Tumors initially classified as malignant were more likely to have an intermodal change in treatment than benign masses, the researchers found. Additionally, higher-stage malignancies were more likely to result in treatment changes than lower-stage malignancies. “This data supports the impact of tumor boards and the notions that comprehensive head and neck tumor treatment should involve a tumor board and a multidisciplinary discussion as a best practice recommendation,” Dr. Zanation said.
Explore this issue:May 2013
Researchers are now evaluating the changes seen in this study and comparing them with best practice guidelines, which Dr. Zanation said will be a first step in correlating tumor conferences to patient outcomes.
Bacterial or Viral?
Dr. Das, the Fowler Award winner, led a team that explored protein analysis for the potential development of a test to tell whether chronic rhinosinusitis is bacterial or viral.
With 258 million prescriptions a year, enough for 80 percent of the U.S. population, antibiotic use poses “not only a cost problem but also a potential catastrophic consequence if an antibiotic-resistant superbacteria propagates,” he said.
His lab hypothesized that bacteria develop unique characteristics when they undergo phenotypic changes distinct from viral infections. These characteristics, if diagnosed, could help doctors decide whether to treat an infection as bacterial.
The team started with non-typeable haemophilus influenzae (NTHI), the most common bacteria present in sinus infections. Using the common protein-analysis techniques of nano liquid chromatography/tandem mass spectrometry to perform a kind of “mini-human genome project,” researchers identified all the proteins present in the secretome of NTHI biofilm.
They used a sinusitis model of a chinchilla to assess the proteins present in the animal’s biofilm and came away with proteins that were candidates for reliable biomarkers.
The researchers then developed an assay, based on work completed by the Centers for Disease Control and Prevention studying meningitis in Mongolia, to test the sensitivity and specificity of certain signature proteins in eight samples of human isolates of bacteria from sinusitis patients. There was 100 percent sensitivity and 100 percent specificity for two types of proteins—outer membrane proteins P2 and P5 (OMP-P2 and OMP-P5).
Researchers now hope to develop a test similar to a pregnancy test that can be placed through a balloon at the time of sinuplasty. They also hope to develop a simple test that can be used by primary care physicians.
“The problem of whether this is a bacterial or viral infection is probably one of the biggest problems in U.S. medicine today,” Dr. Das said. “Ideally, to stop this problem, our physicians would have a meaningful test that allowed them to know if a patient was having a bacterial or viral infection.”