Chukar Cherries Issues Allergy Alert on Undeclared Milk in 7.5 Oz Amaretto Rainier Chocolate Cherries Pouches

Chukar Cherries of Prosser, WA is recalling 7.5oz Amaretto Rainier Chocolate Cherries because they may contain undeclared milk. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume this product. (Source: Food and Drug Administration)

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Brain Protection Beyond the OR: Consensus Statement on Perioperative Neurocognitive Disorders (PND)

No abstract available

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Going With the Flow: Cerebrovascular Disease and Autoregulation

No abstract available

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The World Health Organization Surgical Safety Checklist: Happy 10th Birthday!

No abstract available

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Should We Always Continue β-Blocking Agents Preoperatively?

No abstract available

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The Hidden Value of Ultrasound?

No abstract available

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The Resuscitation Crisis Manual: For the Briefcase, the Breakroom, and Beyond, 1st ed

No abstract available

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Prevention of Thrombophlebitis in Peripheral Intravenous Catheters: The Butterfly Effect

No abstract available

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In Response

No abstract available

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Pediatric Anesthesia Informed Consent: “That’s the Signpost Up Ahead – Your Next Stop, The Twilight Zone!”

No abstract available

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Lack of Bias Evaluation and Inadequate Study Selection May Produce Misleading Results

No abstract available

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Starving Patients Before Cataract Surgery Under Regional Anesthesia: Needed or Not?

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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Education in Anesthesia: How to Deliver the Best Learning Experience

No abstract available

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The Perioperative Management of Ascending Aortic Dissection

Acute aortic syndromes are a distinct group of pathologies involving the wall of the aorta that present acutely and can be potentially fatal unless treated in a timely fashion. The syndrome is dominated by aortic dissections, which comprise ≥95% of all such presentations. Those involving the ascending aorta are particularly lethal and require specific and early surgical treatment compared to dissections involving other parts of the aorta. The surgical repair of an ascending aortic dissection presents multiple challenges to the anesthesiologist. Thoughtful management throughout the perioperative period is critical for minimizing the significant morbidity and mortality associated with this condition. In this narrative review, we provide an overview of the perioperative management of patients presenting for the surgical repair of an ascending aortic dissection. Preoperative discussion focuses on assessment, hemodynamic management, and risk stratification. The intraoperative section includes an overview of anesthetic management, transesophageal echocardiographic assessment, and coagulopathy, as well as surgical considerations that may influence anesthetic management.

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Acute Stroke Management in the First 24 Hours: A Practical Guide for Clinicians

No abstract available

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Cerebral Small Vessel, But Not Large Vessel Disease, Is Associated With Impaired Cerebral Autoregulation During Cardiopulmonary Bypass: A Retrospective Cohort Study

BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS: Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25–0.86; P = .014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02–1.475; P = .029), but not moderate-severe large cerebral arterial stenosis (P = .406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21–8.71; P = .019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS: These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.

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In Response

No abstract available

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‘One tooth one child’: evaluating the effects of diet and fertility on the oral health of women from archaeological sites in South America

Women from ancient societies have shown a higher prevalence of dental caries in comparison with men. Recent research has shown that the relationship between increased oestrogen production during pregnancy and decreased salivary flow is a possible cause for the higher levels of caries in women, which is in contrast to the traditional view of sexual division of labour resulting in unequal access to cariogenic food. In order to test these two hypotheses, individuals exhumed from 12 South American archaeological sites were examined for markers of oral health (caries, ante mortem tooth loss, deep caries, and enamel hypoplasia) and compared in terms of fertility (Crude Birth Rate) and subsistence systems. Our results suggest that diet and other cultural practices remain the most important factors affecting oral health and that the effects of hormones can be masked by them. Such findings add to the discussion regarding the availability of micronutrients in such societies affecting caries experience in pregnant women, because of their special nutritional requirements.

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Dental anxiety in relation to torture experiences and symptoms of post‐traumatic stress disorder

Torture victims often show symptoms of dental anxiety when receiving dental care, but little systematic research is available. The purpose of this study was to explore torture experiences, symptoms of post‐traumatic stress disorder (PTSD), and dental anxiety in refugees in Norway and to test the hypothesis that refugees with torture experiences are more prone to dental anxiety than refugees with no such experiences. A total of 173 refugees were interviewed shortly after an oral examination. The Modified Dental Anxiety Scale (MDAS) and the Harvard Trauma Questionnaire‐PTSS16 were administered verbally through attending interpreters. Among torture victims (47%, n = 81), the prevalence of torture experiences involving mouth or teeth was 35% and 23%, respectively. Harvard Trauma Questionnaire mean sum scores were statistically significantly higher in torture victims (34.3 vs. 24.8). Torture survivors report a larger number of symptoms of PTSD, and dental anxiety shows a higher prevalence in refugees reporting PTSD symptoms than in refugees who do not report such symptoms. When analysed using logistic regression models, the data showed the odds of high levels of dental anxiety being 6.1 times higher in refugees with torture experiences compared with other refugees and 9.3 times higher in torture victims with PTSD symptoms. Oral health professionals should be aware of these associations when providing dental care to refugees. The hypothesis that tortured refugees are more prone to dental anxiety is supported.

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‘One tooth one child’: evaluating the effects of diet and fertility on the oral health of women from archaeological sites in South America

Women from ancient societies have shown a higher prevalence of dental caries in comparison with men. Recent research has shown that the relationship between increased oestrogen production during pregnancy and decreased salivary flow is a possible cause for the higher levels of caries in women, which is in contrast to the traditional view of sexual division of labour resulting in unequal access to cariogenic food. In order to test these two hypotheses, individuals exhumed from 12 South American archaeological sites were examined for markers of oral health (caries, ante mortem tooth loss, deep caries, and enamel hypoplasia) and compared in terms of fertility (Crude Birth Rate) and subsistence systems. Our results suggest that diet and other cultural practices remain the most important factors affecting oral health and that the effects of hormones can be masked by them. Such findings add to the discussion regarding the availability of micronutrients in such societies affecting caries experience in pregnant women, because of their special nutritional requirements.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zXN0mB

Dental anxiety in relation to torture experiences and symptoms of post‐traumatic stress disorder

Torture victims often show symptoms of dental anxiety when receiving dental care, but little systematic research is available. The purpose of this study was to explore torture experiences, symptoms of post‐traumatic stress disorder (PTSD), and dental anxiety in refugees in Norway and to test the hypothesis that refugees with torture experiences are more prone to dental anxiety than refugees with no such experiences. A total of 173 refugees were interviewed shortly after an oral examination. The Modified Dental Anxiety Scale (MDAS) and the Harvard Trauma Questionnaire‐PTSS16 were administered verbally through attending interpreters. Among torture victims (47%, n = 81), the prevalence of torture experiences involving mouth or teeth was 35% and 23%, respectively. Harvard Trauma Questionnaire mean sum scores were statistically significantly higher in torture victims (34.3 vs. 24.8). Torture survivors report a larger number of symptoms of PTSD, and dental anxiety shows a higher prevalence in refugees reporting PTSD symptoms than in refugees who do not report such symptoms. When analysed using logistic regression models, the data showed the odds of high levels of dental anxiety being 6.1 times higher in refugees with torture experiences compared with other refugees and 9.3 times higher in torture victims with PTSD symptoms. Oral health professionals should be aware of these associations when providing dental care to refugees. The hypothesis that tortured refugees are more prone to dental anxiety is supported.

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Global Larynx Cancer Market Epidemiology Research Report 2018

Global Larynx Cancer Market Epidemiology Research Report 2018  thebankingsector.comFull coverage

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Veterans' contribution to America should not be minimized

Veterans' contribution to America should not be minimized  Mesabi Daily NewsFull coverage

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Global Larynx Cancer Market Epidemiology Research Report 2018

Global Larynx Cancer Market Epidemiology Research Report 2018  thebankingsector.comFull coverage

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Veterans' contribution to America should not be minimized

Veterans' contribution to America should not be minimized  Mesabi Daily NewsFull coverage

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Higher PEEP improves outcomes in ARDS patients with clinically objective positive oxygenation response to PEEP: a systematic review and meta-analysis

Abstract

Background

Mortality in patients with acute respiratory distress syndrome (ARDS) remains high. These patients require mechanical ventilation strategies that include high positive end-expiratory pressure (PEEP). It remains controversial whether high PEEP can improve outcomes for ARDS patients, especially patients who show improvement in oxygenation in response to PEEP. In this meta-analysis, we aimed to evaluate the effects of high PEEP on ARDS patients.

Methods

We electronically searched randomized controlled trials (RCTs) reported in the MEDLINE, CENTRAL, EMBASE, CINAHL and Web of Science databases from January 1990 to December 2017. Meta-analyses of the effects of PEEP on survival in adults with ARDS were conducted using the methods recommended by the Cochrane Collaboration.

Results

A total of 3612 patients from nine randomized controlled trials (RCTs) were included. There were 1794 and 1818 patients in the high and low PEEP groups, respectively. Hospital mortality showed no significant difference between the high and low PEEP groups (RR = 0.92; 95% CI, 0.79 to 1.07; P = 0.26). Similar results were found for 28-d mortality (RR = 0.88; 95% CI, 0.72 to 1.07; P = 0.19) and ICU mortality (RR = 0.83; 95% CI, 0.65 to 1.07; P = 0.15). The risk of clinically objectified barotrauma was not significantly different between the high and low PEEP groups (RR = 1.24; 95% CI, 0.74 to 2.09, P = 0.41). In the subgroup of ARDS patients who responded to increased PEEP by improved oxygenation (from 6 RCTs), high PEEP significantly reduced hospital mortality (RR = 0.83; 95% CI 0.69 to 0.98; P = 0.03), ICU mortality (RR = 0.74; 95% CI, 0.56 to 0.98; P = 0.04),but the 28-d mortality was not decreased(RR = 0.83; 95% CI, 0.67 to 1.01; P = 0.07). For ARDS patients in the low PEEP group who received a PEEP level lower than 10 cmH₂O (from 6 RCTs), ICU mortality was lower in the high PEEP group than the low PEEP group (RR = 0.65; 95% CI, 0.45 to 0.94; P = 0.02).

Conclusions

For ARDS patients who responded to increased PEEP by improved oxygenation, high PEEP could reduce hospital mortality, ICU mortality and 28-d mortality. High PEEP does not increase the risk of clinically objectified barotrauma.

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Sevoflurane preconditioning induces tolerance to brain ischemia partially via inhibiting thioredoxin-1 nitration

Abstract

Background

Sevoflurane preconditioning induces brain ischemic tolerance, but the mechanism remains poorly elucidated. Nitration is an important form of post-translational modification in pathological signaling. This study was to investigate the role of thioredoxin-1 (Trx-1) nitration in neuroprotection effect induced by sevoflurane preconditioning in a transient stroke model in rats.

Methods

Adult male Sprague–Dawley rats were preconditioned with 2% sevoflurane or vehicle oxygen exposure, 1 h per day, for 5 consecutive days. At 24 h after the last exposure, rats were subjected to focal brain ischemia induced by middle cerebral artery occlusion (MCAO) for 90 min, followed by 72-h reperfusion. Trx-1 expression and activity, as well as the content of nitrotyrosine at penumbra were detected at 24 h after preconditioning and 2, 8, 24, 72 h after MCAO. Nitrated Trx-1 was examined by immunoprecipitation at 8 h after MCAO. The role of Trx-1 nitration in ischemic tolerance was assessed by administration of nitrated human-Trx-1 prior to MCAO. Neurological scores, brain infarct volumes and TUNEL staining were evaluated at 24 h after reperfusion.

Results

Ischemic stroke decreased Trx-1 activity but not the expression in penumbra tissue. The content of nitrotyrosine was elevated after MCAO. Preconditioning with sevoflurane increased Trx-1 activity and reduced its nitration at 8 h after MCAO in comparison with vehicle preconditioning. The decrement of Trx-1 activity was correlated with its nitration level. Exogenous administration of nitrated human-Trx-1 reversed the brain ischemic tolerance of sevoflurane preconditioning, exacerbating brain infarct volume, neurobehavioral defects and apoptosis, while administration of human-Trx-1 had no effect on the sevoflurane preconditioning-induced neuroprotection.

Conclusion

Ischemic stroke reduces Trx-1 activity via post-translational nitrative modulation in rats. Sevoflurane preconditioning induces brain ischemic tolerance and anti-apoptosis by partially preserving Trx-1 activity via inhibiting nitration.

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Higher PEEP improves outcomes in ARDS patients with clinically objective positive oxygenation response to PEEP: a systematic review and meta-analysis

Abstract

Background

Mortality in patients with acute respiratory distress syndrome (ARDS) remains high. These patients require mechanical ventilation strategies that include high positive end-expiratory pressure (PEEP). It remains controversial whether high PEEP can improve outcomes for ARDS patients, especially patients who show improvement in oxygenation in response to PEEP. In this meta-analysis, we aimed to evaluate the effects of high PEEP on ARDS patients.

Methods

We electronically searched randomized controlled trials (RCTs) reported in the MEDLINE, CENTRAL, EMBASE, CINAHL and Web of Science databases from January 1990 to December 2017. Meta-analyses of the effects of PEEP on survival in adults with ARDS were conducted using the methods recommended by the Cochrane Collaboration.

Results

A total of 3612 patients from nine randomized controlled trials (RCTs) were included. There were 1794 and 1818 patients in the high and low PEEP groups, respectively. Hospital mortality showed no significant difference between the high and low PEEP groups (RR = 0.92; 95% CI, 0.79 to 1.07; P = 0.26). Similar results were found for 28-d mortality (RR = 0.88; 95% CI, 0.72 to 1.07; P = 0.19) and ICU mortality (RR = 0.83; 95% CI, 0.65 to 1.07; P = 0.15). The risk of clinically objectified barotrauma was not significantly different between the high and low PEEP groups (RR = 1.24; 95% CI, 0.74 to 2.09, P = 0.41). In the subgroup of ARDS patients who responded to increased PEEP by improved oxygenation (from 6 RCTs), high PEEP significantly reduced hospital mortality (RR = 0.83; 95% CI 0.69 to 0.98; P = 0.03), ICU mortality (RR = 0.74; 95% CI, 0.56 to 0.98; P = 0.04),but the 28-d mortality was not decreased(RR = 0.83; 95% CI, 0.67 to 1.01; P = 0.07). For ARDS patients in the low PEEP group who received a PEEP level lower than 10 cmH₂O (from 6 RCTs), ICU mortality was lower in the high PEEP group than the low PEEP group (RR = 0.65; 95% CI, 0.45 to 0.94; P = 0.02).

Conclusions

For ARDS patients who responded to increased PEEP by improved oxygenation, high PEEP could reduce hospital mortality, ICU mortality and 28-d mortality. High PEEP does not increase the risk of clinically objectified barotrauma.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PyIYvG

Sevoflurane preconditioning induces tolerance to brain ischemia partially via inhibiting thioredoxin-1 nitration

Abstract

Background

Sevoflurane preconditioning induces brain ischemic tolerance, but the mechanism remains poorly elucidated. Nitration is an important form of post-translational modification in pathological signaling. This study was to investigate the role of thioredoxin-1 (Trx-1) nitration in neuroprotection effect induced by sevoflurane preconditioning in a transient stroke model in rats.

Methods

Adult male Sprague–Dawley rats were preconditioned with 2% sevoflurane or vehicle oxygen exposure, 1 h per day, for 5 consecutive days. At 24 h after the last exposure, rats were subjected to focal brain ischemia induced by middle cerebral artery occlusion (MCAO) for 90 min, followed by 72-h reperfusion. Trx-1 expression and activity, as well as the content of nitrotyrosine at penumbra were detected at 24 h after preconditioning and 2, 8, 24, 72 h after MCAO. Nitrated Trx-1 was examined by immunoprecipitation at 8 h after MCAO. The role of Trx-1 nitration in ischemic tolerance was assessed by administration of nitrated human-Trx-1 prior to MCAO. Neurological scores, brain infarct volumes and TUNEL staining were evaluated at 24 h after reperfusion.

Results

Ischemic stroke decreased Trx-1 activity but not the expression in penumbra tissue. The content of nitrotyrosine was elevated after MCAO. Preconditioning with sevoflurane increased Trx-1 activity and reduced its nitration at 8 h after MCAO in comparison with vehicle preconditioning. The decrement of Trx-1 activity was correlated with its nitration level. Exogenous administration of nitrated human-Trx-1 reversed the brain ischemic tolerance of sevoflurane preconditioning, exacerbating brain infarct volume, neurobehavioral defects and apoptosis, while administration of human-Trx-1 had no effect on the sevoflurane preconditioning-induced neuroprotection.

Conclusion

Ischemic stroke reduces Trx-1 activity via post-translational nitrative modulation in rats. Sevoflurane preconditioning induces brain ischemic tolerance and anti-apoptosis by partially preserving Trx-1 activity via inhibiting nitration.

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Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature - Šarkić B, Douglas JM, Simpson A.

PRIMARY OBJECTIVE: To understand the effects of non-blast-related TBI on peripheral auditory function in adults, as measured through basic and advanced audiological assessments. BACKGROUND: Despite numerous studies demonstrating hearing loss post T... (Source: SafetyLit)

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Health Tip: How Bad is Your Hearing Loss?

Title: Health Tip: How Bad is Your Hearing Loss?Category: Health NewsCreated: 11/15/2018 12:00:00 AMLast Editorial Review: 11/15/2018 12:00:00 AM (Source: MedicineNet Hearing General)

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Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature - Šarkić B, Douglas JM, Simpson A.

PRIMARY OBJECTIVE: To understand the effects of non-blast-related TBI on peripheral auditory function in adults, as measured through basic and advanced audiological assessments. BACKGROUND: Despite numerous studies demonstrating hearing loss post T... (Source: SafetyLit)

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Health Tip: How Bad is Your Hearing Loss?

Title: Health Tip: How Bad is Your Hearing Loss?Category: Health NewsCreated: 11/15/2018 12:00:00 AMLast Editorial Review: 11/15/2018 12:00:00 AM (Source: MedicineNet Hearing General)

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Epinephrine Personal Autoinjectors Cost-Effective at & #36;24

FRIDAY, Nov. 16, 2018 -- In a simulation of children with peanut allergy, epinephrine personal autoinjectors are cost-effective at $24, according to a study published online Nov. 16 in JAMA Network Open. Marcus Shaker, M.D., from the... (Source: Drugs.com - Pharma News)

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ACAAI: Hospital Stay, Caregiver Knowledge of Asthma Linked

Children of caregivers with poor asthma knowledge more likely to have prolonged hospital stay (Source: Pulmonary Medicine News - Doctors Lounge)

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ACAAI: Almost 2 Percent of Children Have Milk Allergy

FRIDAY, Nov. 16, 2018 -- Almost 2 percent of children in the United States have a milk allergy, according to a study presented at the annual meeting of the American College of Allergy, Asthma& Immunology, held from Nov. 15 to 17 in... (Source: Drugs.com - Pharma News)

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ACAAI: Almost 2 Percent of Children Have Milk Allergy

FRIDAY, Nov. 16, 2018 -- Almost 2 percent of children in the United States have a milk allergy, according to a study presented at the annual meeting of the American College of Allergy, Asthma& Immunology, held from Nov. 15 to 17 in... (Source: Drugs.com - Pharma News)

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Epinephrine Personal Autoinjectors Cost-Effective at & #36;24

FRIDAY, Nov. 16, 2018 -- In a simulation of children with peanut allergy, epinephrine personal autoinjectors are cost-effective at $24, according to a study published online Nov. 16 in JAMA Network Open. Marcus Shaker, M.D., from the... (Source: Drugs.com - Pharma News)

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ACAAI: Hospital Stay, Caregiver Knowledge of Asthma Linked

FRIDAY, Nov. 16, 2018 -- For children hospitalized with asthma exacerbations, caregiver knowledge predicts length of stay, according to a study presented at the annual meeting of the American College of Allergy, Asthma& Immunology, held from... (Source: Drugs.com - Pharma News)

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Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature - Šarkić B, Douglas JM, Simpson A.

PRIMARY OBJECTIVE: To understand the effects of non-blast-related TBI on peripheral auditory function in adults, as measured through basic and advanced audiological assessments. BACKGROUND: Despite numerous studies demonstrating hearing loss post T... (Source: SafetyLit)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Health Tip: How Bad is Your Hearing Loss?

Title: Health Tip: How Bad is Your Hearing Loss?Category: Health NewsCreated: 11/15/2018 12:00:00 AMLast Editorial Review: 11/15/2018 12:00:00 AM (Source: MedicineNet Hearing General)

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Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature - Šarkić B, Douglas JM, Simpson A.

PRIMARY OBJECTIVE: To understand the effects of non-blast-related TBI on peripheral auditory function in adults, as measured through basic and advanced audiological assessments. BACKGROUND: Despite numerous studies demonstrating hearing loss post T... (Source: SafetyLit)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zVRKZU

Health Tip: How Bad is Your Hearing Loss?

Title: Health Tip: How Bad is Your Hearing Loss?Category: Health NewsCreated: 11/15/2018 12:00:00 AMLast Editorial Review: 11/15/2018 12:00:00 AM (Source: MedicineNet Hearing General)

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Veterans' contribution to America should not be minimized

Veterans' contribution to America should not be minimized  Mesabi Daily NewsFull coverage

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Veterans' contribution to America should not be minimized

Veterans' contribution to America should not be minimized  Mesabi Daily NewsFull coverage

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PxlvuB

Epinephrine Personal Autoinjectors Cost-Effective at & #36;24

FRIDAY, Nov. 16, 2018 -- In a simulation of children with peanut allergy, epinephrine personal autoinjectors are cost-effective at $24, according to a study published online Nov. 16 in JAMA Network Open. Marcus Shaker, M.D., from the... (Source: Drugs.com - Pharma News)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Q54IP3

ACAAI: Hospital Stay, Caregiver Knowledge of Asthma Linked

Children of caregivers with poor asthma knowledge more likely to have prolonged hospital stay (Source: Pulmonary Medicine News - Doctors Lounge)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DqXfDg

ACAAI: Hospital Stay, Caregiver Knowledge of Asthma Linked

FRIDAY, Nov. 16, 2018 -- For children hospitalized with asthma exacerbations, caregiver knowledge predicts length of stay, according to a study presented at the annual meeting of the American College of Allergy, Asthma& Immunology, held from... (Source: Drugs.com - Pharma News)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Q47c0b

ACAAI: Almost 2 Percent of Children Have Milk Allergy

FRIDAY, Nov. 16, 2018 -- Almost 2 percent of children in the United States have a milk allergy, according to a study presented at the annual meeting of the American College of Allergy, Asthma& Immunology, held from Nov. 15 to 17 in... (Source: Drugs.com - Pharma News)

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Epinephrine Personal Autoinjectors Cost-Effective at & #36;24

FRIDAY, Nov. 16, 2018 -- In a simulation of children with peanut allergy, epinephrine personal autoinjectors are cost-effective at $24, according to a study published online Nov. 16 in JAMA Network Open. Marcus Shaker, M.D., from the... (Source: Drugs.com - Pharma News)

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ACAAI: Hospital Stay, Caregiver Knowledge of Asthma Linked

Children of caregivers with poor asthma knowledge more likely to have prolonged hospital stay (Source: Pulmonary Medicine News - Doctors Lounge)

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ACAAI: Hospital Stay, Caregiver Knowledge of Asthma Linked

FRIDAY, Nov. 16, 2018 -- For children hospitalized with asthma exacerbations, caregiver knowledge predicts length of stay, according to a study presented at the annual meeting of the American College of Allergy, Asthma& Immunology, held from... (Source: Drugs.com - Pharma News)

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ACAAI: Almost 2 Percent of Children Have Milk Allergy

FRIDAY, Nov. 16, 2018 -- Almost 2 percent of children in the United States have a milk allergy, according to a study presented at the annual meeting of the American College of Allergy, Asthma& Immunology, held from Nov. 15 to 17 in... (Source: Drugs.com - Pharma News)

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Citation for Michael J Fardy for Downs Surgical Prize 2017

Mike is the eldest son of an RAF navigator and ward sister. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Association between impacted third molars and position of the mandibular canal: a morphological analysis using cone-beam computed tomography

Our aim was to assess the association between the angle of impaction of the third molar and the position of the mandibular canal on cone-beam computed tomography (CT). We designed a retrospective study of 100 cone-beam CT images of 173 mandibular third molars that were obtained between January 2012 and December 2015, and recorded the angle of impaction of the third molar, the position of the mandibular canal in relation to the impacted tooth, and the potential contact between the roots of the tooth and the mandibular canal. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Citation for Michael J Fardy for Downs Surgical Prize 2017

Mike is the eldest son of an RAF navigator and ward sister. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Citation for the 2017 Down Surgical Prize – Paul Johnson

Ladies and Gentlemen, Mr President, Paul and Karen. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Association between impacted third molars and position of the mandibular canal: a morphological analysis using cone-beam computed tomography

Our aim was to assess the association between the angle of impaction of the third molar and the position of the mandibular canal on cone-beam computed tomography (CT). We designed a retrospective study of 100 cone-beam CT images of 173 mandibular third molars that were obtained between January 2012 and December 2015, and recorded the angle of impaction of the third molar, the position of the mandibular canal in relation to the impacted tooth, and the potential contact between the roots of the tooth and the mandibular canal. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Allergic contact dermatitis to Finn Chambers AQUA in two patients

Adhesives are widely used in medical material and my cause allergic contact dermatitis (ACD). It is important to know the full composition of medical material to avoid iatrogenic ACD in sensitised patients. Over time, colophonium and rubber components have been replaced by other adhesives to avoid ACD.¹

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Severe allergic contact dermatitis in a detergent production worker caused by exposure to methylisothiazolinone

Methylisothiazolinone (MI) is a preservative commonly used in paints, detergents and cosmetics. It has been found to be a potent sensitizer. During the recent years there has been an epidemic increase in allergic contact dermatitis caused by MI (1). We present the case of a worker in the detergent production industry who developed severe allergic contact dermatitis following occupational exposure to MI, illustrating the need for attention to occupational exposure to MI in the production setting, where high concentrations of MI are used.

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Temporal changes in chromium allergy in Denmark between 2002 and 2017

Background

In 2012, Danish authorities submitted a proposal to the European Chemical Agency (ECHA) restricting the content of hexavalent chromium to a maximum of 3 ppm in leather goods. Following its adoption, this proposal was implemented in 2015 as a directive in the European Union (EU).

Objectives

We examined the temporal trend of chromium contact allergy in adult dermatitis patients patch tested between 2002 and 2017. Furthermore, we determined clinical characteristics and causative exposures in these patients.

Methods

All adult dermatitis patients patch tested between 2002 and 2017 were included. Patch test data was reviewed retrospectively. Comparisons were done using χ² ‐test and logistic regression analysis.

Results

A total of 13379 adults aged 18‐99 were patch tested 2002 to 2017. The overall prevalence of chromium allergy was 2.2%. An overall decreasing trend of the prevalence of chromium allergy was found (P _trend=0.00002). Specifically, a significant difference was found for the study periods 2010‐2013 (P _trend=0.002) and 2014‐2017 (P _trend<0.0001) when compared to 2002‐2005. Leather remained the most important single cause of allergic contact dermatitis to chromium. The proportion of clinically relevant leather exposure increased from 42.3% during 2002‐2009 to 54.8% during 2010‐2017 (P=0.04).

Conclusions

The prevalence of chromium allergy is decreasing. The EU Directive restricting the use of hexavalent chromium in leather goods is thought to play a central role in this change.

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A case of recalcitrant face eczema

A 37‐year‐old woman with a history of mild atopic dermatitis involving her antecubital flexures and sporadically her face presented with face eczema of one year duration. Due to acne and solar brown spots, she had applied a retinoic acid containing cream for one year and she had slowly developed recalcitrant face eczema that was unsuccessfully treated with different moisturizing creams, corticosteroid creams and sunscreens. As her face eczema further worsened the patient was referred for patch testing.

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Cleaning Your Baby's Pacifier By Sucking On It May Do Baby Good

FRIDAY, Nov. 16, 2018 -- Sucking your baby's pacifier to clean it may help protect your child against allergies, new research suggests. Researchers interviewed 128 U.S. mothers of infants a number of times over 18 months. Among the moms of babies... (Source: Drugs.com - Daily MedNews)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qYMNvv

Allergic contact dermatitis to Finn Chambers AQUA in two patients

Adhesives are widely used in medical material and my cause allergic contact dermatitis (ACD). It is important to know the full composition of medical material to avoid iatrogenic ACD in sensitised patients. Over time, colophonium and rubber components have been replaced by other adhesives to avoid ACD.¹

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2BaVAjx

Severe allergic contact dermatitis in a detergent production worker caused by exposure to methylisothiazolinone

Methylisothiazolinone (MI) is a preservative commonly used in paints, detergents and cosmetics. It has been found to be a potent sensitizer. During the recent years there has been an epidemic increase in allergic contact dermatitis caused by MI (1). We present the case of a worker in the detergent production industry who developed severe allergic contact dermatitis following occupational exposure to MI, illustrating the need for attention to occupational exposure to MI in the production setting, where high concentrations of MI are used.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Kb4SyR

Temporal changes in chromium allergy in Denmark between 2002 and 2017

Background

In 2012, Danish authorities submitted a proposal to the European Chemical Agency (ECHA) restricting the content of hexavalent chromium to a maximum of 3 ppm in leather goods. Following its adoption, this proposal was implemented in 2015 as a directive in the European Union (EU).

Objectives

We examined the temporal trend of chromium contact allergy in adult dermatitis patients patch tested between 2002 and 2017. Furthermore, we determined clinical characteristics and causative exposures in these patients.

Methods

All adult dermatitis patients patch tested between 2002 and 2017 were included. Patch test data was reviewed retrospectively. Comparisons were done using χ² ‐test and logistic regression analysis.

Results

A total of 13379 adults aged 18‐99 were patch tested 2002 to 2017. The overall prevalence of chromium allergy was 2.2%. An overall decreasing trend of the prevalence of chromium allergy was found (P _trend=0.00002). Specifically, a significant difference was found for the study periods 2010‐2013 (P _trend=0.002) and 2014‐2017 (P _trend<0.0001) when compared to 2002‐2005. Leather remained the most important single cause of allergic contact dermatitis to chromium. The proportion of clinically relevant leather exposure increased from 42.3% during 2002‐2009 to 54.8% during 2010‐2017 (P=0.04).

Conclusions

The prevalence of chromium allergy is decreasing. The EU Directive restricting the use of hexavalent chromium in leather goods is thought to play a central role in this change.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Bc4ayz

A case of recalcitrant face eczema

A 37‐year‐old woman with a history of mild atopic dermatitis involving her antecubital flexures and sporadically her face presented with face eczema of one year duration. Due to acne and solar brown spots, she had applied a retinoic acid containing cream for one year and she had slowly developed recalcitrant face eczema that was unsuccessfully treated with different moisturizing creams, corticosteroid creams and sunscreens. As her face eczema further worsened the patient was referred for patch testing.

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Side effects of tango: connubial contact dermatitis

The term "Connubial or Consort allergic contact dermatitis" defines a peculiar dermatitis caused by sensitization towards substances used by people in close contact with the patient. A connubial allergic contact dermatitis in a tango dancer is reported.

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Cleaning Your Baby's Pacifier By Sucking On It May Do Baby Good

FRIDAY, Nov. 16, 2018 -- Sucking your baby's pacifier to clean it may help protect your child against allergies, new research suggests. Researchers interviewed 128 U.S. mothers of infants a number of times over 18 months. Among the moms of babies... (Source: Drugs.com - Daily MedNews)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qYMNvv

Cleaning Your Baby's Pacifier By Sucking On It May Do Baby Good

FRIDAY, Nov. 16, 2018 -- Sucking your baby's pacifier to clean it may help protect your child against allergies, new research suggests. Researchers interviewed 128 U.S. mothers of infants a number of times over 18 months. Among the moms of babies... (Source: Drugs.com - Daily MedNews)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qYMNvv

Mass‐forming intrahepatic cholangiocarcinoma: Can diffusion‐weighted imaging predict microvascular invasion?

Background

Microvascular invasion (MVI) is a risk factor influencing the survival rate of patients with mass‐forming intrahepatic cholangiocarcinoma (IMCC).

Purpose

To investigate whether diffusion‐weighted imaging (DWI) could be useful in predicting MVI of IMCC.

Study Type

Retrospective.

Subjects

Eighty patients with surgically resected single IMCC (21 MVI‐positive lesions and 59 MVI‐negative lesions).

Field Strength/Sequence

Preoperative hepatic MRI (1.5T), including T₁‐ and T₂‐weighted images (T₁WI, T₂WI), DWI, and dynamic enhancement imaging.

Assessment

Morphologic characteristics including contour of the lesion, biliary dilation and hepatic capsule retraction, signal features on T₁WI, T₂WI, and DWI, and dynamic enhancement patterns were qualitatively evaluated. The quantitative analysis was performed for the size and apparent diffusion coefficient (ADC) values.

Statistical Tests

Chi‐square test, Fisher's exact test, and the independent t‐test were used for univariate analysis to determine the relationships between these radiological parameters and the presence of MVI. Logistic regression analysis was used to identify the independent predictors of MVI among these radiological parameters. Receiver operating characteristic curve analysis was performed to evaluate their diagnostic performance.

Results

Larger tumor size (P = 0.006) and higher ADC values (P < 0.001) were positively correlated with MVI. Multivariate logistic regression analysis demonstrated that the ADC value (odds ratio, 3.099; P = 0.001) was an independent predictor for MVI of IMCC. The ADC value for MVI of IMCC showed an area under the receiver operating characteristic curve of 0.782 (optimal cutoff value was 1.59 × 10⁻³ mm²/s).

Data Conclusion

Larger tumor size was associated with MVI and higher ADC values can be a useful predictor of MVI during the preoperative evaluation of IMCC.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018.

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Accelerated multi‐snapshot free‐breathing mapping based on the dual refocusing echo acquisition mode technique (DREAM): An alternative to measure RF nonuniformity for cardiac MRI

Background

Field inhomogeneities in MRI caused by interactions between the radiofrequency field and the patient anatomy can lead to artifacts and contrast variations, consequently degrading the overall image quality and thereby compromising diagnostic value of the images.

Purpose

To develop an efficient free‐breathing and motion‐robust mapping method that allows for the investigation of spatial homogeneity of the transmitted radiofrequency field in the myocardium at 3.0T. Three joint approaches are used to adapt the dual refocusing echo acquisition mode (DREAM) sequence for cardiac applications: (1) electrocardiograph triggering; (2) a multi‐snapshot undersampling scheme, which relies on the Golden Ratio, to accelerate the acquisition; and (3) motion‐compensation based on low‐resolution images acquired in each snapshot.

Study type

Prospective.

Phantom/subjects

Eurospin II T05 system, torso phantom, and five healthy volunteers.

Field strength/sequence

3.0T/DREAM.

Assessment

The proposed method was compared with the Bloch‐Siegert shift (BSS) method and validated against the standard DREAM sequence. Cardiac maps were obtained in free‐breathing and breath‐hold as a proof of concept of the in vivo performance of the proposed method.

Statistical tests

Mean and standard deviation (SD) values were analyzed for six standard regions of interest within the myocardium. Repeatability was assessed in terms of SD and coefficient of variation.

Results

Phantom results indicated low deviation from the BSS method (mean difference = 3%). Equivalent distributions for free‐breathing and breath‐hold in vivo experiments demonstrated the motion robustness of this method with good repeatability (SD < 0.05). The amount of variations was found to be 26% over the myocardium within a short axis slice.

Data conclusion

The feasibility of a cardiac mapping method with high spatial resolution in a reduced scan time per trigger was demonstrated. The free‐breathing characteristic could be beneficial to determine shim components for multi‐channel systems, currently limited to two for a single breath‐hold.

Level of Evidence: 1

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2018.

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White matter myelin profiles linked to clinical subtypes of Parkinson's disease

Background

White matter (WM) microstructural integrity is important for effective brain functioning and alterations have been shown in many neurodegenerative diseases.

Purpose

To investigate WM myelin profiles and their relation to clinical features of Parkinson's disease (PD).

Study Type

Retrospective cross‐sectional.

Population

In all, 29 PD subjects and 15 healthy controls.

Field Strength/Sequence

Multiecho GRASE with 10 msec echo spacing and echo planar imaging (EPI) diffusion‐weighted (b‐value = 700 with 32 gradient directions) on a 3T scanner.

Assessment

Myelin water fraction (MWF) and fractional anisotropy (FA) across 20 WM regions of interest (ROIs) were compared between groups. Partial least squares (PLS) was used to associate MWF and FA with clinical and behavioral measures.

Statistical Tests

Group comparisons were done using two‐sample t‐tests. PLS was assessed with permutation tests. Bootstrapping was used to investigate the robustness of imaging features.

Results

No group differences in myelin content could be detected with univariate tests. A three‐component PLS model linked MWF profiles to clinical phenotypes but no FA profiles. The three components appeared to follow along broad motor/nonmotor subtypes of "akinetic‐rigid," "tremor‐predominant," and "depression/apathy" subtypes, respectively. The first component showed associations between overall motor scores (r = –0.43, P = 0.0196) and cognitive performance (r = 0.44, P = 0.0171) with interhemispheric and long‐range association fibers. A second component linked overall motor scores (r = –0.58, P = 0.0009) and tremor scores (r = –0.48, P = 0.0091) to predominantly projection fibers. The last component related depression (r = –0.60, P = 0.0006) and apathy scores (r = –0.66, P = 0.0001 and r = –49, P = 0.0072) to a mixture of association and projection fibers.

Data Conclusion

MWF was robustly linked to distinct clinical subtypes of PD and may serve as an additional tool to characterize the disease.

Level of Evidence: 4

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2018.

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Test–retest multisite reproducibility of neurovascular 4D flow MRI

Background

4D flow MRI shows great potential in neurovascular disorders such as stenosis, atherosclerotic disease, aneurysms, and vascular malformations. Its widespread application in the neurovascular system requires evidence of good test–retest multicenter reproducibility.

Purpose

To assess the multicenter reproducibility, test–retest reliability and interobserver dependence of 4D flow MRI in measurements of cerebral blood flow/velocity in main intracranial vessels.

Study Type

Prospective study.

Subjects

Ten healthy subjects underwent 4D flow scans at three different centers. All subjects were scanned twice at 2 different days at each center.

Field Strength/Sequence

3.0 T; 4D flow sequence.

Assessment

Multicenter reproducibility, test–retest reliability and interobserver agreement for measurements of the blood flow and peak velocity from five regions of interest were assessed (bilateral internal carotid arteries, bilateral medial cerebral arteries, and sagittal sinus).

Statistical Test

A Shapiro–Wilks test was conducted to assess normality of measurements in each scan. Coefficient of variances (CVs) was computed to evaluate intra‐ and intersite variances of all measurements. The multicenter reproducibility was assessed by two‐way mixed intraclass correlation coefficient (ICC). A Bland–Altman plot and Pearson correlation were used to evaluate test–retest reliability. ICC was calculated to assess interobserver agreements.

Results

All P‐values for Shapiro–Wilks tests were greater than 0.05, which indicated the normality of all measurements. Both intra‐ and intersite CVs were lower than 12%. There was good test–retest reliability for both blood flow and peak velocity of all ROIs (r = 0.75–0.94). In addition, high multicenter reproducibility was detected (ICC = 0.77–0.96, all P < 0.001). The results of these measurements also showed great interobserver agreement (all ICC > 0.9 and all P < 0.001).

Data Conclusion

High multicenter reproducibility and test–retest reliability was shown for 4D flow in the measurements of blood flow and peak velocity of intracranial vessels. In addition, these measurements showed great interobserver agreement.

Level of Evidence: 2

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2018.

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Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

Objectives/Hypothesis

Patients with muscle tension dysphonia often demonstrate an elevation in Reflux Symptom Index (RSI) and 10‐item Voice Handicap Index (VHI‐10) scores, and may be erroneously diagnosed with laryngopharyngeal reflux disease. In this study we assessed the effects of voice therapy on RSI and VHI‐10 scores in patients with voice complaints not responsive to antireflux medications.

Study Design

Retrospective cohort study.

Methods

A study of patients was conducted at a single tertiary‐care center over 1 year (January 2012–January 2013). Patients were included if they had dysphonia not responsive to proton pump inhibition, did not have neurologic or neoplastic disease, and participated in at least three voice‐therapy sessions in the absence of antireflux therapy. Primary analysis assessed change in RSI scores between the initial and follow‐up visits with a laryngologist.

Results

A total of 18 patients were included (mean age = 49.9 ± 14.5 years, 89% female, 83% with a primary complaint of dysphonia). From initial to follow‐up visit, the median RSI score (18.5 [interquartile range {IQR}, 9.5–22.8] vs. 10.5 [IQR, 4.5–14]; P = .02) and median VHI‐10 score (25.5 [IQR, 11.3–30.0] vs. 13.5 [IQR, 9.5–20.8]; P = .03) significantly decreased. A significant inverse correlation was found between the number of voice therapy sessions/month and change in RSI score (r = −0.4; P = .05).

Conclusions

In this study of patients with muscle tension dysphonia or vocal hyperfunction not responsive to antireflux therapy, RSI and VHI‐10 scores improved following voice therapy. Results suggest that self‐reported symptoms typically attributed to laryngopharyngeal reflux disease may actually be secondary to inefficient voice use patterns or anxiety about dysphonia that are responsive to voice therapy.

Level of Evidence

4 Laryngoscope, 2018

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Sex bias: Is it pervasive in otolaryngology clinical research?

Objectives/Hypothesis

Recent initiatives highlight substantial sex bias in biomedical research. The objective was to determine whether sex bias is present in otolaryngology and whether sex is appropriately analyzed as an independent variable in otolaryngology clinical research.

Study Design

Literature review.

Methods

We systematically reviewed all 2016 articles in three major otolaryngology journals: The Laryngoscope, JAMA Otolaryngology–Head and Neck Surgery, and Otolaryngology–Head and Neck Surgery. Extracted data included study origin, location, subspecialty, number/sex of subjects, ≥50% sex matching (SM_≥50), and sex‐based statistical analysis.

Results

Six hundred of 1,209 articles comprising original clinical research were reviewed including 8,997,345,495 subjects (males: 3,898,559,264 [43.3%]; females: 5,095,592,583 [56.6%]; and unknown: 3,193,648 [0.04%]). There were 533/600 (88.8%) studies that included both sexes, eight (1.3%) included females only, five (0.8%) included males only, and 56 (9.3%) did not document participant sex. Only 280 studies (46.7%) analyzed data by sex, and 330 studies (60.7%) had SM_≥50. Sex‐based statistical analysis and SM_≥50 were similar in domestic and international studies (48.7% vs. 42.8% and 60.9% vs. 62%, respectively). Database studies performed sex‐based statistical analysis more frequently than single and multi‐institutional studies (79.1% vs. 40.4% and 43.4%, P < .00001). Analysis by sex was more frequently performed in head and neck surgery (53.6%) and pediatric otolaryngology (51.3%), whereas SM_≥50 was highest in pediatric otolaryngology (86.8%) and otology (82.4%).

Conclusions

Sex bias exists in the clinical otolaryngology literature, with less than half the studies analyzing sex. Acknowledging the intertwinement of sex with disease pathophysiology and outcomes is important. Eliminating sex bias in research and clinical care should become a major focus for otolaryngologists.

Level of Evidence

NA Laryngoscope, 2018

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Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger—United States 2012

Objectives/Hypothesis

To estimate the number, demographics, and outcomes of pediatric patients who underwent tracheostomy in 2012 and to contrast those outcomes by age, race, and gender.

Study Design

Cross‐sectional study.

Methods

The 2012 Kids Inpatient Database was queried to identify tracheostomy patients using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedural codes 311, 3121, and 3129. All patients ≤18 years of age at the time of admission were included and categorized as neonates (≤28 days), infants (>28 days ≤1 year), toddler (1 to 3 years), children (4 to 12 years), adolescents (13 to 17 years), and adults (=18 years). We recorded age, gender, race, insurance status, and zip code of primary residence. We used these variables to contrast the following outcomes: length of stay, total charges, complications of care, and mortality using multiple regression analysis.

Results

An estimated 4,424 pediatric tracheostomies occurred during 2012. Fifty‐one percent of the patients were ≤3 years old, and 62% were male. Forty‐eight percentwere white followed by black (21%), Hispanic (20%), and Asian (3%). The median length of stay was 42 days, and the median total charges were $472,738. The complication rate was 29% and the mortality rate was 8.0%. The length of stay and total charges was predicted by age, with neonates having significantly longer hospitalizations. The complication rate was not associated with age, gender, or ethnicity. However, the mortality rate was associated with younger age.

Conclusions

Pediatric tracheostomies are associated with significant hospital utilizations, complications, and mortality. Increased risk of mortality is observed among neonates and infants. Continued study of tracheostomy outcomes among these subsets of the pediatric population are warranted.

Level of Evidence

4 Laryngoscope, 2018

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Long‐term swallowing performance following transoral robotic surgery for obstructive sleep apnea

Objectives/Hypothesis

This study aimed to evaluate the long‐term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA).

Study Design

Retrospective and prospective cohort study.

Methods

Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long‐term swallowing functions were assessed using subjective self‐evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES).

Results

Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty‐five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration.

Conclusions

BOT reduction via TORS has a negative effect on long‐term swallowing function. A self‐assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow‐up. Proper patient selection and detailed information about surgery and possible late‐swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment.

Level of Evidence

4 Laryngoscope, 2018

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Impact of a Formal Patient Safety and Quality Improvement Curriculum: A Prospective, Controlled Trial

Objective

To assess the impact of implementing a dedicated Patient Safety and Quality Improvement (PSQI) curriculum for otolaryngology residents.

Methods

Residents in two otolaryngology residency programs were recruited to participate in the study. Residents at institution A (intervention group) participated in a formal, newly developed, year‐long PSQI curriculum. Residents at institution B (control group) participated in traditional, morbidity, and mortality conference‐based PSQI education, with no formal curriculum in place. Curriculum participants completed anonymous surveys to assess learner satisfaction. Validated instruments were administered to assess for changes in resident confidence in the ability to develop PSQI projects, their attitudes toward patient safety, and PSQI‐related knowledge. The number and quality of PSQI‐related resident projects were also assessed.

Results

Survey responses demonstrated excellent learner satisfaction with the curriculum. Based on validated instrument‐based responses, both programs demonstrated similar confidence scores (P = 0.05), safety attitudes (P = 0.82), and PSQI knowledge (P = 0.29) at the beginning of the year. The residents of institution A demonstrated significant improvement in confidence (P = 0.00009) and knowledge (P = 0.0006) after completing the curriculum, with no improvement noted for residents at institution B in either confidence (P = 0.06) or knowledge (P = 0.79). Neither program demonstrated improvement in attitudes toward patient safety at the end of the year‐long curriculum.

Conclusion

Implementing a formal curriculum dedicated to PSQI led to an improvement in PSQI‐related project development confidence and PSQI knowledge. Attitudes toward safety did not improve over the course of a year. Longer‐term studies involving multiple institutions and other interventions are needed to evaluate the impact and duration of changes that occur.

Level of Evidence

1b. Laryngoscope, 2018

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Evolving phenotype of the head and neck surgeon

Objective

Characterize the evolution of head and neck (H&N) surgical practices in the United States over two decades by using resident case log data as a surrogate.

Methods

National residency case log data from all Accreditation Council for Graduate Medical Education‐accredited otolaryngology residency programs was reviewed for the past 20 academic years (1996–2015). Key indicator procedures in each subcategory of H&N were analyzed to characterize standard ablative H&N surgical practices. Mean number of cases completed per resident each year was calculated.

Results

The proportion of H&N surgeries contributing to the total number of otolaryngology cases performed yearly remained relatively stable during the study period, ranging from 6.4% to 8.7%, indicating concurrent growth of H&N cases with all otolaryngology surgeries. Although each subcategory within H&N demonstrated modest increases in the number of cases performed per resident each year over the study period, the most significant growth occurred in the endocrine surgery subcategory: a 288% increase from 18.4 in 1996 to 71.5 in 2015. The proportion of H&N cases represented by each subcategory decreased, except for endocrine, which more than doubled in proportion from 21% in 1996 to 43% in 2015.

Conclusion

Our findings suggest that the modern H&N surgeon is increasingly becoming an endocrine and H&N surgeon. The proportion of endocrine surgeries performed in residency, which serves as a surrogate for H&N practices, has more than doubled over the past 20 years and now represents the largest subcategory of H&N surgery.

Level of Evidence

NA. Laryngoscope, 2018

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Dysfunctional hypoglossal nerve stimulator after electrical cardioversion: A case series

Objectives/Hypothesis

Upper airway stimulation has demonstrated marked improvements in apnea‐hypopnea index, oxygen desaturation index, and quality‐of‐life measures in patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure. Cardiac arrhythmias are common in patients with OSA and can require electrical cardioversion. We describe the first four reported cases of hypoglossal nerve stimulator (HGNS) dysfunction after electrical cardioversion and illustrate our operative approach to device troubleshooting and repair.

Study Design

Retrospective case series.

Methods

A retrospective review of 201 HGNS implantations performed at two academic institutions revealed four cases of HGNS device dysfunction after electrical cardioversion requiring surgical revision. Preoperative and postoperative device performance metrics and electrical cardioversion specifications were retrospectively assessed and compiled for this case series. The senior authors (R.J.S., M.S.B.) detail operative planning and approach for HGNS implantable pulse generator (IPG) replacement.

Results

At least two patients with HGNS device dysfunction had received cardioversion via anterolateral electrode pad placement. Three patients had received multiple shocks. All four patients experienced a change in device functionality or complete cessation of functionality after electrocardioversion. Operatively, each patient required replacement of the IPG, with subsequent intraoperative interrogation revealing proper device functionality.

Conclusion

Counseling for patients with HGNS undergoing external electrical cardioversion should include possible device damage and need for operative replacement. Anteroposterior electrode pad placement should be considered for patients with HGNS who require electrocardioversion. Operative replacement of an HGNS system damaged by electrocardioversion begins with IPG replacement and intraoperative device interrogation.

Level of Evidence

4. Laryngoscope, 2018

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Are chronic cough and laryngopharyngeal reflux more common in obstructive sleep apnea patients?

Objectives/Hypothesis

To assess if there is a significant difference in the prevalence and severity of chronic cough symptoms in obstructive sleep apnea (OSA) patients versus non‐OSA patients and examine this relationship in regard to laryngopharyngeal reflux (LPR) symptoms.

Study Design

Prospective cohort study.

Methods

Patients referred to Northwestern Medicine Sleep Lab for home sleep testing were enrolled. Patients filled out the Leicester Cough Questionnaire (LCQ) and Reflux Symptom Index (RSI) before completing sleep testing. Home sleep testing results were reviewed, and patients were separated into non‐OSA and OSA groups by standard Apnea‐Hypopnea Index (AHI) criteria. Demographic characteristics and questionnaire scores of the two groups were compared. The relationship between OSA severity, as determined by AHI, and LCQ and RSI scores was assessed.

Results

Of the 52 patients enrolled, 33 patients met criteria for OSA and 19 patients did not. Comparing patients without OSA versus those with OSA, there was a significant difference in mean LCQ score (129.9 vs. 120.0, respectively; P = .02), implying worse cough symptoms among OSA patients, and mean RSI score (3.2 vs. 11.2, respectively; P = .0013), implying worse upper‐airway reflux symptoms among OSA patients. There was a significant correlation between LCQ score and AHI (r = –0.39, P = .0061) and between RSI score and AHI (r = 0.37, P = .0078).

Conclusions

OSA patients demonstrate worse chronic cough and LPR‐related quality of life versus non‐OSA patients. Furthermore, the severity of these quality‐of‐life measures was correlated with the severity of the AHI. Chronic cough and particularly the pharyngeal LPR symptoms may be associated with the presence and severity of OSA.

Level of Evidence

2 . Laryngoscope, 2018

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The effect of omalizumab treatment on severe allergic asthma and allergic comorbidities: real-life experience from the Czech Anti-IgE Registry.

Conclusions: In the CAR registry, patients with SAA treated with omalizumab showed a significant positive effect of anti-IgE therapy not only on the asthma control, but also on allergic comorbidities. PMID: 30429711 [PubMed] (Source: Advances in Dermatology and Allergology)

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Variances in the mRNA expression profile of TGF- β1-3 isoforms and its TGF-βRI-III receptors during cyclosporin a treatment of psoriatic patients.

Conclusions: The changes in expression profiles of TGF-β1-3 and TGF-βRI-III during CsA therapy can be a useful molecular marker of lost sensitivity to the medicine. PMID: 30429710 [PubMed] (Source: Advances in Dermatology and Allergology)

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The importance of specific IgE antibodies in epidemiology of allergic rhinitis and asthma - the Epidemiology of Allergic Diseases in Poland (ECAP) survey: part one. Influence of allergy risk factors on concentration of specific IgE antibodies in serum.

Conclusions: Carpets/rugs capture a portion of mite, epidermal, mould allergens located at home, wherefore absence of a carpet or rug causes greater stimulation of an immune system by these allergens; as a consequence, IgE antibodies are the most frequently detected in respondents. Household contacts of the respondents, at the age of 1-4 years, with cats induced partial immune tolerance to cat dander. PMID: 30429713 [PubMed] (Source: Advances in Dermatology and Allergology)

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Allergic contact dermatitis to dorzolamide and benzalkonium chloride.

Authors: Orsini D, D'Arino A, Pigliacelli F, Assorgi C, Latini A, Cristaudo A PMID: 30429718 [PubMed] (Source: Advances in Dermatology and Allergology)

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Sputum interleukin-25 correlates with asthma severity: a preliminary study.

Conclusions: Our results suggest that IL-25 is particularly associated with severe asthma. The relationship between IL-25 and neutrophilic airway inflammation suggests the pleiotropic role of IL-25 in the immune response in this disease. PMID: 30429702 [PubMed] (Source: Advances in Dermatology and Allergology)

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Mass‐forming intrahepatic cholangiocarcinoma: Can diffusion‐weighted imaging predict microvascular invasion?

Background

Microvascular invasion (MVI) is a risk factor influencing the survival rate of patients with mass‐forming intrahepatic cholangiocarcinoma (IMCC).

Purpose

To investigate whether diffusion‐weighted imaging (DWI) could be useful in predicting MVI of IMCC.

Study Type

Retrospective.

Subjects

Eighty patients with surgically resected single IMCC (21 MVI‐positive lesions and 59 MVI‐negative lesions).

Field Strength/Sequence

Preoperative hepatic MRI (1.5T), including T₁‐ and T₂‐weighted images (T₁WI, T₂WI), DWI, and dynamic enhancement imaging.

Assessment

Morphologic characteristics including contour of the lesion, biliary dilation and hepatic capsule retraction, signal features on T₁WI, T₂WI, and DWI, and dynamic enhancement patterns were qualitatively evaluated. The quantitative analysis was performed for the size and apparent diffusion coefficient (ADC) values.

Statistical Tests

Chi‐square test, Fisher's exact test, and the independent t‐test were used for univariate analysis to determine the relationships between these radiological parameters and the presence of MVI. Logistic regression analysis was used to identify the independent predictors of MVI among these radiological parameters. Receiver operating characteristic curve analysis was performed to evaluate their diagnostic performance.

Results

Larger tumor size (P = 0.006) and higher ADC values (P < 0.001) were positively correlated with MVI. Multivariate logistic regression analysis demonstrated that the ADC value (odds ratio, 3.099; P = 0.001) was an independent predictor for MVI of IMCC. The ADC value for MVI of IMCC showed an area under the receiver operating characteristic curve of 0.782 (optimal cutoff value was 1.59 × 10⁻³ mm²/s).

Data Conclusion

Larger tumor size was associated with MVI and higher ADC values can be a useful predictor of MVI during the preoperative evaluation of IMCC.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018.

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Accelerated multi‐snapshot free‐breathing mapping based on the dual refocusing echo acquisition mode technique (DREAM): An alternative to measure RF nonuniformity for cardiac MRI

Background

Field inhomogeneities in MRI caused by interactions between the radiofrequency field and the patient anatomy can lead to artifacts and contrast variations, consequently degrading the overall image quality and thereby compromising diagnostic value of the images.

Purpose

To develop an efficient free‐breathing and motion‐robust mapping method that allows for the investigation of spatial homogeneity of the transmitted radiofrequency field in the myocardium at 3.0T. Three joint approaches are used to adapt the dual refocusing echo acquisition mode (DREAM) sequence for cardiac applications: (1) electrocardiograph triggering; (2) a multi‐snapshot undersampling scheme, which relies on the Golden Ratio, to accelerate the acquisition; and (3) motion‐compensation based on low‐resolution images acquired in each snapshot.

Study type

Prospective.

Phantom/subjects

Eurospin II T05 system, torso phantom, and five healthy volunteers.

Field strength/sequence

3.0T/DREAM.

Assessment

The proposed method was compared with the Bloch‐Siegert shift (BSS) method and validated against the standard DREAM sequence. Cardiac maps were obtained in free‐breathing and breath‐hold as a proof of concept of the in vivo performance of the proposed method.

Statistical tests

Mean and standard deviation (SD) values were analyzed for six standard regions of interest within the myocardium. Repeatability was assessed in terms of SD and coefficient of variation.

Results

Phantom results indicated low deviation from the BSS method (mean difference = 3%). Equivalent distributions for free‐breathing and breath‐hold in vivo experiments demonstrated the motion robustness of this method with good repeatability (SD < 0.05). The amount of variations was found to be 26% over the myocardium within a short axis slice.

Data conclusion

The feasibility of a cardiac mapping method with high spatial resolution in a reduced scan time per trigger was demonstrated. The free‐breathing characteristic could be beneficial to determine shim components for multi‐channel systems, currently limited to two for a single breath‐hold.

Level of Evidence: 1

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2018.

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White matter myelin profiles linked to clinical subtypes of Parkinson's disease

Background

White matter (WM) microstructural integrity is important for effective brain functioning and alterations have been shown in many neurodegenerative diseases.

Purpose

To investigate WM myelin profiles and their relation to clinical features of Parkinson's disease (PD).

Study Type

Retrospective cross‐sectional.

Population

In all, 29 PD subjects and 15 healthy controls.

Field Strength/Sequence

Multiecho GRASE with 10 msec echo spacing and echo planar imaging (EPI) diffusion‐weighted (b‐value = 700 with 32 gradient directions) on a 3T scanner.

Assessment

Myelin water fraction (MWF) and fractional anisotropy (FA) across 20 WM regions of interest (ROIs) were compared between groups. Partial least squares (PLS) was used to associate MWF and FA with clinical and behavioral measures.

Statistical Tests

Group comparisons were done using two‐sample t‐tests. PLS was assessed with permutation tests. Bootstrapping was used to investigate the robustness of imaging features.

Results

No group differences in myelin content could be detected with univariate tests. A three‐component PLS model linked MWF profiles to clinical phenotypes but no FA profiles. The three components appeared to follow along broad motor/nonmotor subtypes of "akinetic‐rigid," "tremor‐predominant," and "depression/apathy" subtypes, respectively. The first component showed associations between overall motor scores (r = –0.43, P = 0.0196) and cognitive performance (r = 0.44, P = 0.0171) with interhemispheric and long‐range association fibers. A second component linked overall motor scores (r = –0.58, P = 0.0009) and tremor scores (r = –0.48, P = 0.0091) to predominantly projection fibers. The last component related depression (r = –0.60, P = 0.0006) and apathy scores (r = –0.66, P = 0.0001 and r = –49, P = 0.0072) to a mixture of association and projection fibers.

Data Conclusion

MWF was robustly linked to distinct clinical subtypes of PD and may serve as an additional tool to characterize the disease.

Level of Evidence: 4

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2018.

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Test–retest multisite reproducibility of neurovascular 4D flow MRI

Background

4D flow MRI shows great potential in neurovascular disorders such as stenosis, atherosclerotic disease, aneurysms, and vascular malformations. Its widespread application in the neurovascular system requires evidence of good test–retest multicenter reproducibility.

Purpose

To assess the multicenter reproducibility, test–retest reliability and interobserver dependence of 4D flow MRI in measurements of cerebral blood flow/velocity in main intracranial vessels.

Study Type

Prospective study.

Subjects

Ten healthy subjects underwent 4D flow scans at three different centers. All subjects were scanned twice at 2 different days at each center.

Field Strength/Sequence

3.0 T; 4D flow sequence.

Assessment

Multicenter reproducibility, test–retest reliability and interobserver agreement for measurements of the blood flow and peak velocity from five regions of interest were assessed (bilateral internal carotid arteries, bilateral medial cerebral arteries, and sagittal sinus).

Statistical Test

A Shapiro–Wilks test was conducted to assess normality of measurements in each scan. Coefficient of variances (CVs) was computed to evaluate intra‐ and intersite variances of all measurements. The multicenter reproducibility was assessed by two‐way mixed intraclass correlation coefficient (ICC). A Bland–Altman plot and Pearson correlation were used to evaluate test–retest reliability. ICC was calculated to assess interobserver agreements.

Results

All P‐values for Shapiro–Wilks tests were greater than 0.05, which indicated the normality of all measurements. Both intra‐ and intersite CVs were lower than 12%. There was good test–retest reliability for both blood flow and peak velocity of all ROIs (r = 0.75–0.94). In addition, high multicenter reproducibility was detected (ICC = 0.77–0.96, all P < 0.001). The results of these measurements also showed great interobserver agreement (all ICC > 0.9 and all P < 0.001).

Data Conclusion

High multicenter reproducibility and test–retest reliability was shown for 4D flow in the measurements of blood flow and peak velocity of intracranial vessels. In addition, these measurements showed great interobserver agreement.

Level of Evidence: 2

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2018.

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Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

Objectives/Hypothesis

Patients with muscle tension dysphonia often demonstrate an elevation in Reflux Symptom Index (RSI) and 10‐item Voice Handicap Index (VHI‐10) scores, and may be erroneously diagnosed with laryngopharyngeal reflux disease. In this study we assessed the effects of voice therapy on RSI and VHI‐10 scores in patients with voice complaints not responsive to antireflux medications.

Study Design

Retrospective cohort study.

Methods

A study of patients was conducted at a single tertiary‐care center over 1 year (January 2012–January 2013). Patients were included if they had dysphonia not responsive to proton pump inhibition, did not have neurologic or neoplastic disease, and participated in at least three voice‐therapy sessions in the absence of antireflux therapy. Primary analysis assessed change in RSI scores between the initial and follow‐up visits with a laryngologist.

Results

A total of 18 patients were included (mean age = 49.9 ± 14.5 years, 89% female, 83% with a primary complaint of dysphonia). From initial to follow‐up visit, the median RSI score (18.5 [interquartile range {IQR}, 9.5–22.8] vs. 10.5 [IQR, 4.5–14]; P = .02) and median VHI‐10 score (25.5 [IQR, 11.3–30.0] vs. 13.5 [IQR, 9.5–20.8]; P = .03) significantly decreased. A significant inverse correlation was found between the number of voice therapy sessions/month and change in RSI score (r = −0.4; P = .05).

Conclusions

In this study of patients with muscle tension dysphonia or vocal hyperfunction not responsive to antireflux therapy, RSI and VHI‐10 scores improved following voice therapy. Results suggest that self‐reported symptoms typically attributed to laryngopharyngeal reflux disease may actually be secondary to inefficient voice use patterns or anxiety about dysphonia that are responsive to voice therapy.

Level of Evidence

4 Laryngoscope, 2018

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Sex bias: Is it pervasive in otolaryngology clinical research?

Objectives/Hypothesis

Recent initiatives highlight substantial sex bias in biomedical research. The objective was to determine whether sex bias is present in otolaryngology and whether sex is appropriately analyzed as an independent variable in otolaryngology clinical research.

Study Design

Literature review.

Methods

We systematically reviewed all 2016 articles in three major otolaryngology journals: The Laryngoscope, JAMA Otolaryngology–Head and Neck Surgery, and Otolaryngology–Head and Neck Surgery. Extracted data included study origin, location, subspecialty, number/sex of subjects, ≥50% sex matching (SM_≥50), and sex‐based statistical analysis.

Results

Six hundred of 1,209 articles comprising original clinical research were reviewed including 8,997,345,495 subjects (males: 3,898,559,264 [43.3%]; females: 5,095,592,583 [56.6%]; and unknown: 3,193,648 [0.04%]). There were 533/600 (88.8%) studies that included both sexes, eight (1.3%) included females only, five (0.8%) included males only, and 56 (9.3%) did not document participant sex. Only 280 studies (46.7%) analyzed data by sex, and 330 studies (60.7%) had SM_≥50. Sex‐based statistical analysis and SM_≥50 were similar in domestic and international studies (48.7% vs. 42.8% and 60.9% vs. 62%, respectively). Database studies performed sex‐based statistical analysis more frequently than single and multi‐institutional studies (79.1% vs. 40.4% and 43.4%, P < .00001). Analysis by sex was more frequently performed in head and neck surgery (53.6%) and pediatric otolaryngology (51.3%), whereas SM_≥50 was highest in pediatric otolaryngology (86.8%) and otology (82.4%).

Conclusions

Sex bias exists in the clinical otolaryngology literature, with less than half the studies analyzing sex. Acknowledging the intertwinement of sex with disease pathophysiology and outcomes is important. Eliminating sex bias in research and clinical care should become a major focus for otolaryngologists.

Level of Evidence

NA Laryngoscope, 2018

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Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger—United States 2012

Objectives/Hypothesis

To estimate the number, demographics, and outcomes of pediatric patients who underwent tracheostomy in 2012 and to contrast those outcomes by age, race, and gender.

Study Design

Cross‐sectional study.

Methods

The 2012 Kids Inpatient Database was queried to identify tracheostomy patients using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedural codes 311, 3121, and 3129. All patients ≤18 years of age at the time of admission were included and categorized as neonates (≤28 days), infants (>28 days ≤1 year), toddler (1 to 3 years), children (4 to 12 years), adolescents (13 to 17 years), and adults (=18 years). We recorded age, gender, race, insurance status, and zip code of primary residence. We used these variables to contrast the following outcomes: length of stay, total charges, complications of care, and mortality using multiple regression analysis.

Results

An estimated 4,424 pediatric tracheostomies occurred during 2012. Fifty‐one percent of the patients were ≤3 years old, and 62% were male. Forty‐eight percentwere white followed by black (21%), Hispanic (20%), and Asian (3%). The median length of stay was 42 days, and the median total charges were $472,738. The complication rate was 29% and the mortality rate was 8.0%. The length of stay and total charges was predicted by age, with neonates having significantly longer hospitalizations. The complication rate was not associated with age, gender, or ethnicity. However, the mortality rate was associated with younger age.

Conclusions

Pediatric tracheostomies are associated with significant hospital utilizations, complications, and mortality. Increased risk of mortality is observed among neonates and infants. Continued study of tracheostomy outcomes among these subsets of the pediatric population are warranted.

Level of Evidence

4 Laryngoscope, 2018

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Long‐term swallowing performance following transoral robotic surgery for obstructive sleep apnea

Objectives/Hypothesis

This study aimed to evaluate the long‐term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA).

Study Design

Retrospective and prospective cohort study.

Methods

Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long‐term swallowing functions were assessed using subjective self‐evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES).

Results

Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty‐five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration.

Conclusions

BOT reduction via TORS has a negative effect on long‐term swallowing function. A self‐assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow‐up. Proper patient selection and detailed information about surgery and possible late‐swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment.

Level of Evidence

4 Laryngoscope, 2018

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Evolving phenotype of the head and neck surgeon

Objective

Characterize the evolution of head and neck (H&N) surgical practices in the United States over two decades by using resident case log data as a surrogate.

Methods

National residency case log data from all Accreditation Council for Graduate Medical Education‐accredited otolaryngology residency programs was reviewed for the past 20 academic years (1996–2015). Key indicator procedures in each subcategory of H&N were analyzed to characterize standard ablative H&N surgical practices. Mean number of cases completed per resident each year was calculated.

Results

The proportion of H&N surgeries contributing to the total number of otolaryngology cases performed yearly remained relatively stable during the study period, ranging from 6.4% to 8.7%, indicating concurrent growth of H&N cases with all otolaryngology surgeries. Although each subcategory within H&N demonstrated modest increases in the number of cases performed per resident each year over the study period, the most significant growth occurred in the endocrine surgery subcategory: a 288% increase from 18.4 in 1996 to 71.5 in 2015. The proportion of H&N cases represented by each subcategory decreased, except for endocrine, which more than doubled in proportion from 21% in 1996 to 43% in 2015.

Conclusion

Our findings suggest that the modern H&N surgeon is increasingly becoming an endocrine and H&N surgeon. The proportion of endocrine surgeries performed in residency, which serves as a surrogate for H&N practices, has more than doubled over the past 20 years and now represents the largest subcategory of H&N surgery.

Level of Evidence

NA. Laryngoscope, 2018

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Real‐time robotic airway measurement: An additional benefit of a novel steady‐hand robotic platform

Objective

Describe the secondary capability of a robotic system to provide real‐time measurements of airway dimensions with high fidelity.

Methods

Seven unique phantoms of laryngotracheal stenosis (LTS) were modeled using a computer‐aided design tool and were three dimensionally printed. These stenoses were of different dimensions and orientations, and some were purposefully oblique. The dimensions of the stenoses were then measured with the novel Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS; Galen Robotics, Inc., Sunnyvale, CA) because it is capable of tool position memory in three dimensional (3D) space. Five participants (two laryngologists, two otolaryngology–head and neck surgery residents, one neurotology fellow) measured each axis of stenosis (anteroposterior, lateral, and craniocaudal) three times for each of the seven stenosis phantoms. These measurements were then compared to the known design dimensions. Mean magnitude of error (MOE) and interrater reliability (IRR) using an intraclass correlation coefficient (ICC) were then calculated.

Results

Mean MOE and standard deviation for all measurements was 0.306 ± 0.247 mm. Mean MOE was 0.374 ± 0.292 mm, 0.300 ± 0.237 mm, and 0.244 ± 0.185 mm for the anteroposterior, lateral, and craniocaudal dimensions of stenosis, respectively. Eighty‐two percent of all measurements had MOE < 0.5 mm. ICC was 0.945 (95% confidence interval [CI]: 0.847–0.989), 0.995 (95% CI: 0.984–0.999), and 0.993 (95% CI: 0.987–0.999) for anteroposterior, lateral, and craniocaudal dimensions, respectively, indicating excellent agreement among participants.

Conclusion

The REMS can be used to reliably and accurately measure airway dimensions in 3D regardless of the orientation of stenosis. This ability may be easily extrapolated to the measurement of any airway lesion during laryngotracheal surgery.

Level of Evidence

4. Laryngoscope, 2018

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Dysfunctional hypoglossal nerve stimulator after electrical cardioversion: A case series

Objectives/Hypothesis

Upper airway stimulation has demonstrated marked improvements in apnea‐hypopnea index, oxygen desaturation index, and quality‐of‐life measures in patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure. Cardiac arrhythmias are common in patients with OSA and can require electrical cardioversion. We describe the first four reported cases of hypoglossal nerve stimulator (HGNS) dysfunction after electrical cardioversion and illustrate our operative approach to device troubleshooting and repair.

Study Design

Retrospective case series.

Methods

A retrospective review of 201 HGNS implantations performed at two academic institutions revealed four cases of HGNS device dysfunction after electrical cardioversion requiring surgical revision. Preoperative and postoperative device performance metrics and electrical cardioversion specifications were retrospectively assessed and compiled for this case series. The senior authors (R.J.S., M.S.B.) detail operative planning and approach for HGNS implantable pulse generator (IPG) replacement.

Results

At least two patients with HGNS device dysfunction had received cardioversion via anterolateral electrode pad placement. Three patients had received multiple shocks. All four patients experienced a change in device functionality or complete cessation of functionality after electrocardioversion. Operatively, each patient required replacement of the IPG, with subsequent intraoperative interrogation revealing proper device functionality.

Conclusion

Counseling for patients with HGNS undergoing external electrical cardioversion should include possible device damage and need for operative replacement. Anteroposterior electrode pad placement should be considered for patients with HGNS who require electrocardioversion. Operative replacement of an HGNS system damaged by electrocardioversion begins with IPG replacement and intraoperative device interrogation.

Level of Evidence

4. Laryngoscope, 2018

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