bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurements of Diffusion and Perfusion in Vertebral Bone Marrow Using Intravoxel Incoherent Motion (IVIM) With Multishot, Readout‐Segmented (RESOLVE) Echo‐Planar Imaging
Authors: Lasbleiz Jérémy , Le Ster Caroline , Guillin Raphaël , Saint‐Jalmes Hervé , Gambarota Giulio
Published: September 2018

Background

A limited number of studies have used the intravoxel incoherent motion (IVIM) approach on bone marrow. In none of the previous studies were the effects of fat suppression on the IVIM parameters investigated.

Purpose

To measure the water diffusion coefficient and the perfusion fraction in vertebral bone marrow using IVIM with multishot, readout‐segmented (RESOLVE) echo‐planar imaging and to assess the effects of different fat suppression techniques on the measurement of the IVIM parameters.

Study Type

Prospective.

Population/Subjects

Six healthy volunteers (24.2 ± 4.3 years).

Field Strength/Sequence

1.5T, RESOLVE.

Assessment

Four experiments were performed: 1) RESOLVE imaging without fat suppression, 2) with fat saturation (FS), 3) with spectral attenuated inversion recovery (SPAIR), and 4) with short‐tau inversion recovery (STIR). The water diffusion coefficient D, pseudo‐diffusion coefficient D*, and the perfusion fraction f were assessed in the vertebral bodies of the lumbar vertebrae.

Statistical Tests

One‐way repeated‐measures analysis of variance (ANOVA) followed by Bonferroni's multiple comparison test.

Results

The RESOLVE IVIM protocol allowed for measurement of D, D*, and f in all volunteers. The signal of lipid protons affected the quantification of the IVIM diffusion coefficient: D = 0.24 ± 0.10 (×10−3 mm2/s), no FS; D = 0.43 ± 0.07 (×10−3 mm2/s), FS; D = 0.42 ± 0.07 (×10−3 mm2/s), SPAIR; D = 0.35 ± 0.10 (×10−3 mm2/s), STIR; and IVIM perfusion fraction f = 7.5 ± 1.9% no FS, f = 14.5 ± 5.4%, FS; f = 12.5 ± 2.6%, SPAIR; f = 18.1 ± 6.1%, STIR. No significant effect (P = 0.36) was found on the quantification of D*.

Data Conclusion

An IVIM‐MRI protocol using the RESOLVE sequence was implemented for measurements of vertebral bone marrow diffusion and the perfusion. The comparison between the protocols with and without fat suppression indicates that the lipid signal results in an underestimation of both D and f.

Level of Evidence:

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019;49:768–776.
Emerging role of MRI in radiation therapy
Authors: Chandarana Hersh , Wang Hesheng , Tijssen R.H.N. , Das Indra J.
Published: September 2018

Advances in multimodality imaging, providing accurate information of the irradiated target volume and the adjacent critical structures or organs at risk (OAR), has made significant improvements in delivery of the external beam radiation dose. Radiation therapy conventionally has used computed tomography (CT) imaging for treatment planning and dose delivery. However, magnetic resonance imaging (MRI) provides unique advantages: added contrast information that can improve segmentation of the areas of interest, motion information that can help to better target and deliver radiation therapy, and posttreatment outcome analysis to better understand the biologic effect of radiation. To take advantage of these and other potential advantages of MRI in radiation therapy, radiologists and MRI physicists will need to understand the current radiation therapy workflow and speak the same language as our radiation therapy colleagues. This review article highlights the emerging role of MRI in radiation dose planning and delivery, but more so for MR‐only treatment planning and delivery. Some of the areas of interest and challenges in implementing MRI in radiation therapy workflow are also briefly discussed.

Level of Evidence: 5

Technical Efficacy: Stage 5

J. Magn. Reson. Imaging 2018;48:1468–1478
Abbreviated MRI of the Breast: Does It Provide Value?
Authors: Leithner Doris , Moy Linda , Morris Elizabeth A , Marino Maria A , Helbich Thomas H , Pinker Katja
Published: September 2018

MRI of the breast is the most sensitive test for breast cancer detection and outperforms conventional imaging with mammography, digital breast tomosynthesis, or ultrasound. However, the long scan time and relatively high costs limit its widespread use. Hence, it is currently only routinely implemented in the screening of women at an increased risk of breast cancer. To overcome these limitations, abbreviated dynamic contrast‐enhanced (DCE)‐MRI protocols have been introduced that substantially shorten image acquisition and interpretation time while maintaining a high diagnostic accuracy. Efforts to develop abbreviated MRI protocols reflect the increasing scrutiny of the disproportionate contribution of radiology to the rising overall healthcare expenditures. Healthcare policy makers are now focusing on curbing the use of advanced imaging examinations such as MRI while continuing to promote the quality and appropriateness of imaging. An important cornerstone of value‐based healthcare defines value as the patient's outcome over costs. Therefore, the concept of a fast, abbreviated MRI exam is very appealing, given its high diagnostic accuracy coupled with the possibility of a marked reduction in the cost of an MRI examination. Given recent concerns about gadolinium‐based contrast agents, unenhanced MRI techniques such as diffusion‐weighted imaging (DWI) are also being investigated for breast cancer diagnosis. Although further larger prospective studies, standardized imaging protocol, and reproducibility studies are necessary, initial results with abbreviated MRI protocols suggest that it seems feasible to offer screening breast DCE‐MRI to a broader population. This article aims to give an overview of abbreviated and fast breast MRI protocols, their utility for breast cancer detection, and their emerging role in the new value‐based healthcare paradigm that has replaced the fee‐for‐service model.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019;49:e85–e100.
Postharvest metabolomic changes in Pyrus ussuriensis Maxim. wild accession ‘Zaoshu Shanli’
Authors: Xu Jiayu , Zhang Ying , Qi Dan , Huo Hongliang , Dong Xingguang , Tian Luming , Zhang Xiaoshuang , Liu Chao , Cao Yufen
Published: September 2018

There are strong economic drivers for understanding the process of fruit post‐harvest softening. In this study, liquid chromatography with electrospray ionization tandem mass spectrometry was used to analyze metabolite changes in ‘Zaoshu Shanli’ fruit after different storage periods; this wild accession of Pyrus ussuriensis presents good fruit quality and relatively low flesh firmness after fruit storage. The lipid metabolites in ‘Zaoshu Shanli’ fruit were significantly higher at 18 days of storage compared with those at 0 days of storage, and glycerophospholipid metabolism was different metabolic pathway. It was therefore speculated that lipid metabolism play an important role in pear fruit post‐harvest processes and softening. Furthermore, the abscisic acid and trans‐zeatin contents in ‘Zaoshu Shanli’ fruit at 18 days of storage were significantly greater than those at 0 days of storage. Therefore, it was speculated that the abovementioned hormones play an important role in pear fruit post‐harvest softening. Together, these results provide fundamental insight into the reasonable control of pear fruit post‐harvest softening and lay a solid foundation for additional research.
Sample preparation for the analysis of fire debris – Past and present
Authors: Kerr Tanya J.
Published: September 2018

Identification of ignitable liquids from fire debris is such a major part of an arson investigation that much time and effort has gone into advancing sample preparation techniques to capture complicated and unexpected hydrocarbon compounds. Advancements in sample preparation have been made in order to account for biodegradation of commonly used accelerants, rarely encountered compounds, such as vegetable oils, biodiesel, and alcohols. Improvements have also been made to manage interference from the sample matrix, particularly with regards to new materials. This paper is a review of the sample preparation techniques that are foundational to fire debris analysis as well as recent advances. Also explored are modifications to the traditional sample preparation methods to accommodate the analysis of environmental samples (soil and water), and the presence of vegetable oils and biofuels on the fire scene.
A chromatographic study on the retention behavior of the amylose tris(3‐chloro‐5‐methylphenylcarbamate) chiral stationary phase under aqueous conditions
Authors: Cirilli Roberto , Carradori Simone , Casulli Adriano , Pierini Marco
Published: September 2018

In this study, the retention properties of the immobilized polysaccharide‐derived Chiralpak IG‐3 chiral stationary phase under aqueous‐organic conditions were investigated. A systematic evaluation of the retention factors of the enantiomers of the chiral sulfoxide oxfendazole, endowed with anthelmintic activity and selected as test compound, was carried out changing progressively the water content in hydro‐organic eluents containing methanol, ethanol or acetonitrile. From the results obtained with acetonitrile/water mobile phases and the associated retention plots, clear U‐shape retention dependencies, indicative of the interplay of both hydrophilic interaction liquid chromatography and reversed‐phase modes, were highlighted. A U‐turn point of retention mechanism was recorded in correspondence of the acetonitrile/water 100:40 v/v mobile phase. Retention was significantly affected by small percentages of trifluoroacetic acid or diethylamine additives incorporated in the mobile phase. It is worth emphasizing that the basic additive was more effective in reducing retention in the reversed‐phase region, while the action of acid additive was more pronounced in the hydrophilic interaction liquid chromatography region. Finally, either in the transition from hydrophilic interaction liquid chromatography to reversed‐phase conditions or after additive addition, the enantioselectivity did not vary significantly.
Zirconium(IV)‐based metal–organic frameworks (UiO‐67) as solid‐phase extraction adsorbents for extraction of phenoxyacetic acid herbicides from vegetables
Authors: Duo Huixiao , Wang Yuhuan , Wang Licheng , Lu Xiaofeng , Liang Xiaojing
Published: September 2018

A zirconium(IV)‐based metal organic framework, composed of 4,4′‐biphenyldicarboxylic acid ligands and Zr6O4(OH)4 clusters, was successfully fabricated. Characterizations were performed on fourier transform infrared spectroscopy, scanning electron microscopy, X‐ray diffraction, Brunauer‐Emmett‐Teller, and thermogravimetric analysis, which confirmed that it possessed large specific surface area, high pore volume, and strong acid resistant stability. Furthermore, the prepared material containing biphenyl skeleton and a large number of Zr‐O bonds, can grasp acid herbicides especially phenoxyacetic acid herbicides with aromatic structures through π‐π interaction, hydrophobic interaction and Zr‐O‐H+ bonds. Based on these advantages, a method was developed for the determination of four phenoxyacetic acid herbicides from vegetable samples. Under the optimal conditions, wide linearities from 0.3 to 250 μg/L and low limits of detection from 0.1 to 0.5 μg/L were obtained. The intra‐ and interday relative standard deviations were 1.56‐3.92 and 5.01‐7.65%, respectively. The proposed method was applied to analyze phenoxyacetic acid herbicides residues in the tomato, cucumber, and white gourd samples. The satisfactory recoveries (86.12–103.44%) for the spiked samples in vegetable samples were achieved which demonstrated the method was an efficient pretreatment procedure and has a potential application for the trace determination of phenoxyacetic acids from a complex matrix.
Postoperative revisits and readmissions after facelift surgery
Authors: Lee Linda N. , Quatela Olivia , Bhattacharyya Neil
Published: September 2018

Objectives/Hypothesis

To determine 30‐day rates and reasons for revisit and readmission after rhytidectomy surgery.

Study Design

Cross‐sectional analysis.

Methods

Cross‐sectional analysis was performed of multistate ambulatory surgery and hospital databases. Ambulatory rhytidectomy cases were extracted from State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010 and 2011. Cases were linked to State Emergency Department and Inpatient Databases for visits occurring 1 to 30 days postoperatively.

Results

A total of 6,089 rhytidectomy cases were extracted (87.9% female). The mean age was 61.1 years, and the most common age group was 61 to 70 years (40.2%), followed by 51 to 60 years (33.2%), and 71 to 80 years (12.0%). Overall, 3.6% of patients had a revisit after surgery (42.7% to an ambulatory surgery center, 42.2% to an emergency department, and 15.1% to inpatient admission). The most common primary diagnoses at the time of the revisit were hematoma (17.0%), fever/nausea/diarrhea (4.1%), and urinary tract infection (4.1%).

Conclusions

Rhytidectomy is performed to treat facial aging, and can provide surgical outcomes which may not be achievable with nonsurgical alternatives. The 30‐day revisit and readmission rate for this procedure in a large multistate cohort has not previously been reported. The revisit rate is low after rhytidectomy, and the most common reason for revisit is hematoma. These data provide important insight to optimize perioperative management and decrease postoperative revisits. This study does not capture return visits to the physician's office; however, postoperative issues that require presentation to outside facilities are important to distinguish from those managed in the practitioner's office, because they may incur additional, unplanned cost to both the patient and the healthcare system.

Level of Evidence

NA Laryngoscope, 128:2714–2717, 2018
Noma surgery
Authors: Shaye David A. , Winters Ryan , Rabbels Jens , Adentunji Adenyiyi Seminyu , Magee Aidan , Vo Daniel
Published: September 2018

Objective

Noma is a devastating and destructive disease of the face for which there is a dearth of information regarding surgical options. Herein, we describe the facial deformities and patient characteristics in a patient population affected by noma and the surgical approaches used in treatment.

Methods

Retrospective case series of a Doctors Without Borders (Médecins Sans Frontières) intervention at Sokoto Children's Noma Hospital in northern Nigeria, the highest‐volume noma hospital in the world.

Results

Twenty‐two procedures were performed on 18 patients with noma, 44% of whom were children. The majority of patients (n = 10, 55.5%) were made aware of surgical care through a Doctors Without Borders outreach program. Patients' reasons for seeking care included functional (61.1%, n = 11), appearance (61.1%, n = 11), and social stigma (66.7%, n = 12). The majority (83.3%, n = 15) had lip involvement. Four patients (22.2%) underwent staged flap procedures including prelamination, flap delay, or pedicle division. The mean duration of surgical procedure was 87 minutes (range 5–306 minutes). The minor complication rate was 16%. There were no major complications or deaths.

Conclusion

Noma is a mutilating disease of the face that occurs in settings of extreme malnutrition. A total of 55.5% of noma patients were made aware of surgical care through outreach programs. The majority of noma patients seek care to improve function (61.1%) and appearance (61.1%), and to address social stigma (66.7%). A total of 83.3% of noma patients had lip involvement. Facial reconstructive surgeons must rely on principles of congenital, traumatic, and oncologic deformity repair while focusing on safe, reliable procedures for low‐resource settings.

Level of Evidence

4 Laryngoscope, 129:96–99, 2019
Significant orbital and intracranial complications from balloon sinus dilation as a stand‐alone and powered dissector‐assisted procedure
Authors: Alam Elie S. , Hadley James A. , Justice Jeb M. , Casiano Roy R.
Published: September 2018

Chronic rhinosinusitis is one of the most common chronic conditions affecting millions of people in the United States every year. Balloon sinus dilation is a minimally invasive intervention that was introduced as a possible alternative to endoscopic sinus surgery (ESS). In select patients, balloon dilation has been advocated as a relatively safe procedure with comparable efficacy to traditional ESS. Over the past 12 months, significant intracranial and intraorbital complications have been observed on five patients who underwent balloon sinus dilation as a stand‐alone procedure, as well as what could be termed a power dissector‐assisted balloon dilation procedure, obviating the need for a wide sinusotomy or any significant ethmoid surgery, which are typically performed to establish anatomical landmarks before the introduction of power instruments into dependent sinus cavities. Laryngoscope, 2455–2459, 2018
Enhanced interdisciplinary communication: development of an interactive thyroid nodule/cancer disease map
Authors: Moubayed Sami P. , Machado Rosalie , Tuttle R. Michael , Orloff Lisa A. , Randolph Gregory , Hernandez‐Prera Juan C. , Griffin Martha J. , Urken Mark L.
Published: September 2018

Objectives

Deficits related to inadequate clinical communication can result in incorrect diagnoses, inappropriate surgery, incorrect disease stratification, pathologic reporting, and/or interpretation. There are currently no validated or defined solutions to disease‐specific communication with regard to thyroid care.

Methods

We propose a solution that could ameliorate problems arising from inadequate disease‐specific communications between physicians through the development of a thyroid disease‐specific database, the Thyroid Care Collaborative.

Results

To improve the quality of thyroid nodule and cancer care, we have developed an imaging module for enhanced reporting of ultrasound, cytologic, surgical, and pathologic details that are obtained during the workup and treatment of a patient.

Conclusion

The main advantages of this disease‐specific, dynamic, three‐dimensional, anatomic disease map are: 1) portability across institutions and disciplines, 2) disease specificity to thyroid nodule and cancer care, and 3) ability to trigger more detailed evaluation or reconciliation of any change in a patient's status regarding the nature or the extent of a patient's disease. The first and second advantages above have been identified as areas representing opportunities for quality improvement in health informatics research. Laryngoscope, 129:269–274, 2019
Totally implantable active middle ear implant: Hearing and safety results in a large series
Authors: Shohet Jack A. , Gende Deanna M. , Tanita Cheryl S.
Published: September 2018

Objectives

To evaluate hearing performance and safety measures in a large group of totally implantable active middle ear implant (AMEI) wearers.

Methods

Retrospective case review of 172 ears (166 patients) with sensorineural hearing loss undergoing implantation of a totally implantable AMEI. Pure‐tone air and bone thresholds, pure‐tone average, speech reception threshold (SRT), and word recognition scores (WRS) at phonetically balanced maximum and at 50 dB (WRS50) were assessed at baseline unaided, with a hearing aid (baseline aided [BLA]), with the implant at activation, and for best implant postoperative measurement. Adverse events were reviewed.

Results

Mean length of follow‐up was 35.7 months. Compared to unaided, the implant provided significant gain at all frequencies through 6 kHz. Amount of gain was significantly better with the implant than BLA at 1,500 and 2,000 Hz (P ≤ .001). Implant SRT was also significantly improved compared to BLA (29.9 dB vs. 38.5 dB, P ≤ .001). At a 50‐dB presentation level, WRS was significantly better with the implant than BLA (65.6% vs. 45.5%, P ≤ .001). Bone conduction thresholds were not affected by the implant. The most common adverse event was taste disturbance, which occurred in 39.1%. In subjects with preimplant tinnitus, 56.1% experienced resolution of their tinnitus. Revision surgery was required in 15.7%, and 4% were ultimately explanted.

Conclusion

The implant provided significant hearing benefit compared to unaided and to the subjects' own hearing aids in most test categories, with minimal adverse events. Many subjects experienced complete resolution of their tinnitus after implantation.

Level of Evidence

4 Laryngoscope, 128:2872–2878, 2018
Unearthing a consistent bilateral R1 component of the laryngeal adductor reflex in awake humans
Authors: Téllez Maria J. , Ulkatan Sedat , Blitzer Andrew , Sinclair Catherine F.
Published: September 2018

Objective

The laryngeal adductor reflex (LAR) is an essential tracheobronchial protective mechanism resulting in vocal fold adduction to laryngeal stimulation. It was thought to consist of an early ipsilateral R1 component and a later, bilateral but highly centrally modulated R2 component. We recently demonstrated that bilateral R1 responses are robustly present in humans under general anesthesia. We herein give evidence that the R1 response is also bilateral in awake humans and is likely the primary component responsible for initiating the LAR.

Methods

Seven volunteers were included (3 males, 4 females). The reflex was elicited by direct percutaneous monopolar needle stimulation of the internal superior laryngeal nerve. Electromyography traces from bilateral lateral cricoarytenoid muscles were recorded using hookwire electrodes. Reflex responses to variations in stimulus intensity and duration were evaluated.

Results

Bilateral R1 responses were recorded in all patients, even during deep inspiration when the vocal folds were maximally abducted. R1, but not R2, responses increased linearly in amplitude, with sequential increases in both stimulation intensity (1–8 mA) and duration (100–500 µsec) (Pearson correlation 0.94).

Conclusion

Contradicting over 40 years of research, we demonstrate that the R1 LAR component is consistently bilateral in awake humans. It increases linearly with stimulus intensity and is unaffected by conscious state suggesting minimal central control. These findings may provide a means to objectively stratify patients for risk of laryngeal aspiration, even in unconscious states, and its potentially cardinal role in disease states such as laryngospasm and sudden infant death needs to be reevaluated.

Level of Evidence

4. Laryngoscope, 2581–2587, 2018
Current practices in microvascular reconstruction in otolaryngology–head and neck surgery
Authors: Kovatch Kevin J. , Hanks John E. , Stevens Jayne R. , Stucken Chaz L.
Published: September 2018

Objectives/Hypothesis

Despite major advances in the field of head and neck microvascular free tissue transfer (MFTT) over the past several decades, there are no standardized perioperative regimens for the care of patients undergoing free flap reconstructive surgery, and continued variation in practice exists. This study aimed to report current trends in the field of MFTT performed by otolaryngologists, including surgeon training, institutional operative practices, and perioperative management.

Study Design

Cross‐sectional survey.

Methods

A survey of Accreditation Council for Graduate Medical Education–accredited residency programs and American Head and Neck Society fellowship sites was conducted.

Results

Seventy‐one (62.8%) programs responded, with 67 (94.4%) routinely performing MFTT and 23 (32.4%) having a dedicated microvascular fellowship program. Of institutions performing MFTT, 66 (98.5%) reported the use of a two‐surgeon team, most commonly both otolaryngologists (76.3%). Institutional MFTT volumes and donor site frequency are reported. Postoperative care includes routine admission to the intensive care unit (75.2%), step‐down unit (15.0%), or general care floor (8.1%). Postoperative flap monitoring practices, including modalities, personnel, and timing/frequency show institutional variation. Despite differences in postoperative monitoring regimen and management (sedation, anticoagulation, antibiotic use), surgeon‐reported measures of flap success rate (95.7%, standard deviation [SD] 4.7%) and complication rate (6.8%, SD 2.4%) show little difference across institutions.

Conclusions

Many elements of MFTT perioperative care show continued variation at an institutional level. There is a notable shift toward the two‐team approach within otolaryngology. Self‐reported flap complication and success rates showed no significant differences based on perioperative care and monitoring regimen. Further study of perioperative practices should focus on standardization of care to improve overall outcomes in this complex patient population.

Level of Evidence

NA Laryngoscope, 129:138–145, 2019
Enhancing pediatric airway safety using the electronic medical record
Authors: Rameau Anaïs , Wang Ellen , Saraswathula Anirudh , Pageler Natalie , Perales Shanna , Sidell Douglas R.
Published: September 2018

Objective

Difficult intubations are not uncommon in tertiary care children's hospitals, and effective documentation of the difficult airway is a fundamental element of safe airway management. The primary goal of our quality improvement initiative was to improve access to airway information via an alert and documentation system within the electronic medical record (EMR).

Methods

We created a difficult airway alert within the EMR, linking common airway evaluation templates used by specialists involved in airway management. We assessed the time required for different specialists to answer an airway information questionnaire using the electronic charts of patients before and after the EMR modification. Satisfaction with the EMR modification was also surveyed.

Results

Questionnaires were administered to 12 participants before the Epic (Epic Systems Corp., Verona, WI) changes were implemented and to 19 participants after they were implemented. Each participant was asked to answer the airway data questionnaire for two patients, for a total of 24 questionnaires before the EMR changes and 38 questionnaires after the changes. Respondents averaged 7.24 minutes to complete the entire airway data questionnaire before the EMR changes and 3.16 minutes following modification (P < 0.0001). Correct airway information was more consistently collected with the modified EMR (98.6% vs 51.4%, P < 0.00001). Satisfaction surveys revealed that participants found the accessibility of airway data to be significantly improved following the EMR changes.

Conclusion

An EMR airway alert that provides rapid access to relevant airway information critical tool during urgent and emergent events. Based on our preliminary data, further use of this instrument is expected to continue to improve patient safety and practitioner satisfaction.

Level of Evidence

4 Laryngoscope, 128:2885–2892, 2018
Continuous lumbar drainage and the postoperative complication rate of open anterior skull base surgery
Authors: Ringel Barak , Carmel‐Neiderman Narin N. , Peri Aviyah , Ben Ner Daniel , Safadi Ahmad , Abergel Avraham , Margalit Nevo , Fliss Dan M.
Published: September 2018

Objectives/Hypothesis

Anterior skull base operations pose the risk for postoperative cerebrospinal fluid (CSF) leak. Routine lumbar continuous drainage catheter (LD) placement is intended to decrease CSF leaks and central nervous system (CNS) complications, but there are no sound evidence‐based data on its efficacy. The primary goal of this study was to review CNS complications following anterior open skull base surgery and their association with LD placement. The secondary goal was to define predictors for the development of early CNS complications.

Study Design

Retrospective case series.

Methods

We conducted a retrospective analysis of all patients who underwent anterior skull base surgery between 2000 and 2016 at the Tel Aviv Sourasky Medical Center, an Israeli tertiary referral center.

Results

A total of 226 patients underwent open skull base surgery, of whom 118 had elective perioperative continuous LD insertion and 108 did not. Delayed complications were defined as those occurring more than 30 days after the index operation. Thirty‐one (26%) patients in the LD group had early CNS complications compared with only two (1.6%) in the non‐LD group, whereas 13 (11%) of the former patients had late CNS complications compared with four (3%) of the latter patients. Early systemic and late wound complications were also significantly more numerous in the LD group. On multivariate analysis, elective LD insertion and intracranial tumor extension were found to be predictors for developing early CNS complications.

Conclusions

The placement of continuous LDs might increase the risk of developing early and late CNS complications after open anterior skull base surgery.

Level of Evidence

4 Laryngoscope, 128:2702–2706, 2018
Combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma
Authors: Sokoya Mofiyinfolu , Chowdhury Farshad , Kadakia Sameep , Ducic Yadranko
Published: September 2018

Objectives/Hypothesis

With positron emission tomography/computed tomography (PET/CT) now commonplace as a diagnostic tool, new questions have arisen regarding the utility and cost‐effectiveness of panendoscopy. In this retrospective review of a large cohort of head and neck squamous cell carcinoma of unknown primary (HNSCC‐UP), we describe the enduring utility of panendoscopy in the detection of the primary site of mucosal disease even when PET/CT is negative.

Study Design

Retrospective cohort study.

Methods

A retrospective analysis of patients presenting to the senior author (y.d.) from July 1 1997 to July 1 2017 with fine‐needle aspiration–proven metastatic squamous cell carcinoma to the neck. All patients underwent formal panendoscopy (direct laryngoscopy, bronchoscopy, and rigid esophagoscopy). Presence of squamous cell carcinoma on final pathology was examined.

Results

A total of 190 patients had HNSCC‐UP, with 87 positive and 103 negative on PET/CT. Of the PET/CT‐negative patients, 71 patients retained the HNSCC‐UP designation after panendoscopy. Eighteen patients (56% of cases) were found to have primary tonsillar squamous cell carcinoma. Eight of 32 primary sites were found in the base of tongue (25%), with HPV positivity in two of these patients. The sensitivity and negative predictive value of PET/CT in detecting the primary site in unknown primary head and neck squamous cell carcinoma in the total study population were 73.1% and 68.9%, respectively.

Conclusions

Surgical panendoscopy has an important role in the workup of patients with unknown primary head and neck squamous cell carcinoma. There is a high rate of cancer diagnosis, even in PET/CT negative patients.

Level of Evidence

4 Laryngoscope, 2573–2575, 2018
The role of quality‐of‐life instruments in predicting voice therapy dropout
Authors: Kavookjian Hannah , Holcomb Andrew , Garnett James D. , Kraft Shannon
Published: September 2018

Objectives/Hypothesis

Voice therapy (VT) is essential to the successful management of voice disorders. Despite this, two‐thirds of patients drop out of therapy before completion. In this study we examine whether responses to specific question items or domains from the Voice Handicap Index (VHI) are associated with VT compliance.

Study Design

Single‐institution retrospective cohort study.

Methods

All patients presented to a tertiary care center between January 2011 and June 2016 with dysphonia. Patients were excluded if seen by speech language pathology (SLP) for preoperative assessment only, there was no order for therapy, or there was no documentation of therapy performed at outside facilities. Data collected included VHI responses, demographics, diagnosis, social history, and clinical exam. Patients were divided into three groups for analysis: 1) did not attend therapy, 2) partially completed therapy, or 3) completed therapy.

Results

Of 489 patients referred for VT, 36.2% did not attend, 36.0% partially completed VT, and 27.8% completed VT. Patients who did not attend had significantly lower scores in VHI, VHI‐10, and each of the VHI domains. There was a significant difference in age between VT groups, with those electing to not attend representing older age. Patients who attended VT were more likely to use their voice for work (P = .015). There were statistically significant differences among the groups for six VHI question items.

Conclusions

Understanding patient motivations, whether a patient uses their voice for work, and specific responses to the VHI questionnaire may allow clinicians to better understand patient engagement in voice therapy.

Level of Evidence

4 Laryngoscope, 128:2832–2837, 2018
Adenoidectomy With Balloon Catheter Sinuplasty: A Randomized Trial for Pediatric Rhinosinusitis
Authors: Gerber Mark E. , Kennedy Aimee A.
Published: September 2018

Objectives/Hypothesis

To compare treatment outcomes in pediatric patients with chronic rhinosinusitis (CRS) using adenoidectomy and maxillary sinus irrigation with or without balloon catheter sinuplasty (BCS).

Methods

Prospective, randomized, and blinded. Patients between 2 and 12 years who met clinical and computed tomography criteria for CRS unresponsive to maximal medical therapy and no prior sinus‐ or adenoid‐related procedures were eligible. Twenty‐five patients were randomized, had surgery, and completed the follow‐up. The control group underwent adenoidectomy with maxillary sinus irrigation alone; the treatment group underwent the same, with the addition of maxillary BCS for the maxillary sinus irrigation. Patients and parents were blinded to group assignment throughout the follow‐up time frame. A validated questionnaire, the Sinus and Nasal Quality of Life Survey (SN‐5), was used to measure health status changes and quality of life (QOL) at baseline, 6 months, and 12 months postintervention. Data was analyzed using t tests and multivariate linear regression.

Results

There were 12 patients in the BCS group and 13 in the control group. Other than a higher atopic history in the control group (P = 0.047), there were no significant differences (P = 0.07) in the two groups (demographics and baseline SN‐5 scores). Following surgery, both groups demonstrated similar improvement in QOL scores and median SN‐5 scores in all domains (number of sinus infections, nasal obstruction, allergy symptoms, emotional distress, and activity limitations).

Conclusion

The addition of BCS to adenoidectomy/maxillary sinus irrigation did not provide additional QOL and sinonasal symptom improvement in the surgical treatment of pediatric CRS.

Level of Evidence

1b Laryngoscope, 128:2893–2897, 2018
Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P
Authors: Rawal Rounak B. , Farquhar Douglas R. , Kilpatrick Lauren A. , Drake Amelia F. , Zdanski Carlton J.
Published: September 2018

Objectives

Neonates weighing < 2.5 kg have known higher rates of surgical mortality and morbidity, but this remains unexamined specifically for tracheostomy. We present outcomes of neonates undergoing tracheostomy stratified by weight.

Methods

Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program–Pediatric from 2012 to 2014. Patients undergoing tracheostomy were included. Thirty‐day mortality and major/minor complication rates were stratified by weight (group 1: < 2.5 kg; group 2: ≥ 2.5 kg and < 4 kg; group 3: ≥ 4 kg). Patient comorbidities were assessed for independent risk factors of morbidity and mortality.

Results

Of 183,233 patients, 543 underwent tracheostomy. Forty‐four patients were group 1 (mean: 2.2 kg ± 0.25); 170 patients were group 2 (mean: 3.31 kg ± 0.42); and 329 patients were group 3 (mean: 6.4 kg ± 2.7). Between groups 1 and 2, there were no significant differences in mortality (P = 0.47), major complication rates (P = 0.99), or minor complication rates (P = 0.64). In comparing all three groups, there were no significant differences in mortality (P = 0.47), major complication rates (P = 0.80), or minor complication rates (P = 0.77). The overall 30‐day mortality for all patients was 4.24%. In a multivariate logistical regression model, weight group did not change the odds of all negative outcomes (group 1: odds ratio [OR] of 0.71; 95% confidence interval [CI], 0.33–1.53 and group 2: OR of 0.78; 95% CI, 0.50–1.22). Bronchopulmonary dysplasia was the only independent significant predictor of major complications (OR, 1.69; 95% CI, 1.02–2.79) (P = 0.04).

Conclusion

Our data indicate that 30‐day mortality and morbidity outcomes for neonatal tracheostomy are not affected by weight. Overall 30‐day mortality should be discussed with caregivers preoperatively.

Level of Evidence

4 Laryngoscope, 129:500–505, 2019
Cardiovascular endpoints for obstructive sleep apnea with twelfth cranial nerve stimulation (CARDIOSA‐12): Rationale and methods
Authors: Dedhia Raj C. , Quyyumi Arshed A. , Park Jeanie , Shah Amit J. , Strollo Patrick J. , Bliwise Donald L.
Published: September 2018

Objectives/Hypothesis

To determine the effect of therapeutic levels of hypoglossal nerve stimulation therapy (HGNS), compared to subtherapeutic levels of HGNS, on 24‐hour ambulatory blood pressure, sympathetic activity, and vascular function.

Study Design

Double‐blind, sham‐controlled, randomized crossover trial of 10‐week duration at a university medical center

Methods

The target enrollment is 60 randomly assigned subjects. Interventions are active versus sham (subtherapeutic) HGNS therapy.

Results

The primary outcome is 24‐hour ambulatory systolic blood pressure. Secondary outcomes include 24‐hour ambulatory diastolic blood pressure, nocturnal systolic and diastolic pressure, muscle sympathetic nerve activity, pre‐ejection period, flow‐mediated dilation, and pulse wave velocity.

Conclusions

The Cardiovascular Endpoints for Obstructive Sleep Apnea With Twelfth Cranial Nerve Stimulation study is designed to examine obstructive sleep apnea and test the effects of HGNS on the cardiovascular system through a sham‐controlled trial in patients with moderate–severe obstructive sleep apnea.

Level of Evidence

1 Laryngoscope, 2635–2643, 2018
Demographic predictors of head and neck cancer survival differ in the elderly
Authors: Massa Sean T. , Cass Lauren M. , Challapalli Sai , Zahirsha Zisansha , Simpson Matt , Ward Gregory , Osazuwa‐Peters Nosayaba
Published: September 2018

Objectives/Hypothesis

Head and neck squamous cell carcinoma (HNSCC) prognosis strongly correlates with demographic factors. This study aimed to determine whether demographic predictors of HNSCC survival differ between age cohorts, with an emphasis on the growing elderly demographic.

Study Design

Outcomes research.

Methods

Adults with squamous cell carcinoma of the upper aerodigestive tract were identified from the Surveillance, Epidemiology and End Results 18 database. Demographic and oncologic factors were compared between three age groups: 18 to 49, 50 to 74, and >75 years. Factors associated with cancer‐specific survival were assessed in each cohort using subdistribution hazard ratio (sHR) and 95% confidence interval (CI) produced by multivariate competing risk models.

Results

A cohort of 69,098 patients included 10,588 (15.3%) 75 years or older and 9,882 (14.3%) less than 50 years old. Older patients were more often female (35.4% vs. 25.1% aged 18–49 years and 20.4% aged 50–74 years), white (78.7% vs. 69.4% and 75.9%), insured (63.5% vs. 46.5% and 56.8%), and married (56.6% vs. 53% and 51.1%), but received adequate treatment less often (72.0% vs. 86.3% and 82.7%). In the older cohort, male sex was associated with lower mortality (sHR: 0.92, 95% CI: 0.85‐1.00), and unlike the younger cohorts, black race was no longer associated with mortality (sHR: 1.07, 95% CI: 0.94‐1.22). Marriage was associated with lower mortality in all age groups but with diminishing effects (single sHR: young 1.52, middle 1.31, older 1.14).

Conclusions

Elderly HNSCC patients have distinct effects from demographic prognostic factors and should be considered a separate subgroup with unique epidemiology, risks, and preferences.

Level of Evidence

2c Laryngoscope, , 129:146–153, 2018
Predictors of gastrostomy tube dependence in surgically managed oropharyngeal squamous cell carcinoma
Authors: Varma Vivek R. , Eskander Antoine , Kang Stephen Y. , Kumar Bhavna , Brown Nicole V. , Zhao Songzhu , Brock Guy , Agrawal Amit , Carrau Ricardo L. , Old Matthew O. , Ozer Enver , Rocco James W. , Schuller David E. , Dziegielewski Peter T. , Cipolla Michael J. , Teknos Theodoros N.
Published: September 2018

Objectives

To elucidate predictive factors in the perioperative period resulting in gastrostomy tube (G‐tube) dependence for patients undergoing primary surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) in the modern era.

Methods

Two hundred and thirty patients with known OPSCC treated with primary surgery were screened and selected from a retrospective database spanning from 2002 to 2012 at The Ohio State University Wexner Medical Center (Columbus, Ohio), with univariable and multivariable logistic regression modeling used to determine independent predictive factors resulting in G‐tube dependence (defined as tube persistence/presence 1 year after surgery).

Results

Surgical approach, baseline characteristics, tumor (T)‐nodal‐metastasis stage, human papillomavirus status, extent of tissue resected, surgical complications, reconstructive technique, preoperative G‐tube presence, and adjuvant treatment were recorded. Patients undergoing open surgery for OPSCC without adjuvant treatment had 42.9% G‐tube dependence (44.6% with adjuvant chemoradiation [CRT]) compared to 0% for those undergoing transoral nonrobotic surgery (8.1% with adjuvant CRT) and 0% for those undergoing transoral robotic surgery (10.3% with adjuvant CRT). In multivariable analysis, greater than 25% of the oral tongue resected (odds ratio [OR] 12.29; P = 0.03), an open surgical approach (OR 5.72; P < 0.01) and T3/T4 tumor stage (OR 2.84; P = 0.02) were independent and significant predictors of G‐tube dependence.

Conclusion

Surgical approach, advanced tumor stage, and oral tongue resection may influence the development of nutritional dependence for surgically treated patients with OPSCC.

Level of Evidence

4 Laryngoscope, 129:415–421, 2019
The incidence of microscopic thyroglossal duct tissue superior to the hyoid bone
Authors: Garcia Erick , Osterbauer Beth , Parham David , Koempel Jeffrey
Published: September 2018

Objective

Despite the success of the Sistrunk procedure, persistence of a thyroglossal duct cyst (TGDC), sinus, or remnant following excision remains a clinical problem. This is most likely due to the presence of microscopic disease that was not excised at the time of surgery. The purpose of this study is to determine the incidence of microscopic disease superior to the hyoid bone in children who have had either a primary or revision procedure for a TGDC.

Methods

A prospective review of pathologic specimens was conducted of all consecutive patients undergoing TGDC excision by pediatric otolaryngologists at the Children's Hospital Los Angeles beginning March 2014 through July 2017 in both primary and revision procedures.

Results

Microscopic disease was present superior to the hyoid bone in 25 of the 34 (74%) specimens and in 100% (6) of the specimens from a revision procedure.

Conclusion

The majority of persons who have a TGDC will have microscopic disease superior to the hyoid bone. In order to minimize the incidence of persistence following a primary procedure, tissue superior to the hyoid bone should be removed routinely even if no gross disease is noted at the time of surgery. When performing a revision procedure, special attention should be given to the suprahyoid area as a likely site of persistent disease.

Level of Evidence

2b Laryngoscope, 129:1215–1217, 2019
Clinical use of the STOP‐BANG questionnaire to determine postoperative risk in veterans
Authors: Chang Katherine W. , Steward David L. , Tabangin Meredith E. , Altaye Mekibib , Malhotra Vidhata , Patil Reena Dhanda
Published: September 2018

Objectives

To determine whether STOP‐BANG (snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, gender) scores are associated with immediate postoperative adverse events in veterans undergoing surgery.

Methods

In this prospective cohort study, veterans presenting to the presurgical clinic at a Veterans Affairs hospital answered the STOP‐BANG questionnaire, which was scored as high risk (5–8), intermediate risk (3–4), and low risk (0–2) for obstructive sleep apnea (OSA), during a 6‐month study period. Immediate postoperative respiratory and cardiovascular adverse events were recorded.

Results

The patient population included 1,080 veterans. Ninety‐five patients (8.8%) experienced adverse events, of which 74 (6.9%) were respiratory and 21 (1.9%) were cardiovascular in nature. Patients with high‐risk STOP‐BANG scores (5–8) had significantly greater odds of having an adverse event odds ratio (OR) 2.1 (95% confidence interval [CI]: 1.4, 3.3) and hypoxia OR 2.8 (95% CI: 1.7, 4.6) compared to those with low‐ to intermediate‐risk scores (0–4). Among patients with OSA, those with high‐risk scores (5–8) had greater odds of an adverse event OR 3.9 (95% CI: 1.1, 13.9) and hypoxia OR 3.7 (95% CI: 1.1, 13.0) compared to those with low‐ to intermediate‐risk scores (0–4). Patients without a history of OSA with high‐risk scores (5–8) did not have significantly greater odds of an adverse event OR 1.5 (95% CI: 0.82, 2.6) or a hypoxic event OR 1.7 (95% CI: 0.87, 3.4) compared to those with low‐ to intermediate‐risk scores (0–4).

Conclusion

The STOP‐BANG questionnaire was useful in the veteran population because high‐risk scores were predictive of adverse events, in particular, hypoxia for patients with a previous diagnosis of OSA. In the future, this may direct studies and clinical activities aimed at optimizing safe and effective perioperative practices.

Level of Evidence

2b Laryngoscope, 129:259–264, 2019
Initial presentation of human papillomavirus‐related head and neck cancer: A retrospective review
Authors: Khalid Mian B. , Ting Peter , Pai Akila , Russo Jack L. , Bakst Richard , Chai Raymond L. , Teng Marita S. , Genden Eric M. , Miles Brett A.
Published: September 2018

Objective

Human papillomavirus (HPV) has been identified as a risk factor for oropharyngeal squamous cell carcinoma (OPSCC) and a cause of the recent dramatic rise in the incidence of this disease. HPV‐positive OPSCC typically affects a younger population and has no validated screening test. This study aims to outline the common presenting signs of HPV‐positive OPSCC.

Methods

We conducted a retrospective single‐institution review on 370 patients who were treated at the Icahn School of Medicine at Mount Sinai, New York City, between April 2007 and November 2015 for OPSCC. We included patients with newly diagnosed OPSCC and sufficient history and physical data in the final analysis. Univariate analysis was used to compare HPV‐positive and HPV‐negative cohorts for demographics, tumor location, tumor staging, initial presentation and symptoms, and physical exam findings.

Results

Two hundred and seven patients met the inclusion criteria. The most common initial symptoms for OPSCC were neck mass (51.7%) and sore throat (13.0%). The HPV‐positive cohort was more likely to present with a chief complaint of neck mass compared to the HPV‐negative cohort (56.1% vs. 22.2%; P = 0.0015). A positive neck exam was associated with HPV‐positive status (73.9% vs. 40.7%; P = 0.0012).

Conclusion

HPV‐positive OPSCC is an incipient epidemic, poised to surpass cervical cancer as the most common HPV‐related cancer by 2020. Initial presenting signs may often be mistaken for benign processes. This study provides physicians with a better understanding of initial presentation of patients with HPV‐positive OPSCC, leading to earlier diagnosis and improved outcomes.

Level of Evidence

4 Laryngoscope, 129:877–882, 2019