Predictors of swallowing outcome in patients treated with surgery and radiotherapy for advanced oral and oropharyngeal cancer

Retaining effective swallowing is a key element when optimising outcomes in the management of head and neck cancer. We report the functional swallowing outcomes for a cohort of 31 individuals with advanced oral and oropharyngeal cancer who underwent free or pedicled flap reconstruction of surgical defects. Swallowing was assessed pre and immediately post surgery and at four months post treatment. Swallowing assessments were related to site, size and volume of defect and composition of flap reconstruction. The effect of radiotherapy on swallowing was assessed among 17 of the 31 individuals who were submitted to radiotherapy after surgery. The proportion of patients on a total oral diet four months post treatment varied significantly by site of defect (Fishers exact test p=0.006), from 100% (7/7) of patients with a lateral defect to only 22% (2/9) of patients with a central defect. The proportion of patients on a total oral diet at the final assessment did not vary by flap reconstruction or radiotherapy.

Datenanalyse. Das Null-Ritual und der Umgang mit Effekten in der Zeitschrift für Sportpsychologie

Ziel dieses Beitrages ist die Analyse der Anwendung empirischer Tests in der deutschsprachigen Sportpsychologie. Die Ergebnisse vergleichbarer Analysen, bspw. in der Psychologie, zeigen, dass zwischen Anforderungen aus Testkonzepten und empirischer Realität Unterschiede existieren, die bislang für die Sportpsychologie nicht beschrieben und bewertet worden sind. Die Jahrgänge 1994–2007 der Zeitschrift für Sportpsychologie (früher psychologie und sport) wurden danach untersucht, ob Forschungsfragen formuliert, welche Stichprobenart gewählt, welches Testkonzept verwendet, welches Signifikanzniveau benutzt und ob statistische Probleme diskutiert wurden. 83 Artikel wurden von zwei unabhängigen Bewertern nach diesen Aspekten kategorisiert. Als Ergebnis ist festzuhalten, dass in der sportpsychologischen Forschung überwiegend eine Mischung aus Fishers Signifikanztesten sowie Neyman-Pearsons-Hypothesentesten zur Anwendung kommt,das sogenannte „Hybrid-Modell” oder „Null-Ritual”. Die Beschreibung der Teststärke ist kaum zu beobachten. Eine zeitliche Analyse der Beiträge zeigt, dass vor allem die Benutzung von Effektgrößen in den letzten Jahren zugenommen hat. Abschließend werden Ansätze zur Verbesserung und der Vereinheitlichung der Anwendung empirischer Tests vorgeschlagen und diskutiert.

Do different anesthesia regimes affect hippocampal apoptosis and neurologic deficits in a rodent cardiac arrest model?

Background Different anesthesia regimes are commonly used in experimental models of cardiac arrest, but the effects of various anesthetics on clinical outcome parameters are unknown. We conducted a study in which we subjected rats to cardiac arrest under medetomidine/ketamine or sevoflurane/fentanyl anesthesia. Methods Asystolic cardiac arrest for 8 minutes was induced in 73 rats with a mixture of potassium chloride and esmolol. Daily behavioral and neurological examination included the open field test (OFT), the tape removal test (TRT) and a neurodeficit score (NDS). Animals were randomized for sacrifice on day 2 or day 5 and brains were harvested for histology in the hippocampus cornus ammonis segment CA1. The inflammatory markers IL-6, TNF-α, MCP-1 and MIP-1α were assessed in cerebrospinal fluid (CSF). Proportions of survival were tested with the Fisher’s exact test, repeated measurements were assessed with the Friedman’s test; the baseline values were tested using Mann–Whitney U test and the difference of results of repeated measures were compared. Results In 31 animals that survived beyond 24 hours neither OFT, TRT nor NDS differed between the groups; histology was similar on day 2. On day 5, significantly more apoptosis in the CA1 segment of the hippocampus was found in the sevoflurane/fentanyl group. MCP-1 was higher on day 5 in the sevoflurane/fentanyl group (p = 0.04). All other cyto- and chemokines were below detection threshold. Conclusion In our cardiac arrest model neurological function was not influenced by different anesthetic regimes; in contrast, anesthesia with sevoflurane/fentanyl results in increased CSF inflammation and histologic damage at day 5 post cardiac arrest.