NA Laryngoscope, 126:2528-2533, 2016.

Objectives: To systematically review the success rate and safety profile of the available endoscopic surgical options for radiation-induced dysphagia in head and neck cancer patients following organ preservation treatment, including upper esophageal sphincter (UES) dilation, cricopharyngeus (CP) myotomy (CPM), and CP intramuscular botulinum toxin (Botox) injection. Methods: A search of MEDLINE, Scopus, Google Scholar, and Cochrane databases was done to identify articles published between January 1980 and December 2017. Pediatric series, foreign language articles, series with Zenker’s diverticulum or following primary surgical treatment including laryngectomy, open UES/CP surgery, or samples with fewer than 5 patients were excluded. Results: An initial search identified 539 articles. All titles and abstracts were reviewed. One hundred and sixteen potentially relevant articles were inspected in more detail, and 14 retrospective studies met eligibility criteria. Dilation group included 10 studies on anterograde and/or retrograde dilation, with an overall 208 patients. Success rate ranged from 42% to 100%. The endoscopic CPM group included 3 studies with a total of 36 patients, and the success rate ranged from 27% to 90%. In the Botox group, 1 one study with 20 patients met our inclusion criteria, with an overall 65% success rate (13/20). Major complications were only reported in the dilation group, which included esophageal perforation and death. Conclusions: The lack of consistency across trials indicates insufficient evidence for guiding clinical practice. This systematic review suggests the need for greater standardization of outcomes and instruments. Future prospective evaluation should use validated patient-rated and clinician-rated assessment tools to optimally measure postoperative swallowing outcomes of head and neck cancer dysphagic patients following organ preservation therapy.

Essential vocal tremor (EVT) is the presence of a tremulous voice that is commonly associated with essential tremor. Patients with EVT often report a necessary increase in vocal effort that significantly worsens with stress and anxiety and can significantly impact quality of life despite optimal medical and behavioral treatment options. Deep brain stimulation (DBS) has been proposed as an effective therapy for vocal tremor, but very few studies exist in the literature that comprehensively evaluate the efficacy of DBS for specifically addressing EVT. We present a technical report on our multidisciplinary, comprehensive operative methodology for treatment of EVT with frameless, awake deep brain stimulation (DBS).

Introduction: Electronic cigarettes pose a serious emerging risk for cardiovascular disease. Despite a significant association between exposure to e-cigarettes (e-cigs) and burden of coronary artery disease, the pathogenic mechanism is not well understood. The environment sensing transcription factor aryl-hydrocarbon receptor (Ahr) pathway has been implicated in tobacco-induced atherosclerosis but its role in e-cigarette exposure is not known. Methods: SMC-lineage tracing mice (WT, n=3) and SMC-specific Ahr knockout (KO, n=3) mice on a ApoE null hyperlipidemic background were put on high fat diet for 12 weeks and exposed to pod-based e-cigs (Juul) daily for 2 weeks in a whole body chamber (inExpose, Scireq) and compared to WT mice exposed to air (n=3). The aortic sinus was dissected and digested, FACS was performed to sort for live single cells, then single-cell RNA-Seq and ATAC-seq were performed on the 10X Genomics platform. Analyses were completed with Seurat and Signac tools. Results: There were total of 20102 cells included in the scRNA-Seq analysis (WT Control 5282, WT exposed to e-cig (WT-Ecig) 9425, and KO exposed to Juul (KO-Ecig) 5395). We found increased Cyp1b1 expression in the modulated SMC population in the WT-Ecig group, suggesting activation of the Ahr pathway. The proportion of modulated SMC to quiescent SMC remained comparable following E-cig exposure in the WT mice. We identified a new cluster of SMC lineage cells that were enriched for markers of heat shock response, including Hspb1, Hsp90aa1 , and Cryab . This subpopulation of SMC was nearly absent in the SMC-specific Ahr KO mice exposed to E-cigs. The scATAC-seq profiles showed enrichment for motifs of CCAAT/enhancer-binding proteins, and pathways of cytokine production, ECM organization, and cell migration in the clusters of heat shock response-activated SMC, as well as significant enrichment for Hsf2 motifs in open chromatin regions following E-cig exposure. Conclusion: Using single-cell genomics of atherosclerotic plaque from mice exposed to e-cigs, we identified the heat shock response pathway to be uniquely activated in the modulated SMC-lineage population, and that this process may be mediated by Ahr.