bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended Inferior Turbinate Flap for Skull Base Defects
Authors: Choby Garret W. , Pinheiro‐Neto Carlos , Wang Eric W. , Fernandez‐Miranda Juan , Gardner Paul , Snyderman Carl H.
Published: February 2015

Objective

1) Develop a novel extended inferior turbinate flap (EITF) for endoscopic skull base reconstruction when the nasoseptal flap is unavailable. 2) Describe the anatomic and reconstructive limits of this flap. 3) Understand what types of skull base defects would benefit from this flap.

Method

The EITF was designed for harvest in cadaveric specimens based on the inferior turbinate (IT) artery, a terminal branch of the sphenopalatine artery. The anatomical limits of the EITF were assessed. The arc of rotation and reach for reconstruction of ventral skull base defects were assessed in the cadaver.

Results

The average width of the flap was 55.8 ± 4.1 mm. The average length of the flap was 52.5 ± 5.5 mm. The average surface area was 29.3 ± 4.4 cm2. The flap was rotated with the turbinate surface at the inferior aspect of the clival defect, and the extended mucosa of the floor was able to cover the upper portion of the defect. Thus, the angle of rotation was smaller when compared to the 180° angle necessary for the traditional ITF to reach the clivus. The EITF was sufficient to cover defects extending between the paraclival internal carotid arteries.

Conclusion

The EITF presents an additional option for reconstruction of skull base defects when the nasoseptal flap is unavailable or fails. In contrast to the traditionally described ITF, the EITF provides a greater surface area and better arc of rotation.
Use of SMAS Flap and Fat Graft: Viability and Effectiveness
Authors: Goodstein Lindsay , Ambro Bryan T. , Morales Robert E. , Taylor Rodney J.
Published: February 2015

Objective

1) Evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. 2) Evaluate the long‐term viability of the free fat graft, including in the setting of postoperative radiation.

Method

A prospective, consecutive analysis of patients undergoing parotidectomy for benign and malignant disease from 2006‐2011 was performed at an academic university setting. The main outcome measures were the effectiveness of achieving symmetric volume of the ipsilateral parotid defect, long‐term viability of the free fat graft, and presence of Frey’s syndrome.

Results

Twenty‐four consecutive patients received parotidectomy with SMAS flap and free fat graft from 2006‐2011. The average age was 56 (range 16‐84). Nineteen patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. Five procedures were done for malignant disease, and, in each instance, postoperative radiation was administered. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. MRI imaging confirmed graft viability even in the setting of postoperative radiation. There was 1 case of Frey’s syndrome and no instances of long‐term facial weakness among the patients.

Conclusion

The SMAS flap and free fat graft are an effective approach to reconstructing the parotidectomy defect with minimal morbidity and complication. This study demonstrates long‐term viability of the free fat graft in the setting of postoperative radiation. Reconstruction reduces the rate of Frey’s syndrome compared to historic rates following surgery.
Navigational Balloon Sinuplasty
Authors: Kao Yi H. , Pallanch John F.
Published: February 2015

Objective

1) Use computer navigation to preplan sinuplasty. 2) To evaluate the success rate of cannulation with real time computer guidance.

Method

IRB approved prospective study at a community hospital and surgicenter using Paint software with Brainlab computer navigation for 2 years. Patients with recurrent and chronic sinusitis are selected. Balloon sinuplasty is used in conjunction with FESS in a “hybrid” procedure. Sinus ostia on CT scans are colorized. Guides are calibrated then directed to the selected sinus ostia with real time navigation for deployment of the catheter. Cannulation rates, complications, and SNOT scores are measured.

Results

We report a 99% cannulation rate for frontal and sphenoid sinuses with no major complications in 200 patients. SNOT scores decreased from over 2 to under 1. Both cases of failure to cannulate were for repeat frontal sinus surgeries.

Conclusion

Real time navigation with preop colorization of the sinuses allowed for high success rate of cannulation and increased patient satisfaction according to SNOT scores with no major complications when using balloon sinuplasty in conjunction with FESS.
Quality of Life Changes after Endoscopic Pituitary Surgery
Authors: Zimmer Lee A. , Shah Ojas , Theodosopoulos Philip
Published: February 2015

Objective

Given that the transnasal endoscopic approach to the sella involves resection of nasal cavity and sinus anatomy, the effect of surgery on sinonasal quality of life was tested.

Method

Case series with planned data collection at a single tertiary care institution. Adults with a pituitary mass scheduled for transnasal endoscopic resection underwent preoperative testing using the Sinonasal Outcome Test‐22 (SNOT‐22). Repeat testing was performed 1 and 3 months postoperatively. Paired Student t tests and confidence intervals compared pre‐ and postoperative scores.

Results

Thirty‐nine consecutive patients were enrolled. Thirty‐seven patients (19 males, 18 females) completed testing at 1 month. Thirty‐four (17 males, 17 females) completed a 3‐month evaluation. The average score (out of 120) was 23.9 preoperatively, 27.5 at 1 month, and 15.3 at 3 months. A significant improvement was found between preoperative and 3‐month scores (P =. 03), but no change was found at 1 month (P =. 4). Emotional well‐being questions such as sadness, frustration, concentration, productivity, and fatigue significantly improved 3 months after surgery (P <. 05). Physiological questions such as olfaction, obstruction, and postnasal drainage decreased at 1 month (<.05) and normalized at 3 months.

Conclusion

No difference was found between total preoperative and 1 month SNOT‐22 scores. At 3 months clinically significant improvement was seen in SNOT‐22 scores. Analysis of individual SNOT‐22 questions shows marked improvement in emotional well‐being and temporary physiologic changes after endoscopic pituitary surgery.
Reducing Radiation Exposure and Standardizing Sinus CT
Authors: Holmes Janalee K. , Ruggieri Paul , Sindwani Raj
Published: February 2015

Objective

Computed tomography (CT) is the standard imaging modality for the sinuses. Patients frequently undergo multiple scans from diagnosis to image‐guided surgery, and incorrect scans necessitate repeat imaging. A protocol was established to reduce the number of scans obtained and to limit radiation exposure to our sinus patients.

Method

We designed a single isotropic study for diagnosis and surgical navigation. Reductions in kVp were made that would not compromise image detail or navigation fidelity. Two hundred adult CT sagittal sinus topograms were analyzed to determine how much cranial vertex could be eliminated from the imaged field.

Results

The total radiation dose during image capture was reduced from 120 to 100 kVp without an appreciable change in detail. Average distance from supraorbital rim to the cephalad aspect of the frontal sinus was 1.4 (0‐3.5) cm, and from the cephalad aspect to the vertex was 6.8 (3.9‐10) cm. It was conservatively calculated that 3.0 cm of vertex could be cropped without compromising the frontal sinuses and would permit successful placement of the navigation headset. These changes resulted in approximately 30% reduction in radiation exposure per scan. This standardized sinus CT replaced other options, reducing the need for repeat imaging.

Conclusion

Reducing dose, eliminating the vertex of the head, and offering only 1 multipurpose sinus CT results in significant reductions in radiation exposure without compromising diagnostic or navigational functionality. This new sinus CT protocol has been successfully implemented throughout our healthcare system.
Symptom Score for Allergic Rhinitis
Authors: Ologe Foluwasayo E. , Adebola Stephen O. , Alabi Biodun S. , Nwabuisi Charles
Published: February 2015

Objective

To determine the prevalence of allergic rhinitis; and the correlation between Score for Allergic Rhinitis (SFAR) and nasal smear eosinophil count among patients with nasal symptoms.

Method

This cross‐sectional prospective study was conducted on patients attending ENT clinic, University of Ilorin Teaching Hospital, Nigeria. Information on the 8 parameters symptom score were collected using semi‐structured questionnaire by interview. Nasal smear slides were air‐dried, fixed with 95% alcohol, stained using May‐Grünwald‐Giemsa stain, and examined under light microscope.

Results

Of 275 participants seen during the 1‐year study, 116 (42.2%) were males. The mean age was 38.5 years; range being 14 to 75 years. Eighty‐one (29.5%) were diagnosed with allergic rhinitis using nasal smear eosinophil count. The most common symptom was excessive sneezing, involving 93% of allergic rhinitis patients (P‐value. 001). The prevalence of allergic rhinitis using SFAR was 31.6%. The SFAR cut‐off was set at 8 and above (P‐value. 001). The sensitivity and specificity for SFAR was 94.8% (CI 90.5, 97.4) and 95.1% (CI 87.2, 98.4), respectively. A high Spearman correlation, 0.88, was obtained for SFAR when correlated with nasal smear eosinophil count.

Conclusion

The prevalence of allergic rhinitis using SFAR was 31.6%. The study shows that SFAR can be used as a simple, valid diagnostic tool in allergic rhinitis. This is important in rural settings where access to laboratory investigations might not be readily available.
The Role of Clarithromycin in Recurrent CRSwNP
Authors: Bezerra Thiago , Soter Ana C. , Abdo Tatiana , Pezato Rogerio , Pinna Fabio D. R. , Voegels Richard L.
Published: February 2015

Objective

1) Evaluate the role of clarithromycin in recurrent CRSwNP. 2) Evaluate the factors related to clinical improvement after clarithromycin in recurrent CRSwNP.

Method

This was an open label study conducted in a tertiary setting in 2011 on patients with CRSwNP recurrent after surgery. Patients received clarithromycin for 12 weeks. Outcome measures included the SNOT‐20, NOSE, and Lund‐Kennedy scores. Blood testing at enrollment in the study included serum C3, C4, IgG, IgA, IgE, IgM, and eosinophil count.

Results

A total of 45 patients were enrolled. The patients showed a statistically significant improvement in SNOT‐20, NOSE, and Lund‐Kennedy scores after clarithromycin trial (P. 001), but only 46.7% of patients showed a clinically meaningful difference in SNOT‐20 higher than 0.8. There was statistically significant difference in serum IgG count between groups (P. 001). The analysis of this group of patients revealed a statistically insignificant difference in serum C3, C4, IgA, IgE, and IgM.

Conclusion

Our group of patients presents an improvement of QoL after clarithromycin treatment, and it was clinically meaningful in 46.7% of patients. This group showed a higher serum IgG, and perhaps this immunological imbalance is partially responsible for poor response in this group of patients.
Three‐Dimensional Imaging for Sinus Surgery Informed Consent
Authors: Victores Andrew J. , Huynh Nancy , Butler E. B. , Takashima Masayoshi
Published: February 2015

Objective

1) Compare the efficacy of using standard 2‐dimensional computed tomography (CT) and magnetic resonance imaging (MRI) against 3‐dimensional reconstruction during the informed consent process of sinus surgery. 2) Determine whether 3D visualization technology affects patient anxiety prior to sinus surgery.

Method

A randomized, controlled prospective study of patients undergoing sinus surgery was conducted at a tertiary academic center from 2011‐2012. Patients were assigned to receive preoperative informed consent with the assistance of 2‐dimensional CT/MRI or 3D reconstruction. Questionnaires were administered and compared to assess understanding, satisfaction, and anxiety during the process.

Results

Thirty‐four patients were enrolled in this study. There was no significant variation of age, gender, or education level between the groups. The 3D reconstruction group demonstrated significant improvement in the perceived understanding of their condition, the operation, and the potential complications from the procedure as compared to the 2‐dimensional CT/MRI group (P <. 05). Patients in the 3D reconstruction group were also more satisfied with the informed consent process as a whole. Preoperative anxiety did not vary significantly between the groups.

Conclusion

Three‐dimensional reconstruction technology is an effective tool to improve patient understanding and satisfaction during the informed consent process prior to sinus surgery.
Triamcinolone versus Saline Soaked Spacers Post‐FESS
Authors: Hathorn Iain F. , Habib Al‐Rahim , Manji Jamil , Mohamed Safia , Javer Amin R.
Published: February 2015

Objective

1) To determine the effectiveness of triamcinolone‐soaked middle‐meatal‐spacers (MMS) within a perforated surgical gloved finger on improving healing and reducing inflammation in CRS patients post‐FESS.

2) To determine if triamcinolone‐soaked MMS within a perforated surgical gloved finger improves patient reported outcomes post‐FESS.

Methods

Double‐blind randomized controlled trial of 50 CRS patients undergoing FESS. Patients receive MMS in perforated glove fingers bilaterally, impregnated with triamcinolone (experimental arm) or saline (control). Primary outcome measure is the validated Philpott‐Javer endoscopic mucosal inflammation scoring system at postoperative days 14, 28, and 3, 6 months. SNOT‐22 scores were secondary outcomes.

Results

Our interim results, based on 36 participants, are optimistic. Patients in the triamcinolone group show clinically significant improvement in Philpott‐Javer endoscopic scores compared to saline controls at 28 days postoperative examination, however this difference was not currently statistically significant (1.185 vs 2.65; P =. 084). There was no significant difference between SNOT‐22 scores for the 2 groups at postoperative day 28 (P =. 88).

Conclusion

Triamcinolone‐impregnated MMS may improve postoperative inflammation and healing in CRS patients following FESS.
Attainment of Surgical Competence in Otolaryngology Training
Authors: Reiter Evan R. , Chadwick Keith A. , Dodson Kelley M.
Published: February 2015

Objective

Determine postgraduate year (PGY) at which competence is achieved in key otolaryngologic procedures as reported by residents and program directors (PDs) and evaluate relationship between resident and PD perceptions.

Method

Cross‐sectional survey of residents and PDs in US otolaryngology residencies conducted in 2011 using surveymonkey.com, assessing attainment of competence by residents for 32 otolaryngologic procedures. PGYs at which competence is achieved per residents and PDs were determined using linear regression models, and associations were assessed with chi‐square goodness‐of‐fit test.

Results

A total of 277 residents (19.45%) and 39 PDs (37.86%) completed surveys. Compared with PD perceptions, residents felt they achieved subjective competence earlier than expected by PDs for 13 of 32 procedures, later than expected by PDs for 3 of 32, and at the same PGY for 16 of 32 (significance at P <. 05 level by pooled t test). Degrees held, fellowship plans, and size of residency program did not significantly impact PGY at which residents felt competence was achieved for most procedures.

Conclusion

We provide baseline data on PGY at which residents achieve competence in key otolaryngologic procedures. These results may guide efforts to establish appropriate milestones for resident training and assessment and better structure resident operative experiences.
Medical Malpractice and Salivary Gland Surgery
Authors: Hong Steven S. , Sniezek Joseph , Woods Roberta , Beh Hazel
Published: February 2015

Objective

To analyze malpractice litigation trends and to better understand the causes and outcomes of suits involving salivary gland surgeries to prevent future litigation and improve physician education.

Method

Jury verdict reviews from January 1987 to March 2011 were obtained from a computerized legal database, WESTLAW. Data were compiled on the demographics of the defendant and plaintiff, medical specialty of the defendant, use of otolaryngologists as expert witnesses, nature of injury, legal allegations, verdicts, and judgments.

Results

Twenty‐six cases met inclusion criteria and were selected for review. Specialties that were listed as defendants were otolaryngologists (66%), general surgeons (25%), and oral surgeons (13%). Verdicts for the plaintiffs predominated (54%) and the average sum of plaintiff’s monetary award was $978,466. Sixteen cases (62%) directly involved initial pathology or surgical complication of parotid gland etiology. Six cases (23%) involved injury to the lingual nerve. Five cases (19%) involved complications following surgical intervention for sialolithiasis or sialadenitis. Two of the more common complaints were failure to adequately diagnose and treat (31%) and lack of informed consent (15%).

Conclusion

In salivary gland surgeries, risk management goals should include a thorough preoperative assessment of salivary gland masses with appropriate and adequate radiologic and pathologic studies. Additionally, thorough and detailed written informed consent with discussion of alternative treatment options and surgical plans may assist in mitigating risk for potential lawsuits.
Ho:Yag Laser for Sialolithiasis of Wharton’s Duct
Authors: Martellucci Salvatore , Gallo Andrea , Pagliuca Giulio , De Vincentiis Marco , Gallipoli Camilla , Rosato Chiara , Benedetti Ferdinando Nobili
Published: February 2015

Objective

Endoscopic laser lithotripsy can potentially treat most cases of salivary gland stones with minimal complications while preserving a functional salivary gland. Various types of lasers have been tested during sialoendoscopic procedures. This case study describes results obtained using the Ho:YAG‐Laser.

Method

Sixteen patients with sialolithiasis in Wharton’s duct (diameter of the stones between 5 and 10 mm) underwent to intracorporeal lithotripsy with Ho:Yag laser under sialoendoscopic control. Debris were removed using a wire basket. A sialostent was placed at the end of procedure. After a 6‐month follow‐up radiological tests were rerun.

Results

Stone fragmentation was successful in all cases. All 16 patients experienced a regular postoperative course. No complications in terms of nerve damage arose during follow‐up. Postoperative radiological findings showed that all patients but 2 were stone‐free. Complete canalization of the duct was obtained in 15 patients.

Conclusion

Endoscopic laser lithotripsy is a safe and viable technique in Wharton’s duct lithiasis in clinical practice.
NSQIP in Otolaryngology: Our 4‐Year Experience
Authors: Stachler Robert J. , Ritz Jennifer , Yaremchuk Kathleen L. , Ghanem Tamer A. , Hall Francis T.
Published: February 2015

Objective

To present a 4‐year experience with the American College of Surgeons (ACS) National Surgical Quality and Improvement Program (NSQIP) in Otolaryngology, Head and Neck Surgery, to highlight successes, and to demonstrate areas that provide opportunities for quality improvement.

Method

The Henry Ford Health System (HFHS) database was utilized to analyze NSQIP outcomes and quality measures obtained for the Department of Otolaryngology–Head and Neck Surgery. This had been an ongoing project in our department over the last 4 years.

Results

Overall mortality (0.34%) continues to be equal to the national average (0.34%). The overall wound infection rate (23.38%) has improved but is still slightly higher than the national average (17.4%). Initially, the wound infection rate was a significant high outlier (16.67%). The incidence of infection has improved to 0.00% (3rd Q, 2011). Individual categorical gains have been made in unplanned intubations, pneumonia rates, and off the ventilator rates within 48 hours. Sepsis and septic shock rates continue to be benchmarked compared to the national average. Patient length of stay with wound infection have improved and resulted in savings for the institution.

Conclusion

Institutional participation in NSQIP has resulted in demonstrable improvements in patient care outcomes and key quality measures for patients treated at the Department of Otolaryngology–Head and Neck Surgery.
The Utility of Facial Nerve Monitoring for Parotid Surgery
Authors: Samuelson Christian G. , Friedman Michael , Hamilton Craig S.
Published: February 2015

Objective

To assess the utility of facial nerve monitoring in preventing transient and permanent facial paralysis in patients undergoing parotid surgery.

Method

PubMed, MEDLINE, and Cochrane Trial Registry through December 2011 were searched and combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis were performed of studies comparing the incidence of facial nerve injury in monitored and unmonitored parotid surgery.

Results

Five studies met inclusion criteria and had data suitable for pooling (374 patients). Overall, monitoring provided no benefit in reduction of facial paralysis with an odds ratio (OR) of 0.754 (0.488, 1.165; P =. 203). In addition, sensitivity analysis revealed that neither transient nor permanent facial paralysis is significantly reduced with the use of monitoring. Analysis of publication bias revealed a nonsignificant Egger’s regression intercept; however, a single imputed value representing a “missing” study was found to the left of the calculated OR. Addition of this imputed value in no way altered the significance of our findings.

Conclusion

Facial nerve monitoring does not significantly reduce the incidence of transient or permanent facial paralysis in parotid surgery. While few “high‐level evidence” studies were available for review, our results were not affected by publication bias. Nerve integrity monitoring should not be considered the standard of care for parotid surgery.
Analysis of PET for Nodal Metastasis following Radiotherapy
Authors: Riggs Sterling B. , Quattlebaum Steven C. , Raju Ryan P. , Anderson Michael , Medina Jesus E. , Vasan Nilesh R.
Published: February 2015

Objective

1) Determine the ability of PET scan to predict pathologically positive nodes in patients with persistent nodal disease following radiation with or without chemotherapy. 2) Evaluate whether performing a single level neck dissection is feasible in patients with persistent nodal disease.

Method

Study design: Retrospective analysis. Setting: Tertiary care center. Patients were evaluated with PET after definitive (chemo) radiation and before neck dissection. The SUV of PET‐positive nodes were recorded and compared to pathology reports of subsequent neck dissections. Data regarding follow‐up, recurrence rates, and survival of these patients was recorded.

Results

When compared to pathology reports, post‐radiation PET scans failed to identify positive nodes in 4/11 separate cervical levels (sensitivity of 63.6%, P =. 005). It successfully identified 33/40 negative neck levels (specificity of 82.5%, P =. 005). This data suggest that PET scan alone may be inadequate for predicting pathologically positive nodal levels for persistent neck disease after (chemo) radiation. It was also shown that 6/13 (46.2%) nodal levels with SUV greater than 3 on PET scan were pathologically positive. Conversely, a PET negative nodal level with SUV less than 3 had a 27.3% chance (3/11) of being found positive upon pathologic evaluation.

Conclusion

While the relatively high specificity demonstrated here may help support the case for selective neck dissection when PET shows positive nodes, the low sensitivity makes it difficult to exclude PET negative levels from the planned dissection. Larger prospective studies are needed to confirm these findings.
Are Prophylactic Antibiotics Required in Thyroidectomies?
Authors: Cheung Veronique Wan Fook , Sung Dave , Anderson Donald W.
Published: February 2015

Objective

In clean surgical wounds, the rate of infection ranges between 0.3% and 5%. Although postoperative prophylactic antibiotics use is not recommended, practice depends on surgeon preference. We wish to report our rate of postsurgical wound infection requiring antibiotic use following thyroidectomies and parathyroidectomies, where no preoperative or postoperative antibiotic prophylaxis was used.

Method

A retrospective chart review of thyroidectomies and parathyroidectomies without additional procedures from January 2005 to June 2011 was undertaken. The incidence of mild and significant postsurgical wound infections, use of antibiotics, need for readmission, surgical drainage, length of hospitalization, and potential risk factors for postsurgical wound infections were assessed.

Results

Of 767 charts reviewed, 697 met the inclusion criteria. Six hundred eighteen thyroidectomies and 95 parathyroidectomies were undertaken, 21 requiring postoperative drains. Nine (1.29%) were on antibiotics preoperatively, and 3 (0.43%) were on postoperative prophylactic antibiotics. Nine (1.31% of patients not on antibiotics) were given oral antibiotics for symptoms of mild infection. Two (0.29%) more significant infections required intravenous antibiotic therapy 16 and 20 days postoperatively, 1 necessitating readmission for 4 days and seroma drainage, although a wound drain was placed intraoperatively. Surgical drains (1/11 infections; P =. 29) and obesity (4/11 infections, P =. 28), among others, were not statistically significant risk factors for postsurgical wound infections.

Conclusion

Although prophylactic antibiotics were not used for our thyroidectomies and parathyroidectomies, our rate of postsurgical wound infections (1.6%) was comparative to current literature values (0.3%‐5%). Our results suggest that it might not be beneficial or cost‐effective to use prophylactic antibiotics in such clean procedures; a randomized control trial is planned.
Clinical Significance of BRAF Mutation in Papillary Cancer
Authors: Fernandez Ignacio J. , Piccin Ottavio , Sciascia Silvia , Cavicchi Ottavio , Repaci Andrea , Vicennati Valentina , Fiorentino Michelangelo
Published: February 2015

Objective

BRAF mutation represents the most common oncogenic event in sporadic papillary thyroid cancer (PTC). There are, however, significant discrepancies regarding the overall frequency and its relationship with clinico‐pathological parameters of poor outcome. We analyzed BRAF mutation in a cohort of patients affected by PTCs, to identify its association with clinical variables.

Method

We analyzed retrospectively a series of 304 patients, treated for PTC from 1992 to 2011 at Bologna University Hospital. We searched BRAF mutation by RT‐PCR followed by single‐stranded conformational polymorphism or by PCR and direct sequencing, to correlate the presence of the mutation with clinico‐pathological parameters of the patients.

Results

BRAF mutation was found in 77.4% of classical PTCs, 31.9% of follicular variant, and 72.2% of high tall cell PTC, being significantly associated with recurrence (P. 005), stage (P. 043), and multicentricity (P. 025). Moreover BRAF was significantly associated with the classic variant of PTC (P. 0001). Higher T, but not N nor M stage, resulted to be associated to BRAF mutation. A significant difference of disease free survival time was found between BRAF mutation positive and BRAF mutation negative patients (P. 005) after a mean follow‐up of 60.2 months (range 10‐228).

Conclusion

Our results indicate that BRAF mutation identifies a subset of PTC with increased risk of recurrence. The presence of BRAF mutation might be a valuable diagnostic and prognostic marker of the disease. In order to confirm the diagnostic usefulness of this marker, further studies should be carried out.
Racial and Ethnic Diversity of US Otolaryngology Residents
Authors: Schwartz Joseph S. , Nguyen Lily H. P.
Published: February 2015

Objective

Racial and ethnic minorities constitute a growing portion of the US population including the medical profession. The purpose of this study was to examine the evolution of racial and ethnic diversity in US otolaryngology residency programs and to compare it to minority representation in other surgical and non‐surgical residency programs.

Method

Information concerning minority representation in US residency programs was obtained from annually published Graduate Medical Education reports by the Journal of the American Medical Association from 1980 to 2010. The diversity of otolaryngology residents was then compared to other medical fields (general surgery, family medicine, and internal medicine).

Results

Overall, minority representation among US medical residents increased dramatically from 1980 to 2010 (20% to 43.9%). However, otolaryngology residents remain a less diverse group with only 29% minority representation in 2010. In contrast to other residency programs compared, African American (AA) and Hispanic (H) representation were consistently underrepresented among otolaryngology residents (AA = 3.1%, H = 4.3%) relative to all residents (AA = 5.7%, H = 6.4%) in recent years.

Conclusion

Despite rising racial and ethnic diversity among medical residents in general, minority representation in US otolaryngology residency programs is lagging. This finding is in contrast to rising trends of diversity within other residency programs including general surgery.
Endoscopic Endonasal Nasopharyngectomy in Selected Cancers
Authors: Turri‐Zanoni Mario , Battaglia Paolo , Villaret Andrea Bolzoni , Gallo Stefania , Nicolai Piero , Castelnuovo Paolo
Published: February 2015

Objective

1) To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and 2) to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs).

Method

NER was tailored to the NPT extension and classified as follows: type‐1‐NER, resection of the posterior nasopharyngeal wall; type‐2‐NER, resection superiorly extended to the sphenoid; type‐3‐NER, transpterygoid approach to the postero‐lateral nasopharyx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal‐petrous‐cavernous segments of the internal carotid artery.

Results

From 1997 to 2011, 36 consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs underwent an NER with curative intent. The lesions were staged (7th edition AJCC staging system) as follows: stage‐I, 16 (44.4%); stage‐II, 3 (8.3%); stage‐III, 13 (36.1%); and stage‐IVA, 4 (11.1%). Type‐1‐NER was performed in 6 cases, type‐2‐NER in 12, type‐3‐NER in 16, and bilateral extended type‐3‐NER in 2. No perioperative mortality or complications were observed. Postoperatively, 11 patients received intensity‐modulated radiation therapy, with or without chemotherapy. Follow‐up ranged from 2 to 173 months (mean, 38 months). Five years overall, disease‐specific and disease‐free survivals were 75.1 ± 9.13, 80.9 ± 7.79, and 58.1 ± 14.8, respectively.

Conclusion

NER is a safe, feasible, and minimally invasive surgical approach to manage selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional open procedures. Larger case series and longer follow‐up are needed to validate the reproducibility and efficacy of the technique.
Hemorrhage after Transoral Robotic Assisted Surgery
Authors: Asher Scott A. , White Hilliary N. , Kejner Alexandra E. , Rosenthal Eben L. , Carroll William R. , Magnuson J. Scott
Published: February 2015

Objective

An increasing rate of head and neck surgeons have begun to utilize transoral robotic assisted surgery, as it is technically feasible and has acceptable safety levels. Our objective was to examine the postoperative bleeding complications we have encountered to determine risk factors and to discuss the topic of hemorrhage control.

Method

Medical records were reviewed in 147 consecutive patients undergoing transoral robotic assisted surgery for any indication at one tertiary academic medical center between March 2007 and September 2011.

Results

Eleven of 147 (7.5%) patients undergoing transoral robotic assisted surgery experienced some degree of postoperative hemorrhage, with 9 patients taken back to the operative room for examination and/or control of bleeding. Bleeding occurred at a mean of 11.1 days after the initial operation. Eight of 11 (72%) patients that bled were on antithrombotic medication (anticoagulants or antiplatelet agents) for other medical comorbidities. Postoperative hemorrhage in patients taking antithrombotic medication (8/48 patients = 17%) was significantly higher than in those not taking antithrombotics (3/99 patients = 3%), P =. 0057. There was no significant difference in patients undergoing primary (8/118 = 6.8%) or salvage (3/29 = 10.3%) surgery.

Conclusion

Potential for postoperative bleeding in association with antithrombotic medications in patients undergoing transoral robotic assisted surgery should be recognized. Indications for antithrombic medication in this patient population should be highly scrutinized and tightly regulated in the perioperative period.
Vocal Rehabilitation after Radiotherapy for Laryngeal Cancer—Pilot Study
Authors: Tuomi Lisa , Björkner Eva
Published: February 2015

Objective

Learning more about to what extent voice therapy with a speech‐language pathologist is an effective method for improved vocal function for patients with laryngeal cancer. Results from self‐evalutation forms as well as temporal and acoustical measures will be presented. The pilot participants are selected from a larger longitudinal study.

Method

Twenty patients were randomized to vocal rehabilitation (VRG) or to a control group (CG). Text reading and sustained vowel production, S‐SECEL (The Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer) and vocal fatigue were recorded pre‐ and post‐voice therapy, 1 and 6 months after radiotherapy.

Results

Maximum phonation time increased for CG and decreased for VRG, but was longer than for CG. Vocal fatigue, assessed on a VA‐scale, as well as mean F0 decreased for both groups. Mean values of the total S‐SECEL score increased for CG and decreased with 16.7% for VRG indicating a better vocal function. For CG shimmer increased with 0.03 dB and decreased for VRG with 0.13 dB, indicating an improved voice quality. Mean harmonic‐to‐noise ratio improved for VRG while it deteriorated for CG.

Conclusion

Our results correspond with earlier studies on voice rehabilitation, showing an improved self‐evaluated communication (S‐SECEL) for VRG, which is also shown in the acoustic measures of voice quality. However, the expected result, with a more pronounced improvement for VRG in most dimensions is not supported.
sLeX Relationship with Head and Neck Cancer Stem Cells CSC
Authors: Papagerakis Silvana
Published: February 2015

Objective

Disseminated head and neck cancer is still considered incurable, as therapeutic options for advanced metastatic head and neck squamous cell carcinomas (HNSCC) are limited. It is not known if CSCs are the metastatic population, nor how they carry out the metastatic process. Our previous studies indicated that metastatic HNSCC express high levels of an endothelial adhesion molecule, Sialyl‐Lewis‐X (sLeX, the main E‐selectin ligand) with a critical role in the initiation of the metastatic dissemination, and that CSCs are significantly more motile and migratory. This study addresses important unknowns about the sLeX relationship with CSC.

Method

A panel of stage‐ and anatomic site‐specific primary and metastatic HNSCC cell lines was examined by flow cytometry to quantify cell‐surface sLeX expression comparatively with known CSC markers. HNSCC‐derived sLeX‐positive cells were injected in the flank of immunodeficient mice to evaluate their tumorigenic potential. Preparations of the cultured cells, and tumor specimens were immunohistochemically stained for sLeX and CSC markers.

Results

HNSCC originating from oral cavity expressed high sLeX that increased with advanced stage and poorer clinical outcomes. A small subpopulation of the sLeX positive cells was also positive for CCS markers. Flank injections of sLeX‐positive tumor cells developed SCC in immunodeficient mice. sLeX‐positive murine primary and metastatic tumors were also positive for CSC markers.

Conclusion

These studies suggest that sLeX could serve as a biomarker for CSC metastatic potential and provide foundation for the design of novel therapeutic approaches, resulting in improvement of HNSCC management and patient outcome.
Reachability-based control for the active SLIP model
Authors: Piovan Giulia , Byl Katie
Published: February 2015

One of the key topics in robotics is legged locomotion, taking inspiration from walking and bouncing gaits of bipeds and quadrupeds. A fundamental tool for analyzing running and hopping is the spring loaded inverted pendulum (SLIP), thanks to its simplicity but also effectiveness in modeling bouncing gaits. Being completely passive, the SLIP model does not have the ability to modify its net energy, which, for example, can be a prohibitive obstacle when traveling on a terrain with varying heights. The actuated version of the SLIP model, the active SLIP, considered in this paper, includes a series actuator that allows energy variations via compressing or extending the spring. In this work, we investigate how different actuator motions can affect the system’s state, and we propose a control strategy, based on graphical and numerical studies of the reachability space, and updated throughout the stance phase, to drive the system to a desired state. We quantify its performance benefits, particularly in serving as an error-recovering method. The objective of our control strategy is not to replace any leg-placement approach proposed by other works, but rather to be paired with any other leg-placement or path planning method. Its main advantage is the ability to reduce the effects of sensing errors and disturbances happening at landing as well as during the stance phase.
Generation of an internal fire whirl in an open roof vertical shaft model with a single corner gap
Authors: Zou GW , Chow WK
Published: February 2015

An internal fire whirl can be generated by burning a pool fire in a vertical shaft with appropriate sidewall ventilation provision. Earlier experimental results show that the flame swirling motion depends on the corner gap width providing ventilation. In this article, experiments on generating an internal fire whirl in a 9 m tall vertical shaft model will be reported. Flame shapes in burning a gasoline pool fire inside the shaft model with different corner wall gap widths and tray diameters were observed. Fuel mass of the pool fire, flame height of the internal fire whirl, and transient air temperatures were measured. From the results, it is further confirmed that an internal fire whirl cannot be generated when the gap width is too wide or too narrow. An internal fire whirl is developed in five stages. The pool fire is burning in a way similar to burning in open air at stage I. The burning rate of pool fire increases at stage II. Swirling flame motion starts to develop at stage III. An internal fire whirl develops fully at stage IV. Stage V is the decay stage. Furthermore, the created internal fire whirl can be divided into three zones. Zone I is at the lower part with the flame rotating violently. Zone II is in the middle part with a slower swirling rate. The upper part zone III has no flame rotation.
“Cause That’s the Only Skills in School You Need”
Authors: Jäggi Lena , Kliewer Wendy
Published: February 2015

Revenge goals are correlated with maladjustment, and retaliation is a factor driving youth violence. However, revenge might be an important social tool adolescents use to achieve (self-)justice in environments where institutionalized interventions from authorities such as teachers or police are limited. This qualitative secondary analysis of 50 revenge scenarios from a larger study ( N = 358 youth-caregiver dyads) expands one-dimensional knowledge from closed-answer vignettes to the rich real-world experiences of youth (aged 10-16; 30 boys, 20 girls), from an urban community sample. Ten patterns of qualitative differences in cognition and emotion of revenge scenarios emerged and are discussed within the revised model of social information processing (SIP). Importance of reputation, confidence in non-violent solutions, and the influence of intense emotions were among the themes. Gender differences and implications for prevention are discussed.
Microfinance Participation and Domestic Violence in Bangladesh
Authors: Murshid Nadine Shaanta , Akincigil Ayse , Zippay Allison
Published: February 2015

This article examines domestic violence among women who participate in microfinance in Bangladesh. Secondary analysis of survey data from nationally representative Bangladesh Demographic and Health Survey was used to investigate the association between microfinance participation and domestic violence of 4,163 ever-married women between the ages of 18 and 49 years. Outcome measure is experience of domestic violence as measured by a modified Conflict Tactics Scale (CTS) and predictor variables include microfinance, binary indicator of relatively better economic status, autonomy, decision-making power, and demographic variables. The likelihood of experiencing domestic violence was not found to vary with microfinance participation. However, the interaction effect of microfinance and better economic status was found to be significantly associated with domestic violence (9% increased probability). Experience of domestic violence was negatively associated with older age, higher education of the husband, and autonomy. In Bangladesh, microfinance participation may be associated with a higher probability of experiencing domestic violence for women with relatively better economic status, but not for the poorest of the poor.
Potato starch-reinforced poly(vinyl alcohol) and poly(lactic acid) composites for biomedical applications
Authors: Eaysmine Shamima , Haque Papia , Ferdous Taslima , Gafur Md Abdul , Rahman Mohammed M
Published: February 2015

Starch platelets of micro particle size in the range of 10–100 µm were extracted from potato by acid hydrolysis. Two types of starch-reinforced composites, one with poly(vinyl alcohol) (PVA) and the other with poly(lactic acid) (PLA), were prepared by solvent casting and hot press molding methods, respectively. Mechanical properties of the starch/PVA and the starch/PLA composites were determined, and the maximum tensile and yield strength obtained were around 19.7 MPa for 6% starch/PVA composite and around 7.2 MPa for 6% starch/PLA composite, correspondingly. The structure of both the composites were characterized by Fourier transform infrared spectroscopy, X-ray diffraction, thermogravimetric analysis (differential thermal analysis/differential thermogravimetric analysis), thermomechanical analysis, and scanning electron microscopy. Finally, antimicrobial test was conducted to assess the potentiality of both the composites to be used for biomedical applications and only starch/PVA composite was observed to inhibit microbial growth against both a gram-positive ( Bacillus subtillis) and a gram-negative ( Escherichia coli) bacteria.
An Exploration of First-Generation College Students’ Career Development Beliefs and Experiences
Authors: Tate Kevin A. , Caperton William , Kaiser Dakota , Pruitt Nathan T. , White Heather , Hall Eric
Published: February 2015

First-generation college students (FGCS) represent a large proportion of individuals seeking higher education in the United States; yet this population does not perform as well academically as, and persist to graduation at lower rates than, their peers who have more familial context for the college-going experience. Completing a college degree is clearly tied to employability and mental wellness, which makes FGCS’s plight an important issue. Although there is a significant body of research about FGCS’s academic performance and experiences, there is little research about this population’s beliefs and experiences along their career path. Using an exploratory qualitative approach (Consensual Qualitative Research) and a well-researched model of career development (Social Cognitive Career Theory), we asked 15 FGCS about external influences on, and internal beliefs about, their career development process. Three major domains emerged from the data— external influences on the career development process, understanding of the career development process, and self-concept. These results provide a foundation for future research, as well as implications for practice with this population.
Dementia Care Management in an Underserved Community
Authors: Chodosh Joshua , Colaiaco Benjamin A. , Connor Karen Ilene , Cope Dennis Wesley , Liu Hangsheng , Ganz David Avram , Richman Mark Jason , Cherry Debra Lynn , Blank Joseph Moshe , Carbone Raquel del Pilar , Wolf Sheldon Mark , Vickrey Barbara Grace
Published: February 2015

Objectives: To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. Methods: We randomized 151 patient–caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient–caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. Results: Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. Discussion: Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected.
Explaining declining industries in developing countries: The case of textiles and apparel in Ghana
Authors: Amankwah-Amoah Joseph
Published: February 2015

Although declining industries have garnered a plethora of scholarly attention, there is still a theoretical deficit in our understanding of factors that precipitate them in developing countries. This paper examines the causes of declining industries in developing countries. The paper develops an integrated framework to shed light on the subject. Using insights from the textile and apparel industries in Ghana, the study uncovered factors such as global competition, the growth of second-hand clothing and smuggling, and obsolete technologies used by firms have interacted to precipitate the incremental decline of the industries. The study outlines the important implications for theory and practice.
Creating legitimate authority for environmental governance and new market creation: A case study from Australia
Authors: Knight Eric , Knox-Hayes Janelle
Published: February 2015

New markets and governance arrangements have emerged in recent years to address grand challenges at the interface of science, economics and politics. Whereas much has been written on the technical design on these markets, this paper focuses on how these complex socio-economic systems are created and evolve over time. Drawing on theories of legitimacy, we propose a model for how legitimate authority is created in environmental governance along three bases: scientific authority, economic authority and emotive authority. We distinguish our approach from the literature on power by examining discursive practices that create legitimacy over time. Our analysis relies on the case study of the Australian carbon market and uses in-depth, semi-structured interviews with 45 respondents across multiple fields. Our findings have implications for theory and policy practice.