bluuebunny/crossref_metadata_2025 huggingface dataset:
Suprascapular Nerve Block for Shoulder Pain in the First Year After Stroke
Authors: Adey-Wakeling Zoe , Crotty Maria , Shanahan E. Michael
Published: August 2013

Background and Purpose—

Shoulder pain is a common complication after stroke that can impede participation in rehabilitation and has been associated with poorer outcomes. Evidence-based treatments for hemiplegic shoulder pain are limited. Suprascapular nerve block (SSNB) is a safe and effective treatment of shoulder pain associated with arthritic shoulder conditions, but its usefulness in a stroke population is unclear.

Methods—

We undertook a randomized controlled trial assessing the effectiveness of SSNB in a population of 64 stroke patients (onset < 1 year) with hemiplegic shoulder pain. The primary outcome was pain measured on a visual analogue scale (VAS). Secondary outcomes were disability (Modified Rankin Scale, Croft Disability Index) and quality of life (EuroQol Health Questionnaire). All participants were assessed before randomization, and at 1, 4, and 12 weeks postintervention. Both groups continued with routine therapy.

Results—

Although both intervention and control groups demonstrated reduction in pain score, participants who received SSNB consistently demonstrated superior, statistically significant pain reduction compared with placebo. Mean VAS reduction in the SSNB group was >18 mm greater than participants receiving placebo injection. The number needed to treat with SSNB to reduce 1 stroke survivor’s pain by 50% at 4 weeks is 4. No significant differences in function or quality of life were observed. No adverse events were reported.

Conclusions—

Suprascapular nerve block is a safe and effective treatment for patients with hemiplegic shoulder pain.

Clinical Trial Registration—

URL:
http://www.anzctr.org.au
. Unique identifier: ACTRN12609000621213.
Genetic Variant
RNF213
c.14576G>A in Various Phenotypes of Intracranial Major Artery Stenosis/Occlusion
Authors: Miyawaki Satoru , Imai Hideaki , Shimizu Masahiro , Yagi Shinichi , Ono Hideaki , Mukasa Akitake , Nakatomi Hirofumi , Shimizu Tsuneo , Saito Nobuhito
Published: August 2013

Background and Purpose—

Recently, we reported a common genetic variant,
ring finger protein 213
(
RNF213
) c.14576G>A variant, a susceptibility gene for moyamoya disease (MMD), among patients with intracranial major artery stenosis/occlusion (ICASO) in a selected Japanese population. The aim of this 2-center–based case–control study was to confirm our previous finding in a larger population.

Methods—

Study participants were recruited from The University of Tokyo Hospital and Kanto Neurosurgical Hospital. The occurrence rate of c.14576G>A variant was investigated in 323 patients, 22 with definite MMD, 8 with unilateral MMD, 84 with ICASO in the absence of MMD (non-MMD ICASO), 34 with extracranial carotid atherosclerosis, 44 with cerebral aneurysm, 21 with intracerebral hemorrhage, and 110 control subjects.

Results—

RNF213 c.14576G>A variant was found in 1.8% (2/110) of the normal control group and had significant associations with definite MMD (
P
<0.0001; odds ratio, 144.0; 95% confidence interval, 26.7–775.9), unilateral MMD (
P
=0.0001; odds ratio, 54.0; 95% confidence interval, 7.5–386.8), and non-MMD ICASO (
P
<0.0001; odds ratio, 16.8; 95% confidence interval, 3.81–74.5). There was no significant association with extracranial carotid atherosclerosis, cerebral aneurysm, or intracerebral hemorrhage. This result replicated our previous findings.

Conclusions—

A particular subset of patients with various phenotypes of ICASO has a common genetic variant,
RNF213
c.14576G>A, indicating that
RNF213
c.14576G>A variant is a high-risk allele for ICASO.
Drought and Deforestation: Has Land Cover Change Influenced Recent Precipitation Extremes in the Amazon?
Authors: Bagley Justin E. , Desai Ankur R. , Harding Keith J. , Snyder Peter K. , Foley Jonathan A.
Published: August 2013

Expansion of agricultural lands and inherent variability of climate can influence the water cycle in the Amazon basin, impacting numerous ecosystem services. However, these two influences do not work independently of each other. With two once-in-a-century-level droughts occurring in the Amazon in the past decade, it is vital to understand the feedbacks that contribute to altering the water cycle. The biogeophysical impacts of land cover change within the Amazon basin were examined under drought and pluvial conditions to investigate how land cover and drought jointly may have enhanced or diminished recent precipitation extremes by altering patterns and intensity. Using the Weather Research and Forecasting (WRF) Model coupled to the Noah land surface model, a series of April–September simulations representing drought, normal, and pluvial years were completed to assess how land cover change impacts precipitation and how these impacts change under varied rainfall regimes. Evaporative sources of water vapor that precipitate across the region were developed with a quasi-isentropic back-trajectory algorithm to delineate the extent and variability that terrestrial evaporation contributes to regional precipitation. A decrease in dry season latent heat flux and other impacts of deforestation on surface conditions were increased by drought conditions. Coupled with increases in dry season moisture recycling over the Amazon basin by ~7% during drought years, land cover change is capable of reducing precipitation and increasing the amplitude of droughts in the region.
Rigorous Evaluation of a Fraternal Twin Ocean OSSE System for the Open Gulf of Mexico
Authors: Halliwell G. R. , Srinivasan A. , Kourafalou V. , Yang H. , Willey D. , Le Hénaff M. , Atlas R.
Published: August 2013

A new fraternal twin ocean observing system simulation experiment (OSSE) system is validated in a Gulf of Mexico domain. It is the first ocean system that takes full advantage of design criteria and rigorous evaluation procedures developed to validate atmosphere OSSE systems that have not been fully implemented for the ocean. These procedures are necessary to determine a priori that the OSSE system does not overestimate or underestimate observing system impacts. The new system consists of 1) a nature run (NR) stipulated to represent the true ocean, 2) a data assimilation system consisting of a second ocean model (the “forecast model”) coupled to a new ocean data assimilation system, and 3) software to simulate observations from the NR and to add realistic errors. The system design is described to illustrate the requirements of a validated OSSE system. The chosen NR reproduces the climatology and variability of ocean phenomena with sufficient realism. Although the same ocean model type is used (the “fraternal twin” approach), the forecast model is configured differently so that it approximately satisfies the requirement that differences (errors) with respect to the NR grow at the same rate as errors that develop between state-of-the-art ocean models and the true ocean. Rigorous evaluation procedures developed for atmospheric OSSEs are then applied by first performing observing system experiments (OSEs) to evaluate one or more existing observing systems. OSSEs are then performed that are identical except for the assimilation of synthetic observations simulated from the NR. Very similar impact assessments were realized between each OSE–OSSE pair, thus validating the system without the need for calibration.
A Comparison of Automated Methods of Front Recognition for Climate Studies: A Case Study in Southwest Western Australia
Authors: Hope Pandora , Keay Kevin , Pook Michael , Catto Jennifer , Simmonds Ian , Mills Graham , McIntosh Peter , Risbey James , Berry Gareth
Published: August 2013

The identification of extratropical fronts in reanalyses and climate models is an important climate diagnostic that aids dynamical understanding and model verification. This study compares six frontal identification methods that are applied to June and July reanalysis data over the Central Wheatbelt of southwest Western Australia for 1979–2006. Much of the winter rainfall over this region originates from frontal systems. Five of the methods use automated algorithms. These make use of different approaches, based on shifts in 850-hPa winds (WND), gradients of temperature (TGR) and wet-bulb potential temperature (WPT), pattern matching (PMM), and a self-organizing map (SOM). The sixth method was a manual synoptic technique (MAN). On average, about 50% of rain days were associated with fronts in most schemes (although methods PMM and SOM exhibited a lower percentage). On a daily basis, most methods identify the same systems more than 50% of the time, and over the 28-yr period the seasonal time series correlate strongly. The association with rainfall is less clear. The WND time series of seasonal frontal counts correlate significantly with Central Wheatbelt rainfall. All automated methods identify fronts on some days that are classified as cutoff lows in the manual analysis, which will impact rainfall correlations. The front numbers identified on all days by the automated methods decline from 1979 to 2006 (but only the TGR and WPT trends were significant at the 10% level). The results here highlight that automated techniques have value in understanding frontal behavior and can be used to identify the changes in the frequency of frontal systems through time.
One-carbon metabolism and bipolar disorder
Authors: Baek Ji Hyun , Bernstein Emily E , Nierenberg Andrew A
Published: August 2013

Objective:

Folate is one of the most widely used nutraceuticals for the treatment of mood disorders. In this article, we review folate metabolism, its relationship with bipolar disorder, and its therapeutic potential.

Methods:

We searched PubMed and the Cochrane Library for relevant articles up to and including the year 2012. Background information, proposed mechanisms of action, and results from clinical trials were reviewed.

Results:

Folate is an essential cofactor involved in methylation reactions, which are critical for monoamine synthesis and homocysteine regulation. Folate level is thought to be associated with mood disorders and limited response to antidepressants. Functional deficiency, due to a common genetic variant of the methylenetetrahydrofolate reductase (NAD(P)H) ( MTHFR) gene, could also affect the presentation of bipolar disorder. Sodium valproate and lamotrigine, commonly used mood stabilizers for the treatment of bipolar disorder, can potentially interfere with folate and homocysteine metabolism. Previous studies consistently support the efficacy of folate in the treatment of depression; one study showed efficacy in the treatment of mania. Biologically active forms of folate formulations, which do not require biochemical conversion, could be beneficial in the treatment of bipolar disorder.

Conclusions:

Folate augmentation could be effective for the treatment of bipolar disorder. A common genetic variant of the MTHFR gene might impact the treatment effect of folate augmentation. The biologically active form of folate could potentially correct mood stabilizer-associated functional folate deficiency, help normalize monoamine synthesis, and improve outcomes.
Indian and Chinese Engagement in UN Complex Peacekeeping Operations: A Comparative Perspective
Authors: Choedon Yeshi
Published: August 2013

There were great differences between Indian and Chinese positions on the UN peacekeeping operations during the Cold War. India played a pioneering role both in the conceptualisation and consolidation of the peacekeeping mechanism. On the other hand, China vehemently opposed the UN peacekeeping operation as a tool of imperialism even after joining the United Nations in 1971. Both India and China are apprehensive of motivation of the Western enthusiasm for complex peacekeeping operations of the post-Cold War and both expressed strong reservation on number of issues arising from them. As they do not want to be marginalised hence, despite their reservations, they individually participated actively in the operations with the intention of making a difference through participation. The differences in their participation are partly due to vast experience and confidence of India and partly due to hesitancy of China to engage in new terrain. They have taken similar positions to strengthen UN peacekeeping such as advocating for stronger financial resources, participation of the troop contributing countries in the decision-making process, favouring standby forces, opposing a selective approach and effective training of peacekeepers. Their participation in peacekeeping operations is no longer just a means to prevent Western powers from misusing peacekeeping operations. Different motives and incentives appear to be driving India and China’s participation in the peacekeeping operations.
Trajectories of China’s Integration with the World Economy through SEZs: A Study of Shenzhen SEZ
Authors: Tantri Malini L.
Published: August 2013

By exploring the role of Special Economic Zones (SEZs) in China’s integration with the world economy, we also investigate the underlying challenges faced by the economy. This analysis suggests that SEZs enabled the Chinese economy to trigger its growth standards and to achieve its ambition of integrating with the world economy without compromising its political ideology. This transformation, however, has been accompanied by a few challenges of late that have been posing obstacles to the broader process of development. We argue that the experience of Chinese SEZs provides a number of policy directions for other economies, which may be followed with discrimination.
Coding In-depth Semistructured Interviews
Authors: Campbell John L. , Quincy Charles , Osserman Jordan , Pedersen Ove K.
Published: August 2013

Many social science studies are based on coded in-depth semistructured interview transcripts. But researchers rarely report or discuss coding reliability in this work. Nor is there much literature on the subject for this type of data. This article presents a procedure for developing coding schemes for such data. It involves standardizing the units of text on which coders work and then improving the coding scheme’s discriminant capability (i.e., reducing coding errors) to an acceptable point as indicated by measures of either intercoder reliability or intercoder agreement. This approach is especially useful for situations where a single knowledgeable coder will code all the transcripts once the coding scheme has been established. This approach can also be used with other types of qualitative data and in other circumstances.
The Compassion–Hostility Paradox
Authors: Keller Johannes , Pfattheicher Stefan
Published: August 2013

The present research examined the notion that the prosocial attitude of compassion is positively related to the antisocial attitude of hostility given that compassion and hostility entail elements reflecting vigilant, prevention-focused self-regulation. In fact, it was found in four samples ( N = 4,903) that individuals with a strong vigilant prevention focus reported higher levels on measures of hostility as well as higher levels on compassion than individuals characterized by a weak prevention focus. In addition, compassion and hostility are indeed positively correlated reflecting the Compassion–Hostility Paradox. The positive association between compassion and hostility is substantially reduced when the chronic level of prevention-focused self-regulation is controlled for. A complementary experimental study in which compassion was manipulated revealed an effect of compassion on hostility in chronically prevention-focused individuals.
Different Effects of Religion and God on Prosociality With the Ingroup and Outgroup
Authors: Preston Jesse Lee , Ritter Ryan S.
Published: August 2013

Recent studies have found that activating religious cognition by priming techniques can enhance prosocial behavior, arguably because religious concepts carry prosocial associations. But many of these studies have primed multiple concepts simultaneously related to the sacred. We argue here that religion and God are distinct concepts that activate distinct associations. In particular, we examine the effect of God and religion on prosociality toward the ingroup and outgroup. In three studies, we found that religion primes enhanced prosociality toward ingroup members, consistent with ingroup affiliation, whereas, God primes enhanced prosociality toward outgroup member, consistent with concerns of moral impression management. Implications for theory and methodology in religious cognition are discussed.
Marking Time
Authors: Peetz Johanna , Wilson Anne E.
Published: August 2013

Temporal landmarks such as birthdays and significant calendar dates structure our perception of time. People might highlight temporal landmarks spontaneously in an effort to regulate connections between temporal selves. Five studies demonstrated that landmarks are used spontaneously to induce psychological separation from undesirable temporal selves. Participants were more likely to think of events that fell in between the current and the future self if an imagined future self was negative than if it was positive (Studies 1a, 1b, and 2). Furthermore, when a self-enhancement mindset was activated, participants were more likely to call to mind intervening temporal landmarks to protect themselves from a negative future self than when this mindset was not activated (Study 3). Finally, when psychological separations between the current self and a negative future self were introduced through alternate means, participants no longer selectively used landmarks to separate themselves from this future self (Study 4).
Recognizing Malnutrition in Adults
Authors: Jensen Gordon L. , Compher Charlene , Sullivan Dennis H. , Mullin Gerard E.
Published: August 2013

Appropriate recognition of malnutrition in adults requires knowledge of screening and assessment methodologies. An appreciation for the contributions of inflammation has resulted in a new etiology‐based approach to defining malnutrition syndromes. The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have published a consensus document that extends this approach to describe characteristics for the identification and documentation of malnutrition in adults. Nutrition screening tools are used to identify patients at nutrition risk and those who are likely to benefit from further assessment and intervention. Nutrition assessment serves to guide appropriate intervention. A systematic approach to nutrition assessment that supports the new diagnostic scheme and criteria from the Academy and A.S.P.E.N. has recently been presented. Since screening delays and failures in the diagnosis and management of malnutrition are all too common, a multidisciplinary team approach is recommended to promote improved communication and quality of care.
Addressing Malnutrition in Hospitalized Adults
Authors: Hamilton Cynthia , Boyce Victoria J.
Published: August 2013

Established guidelines and standardized protocols exist to assist clinicians in effectively addressing disease‐related malnutrition in hospitalized adults. The goals of this treatment vary according to the disease state and the severity of the malnutrition. In starvation‐related malnutrition, the goal of nutrition therapy is to restore healthy levels of lean body mass and body fat. For chronic disease‐related malnutrition, the goals of treatment are to maintain and improve lean body mass and body fat. In acute‐disease‐related malnutrition, the goals of nutrition therapy are to support vital organ function and preserve the host response through the acute episode. The success of addressing malnutrition in hospitalized patients depends not just on the nutrition therapy selected, but also on the timely and appropriate application of guidelines and protocols by the clinicians dedicated to caring for malnourished patients. Coordination of nutrition care among providers is highly desirable, and usually includes a multidisciplinary team of clinicians typically comprising a physician, nurse, dietitian, and pharmacist. For greatest success, this attention to recognizing and addressing malnutrition begins at admission and continues beyond discharge to the community. When addressing malnutrition in hospitalized patients, oral feeding through diet enrichment or oral nutrition supplementation (ONS) is the first line of defense. ONS has consistently been demonstrated to provide nutrition, clinical, functional, and economic benefits to malnourished patients in both individual trials and meta‐analyses. In an era when the cost of healthcare is rising as the population ages, addressing malnutrition in hospitalized patients is an important priority.
Cheering on the Collegiate Model
Authors: Southall Richard M. , Staurowsky Ellen J.
Published: August 2013

In January 2012, during his “State of the Association” address, National Collegiate Athletic Association (NCAA) President Mark Emmert urged members to fix the “collegiate model.” Imbedded in the speech’s framework, this relatively new term in the NCAA national office’s lexicon has received spontaneous consent from the association, member universities, and other college-sport constituents including administrators, coaches, athletes, reporters and journalists, and college-sport fans. This anchor—“The Collegiate Model of Athletics”—has been adopted without disclosure regarding its genesis, dissemination, and insertion into college-sport’s institutional consciousness. This process of achieving spontaneous consent among constituents provides a case study illustrating the NCAA’s position as a hegemon, the institutional logics that sustain such hegemony, and the effective use of propaganda to quell critical examination of and dissent to the created collegiate model of athletics. Such examination reveals this process has not only been detrimental to higher education and the general public, but particularly harmful to college athletes.
Grant Writing Pearls and Pitfalls: Maximizing Your Funding
Authors: Schmalbach Cecelia E. , Couch Marion E. , Rosenthal Eben L. , Pynnonen Melissa , Liu Jeffrey
Published: August 2013

Program Description:

Seeking an edge in the competitive grant world? This interactive miniseminar will provide a comprehensive review of key elements to a fundable grant. Practical tips on scientific writing, building a productive research team, and maximizing resources will be provided. An overview of basic statistics will help to maximize collaborative efforts with your statistician. Gain insight into the scoring process from an experienced National Institutes of Health reviewer who will highlight common pitfalls. Current 2013 funding mechanisms will also be provided. Residents and faculty new to the grant process, as well as researchers striving to improve their score, will benefit from this course.

Educational Objectives:

1) Describe key components of a grant to include hypothesis, specific aims, timeline, statistics, budget, and institutional review board. 2) Comprehend the scoring mechanism, review process, and common pitfalls leading to an unfundable grant. 3) Research current grant mechanisms and funding opportunities.
Pediatric Laryngology: Innovations and Updates
Authors: Rickert Scott M. , Statham Melissa M. , de Alarcon Alessandro , Zur Karen B. , Hartnick Christopher J.
Published: August 2013

Program Description:

Pediatric laryngology has experienced tremendous growth with increased focus on voice issues. This miniseminar incorporates viewpoints of several clinicians and will focus on clinically relevant matters for general and specialty otolaryngologists, including diagnosis, common pathologies, and operative and non‐operative approaches and techniques. Pathology includes benign vocal lesions, vocal fold paralysis, recurrent respiratory papillomatosis (RRP), laryngeal webs, and subglottic stenosis. Non‐operative innovations will be discussed, including voice therapy, laryngeal electromyography, botulinum toxin, and fillers. Operative innovations include laser, techniques for vocal fold paralysis, and augmentations to standard open techniques. Differing practical approaches will be discussed in a panel format with presentations of challenging cases.

Educational Objectives:

1) Illustrate the diagnostic approach of pediatric laryngology and give practical advice towards successful techniques. 2) Describe various diagnostic challenges in pediatric laryngological diseases and illustrate approaches towards proper diagnosis and treatment. 3) Elucidate newer innovative techniques in pediatric laryngology through case discussion and panel discussion.
Build a Better Ear: What's New in Chronic Ear Disease
Authors: D'Eredita Riccardo , Devaiah Anand K. , Lee Kenneth H. , Dornhoffer John L. , O'Reilly Robert C.
Published: August 2013

Program Description:

There is a growing interest in implementing surgical techniques and using novel materials for tympanic membrane perforation repair. Bioactive materials, cartilage and fascia grafts derived from the recipient patient, novel partial ossicular replacement prostheses and total ossicular replacement prostheses, and novel technologies (ie, otoendoscopy) are in continuous evolution, striving for higher quality and longer duration and stability in otologic surgery grafting. The presenters will provide descriptions and show videos demonstrating the function of these different materials and techniques. In addition, a non‐committee panel will present an evidence‐based medicine (EBM) algorithm for treatment:”What Literature says—an EBM decision Algorithm as Key to Success.”

Educational Objectives:

1) Describe the variety of grafting materials, protheses, and different techniques available for surgical repair of tympanic membrane perforations. 2) Discuss the advantages and limitations of using these technologies and materials. 3) Assess the validity of the studies presented to evaluate the efficacy of these surgical tools.
Practical Otologic Considerations in Head Injury
Authors: Holtel Michael R. , Littlefield Philip D. , Hoffer Michael , Balough Ben J.
Published: August 2013

Program Description:

After our nation's longest period of conflict, it is important to look for experience and medical advances that might improve our care of the injured patient. Targeting general otolaryngologists, we will present an overview for otologic care of the trauma patient presenting to your office. Emphasis will include an update on surgical management of facial nerve injury, manifestations and treatment of balance disorders after concussion and head trauma, repair of traumatic tympanic membrane perforations, and hearing loss.

Educational Objectives:

1) Articulate timing and indications for surgical treatment of facial nerve injury. 2) Describe treatment principles and best practice for post–head trauma balance disorders. 3) Recognize treatment of traumatic perforations and hearing injury.
AAO‐HNS Clinical Practice Guideline on Tympanostomy Tubes
Authors: Rosenfeld Richard M. , Pynnonen Melissa , Tunkel David E. , Schwartz Seth R.
Published: August 2013

Program Description:

Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. This miniseminar will highlight key recommendations from the new AAO‐HNS guideline on tympanostomy tubes, developed by a multidisciplinary panel using methodology consistent with current Institute of Medicine standards. Emphasis is placed on surgical indications (otitis media with effusion and recurrent acute otitis media), caregiver education, management of tube otorrhea, use of water precautions, and special considerations for children who are at risk for developmental delays. The lively panel discussion will include case presentations and time for questions and answers.

Educational Objectives:

1) Recognize evidence‐based indications for tympanostomy tubes in children with otitis media with effusion and/or recurrent acute otitis media. 2) Identify children with otitis media with effusion who are at risk for developmental delays and might benefit from insertion of tympanostomy tubes. 3) Educate caregivers of children with tympanostomy tubes on the need for water precautions, management of tube otorrhea, and expectations for follow‐up and monitoring while the tubes remain in place.
Endoscopic Orbital Surgery: Current and Future Applications
Authors: Kingdom Todd T. , Ramakrishnan Vijay R. , Durairaj Vikram D. , Strong E. Bradley
Published: August 2013

Program Description:

As otolaryngologists gain experience with endoscopic surgery of the sinuses and skull base, the next natural extension is toward the orbit. The purpose of this miniseminar is to review current and future applications of endoscopic orbital surgery for management of epiphora, thyroid eye disease, orbital trauma, and orbital tumors. We will use a case‐based format to discuss rationale, pearls and pitfalls for dacryocystorhinostomy, orbital and optic nerve decompression, orbital fracture repair, and tumor surgery. Both endoscopic and open approaches to these cases will be compared, and surgical decision‐making will be addressed.

Educational Objectives:

1) Conduct sound decision‐making in the endoscopic and open approaches to DCR and orbital decompression. 2) Examine how endoscopic techniques can be applied to surgery within the orbit. 3) Recognize when endoscopic approaches may be useful adjuncts to traditional open orbital surgery.
Septoplasty: Traditional, Open, Endoscopic, and Advanced
Authors: Setzen Michael , Rhee John S. , Han Joseph
Published: August 2013

Program Description:

Deviated septum is a key factor in altered nasal physiology resulting in nasal obstruction negatively impacting a patient's quality of life. Reported failure rates of septoplasty surgery are as high as 25‐50%. Inadequate assessment and correction of challenging cases contribute to this failure rate. Challenging scenarios include deviation at caudal or high dorsal areas, complex deformations, revision cases, associated perforation, acute traumatic injuries, and association with severe sinonasal inflammation. This interactive case‐based session with audience response will engage attendees. The speakers will share their thought process, surgical strategies, techniques, and pearls promoting better surgical outcomes.

Educational Objectives:

1) Discuss the specific mechanism of nasal obstruction by the deviated septum and minimize complication when performing initial or revision septoplasty. 2) Debate the cause of persistent nasal obstruction after initial septoplasty. 3) Explain effective surgical techniques to optimize outcomes and minimize complication when performing initial or revision septoplasty.
Incidental Thyroid Nodules: Clinical Presentation and Outcomes
Authors: Chaikhoutdinov Irina , Mitzner Ron , Yoo Frederick , Fornadley Jeffrey , Goldenberg David
Published: August 2013

Objectives:

Examine patients with incidentally discovered thyroid nodules (IDTNs) with focus on identification, evaluation, surgical intervention, and rates of malignancy.

Methods:

Retrospective chart review performed at a tertiary care medical center. Patients were identified by cross‐referencing thyroid diagnosis codes with ultrasound (US) codes, identifying a total of 1408 thyroid patients evaluated between July 2008 and June 2009. Information regarding demographics, follow‐up, and outcomes was extracted from the medical record.

Results:

A total of 249 patients with IDTNs were identified. Most were identified on chest CT (44.6%). Most commonly, imaging was obtained for evaluation of an unrelated malignancy (26.9%). Initial evaluation of IDTNs was performed by US in 62.2% and US with fine needle aspiration (FNA) in 36.1% of patients. Patients with US as the initial study appeared to undergo more studies than patients who underwent US/FNA. 170 (68.3%) underwent ultrasound (US)/FNA. The most common pathology was benign follicular nodule (64.1%) and papillary thyroid cancer (PTC) (13.5%). Fifty‐five (22.1%) patients underwent thyroidectomy. Forty‐seven patients underwent surgery for suspicion of malignancy. Preoperative FNA pathology was PTC in 22 patients, followed by follicular neoplasm in 17 patients. On final pathology, 33 malignancies were present. Of these, 28 were PTC. The overall malignancy rate for incidental thyroid nodules was 13.3%.

Conclusions:

This study identified a surprisingly high rate of malignancy of at least 13.3% in IDTNs, reaffirming that incidental thyroid nodules should undergo thorough workup. Obtaining US/FNA early in the workup appears to decrease the number of studies ordered.
Increased Aquaporin‐1 Expression Is Associated with Improved Prognosis in Salivary Gland Adenoid Cystic Carcinoma
Authors: Tan Marietta , Shao Chunbo , Bishop Justin , Westra William H. , Ha Patrick K.
Published: August 2013

Objectives:

Aquaporin‐1 (AQP1) is a candidate oncogene that is epigenetically modified in adenoid cystic carcinoma (ACC). We sought to 1) assess AQP1 promoter methylation and gene expression in an ACC cohort, 2) identify correlations between AQP1 and clinical outcomes, and 3) explore the role of AQP1 in tumor progression in vitro.

Methods:

DNA and RNA were isolated from ACC tumors and control salivary gland tissues. Quantitative methylation‐specific polymerase chain reaction (PCR) was performed on bisulfite‐treated DNA. Quantitative reverse transcription PCR was performed after cDNA synthesis. Retrospective chart review was performed for collection of demographic information and clinical outcomes. Cell lines stably over‐expressing an AQP1 plasmid or empty vector were generated. Cell scratch and Matrigel invasion assays were then performed.

Results:

Methylation results from 77 ACC tumors and 30 controls demonstrated that AQP1 was hypomethylated in tumors (P < 0.0001). Fifty‐eight tumors (75.3%) displayed AQP1 hypomethylation compared to controls. AQP1 expression was assessed in 58 tumors and 23 controls, and a trend towards increased expression in tumors was found (P = 0.08). Statistical analysis revealed no associations between AQP1 methylation status and clinical outcomes. However, increased AQP1 expression was associated with improved overall survival and longer time to metastasis (P < 0.05). AQP1 over‐expression in vitro did not affect cell migratory or invasive capacities in cell scratch and invasion assays.

Conclusions:

AQP1 hypomethylation is common in ACC, and AQP1 tends to be over‐expressed in these tumors. Increased AQP1 expression is associated with improved prognosis. Further in vitro studies are necessary to clarify the role of AQP1 in ACC progression.
Management of the Unknown Primary in the Era of HPV and Robotics
Authors: Newman Jason G. , O'Malley Bert W. , Rassekh Christopher H. , Lin Alexander , Chalian Ara A. , Lajud Shayanne A. , Weinstein Gregory S.
Published: August 2013

Objectives:

A subset of patients with squamous cell carcinoma of the head and neck present with a cervical metastasis from an unknown primary site. Currently, many of these patients have human papillomavirus (HPV) positive tumors, making the oropharynx the most likely primary site. Objectives: 1) Develop a minimally invasive approach to identify and definitively treat patients initially diagnosed with carcinoma of unknown primary (CUP) using transoral robotic surgery (TORS). Additionally, we anticipate that this aggressive approach will yield the primary lesion in a higher subset of patients.

Methods:

A retrospective chart review study was conducted to evaluate a novel minimally‐invasive management approach using TORS to assess the primary site.

Results:

We identified 12 patients with CUP of the head and neck that had undergone this approach from December 2011 to April 2012. Ten patients were classified as HPV positive using p16 staining as surrogate marker. The primary site was identified in 10 of 12 patients (83%), the majority of which was found to be the base of tongue.

Conclusions:

We have developed a minimally invasive surgical approach using TORS for the diagnosis and subsequent management of the patient with CUP. Using this algorithm, we are able to move from frozen section directly to an en bloc definitive resection in many patients. Our results show a significant rate of primary tumor identification using a robotic‐assisted approach and support the rationale for further investigation of this technique.
Computer‐Aided Designed and 3‐Dimensionally Printed Porous Tissue Bioscaffolds for Craniofacial Soft‐Tissue Reconstruction
Authors: Zopf David A. , Mitsak Annie , Flanagan Colleen L. , Maki Aaron , Wheeler Matthew , Green Glenn E. , Hollister Scott J.
Published: August 2013

Objectives:

Introduce our groups’ innovative processes using image‐based design and several 3‐dimensionally printed scaffolds for head and neck cartilaginous reconstruction. Applications for auricular reconstruction and nasal reconstruction are discussed. Study Design: Proof of concept revealing novel methods for bioscaffold production with in vitro and in vivo data demonstrating preliminary scaffold behavior.

Methods:

DICOM computed tomography (CT) images undergo segmentation and image‐based Boolean design. Three‐dimensional (3D) designed, bioresorbable, poly‐L‐caprolactone scaffolds are printed. Subcutaneous in vivo implantation of auricular and nasal scaffolds was performed in a porcine model. Auricular scaffolds were seeded with primary porcine auricular chondrocytes in a hyaluronic acid/collagen hydrogel, and cultured in a prochondrogenic bioreactor environment.

Results:

Auricular and nasal constructs with several micropore architectures are rapidly manufactured with high fidelity anatomic appearance. Subcutaneous in vivo implantation of auricular and nasal scaffolds resulted in excellent appearance. Histologic analysis demonstrated cartilaginous growth within and respecting the boundaries of the scaffold. Cartilage growth was not seen outside of the scaffold, potentially suggesting a prochondrogenic effect of the scaffold or prevention of chondrocyte dedifferentiation.

Conclusions:

Image‐based design processes and 3D printing in the production of cartilaginous structures for several challenging reconstructive applications is introduced. Bioscaffolds may allow regeneration of soft tissue structures that are replaced with native extracellular matrix.
Submandibular Gland Preservation during Concurrent Neck Dissection and Transoral Surgery for Oropharyngeal Squamous Cell Carcinoma
Authors: Howard Brittany E. , Nagel Thomas H. , Cheng Meng‐Ru , Hinni Michael L.
Published: August 2013

Objectives:

Analyze the effect of ipsilateral submandibular gland preservation on patients undergoing concurrent neck dissection and transoral surgery for oropharyngeal squamous cell carcinoma. Evaluate for 1) intraoperative communications between the oropharynx and neck, 2) postoperative salivary leaks, and 3) oncologic outcomes.

Methods:

Retrospective chart review of oropharyngeal squamous cell carcinoma patients undergoing transoral surgery with simultaneous neck dissection(s) at a tertiary referral center between 1999 and 2013 with analysis of operative technique, pathologic diagnosis, postoperative course, complications, and oncologic outcomes.

Results:

Overall 253 patients were identified. Of these, 96 patients underwent ipsilateral submandibular gland preservation and 157 underwent ipsilateral submandibular gland removal at the time of neck dissection. The prevalence of intraoperative communication between the neck and oropharynx was significantly lower (P = 0.0017) in cases with submandibular gland preservation (2.08%, n = 2) compared to those with submandibular gland removal (14.13%, n = 22). Similarly, there were fewer postoperative salivary leaks with gland preservation. No postoperative leaks occurred in the gland preservation group (0%, n = 0) compared to a leak prevalence of 8.92% (n = 14) when the gland was removed (P = 0.0041). There was no difference in local (P = 0.2208), regional (P =0.9624), or distant disease (P = 0.7523) recurrence between the groups.

Conclusions:

Submandibular gland preservation during neck dissection in patients undergoing transoral surgery for oropharyngeal squamous cell carcinoma reduces the risk of intraoperative and postoperative salivary leaks without compromising oncologic outcomes.
Transoral Resection Technique and Resected Tissue Volume in Patients with Oropharyngeal Squamous Cell Carcinoma
Authors: Cho Min‐Jeong , Sumer Baran D.
Published: August 2013

Objectives:

Elucidate the relationship between transoral resection technique and resected tissue volume in patients with early stage oropharyngeal squamous cell cancer (OPSCC) and determine if resection volume affects functional outcome.

Methods:

Forty‐six patients with previously untreated early T‐stage OPSCC underwent transoral laser microsurgery (TLMS) and transoral robotic surgery (TORS) between 2008 and 2013 at academic referral center were studied retrospectively. The resected tissue volume, the location of resection, and MD Anderson Dysphagia Inventory (MDADI) were described.

Results:

Mean resected tissue volume for T1 tumors with TORS was 11.44 cm3 and was 7.90 cm3 with TLMS, (P = 0.44). Mean resected tissue volume for T2 tumors with TORS was 19.45 cm3 and 10.73 cm3 for TLMS (P = 0.194). With a median follow‐up of 11 months, the average of MDADI score was 77.9 for TORS and 74.2 for TLMS for T1 tumors, (P = 1) and 67.9 for TORS and 50.1 for TLMS, (P = 0.052) for T2 tumors. MDADI score for T1 with TLMS and TORS combined was 76.7 and for T2 was 63.45 (P = 0.0048).

Conclusions:

TLMS and TORS are minimally invasive surgical approaches used to treat OPSCC. Both techniques employ different resection techniques; TLMS removes smaller, tumor specific volumes while TORS has anatomy‐based predefined resection limits. Our study shows that despite these differences in surgical technique, there is no statistical difference in resected tissue volumes and swallowing function for T1 and T2 tumors removed by both techniques. However, functional outcome of both techniques combined for T1 tumors were superior to T2 tumors.
The Development and Application of a Rhinoplasty Operation Record System Using a Mobile Device
Authors: Seok Jungirl , Rhee Chae‐Seo , Jin Hong‐Ryul
Published: August 2013

Objectives:

Drawing on a piece of paper and saving the scanned documents has mainly been the way to record in rhinoplasty, so far. However, it is difficult to store and retrieve the drawings using this method. The authors suggest a recording system using a mobile device and have found it useful in storing and transmitting the drawings.

Methods:

Based on iPad 4.0, the rhinoplasty record application program (Rhinograph) was developed. The SQLite was used as an internal database, and the program was developed using XCode 4. The authors kept the operation records of 10 patients who had undergone rhinoplasty and confirmed the usefulness and convenience of this system.

Results:

The program was divided into 6 parts: 1) the operation sheet (operation registration, surgical details, and notations), 2) looking up, modifying, and converting the system to PDF/JPG files with email transmissions, 3) the template developing system with frequently used techniques, 4) the database backup and conversion to Excel files, 5) registering user emails and signatures, and 6) the description of the applications. The program resulted in equal convenience and accuracy as hand‐drawing among the 10 patients. In addition, the mobile device was easily carried in the operating room and outpatient clinics.

Conclusions:

The rhinoplasty recording system using a mobile device was found to be as effective as the traditional way of recording and helped remove the constraints of place. In addition, it was shown to be convenient to store and analyze the data.
Bacterial Biofilms and Increased Bacterial Counts Are Associated with Airway Stenosis
Authors: Mazhar Kashif , Gunawardana Manjula , Webster Paul , Hochstim Christian , Koempel Jeffrey A. , Rice Dale H. , Baum Marc
Published: August 2013

Objectives:

The majority of airway stenoses are acquired secondary to the use of prolonged endotracheal intubation (ETT). Pressure exerted on the tracheal mucosa by the presence of ETT leads to irritation, ulceration, and granulation tissue formation and eventual fibrosis. An excess of granulation tissue promotes excess wound contracture. Antibiotics have been shown to decrease local inflammation and granulation tissue formation in the trachea. However, antibiotic therapy is not 100% effective in preventing or treating granulation tissue formation. Development of bacterial biofilms may explain this finding. This study was done to evaluate the difference between stenotic segment and normal trachea in terms of 1) presence of bacterial biofilms; 2) quantitative analysis of bacterial count; 3) inflammatory markers within tracheal tissue.

Methods:

Institutional review board approved case‐control study, where cases were patients with airway stenosis and controls were patients without airway stenosis. We performed scanning electron microscopy (SEM) for biofilm, quantitative polymerase chain reaction (qPCR) for quantitative analysis of bacterial count, and immunohistochemistry (IHC) for inflammatory markers.

Results:

SEM showed presence of biofilm in cases compared to controls. The number of 16S rRNA gene copies using qPCR, a surrogate for the number of bacterial cells, was significantly higher in cases (mean=198) compared to controls (mean=30) (P < 0.05). Pediatric cases showed a significantly higher bacterial count than adult cases. IHC showed stronger staining for SMAD3 and transforming growth factor β (TGF‐β).

Conclusions:

Biofilms are present in airway stenotic segments, and there exists a difference in tracheal microbiomes and inflammatory markers between patients with airway stenosis and normal controls.
Microdebrider Complications in Laryngologic and Tracheal Surgery
Authors: Solowski Nancy , Belafsky Peter C. , Courey Mark S. , Merati Albert L. , Rosen Clark A. , Weinberger Paul M. , Postma Gregory N.
Published: August 2013

Objectives:

There is no formal body of literature focusing on complications in laryngologic and airway surgery performed with microdebriders. Attendees can expect to: 1) Describe potential complications that may occur with microdebrider use during laryngologic and airway surgery. 2) Recognize which clinical situations are better suited to the use of the microdebrider. 3) Implement changes in clinical practice to improve operative safety when using the microdebrider in laryngologic and airway surgery.

Methods:

A literature review of microdebrider complications in otolaryngologic surgery was performed. A series of exemplary and illustrative cases seen by various surgeons in selected high volume laryngologic centers was confidentially solicited and is described.

Results:

Significant microdebrider complications are described, including severe hemorrhage, extensive tissue loss, and airway perforation, as well as ways to prevent and treat these complications.

Conclusions:

A thorough understanding of the microdebrider and its potential complications will improve surgical outcomes. Implications for Practice: Awareness of the risks and knowing when to use the microdebrider will allow the surgeon to successfully use this device in a safe and efficient manner.