highly correlated. The top of the stable boundary layer, however, mostly deviates from the jet maximum height or the top of the near-surface inversion. The flat-terrain formulations for the boundary-layer height correlate well with the detected top of the stable boundary layer if the near-surface and not the background stratification is used in their formulations; however, they mostly largely overestimate this boundary-layer height. The difference from flat-terrain boundary layers is also shown through the dependence of size of the dominant eddy with height. In katabatic flows the eddy size is semi-constant with height throughout the stable boundary-layer depth, whereas in flat terrain, eddy size varies significantly with height. Flux-gradient and flux-variance relationships show that turbulence data from different stable boundary-layer scaling regimes collapse on top of each other showing that the dominant dependence is not on the scaling regime but on the local stability.
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http://dx.doi.org/10.1002/qj.3734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654318PMC
April 2020

Maximum isometric tongue force in patients with obstructive sleep apnoea.

Eur Arch Otorhinolaryngol 2021 Mar 27;278(3):893-900. Epub 2020 Oct 27.

Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Wuppertal, Wuppertal, Germany.

Background: Obstructive sleep apnea (OSA) is a sleep disorder with a prevalence of 9-38%. The underlying pathology in OSA is a collapse of the upper airway. Especially in more severely affected patients, this collapse is often located at the level of the tongue base. Therefore, various implantable systems (anchors and ligament techniques) were developed to prevent or overcome this collapse. These systems are exposed to various forces. Different models have been developed to measure these forces and data comparing forces in healthy individuals with OSA patients are rare.

Purpose: Purpose of the study was to evaluate possible differences in tongue forces between healthy individuals and patients with OSA.

Method: To evaluate maximum isometric tongue forces, we conducted a matched pair design study including 20 healthy individuals and 20 patients suffering from OSA. Maximum isometric tongue forces were measured in an anterior/posterior direction with the help of self-designed new device that clamps the tongue.

Results: We could show that the maximum isometric force does not differ significantly in healthy individuals (10.7 ± 5.2N) from patients with OSA (14.4 ± 6.3N).

Conclusion: Currently there are no indications that maximum isometric tongue force does differ in healthy individuals and patients with OSA. Higher, as well as lower, tongue forces in patients with OSA seem not to differ from healthy subjects and therefore may not be needed to consider, in the development of tongue management devices, for OSA patients.
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http://dx.doi.org/10.1007/s00405-020-06327-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895774PMC
March 2021

Apoptosis-related Proteins Are Altered by Selective Tyrosine Kinase Inhibitors and Everolimus in HPV-dependent SCC.

Anticancer Res 2020 Nov;40(11):6195-6203

Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

Background: Head and neck squamous cell cancer (HNSCC) affects the oral cavity and the pharynx. The aim of the study was to investigate the effects of selective tyrosine kinase inhibitors (TKIs) erlotinib, gefitinib, nilotinib and dasatinib and the mammalian target of rapamycin (mTOR) inhibitor everolimus on the expression of apoptosis-related proteins caspase-3, FAS cluster of differentiation (CD)-95 and FAS ligand in human papilloma virus (HPV)-dependent squamous cancer.

Materials And Methods: Two HPV-negative cell lines (UMSCC-11A/-14C) and one HPV-positive cell line (CERV196) were incubated with TKIs or everolimus and protein concentrations of target proteins were analyzed with enzyme-linked immunosorbent assay (ELISA).

Results: Caspase-3 was affected by the tested TKIs in HPV-positive SCC, whereas FAS CD95 and FAS ligand were influenced in HPV-negative SCC.

Discussion: This is the first study to analyze the influence of TKIs and everolimus on key proteins of apoptosis. Our results provide novel information contributing to a better understanding of the cell biology of HPV-dependent HNSCC and might contribute to the discovery of novel pharmaceutical treatment strategies for HNSCC.
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http://dx.doi.org/10.21873/anticanres.14639DOI Listing
November 2020

Digital support principles for sustained mathematics learning in disadvantaged students.

PLoS One 2020 23;15(10):e0240609. Epub 2020 Oct 23.

Heinz Nixdorf-Chair of Mathematics Education, TUM School of Education, Technical University of Munich, Munich, Germany.

This study addresses the pressing issue of how to raise the performance of disadvantaged students in mathematics. We combined established findings on effective instruction with emerging research addressing the specific needs of disadvantaged students. A sample of N = 260 disadvantaged 6th-graders received 4 weeks (15 lessons) of fraction instruction either as usual or evidence-based instruction, with and without digital learning support (i.e., interactivity, adaptivity, and immediate explanatory feedback). To examine the sustainability of effects, we assessed students' fraction knowledge immediately after the 4 weeks and once again after a period of additional 8 weeks. Generalized linear mixed models revealed that students only benefitted from evidence-based instruction if digital support was available in addition. Digital support principles implemented in evidence-based instruction helped disadvantaged students to acquire mathematics knowledge-and to maintain this knowledge.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240609PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584209PMC
December 2020

UV light-based decontamination: an effective and fast way for disinfection of endoscopes in otorhinolaryngology?

Eur Arch Otorhinolaryngol 2020 Aug 1;277(8):2363-2369. Epub 2020 May 1.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.

Background: Reprocessing of endoscopes becomes increasingly complex, due to rising demands of hygiene. Established methods are often expensive/time-consuming. Recent studies suggest beneficial aspects of disinfection by UV light. In this study we analyzed the efficiency of UV light disinfection of rigid otorhinolaryngological endoscopes.

Materials And Methods: After mechanical pre-cleaning, the endoscopes were decontaminated for 25 s in the D25 using Impelux™ UV C light technology (UV Smart B.V., Delft, The Netherlands). First, the surface contact samples were taken from 50 used endoscopes to evaluate the bacterial load. Additionally, surface contact samples were taken from further 50 used endoscopes after reprocessing with the D25. Another 50 endoscopes were tested on protein residuals. Furthermore, the absolute effectiveness of the D25 was tested on 50 test bodies (RAMS) with a standardized contamination of 10 colony-forming units (CFU) of Enterococcus faecium.

Results: The used endoscopes showed a high bacterial contamination with an average value of 66.908 (± 239.215) CFU. After reprocessing, only a minimal contamination on 10% (n = 5) of the endoscopes with a mean value of 0.12 CFU (± 0.39) was found, resulting in a log-5 reduction in a clinical environment. The documented bacteria were components of the normal skin flora. All tested endoscopes were practically protein-free (< 1 μg). Furthermore, the average absolute germ reduction of the D25 was about 10 CFU on the tested RAMS.

Conclusion: The D25 UV light system seems to be an effective device for the reprocessing of rigid ORL endoscopes, and therefore, might be suitable for the usage in clinical practice on site.
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http://dx.doi.org/10.1007/s00405-020-05978-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335372PMC
August 2020

Clinical relevance of CYFRA 21-1 as a tumour marker in patients with oropharyngeal squamous cell carcinoma.

Eur Arch Otorhinolaryngol 2020 Sep 13;277(9):2561-2571. Epub 2020 Apr 13.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.

Background: The role of Cytokeratin fraction 21-1 (CYFRA 21-1) as a tumour marker for head and neck cancer is still a matter of research. The aim of the present study was to evaluate the clinical impact of CYFRA 21-1 for patients with oropharyngeal squamous cell carcinoma (OSCC).

Patients And Methods: Data of 180 patients with an initial diagnosis of OSCC of any stage between 2003 and 2017 were retrospectively analysed regarding the association between pretherapeutic CYFRA 21-1 levels, clinical characteristics, overall and disease-free survival. Additionally, the potential of CYFRA 21-1 for the detection of recurrent disease in the follow-up was evaluated. The cut-off value was set at 3.3 ng/ml. The median follow-up time was 2.85 years.

Results: A significant correlation of the CYFRA 21-1 concentration at the time of diagnosis and the N-stage was detected (p = 0.01). Patients with CYFRA 21-1 levels > 3.3 ng/ml at first diagnosis showed a significantly shorter overall survival. In the case of disease-progression, a significant increase of CYFRA 21-1 value was found compared to post-therapeutic CYFRA 21-1 levels (9.1 ng/ml versus 5.1 ng/ml; p < 0.01). CYFRA 21-1 level after treatment showed only a low sensitivity of 32% and a specificity of 78% for tumour recurrence.

Conclusion: CYFRA 21-1 correlates with the tumour stage and, therefore, the survival of OSCC patients. Posttreatment CYFRA21-1 seems not to be a suitable predictor of tumour recurrence in the further course of the disease. However, a sudden increase of CYFRA 21-1 during follow-up may indicate a tumour recurrence in the individual patient.
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http://dx.doi.org/10.1007/s00405-020-05962-4DOI Listing
September 2020

Continuous intraoperative neuromonitoring (cIONM) in head and neck surgery-a review.

HNO 2020 Aug;68(Suppl 2):86-92

Department of Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Straße 2, 04552, Borna, Germany.

Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.
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http://dx.doi.org/10.1007/s00106-020-00824-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403167PMC
August 2020

[Continuous intraoperative neuromonitoring (cIONM) in head and neck surgery-a review. German version].

HNO 2020 Nov;68(11):801-809

Klinik für HNO-Heilkunde, Kopf‑/Hals- und plastische Gesichtschirurgie, Sana Kliniken Leipziger Land, Rudolf-Virchow-Straße 2, 04552, Borna, Deutschland.

Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.
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http://dx.doi.org/10.1007/s00106-020-00823-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591407PMC
November 2020

Correction to: Safety of the "Saxophone" electrode in parotid surgery for continuous intraoperative neuromonitoring of the facial nerve: results of a pro- and retrospective cohort study.

Eur Arch Otorhinolaryngol 2020 May;277(5):1457-1458

Department of Otolaryngology, Head and Neck Surgery, Borromaeus Hospital Leer, Leer, Germany.

In the original publication of the article, first name and last names of all authors were swapped.
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http://dx.doi.org/10.1007/s00405-020-05885-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160065PMC
May 2020

Safety of the "Saxophone" electrode in parotid surgery for continuous intraoperative neuromonitoring of the facial nerve: results of a pro- and retrospective cohort study.

Eur Arch Otorhinolaryngol 2020 May 27;277(5):1449-1456. Epub 2020 Jan 27.

Department of Otolaryngology, Head and Neck Surgery, Borromaeus Hospital Leer, Leer, Germany.

Purpose: Early facial nerve palsy (eFNP) is the most frequent complication of the parotidectomy. Intraoperative neuromonitoring (IONM) in parotid surgery, which aims at reducing eFNP, has not evolved any further than the mere differentiation between the nerve and the surrounding tissue. Continuous IONM (cIONM), used in thyroid and posterior fossa surgery, has developed over the past years and has proved beneficial in reducing the rate of paresis in cases where a pattern of impending nerve injury is identified. In this study, we aim to demonstrate the safety of using the stimulating electrode (Saxophone) for cIONM in parotid surgery.

Methods: From 2016 to 2018, 40 patients who were referred for primary parotidectomy under cIONM according to our study protocol (registered at the German Clinical Trials Register, DRKS-ID: DRKS00011051, http://www.drks.de; http://apps.who.int/trialsearch) were included in this study. All patients with a normal preoperative facial nerve function [House-Brackman (HB)-Index 1] underwent surgery using continuous facial nerve stimulation with the Saxophone electrode (system AVALANCHE XT, Dr. Langer Medical, Waldkirch, Germany). A control group which underwent parotidectomies with only intermittent IONM was recruited from our records.

Results: Half of the patients in our study group suffered from eFNP. All except one regained normal facial nerve function within 6 months of surgery. There was no significant difference regarding eFNP when compared to the control group without cIONM (p = 0.11). No statistically significant correlation between the stimulation threshold (p = 0.74) or the duration of nerve stimulation and eFNP was found (p = 0.51).

Conclusion: We have demonstrated the safety of using the Saxophone-electrode for cIONM of the facial nerve in parotid surgery. Future development of this method could enable the recognition of impending nerve injury and thus reduce eFNP.
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http://dx.doi.org/10.1007/s00405-020-05803-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160092PMC
May 2020

Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach-Long-Term Outcome and Literature Review.

J Clin Med 2019 Nov 5;8(11). Epub 2019 Nov 5.

Department of Oto-Rhino-Laryngology, 1st ENT University Department of Athens, "Ippokrateio" General Hospital of Athens, Leof. Vasilissis Sofias 114, 11527 Athens, Greece.

There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity.
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http://dx.doi.org/10.3390/jcm8111873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912689PMC
November 2019

CYFRA 21-1: a suitable tumor marker in patients with head and neck cutaneous squamous cell carcinoma?

Eur Arch Otorhinolaryngol 2019 Dec 3;276(12):3467-3475. Epub 2019 Sep 3.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.

Purpose: The clinical significance of cytokeratin fraction 21-1 (CYFRA 21-1) for patients with head and neck cutaneous squamous cell carcinoma (CSCC) is unknown. Thus, the aim of the study was to evaluate the clinical value of CYFRA 21-1 in the context of treatment and follow-up for these patients.

Methods: The clinical, histological and laboratory data of a total of 55 patients with the first diagnosis of head and neck cutaneous squamous cell carcinoma (T1-T4, N0-N2b, M0-1) between 2003 and 2017 were retrospectively analyzed. In 25 cases, the primary tumor could be treated successfully without residual or recurrent disease in the further course. The average follow-up period was 2.3 years. In all patients, pretherapeutic determination of CYFRA 21-1 was performed using the ECLIA test kit. The cut-off value was set at 3.3 ng/ml.

Results: In 18 patients (32.7%), regional recurrence was found in the course of treatment. Distant metastases could be observed in two patients (3.6%). In these cases, no significant increase of CYFRA 21-1 blood concentration was detected at the time of recurrence/metastasis. At the time of the first diagnosis, the mean value of CYFRA 21-1 blood concentration was 2.4 ng/ml; and in cases of regional recurrence or distant metastases, the initial mean CYFRA 21-1 concentration was 2.0 ng/ml. There was no statistically significant relationship between CYFRA 21-1 blood concentration and analyzed tumor characteristics.

Conclusions: According to current knowledge, the tumor marker CYFRA 21-1 is not clinically significant for treatment and follow-up of patients with head and neck CSCC.
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http://dx.doi.org/10.1007/s00405-019-05614-2DOI Listing
December 2019

Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure.

Auris Nasus Larynx 2019 Oct 11;46(5):797-802. Epub 2019 Feb 11.

Department of Otorhinolaryngology, Universitaetsklinikum Leipzig, Germany.

Objective: To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series.

Methods: We performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017.

Results: We performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients. Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis.

Conclusion: Holmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.
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http://dx.doi.org/10.1016/j.anl.2019.01.009DOI Listing
October 2019

Shorter hospital stays in epistaxis patients with atrial fibrillation when taking rivaroxaban or apixaban versus phenprocoumon.

J Thromb Thrombolysis 2019 Apr;47(3):384-391

Department of Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany.

Patients taking oral anticoagulants (OACs) currently represent one-third of all patients treated for epistaxis and an upward trend is expected. New direct oral anticoagulants (DOACs) have been on the market for approximately 10 years. DOACs are favoured over Vitamin K-Antagonists (VKAs) in the current guidelines. There are barely studies that investigate the impact of DOACs on patients with epistaxis. A retrospective study was performed analysing all patients who had stationary treatment for epistaxis from 01.01.2011 to 01.01.2018 in a tertiary care centre. In a total of 466 patients, 46.1% were on OACs. The main indication was atrial fibrillation (AF, 67.4%).The number of DOACs taken surpassed that of the VKAs during the past 2 years. The length of hospital stay was significantly longer in the phenprocoumon group (3 ± 0.2 days) in comparison to both the rivaroxaban (2.3 ± 0.1) and the apixaban (2.2 ± 0.1) groups (p = 0.005). Posterior epistaxis occurred more frequently in the phenprocoumon group (10.8%) than in the rivaroxaban (0%) and apixaban (0%) groups (p = 0.03). A correlation between CHADS-VASc score (risk score for apoplexy in patients with AF, p = 0.01), HAS-BLED score (score for assessment of major bleeding in patients taking anticoagulants with AF, p = 0.006), and length of hospital stay (p = 0.002) with recurrence of epistaxis was found. Shorter hospital stays and exclusively anterior bleeding was noted in AF patients taking rivaroxaban and apixaban, whereas AF patients taking phenprocoumon stayed in hospital longer and had more posterior bleeding.
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http://dx.doi.org/10.1007/s11239-019-01824-xDOI Listing
April 2019

Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study.

Int J Otolaryngol 2017 8;2017:8430907. Epub 2017 Aug 8.

Department Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany.

Background: Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TE) could be assumed to decrease PTH compared to traditional tonsillectomy (TE).

Methods: In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured.

Results: 869 patients were included (183 TE; 686 TE). PTH requiring RTT was not seen in the TE group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TE group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TE were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% ( > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH ( = 0.007).

Conclusion: Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TE group. Benefit for TE was observed in high-volume and long experienced surgeons.
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http://dx.doi.org/10.1155/2017/8430907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591894PMC
August 2017

Stimulates TLR2-PI3K Signaling to Escape Immune Clearance and Induce Bone Resorption Independently of MyD88.

Front Cell Infect Microbiol 2017 8;7:359. Epub 2017 Aug 8.

Institute of Dental Sciences, Hebrew University-Hadassah Faculty of Dental MedicineJerusalem, Israel.

is a gram-negative anaerobic periodontal pathogen that persists in dysbiotic mixed-species biofilms alongside a dense inflammatory infiltrate of neutrophils and other leukocytes in the subgingival areas of the periodontium. Toll-like receptor 2 (TLR2) mediates the inflammatory response to and TLR2-deficient mice resist alveolar bone resorption following oral challenge with this organism. Although, MyD88 is an adaptor protein considered necessary for TLR2-induced inflammation, we now report for the first time that oral challenge with leads to alveolar bone resorption in the absence of MyD88. Indeed, in contrast to prototypical TLR2 agonists, such as the lipopeptide Pam3CSK4 that activates TLR2 in a strictly MyD88-dependent manner, strikingly induced TLR2 signaling in neutrophils and macrophages regardless of the presence or absence of MyD88. Moreover, genetic or antibody-mediated inactivation of TLR2 completely reduced cytokine production in -stimulated neutrophils or macrophages, suggesting that TLR2 plays a non-redundant role in the host response to . In the absence of MyD88, inflammatory TLR2 signaling in -stimulated neutrophils or macrophages depended upon PI3K. Intriguingly, TLR2-PI3K signaling was also critical to evasion of killing by macrophages, since their ability to phagocytose this pathogen was reduced in a TLR2 and PI3K-dependent manner. Moreover, within those cells that did phagocytose bacteria, TLR2-PI3K signaling blocked phago-lysosomal maturation, thereby revealing a novel mechanism whereby can enhance its intracellular survival. Therefore, uncouples inflammation from bactericidal activity by substituting TLR2-PI3K in place of TLR2-MyD88 signaling. These findings further support the role of as a keystone pathogen, which manipulates the host inflammatory response in a way that promotes bone loss but not bacterial clearance. Modulation of these host response factors may lead to novel therapeutic approaches to improve outcomes in disease conditions associated with .
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http://dx.doi.org/10.3389/fcimb.2017.00359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550410PMC
April 2018

Coupling between Chemical and Meteorological Processes under Persistent Cold-Air Pool Conditions: Evolution of Wintertime PM Pollution Events and NO Observations in Utah's Salt Lake Valley.

Environ Sci Technol 2017 Jun 16;51(11):5941-5950. Epub 2017 May 16.

Department of Physics, Weber State University , Ogden, Utah 84408, United States.

The Salt Lake Valley experiences severe fine particulate matter pollution episodes in winter during persistent cold-air pools (PCAPs). We employ measurements throughout an entire winter from different elevations to examine the chemical and dynamical processes driving these episodes. Whereas primary pollutants such as NO and CO were enhanced twofold during PCAPs, O concentrations were approximately threefold lower. Atmospheric composition varies strongly with altitude within a PCAP at night with lower NO and higher oxidants (O) and oxidized reactive nitrogen (NO) aloft. We present observations of NO during PCAPs that provide evidence for its role in cold-pool nitrate formation. Our observations suggest that nighttime and early morning chemistry in the upper levels of a PCAP plays an important role in aerosol nitrate formation. Subsequent daytime mixing enhances surface PM by dispersing the aerosol throughout the PCAP. As pollutants accumulate and deplete oxidants, nitrate chemistry becomes less active during the later stages of the pollution episodes. This leads to distinct stages of PM pollution episodes, starting with a period of PM buildup and followed by a period with plateauing concentrations. We discuss the implications of these findings for mitigation strategies.
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http://dx.doi.org/10.1021/acs.est.6b06603DOI Listing
June 2017

Hyperplasia and the degree and activity of inflammation in chronic recurrent tonsillitis: a histopathological study.

Eur Arch Otorhinolaryngol 2017 Jul 24;274(7):2927-2932. Epub 2017 Apr 24.

Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany.

Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p > 0.001). AOI (grade 2) displayed the same properties in the middle section (p < 0.002), but did not reach statistical significance in the cranial and caudal sections (p = 0.107 and p = 0.186). An overabundance of grade 1 GOI, AOI, and HP was seen in the pharyngeal sections. The results show that two out of three relevant parameters that demonstrate histopathological changes in recurrent inflamed tonsils have a significantly stronger presence in the basal section of the tonsil as opposed to the pharyngeal section. The processes initiated by inflammation next to the surface responsible for a clinically relevant recurrent tonsillitis seem to cause stronger reactions in the deep follicular portion of the tonsils.
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http://dx.doi.org/10.1007/s00405-017-4575-yDOI Listing
July 2017

When are metabolic ratios superior to absolute quantification? A statistical analysis.

NMR Biomed 2017 Jul 8;30(7). Epub 2017 Mar 8.

Department of Chemical Physics, Weizmann Institute of Science, Rehovot, Israel.

Metabolite levels measured using magnetic resonance spectroscopy (MRS) are often expressed as ratios rather than absolute concentrations. However, the inter-subject variability of the denominator metabolite can introduce uncertainty into a metabolite ratio. In a clinical setting, there are no guidelines on whether ratios or absolute quantification should be used for a more accurate classification of normal versus abnormal results based on their statistical properties. In a research setting, the choice of one over the other can have significant implications on sample size, which must be factored in at the study design stage. Herein, we derive the probability distribution function for the ratio of two normally distributed random variables, and present analytical expressions for the comparison of ratios with absolute quantification in terms of both sample size and area under the receiver operator characteristic curve. The two approaches are compared for typical metabolite values found in the literature, and their respective merits are illustrated using previously acquired clinical MRS data in two pathologies: mild traumatic brain injury and multiple sclerosis. Our analysis shows that the decision between ratios and absolute quantification is non-trivial: in some cases, ratios might offer a reduction in sample size, whereas, in others, absolute quantification might prove more desirable for individual (i.e. clinical) use. The decision is straightforward and exact guidelines are provided in the text, given that population means and standard deviations of numerator and denominator can be reliably estimated.
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http://dx.doi.org/10.1002/nbm.3710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411280PMC
July 2017

Impact of Different Treatment Concepts on Regional Failure in Advanced Oropharyngeal Cancer.

Anticancer Res 2017 02;37(2):727-734

Department of Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Marburg, Germany.

Background: The management of patients with advanced oropharyngeal cancer is complex and mostly requires a multidisciplinary treatment approach. In general, organ preservation by primary concurrent radiochemotherapy (RCT), or surgery completed by adjuvant radiotherapy are established treatment strategies for these patients. However, it is unclear if primary treatment has an effect on regional tumor control. The purpose of the present study was to evaluate the regional control after different treatment concepts.

Patients And Methods: Clinical data, including histological and radiological results, of 82 patients with T2-T3 oropharyngeal cancer and N2 neck were retrospectively analyzed. They underwent either RCT with salvage neck dissection (ND) (n=45), or primary transoral surgery with ND and adjuvant RCT (n=37). In all cases, the primary tumor was successfully treated, without evidence of local failure in the follow-up.

Results: Overall, 11 (13.4%) patients developed regional failure during the follow-up. There were no significant differences in frequency of regional failure (p=0.75), distant metastasis (p=0.35) and overall survival (p=0.22) between treatment groups. However, 5-year disease-free survival was significantly worse (39.0% vs. 57.0%) for patients treated by RCT, with more frequent regional failure detected compared to surgically-treated patients in univariate analysis (p=0.04).

Conclusion: Treatment concept does not seem to affect regional tumor control in advanced oropharyngeal cancer after successful treatment of the primary tumor.
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http://dx.doi.org/10.21873/anticanres.11370DOI Listing
February 2017

Congenital Unilateral Agenesis of the Parotid Gland: A Case Report and Review of the Literature.

Case Rep Dent 2016 8;2016:2672496. Epub 2016 Nov 8.

Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.

Congenital unilateral agenesis of the parotid gland is a rare condition with only few cases reported in the literature. A review of 21 cases in the available literature is presented in this article. We report on a further case of a 34-year-old woman with agenesis of the left parotid gland and lipoma of the right cheek. Clinicopathological characteristics of described cases in the literature were discussed.
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http://dx.doi.org/10.1155/2016/2672496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118519PMC
November 2016

Advanced Evaluation of the Long-Term Stability of Oxygen Evolution Electrocatalysts.

Anal Chem 2016 08 21;88(15):7597-602. Epub 2016 Jul 21.

Analytical Chemistry-Center for Electrochemical Sciences (CES), Ruhr-Universität Bochum , Universitätsstrasse 150, D-44780 Bochum, Germany.

Evaluation of the long-term stability of electrocatalysts is typically performed using galvanostatic polarization at a predefined current density. A stable or insignificant increase in the applied potential is usually interpreted as high long-term stability of the tested catalyst. However, effects such as (i) electrochemical degradation of a catalyst due to its oxidation, (ii) blocking of the catalyst surface by evolved gas bubbles, and (iii) detachment of the catalyst from the electrode surface may lead to a decrease of the catalyst's active surface area being exposed to the electrolyte. In order to separate these effects and to evaluate the true electrochemical degradation of electrocatalysts, an advanced evaluation protocol based on subsequently performed electrochemical impedance, double layer capacitance, cyclic voltammetry, and galvanostatic polarization measurements was developed and used to evaluate the degradation of IrO2 particles drop-coated on glassy carbon rotating disk electrode using Nafion as a binder. A flow-through electrochemical cell was developed enabling circulation of the electrolyte leading to an efficient removal of evolved oxygen bubbles even at high current densities of up to 250 mA/cm(2). The degradation rate of IrO2 was evaluated over 225 test cycles (0.733 ± 0.022 mV/h) with a total duration of galvanostatic polarization measurements of over 55 h.
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http://dx.doi.org/10.1021/acs.analchem.6b01289DOI Listing
August 2016

Safety and Efficacy of Botulinum Toxin to Preserve Gland Function after Radiotherapy in Patients with Head and Neck Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blinded Phase I Clinical Trial.

PLoS One 2016 18;11(3):e0151316. Epub 2016 Mar 18.

Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.

This prospective, randomized, placebo-controlled, double-blinded phase I clinical trial investigates safety and efficacy of botulinum toxin (BoNT) to preserve gland function after radiotherapy in patients with head and neck cancer. Twelve patients with advanced head and neck cancer were injected with BoNT into the submandibular glands prior to primary radiochemotherapy. Six patients received BoNT/A and 6 patients BoNT/A and B, half of each subgroup into their left and the other half into their right gland. As an internal control, sodium chloride was injected into the respective contralateral gland (placebo). For the evaluation of the salivary gland function, technetium pertechnetate salivary gland scintigraphy was performed before and after the end of radiotherapy. BoNT/A and B were well tolerated. Analysis of the scintigraphic data revealed no statistically significant difference between BoNT and placebo regarding the scintigraphic uptake difference (pBoNT/A = 0.84 and pBoNT/A-B = 0.56 for BoNT/A vs. placebo and BoNT/A-B vs. placebo, respectively). We also found no significant difference in treatment between BoNT and placebo in terms of salivary excretion fraction (pBoNT/A = 0.44; pBoNT/A-B = 0.44). This study demonstrates that BoNT can be safely combined with radiochemotherapy. Dosing and timing of BoNT injection should be further investigated for efficacy analysis. Trial Registration German Registry for Clinical Trails DRKS00004595.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151316PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4798778PMC
August 2016

Extent of Salvage Neck Dissection in Advanced Oro- and Hypopharyngeal Cancer.

Anticancer Res 2016 Mar;36(3):981-6

Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.

Background/aim: Primary radiochemotherapy (RCT) is becoming increasingly important in patients with oro- and hypopharyngeal cancer. However, debate exists on the extent of salvage neck dissection (ND) in those patients. The purpose of the present study was to evaluate the regional control after salvage ND.

Patients And Methods: Clinical, histological and radiological data, results of 51 patients with oro- or hypopharyngeal cancer and N2 neck who underwent selective ND in case of radiological evidence of residual neck disease, were retrospectively analyzed.

Results: Altogether 52 metastases were detected in 20 (39.2%) patients by histological examination. They were localized in level II (n=23), III (n=13), IV (n=11) and V (n=5). Regional recurrence occurred in 4 patients (7.8%) in previous dissected neck levels in the follow-up.

Conclusion: Selective ND of suspicious neck levels for residual disease after RCT of oro- and hypopharyngeal cancer seems to be a sufficient treatment.
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March 2016

Oncological and surgical outcome of total laryngectomy in combination with neck dissection in the elderly.

Eur Arch Otorhinolaryngol 2016 Jul 14;273(7):1825-33. Epub 2016 Mar 14.

Department of Otolaryngology, Head and Neck Surgery, Philipp University, Baldingerstr., 35043, Marburg, Germany.

There are controversial data on oncological and surgical outcome after major head and neck cancer surgery in the elderly. The aim of this study was to evaluate the outcome of elderly cancer patients after total laryngectomy in combination with neck dissection. A total of 58 patients separated into two age groups (28 < 65 vs. 30 ≥ 65 years) with hypopharyngeal and laryngeal cancer who underwent total laryngectomy and neck dissection were enrolled. Comorbidities of both age groups using the Charlson comorbidity index, hospitalization days as well as surgical complications evaluated by the Clavien-Dindo classification were examined. Overall and disease-free survivals of all patients were analyzed. The average follow-up was 2.9 years. Surgical complication rate was significantly increased in elderly (p = 0.04). However, complications could be treated without surgical intervention in most cases without significant extension of hospitalization. Locoregional and distant control did not significantly differ in both age groups. Disease-free and overall survival showed no significant differences for the two age groups by the Kaplan-Meier analysis (p = 0.66 and 0.08, respectively). Total laryngectomy in combination with neck dissection can be considered in elderly patients with satisfactory oncological and surgical outcome.
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http://dx.doi.org/10.1007/s00405-016-3970-0DOI Listing
July 2016

Clinical impact of radiographic carotid artery involvement in neck metastases from head and neck cancer.

Int J Oral Maxillofac Surg 2016 Apr 24;45(4):422-6. Epub 2015 Dec 24.

Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.

The treatment of lymph node metastases involving the carotid artery is controversial. The aim of the present study was to determine the outcomes of head and neck cancer patients with radiographic carotid artery involvement in neck metastases. A total of 27 patients with head and neck cancer and radiologically diagnosed advanced metastases involving the common carotid artery or internal carotid artery were enrolled. All patients underwent a primary or salvage neck dissection and surgical carotid peeling. The oncological outcome and survival of all patients were analyzed. Loco-regional control was observed in 13 of the 27 patients (48.1%). During follow-up, five patients (18.5%) developed second primaries and 11 (40.7%) developed distant metastases. The survival time was poor independent of regional control. The median overall survival was 1.55 years and disease-free survival was 0.71 year. Radiographic carotid artery involvement in neck metastases in head and neck cancer appears to correlate with a poor long-term prognosis, with a high rate of distant metastases despite loco-regional control.
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http://dx.doi.org/10.1016/j.ijom.2015.11.017DOI Listing
April 2016