bluuebunny/crossref_metadata_2025 huggingface dataset:
Bystander activation of Bordetella pertussis‐induced nasal tissue‐resident memory CD4 T cells confers heterologous immunity to Klebsiella pneumoniae
Authors: Curham Lucy M. , Mannion Jenny M. , Daly Clíodhna M. , Wilk Mieszko M. , Borkner Lisa , Lalor Stephen J. , McLoughlin Rachel M. , Mills Kingston H.G.
Published: January 2023

Tissue‐resident memory CD4 T (TRM) cells induced by infection with Bordetella pertussis persist in respiratory tissues and confer long‐term protective immunity against reinfection. However, it is not clear how they are maintained in respiratory tissues. Here, we demonstrate that B. pertussis‐specific CD4 TRM cells produce IL‐17A in response to in vitro stimulation with LPS or heat‐killed Klebsiella pneumoniae (HKKP) in the presence of dendritic cells. Furthermore, IL‐17A‐secreting CD4 TRM cells expand in the lung and nasal tissue of B. pertussis convalescent mice following in vivo administration of LPS or HKKP. Bystander activation of CD4 TRM cells was suppressed by anti‐IL‐12p40 but not by anti‐MHCII antibodies. Furthermore, purified respiratory tissue‐resident, but not circulating, CD4 T cells from convalescent mice produced IL‐17A following direct stimulation with IL‐23 and IL‐1β or IL‐18. Intranasal immunization of mice with a whole‐cell pertussis vaccine induced respiratory CD4 TRM cells that were reactivated following stimulation with K. pneumoniae. Furthermore, the nasal pertussis vaccine conferred protective immunity against B. pertussis but also attenuated infection with K. pneumoniae. Our findings demonstrate that CD4 TRM cells induced by respiratory infection or vaccination can undergo bystander activation and confer heterologous immunity to an unrelated respiratory pathogen.
Enantioselective Nickel‐Catalyzed Hydrocyanation of Homostilbenes
Authors: Strache Joss Pepe , Münzer Lukas , Adler Andreas , Blunk Dirk , Schmalz Hans‐Günther
Published: January 2023

We investigated the previously unknown enantioselective Ni‐catalyzed hydrocyanation of 1,3‐diarylpropenes (homostilbenes). For this purpose, a series of (E)‐homostilbenes were prepared by (microwave‐assisted) Pd‐catalyzed coupling of allylic alcohols with aryl‐boronic acids. Employing our established catalyst system formed from Ni(cod)2 and a TADDOL‐derived chiral phosphine‐phosphite ligand and using TMSCN as an in situ source of HCN, the hydrocyanation of various homostilbenes was studied. The synthetic usefulness of the methodology was demonstrated in a short synthesis of the new (allo‐) colchicine analogue 7‐cyano‐11‐methoxy‐colchinol involving an PIDA‐mediated oxidative cyclization of the corresponding hydrocyanation product to set up the 7‐membered ring. The absolute configuration of 2,4‐diphenylbutyronitrile was assigned by comparison of experimental and calculated ECD spectra.
Impact of partial encapsulation on the fire dynamics of an open‐plan compartment with exposed timber ceiling and columns:CodeRed #04
Authors: Kotsovinos Panagiotis , Christensen Eirik G. , Glew Adam , O'Loughlin Eoin , Mitchell Harry , Amin Rikesh , Robert Fabienne , Heidari Mohammad , Barber David , Rein Guillermo , Schulz Judith
Published: January 2023

The use of mass timber in construction is becoming a compelling option when faced with the high carbon footprint of traditional concrete and steel production. However, fire safety standards are yet to evolve to support these designs. Encapsulation is commonly used to protect all, or some, of the timber surfaces and reduce the risks introduced. This paper presents the results fromCodeRed #04, the final experiment of theCodeRedexperimental campaign. This experiment was carried out inside a purpose‐built facility to capture fire dynamics in large compartments with exposed timber.CodeRed #04had identical characteristics toCodeRed #01with the exception that ~50% of the cross‐laminated timber (CLT) ceiling was encapsulated. The experiments were intentionally similar to the traveling fire experiments,x‐ONEandx‐TWO, which had a non‐combustible ceiling to enable a direct comparison. The overall fire dynamics experienced inCodeRed #04, intersect the characteristics observed inCodeRed #01andx‐ONEandx‐TWO.1. InCodeRed #04, there was a delay in the ignition of the CLT ceiling as the CLT directly above the crib was encapsulated. Once the CLT ceiling ignited, the fire spread rapidly throughout the compartment. The peak heat release rate (HRR) was estimated to be approximately 100 MW, a 17% decrease fromCodeRed #01. Following CLT ignition the resulting fire duration, maximum temperatures, and heat fluxes were broadly similar toCodeRed #01. Flame heights of approximately 1.5 m were observed from the windows while flame heights of 2.5–3 m were observed inCodeRed #01. Therefore, flame heights were found to be comparable tox‐TWO.1, though over a greater number of windows, reflecting the greater extent of simultaneous burning within the compartment. The average charring depth of the exposed CLT panels was ~25 mm, which is similar to that measured inCodeRed #01‐suggesting that the fire severity near the ceiling was not strongly impacted by the 50% encapsulation of timber. No charring was observed where the ceiling was encapsulated and loaded service fixings installed through the encapsulation were found to be less likely to fail than when attached directly to the exposed timber. Smoldering was observed after the cessation of flaming and, in a few locations, was observed to progress through the thickness of the CLT panel and continue behind the encapsulation. This illustrates that, while encapsulation can succcessfully prevent flaming, it cannot be completely relied on to avoid smouldering. The findings fromCodeRed #04contribute to the development of evidence‐based fire safety design methodologies for exposed mass timber buildings.
Phytochemical analysis and nephroprotective potential of Ajwa date in doxorubicin‐induced nephrotoxicity rats: Biochemical and molecular docking approaches
Authors: Baothman Othman A. S. , Altayb Hisham N. , Zeyadi Mustafa A. , Hosawi Salman B. , Abo‐Golayel Mohamed Kamel
Published: January 2023

The purpose of this study is to evaluate the likely defensive impact of Ajwa date aqueous extract (AJDAE) in alleviating the nephrotoxicity generated by doxorubicin (DOX) injection in rats. Sixty male Wister albino rats were randomly and equally separated into six groups (n = 10), and they were treated as follows: untreated control group, extract groups administered with 0.75 and 1.5 mg kg bw of AJDAE, toxicant control group administered with DOX, and prophylactic groups were treated with 0.75 and 1.5 mg/kg of AJDAE and 15 mg/kg DOX. Biochemical parameters, antioxidant enzymes, renal functions, DNA integrity, and histopathology were studied to evaluate the nephroprotective activity of AJDAE. Furthermore, bioactive compounds were utilized for in silico molecular docking. AJDAE treatment resulted in significant improvements in the amended renal biomarkers (urea, creatinine, calcium, phosphorous, and uric acid), antioxidative markers, and MDA. Noticeable histopathological improvements supported this result. Results of in silico studies revealed that d‐Mannitol, 6TMS derivative, palmitic acid, and TMS derivative had a higher docking score with human soluble epoxide hydrolase (−10.9 kcal/mol) and NF‐κB‐DNA (−7 kcal/mol). The present findings indicated that AJDAE could decrease ROS generation and lipid peroxidation (LPO) and repair the DOX injection‐related DNA damage.
Taurine alleviates oxidative stress in porcine mammary epithelial cells by stimulating the Nrf2‐MAPK signaling pathway
Authors: Xu Mengmeng , Che Long , Gao Kaiguo , Wang Li , Yang Xuefen , Wen Xiaolu , Li Mengyun , Jiang Zongyong
Published: January 2023

The high incidence of oxidative stress in sows during late gestation and lactation affects mammary gland health, milk yield, and milk quality. Recently, we found that supplementing maternal diets with 1% taurine improved antioxidant capability and enhanced growth performance in offspring; however, the mechanisms underlying these are unknown. This study aimed to investigate the cytoprotective effects and the mechanism of taurine in mitigating oxidative stress in porcine mammary epithelial cells (PMECs). PMECs were pretreated with 0–2.0 mM taurine for 12 h and then subjected to oxidative injury with 500 μM hydrogen peroxide (H2O2). Pretreatment with taurine attenuated decreased cell viability, enhanced superoxide dismutase, and reduced the intracellular reactive oxygen species accumulation after H2O2 exposure. Taurine also prevented H2O2‐induced endoplasmic reticulum stress. Nuclear factor erythroid 2‐related factor 2 (Nrf2) was essential to the cytoprotective effects of taurine on PMECs, as Nrf2 knockdown significantly inhibited taurine‐induced cytoprotection against oxidative stress. Moreover, we confirmed that Nrf2 induction by taurine was mediated through the inactivation of the p38/MAPK pathway. Overall, taurine supplementation has beneficial effects on redox balance regulation and may protect against oxidative stress in lactating animals.
Weak and pleiotropy robust sex‐stratified Mendelian randomization in the one sample and two sample settings
Authors: Karageorgiou Vasilios , Tyrrell Jess , Mckinley Trevelyan J. , Bowden Jack
Published: January 2023

Background

Mendelian randomization (MR) leverages genetic data as an instrumental variable to provide estimates for the causal effect of an exposure X on a health outcome Y that is robust to confounding. Unfortunately, horizontal pleiotropy—the direct association of a genetic variant with multiple phenotypes—is highly prevalent and can easily render a genetic variant an invalid instrument.

Methods

Building on existing work, we propose a simple method for leveraging sex‐specific genetic associations to perform weak and pleiotropy‐robust MR analysis. This is achieved by constructing an MR estimator in which pleiotropy is perfectly removed by cancellation, while placing it within the powerful machinery of the robust adjusted profile score (MR‐RAPS) method. Pleiotropy cancellation has the attractive property that it removes heterogeneity and therefore justifies a statistically efficient fixed effects model. We extend the method from the typical two‐sample summary‐data MR setting to the one‐sample setting by adapting the technique of Collider‐Correction. Simulation studies and applied examples are used to assess how the sex‐stratified MR‐RAPS estimator performs against other common approaches.

Results

The sex‐stratified MR‐RAPS method is shown to be robust to pleiotropy even in cases where all genetic variants violated the standard Instrument Strength Independent of Direct Effect assumption. In some cases where the strength of the pleiotropic effect additionally varied by sex (and so perfect cancellation was not achieved), over‐dispersed MR‐RAPS implementations can still consistently estimate the true causal effect. In applied analyses, we investigate the causal effect of waist‐hip ratio (WHR), an important marker of central obesity, on a range of downstream traits. While the conventional approaches suggested paradoxical links between WHR and height and body mass index, the sex‐stratified approach obtained a more realistic null effect. Nonzero effects were also detected for systolic and diastolic blood pressure as well as high‐density and low‐density lipoprotein cholesterol.

Discussion

We provide a simple but attractive method for weak and pleiotropy robust causal estimation of sexually dimorphic traits on downstream outcomes, by combining several existing approaches in a novel fashion.
Convergence in a multi‐method study between Rorschach and self‐report data of traumatized refugees assessed before and after psychotherapy
Authors: Hartmann Ellen , Opaas Marianne
Published: January 2023

Rorschach and self‐report instruments represent methodologically different types of assessment, which together may yield incremental information about the test‐taker. There is little evidence on whether and when results from these methods converge.

Objective

To examine possible convergences between Rorschach trauma‐related personality variables and self‐reported variables.

Method

Before and after psychotherapy 22 traumatized adult refugee patients were assessed with the Rorschach Performance Assessment System (R‐PAS), symptom checklists of posttraumatic stress, anxiety and depression, and a quality of life questionnaire. Correlational analyses between eight R‐PAS variables and 10 self‐reported variables were performed.

Results

The findings showed inconsistent and nonsignificant correlations pretherapy. Posttherapy, however, all R‐PAS variables except Complexity correlated positively with symptoms of mental disorder, and negatively with the quality of life variables, as predicted. The R‐PAS variables Mutuality of Autonomy‐Pathology, Poor Human Representation, Critical Content, and Form Quality‐minus%, converged significantly with most of the self‐reported variables, with medium to large correlations.

Conclusion

The finding of convergence only after psychotherapy, may tentatively suggest greater self‐knowledge and internal consistency through the therapy experience, and increased trust and self‐disclosure through the repeated meetings with the researchers. The findings represent a promising contribution to a cumulative validation process of convergence between Rorschach and self‐report data.
Costs and cost‐effectiveness of a collaborative data‐to‐care intervention for HIV treatment and care in the United States
Authors: Shrestha Ram K. , Fanfair Robyn Neblett , Randall Liisa M. , Lucas Crystal , Nichols Lisa , Camp Nasima , Brady Kathleen A. , Jenkins Heidi , Altice Frederick L. , DeMaria Alfred , Villanueva Merceditas , Weidle Paul J.
Published: January 2023

Introduction

Data‐to‐care programmes utilize surveillance data to identify persons who are out of HIV care, re‐engage them in care and improve HIV care outcomes. We assess the costs and cost‐effectiveness of re‐engagement in an HIV care intervention in the United States.

Methods

The Cooperative Re‐engagement Control Trial (CoRECT) employed a data‐to‐care collaborative model between health departments and HIV care providers, August 2016–July 2018. The health departments in Connecticut (CT), Massachusetts (MA) and Philadelphia (PHL) collaborated with HIV clinics to identify newly out‐of‐care patients and randomize them to receive usual linkage and engagement in care services (standard‐of‐care control arm) or health department‐initiated active re‐engagement services (intervention arm). We used a microcosting approach to identify the activities and resources involved in the CoRECT intervention, separate from the standard‐of‐care, and quantified the costs. The cost data were collected at the start‐up and recurrent phases of the trial to incorporate potential variation in the intervention costs. The costs were estimated from the healthcare provider perspective.

Results

The CoRECT trial in CT, MA and PHL randomly assigned on average 327, 316 and 305 participants per year either to the intervention arm (n = 166, 159 and 155) or the standard‐of‐care arm (n = 161, 157 and 150), respectively. Of those randomized, the number of participants re‐engaged in care within 90 days in the intervention and standard‐of‐care arms was 85 and 70 in CT, 84 and 70 in MA, and 98 and 67 in PHL. The additional number of participants re‐engaged in care in the intervention arm compared with those in the standard‐of‐care arm was 15 (CT), 14 (MA) and 31 (PHL). We estimated the annual total cost of the CoRECT intervention at $490,040 in CT, $473,297 in MA and $439,237 in PHL. The average cost per participant enrolled was $2952, $2977 and $2834 and the average cost per participant re‐engaged in care was $5765, $5634 and $4482. We estimated an incremental cost per participant re‐engaged in care at $32,669 (CT), $33,807 (MA) and $14,169 (PHL).

Conclusions

The costs of the CoRECT intervention that identified newly out‐of‐care patients and re‐engaged them in HIV care are comparable with other similar interventions, suggesting a potential for its cost‐effectiveness in the US context.
A compact low‐pass filter using a miniaturized capacitor and honeycomb cavity on substrate integrated suspended line platform
Authors: Zhang Haiyang , Wang Yongqiang , Ma Kaixue
Published: January 2023

This article proposes a compact low‐pass filter (LPF) using a miniaturized capacitor, and honeycomb cavity based on the substrate integrated suspended line platform. A new method for miniaturizing capacitors is proposed, and simultaneously honeycomb cavities are adopted to extend the stopband. As a design case, a seven‐order quasi‐lumped‐element LPF with a cutoff frequency of 0.6 GHz is designed, fabricated, and tested. The size of the LPF is 0.085λg × 0.015λg × 0.012λg, and a wide stopband from 0.82 to 67 GHz with a suppression level greater than 20 dB is obtained.
Early CT physics research at Massachusetts General Hospital
Authors: Pelc Norbert J. , Chesler David A.
Published: January 2023

Although CT imaging was introduced at Massachusetts General Hospital (MGH) quite early, with its first CT scanner installed in 1973, CT research at MGH started years earlier. The goal of this paper is to describe some of this innovative work and related accomplishments.
Radiomics feature analysis and model research for predicting histopathological subtypes of non‐small cell lung cancer on CT images: A multi‐dataset study
Authors: Song Fan , Song Xiao , Feng Youdan , Fan Guangda , Sun Yangyang , Zhang Peng , Li Jinkai , Liu Fei , Zhang Guanglei
Published: January 2023

Purpose

Classifying the subtypes of non‐small cell lung cancer (NSCLC) is essential for clinically adopting optimal treatment strategies and improving clinical outcomes, but the histological subtypes are confirmed by invasive biopsy or post‐operative examination at present. Based on multi‐center data, this study aimed to analyze the importance of extracted CT radiomics features and develop the model with good generalization performance for precisely distinguishing major NSCLC subtypes: adenocarcinoma (ADC) and squamous cell carcinoma (SCC).

Methods

We collected a multi‐center CT dataset with 868 patients from eight international databases on the cancer imaging archive (TCIA). Among them, patients from five databases were mixed and split to training and test sets (560:140). The remaining three databases were used as independent test sets: TCGA set (n = 97) and lung3 set (n = 71). A total of 1409 features containing shape, intensity, and texture information were extracted from tumor volume of interest (VOI), then the ℓ2,1‐norm minimization was used for feature selection and the importance of selected features was analyzed. Next, the prediction and generalization performance of 130 radiomics models (10 common algorithms and 120 heterogeneous ensemble combinations) were compared by the average AUC value on three test sets. Finally, predictive results of the optimal model were shown.

Results

After feature selection, 401 features were obtained. Features of intensity, texture GLCM, GLRLM, and GLSZM had higher classification weight coefficients than other features (shape, texture GLDM, and NGTDM), and the filtered image features exhibited significant importance than original image features (p‐value = 0.0210). Moreover, five ensemble learning algorithms (Bagging, AdaBoost, RF, XGBoost, GBDT) had better generalization performance (p‐value = 0.00418) than other non‐ensemble algorithms (MLP, LR, GNB, SVM, KNN). The Bagging‐AdaBoost‐SVM model had the highest AUC value (0.815 ± 0.010) on three test sets. It obtained AUC values of 0.819, 0.823, and 0.804 on test set, TCGA set and lung3 set, respectively.

Conclusion

Our multi‐dataset study showed that intensity features, texture features (GLCM, GLRLM, and GLSZM) and filtered image features were more important for distinguishing ADCs from SCCs. The method of ensemble learning can improve the prediction and generalization performance on the complicated multi‐center data. The Bagging‐AdaBoost‐SVM model had the strongest generalization performance, and it showed promising clinical value for non‐invasively predicting the histopathological subtypes of NSCLC.
A personal perspective on the development and future of cone‐beam CT for image‐guided radiotherapy
Authors: Jaffray David A.
Published: January 2023

The development of cone‐beam CT guided radiotherapy has transformed radiation oncology in the 20 years since it was first released commercially. The technological pace of change has spurred a massive transformation in our daily clinical practice, forced us to evolve our approach to multi‐ and inter‐disciplinary collaboration, and enabled new treatment paradigms. Further progress in integrating quantitative CT in these robotic platforms promises to do even more by “burying the complexity” of radiotherapy and leveraging the expanding digital fabric that uses machine learning approaches to bring semi‐automated expertise to bear on the issues of expertise and quality. This is the only way we will be able to respond to the massive global shortfall in high‐quality radiotherapy services across the globe.
Iberiotoxin and clofilium regulate hyperactivation, acrosome reaction, and ion homeostasis synergistically during human sperm capacitation
Authors: Wang Yayan , Gao Tian , Shan Lijun , Li Kun , Liang Fei , Yu Jianmin , Ni Ya , Sun Peibei
Published: January 2023

Potassium channels play essential roles in the regulation of male fertility. However, potassium channels mediating K+ currents in human sperm (IKSper) remain controversial. Besides SLO3, the SLO1 potassium channel is a potential candidate for human sperm KSper. This study intends to elucidate the function of SLO1 potassium channel during human sperm capacitation. Human sperm were treated with iberiotoxin (IbTX, a SLO1 specific inhibitor) and clofilium (SLO3 inhibitor) separately or simultaneously during in vitro capacitation. A computer‐assisted sperm analyzer was used to assess sperm motility. The sperm acrosome reaction (AR) was analyzed using fluorescein isothiocyanate‐conjugated Pisum sativum agglutinin staining. Sperm protein tyrosine phosphorylation was studied using western blotting. Intracellular Ca2+, K+, Cl−, and pH were analyzed using ion fluorescence probes. Independent inhibition with IbTX or clofilium decreased the sperm hyperactivation, AR, and protein tyrosine phosphorylation, and was accompanied by an increase in [K+]i, [Cl−]i, and pHi, but a decrease in [Ca2+]i. Simultaneously inhibition with IbTX and clofilium lower sperm hyperactivation and AR more than independent inhibition. The increase in [K+]i, [Cl−]i, and pHi, and the decrease in [Ca2+]i were more pronounced. This study suggested that the SLO1 potassium channel may have synergic roles with SLO3 during human sperm capacitation.
Neurochemical correlations in short echo time proton magnetic resonance spectroscopy
Authors: Hong Sungtak , Shen Jun
Published: January 2023

Neurochemical concentrations determined by magnetic resonance spectroscopy (MRS) have been treated as statistically independent measurements in various clinical MRS studies. However, spectral overlap, independent of any biological effects, could lead to significant correlations between neurochemical concentrations extracted from spectral fitting of MRS data, confounding determination of correlations of biological origin. Short echo time (TE) proton MRS spectra are very crowded because of the comparatively narrow chemical shift dispersion of proton nuclear spins. In this study, the complex neurochemical correlations of spectral origin in short‐TE MRS spectra were quantified. The effects of macromolecules and the background spectral baseline on metabolite–metabolite correlations were also analyzed. Our results demonstrate the importance of factoring in spectral correlations when correlating overlapping metabolite signals in short‐TE spectra with clinical parameters.
Analysis of the current status of community nurses' spiritual care competencies and the factors: A descriptive cross‐sectional analysis
Authors: Zhang XuanYue , Ba Li , Xu JiaLi , Xie SuMei , Tu Jin , Yang Xin , Liu Hanjiao
Published: January 2023

Aim

To examine and analyze the level of spiritual care competency among community nurses.

Design

The study employed a cross‐sectional design.

Methods

From May to July 2022, 442 nurses from community health clinics were chosen as survey respondents using the convenience sample method. The General Information Questionnaire, the version in Chinese of the Nurses' Spiritual Caregiving Awareness Scale and the Chinese version of the Spiritual Caregiving Competence Scale were used in the survey. There were 442 questionnaires distributed, 422 were collected, and the response rate was 95.4%.

Results

The amount of spiritual care competencies of community nurses was positively correlated with the level of spiritual awareness. Simultaneously, their level of education, religious beliefs, marital status and the degree of knowledge of spirituality were all influenced.
Opioid‐involved overdose trainings delivered using remote learning modalities
Authors: Giordano Nicholas A. , Febres‐Cordero Sarah , Baker Helen , Pfeiffer Katherine M. , Walsh Lisa Marie , Gish Andy , Axson Sydney A.
Published: January 2023

Aim

This education‐focused study examined changes in nursing students' knowledge and attitudes towards responding to opioid‐involved overdoses following participation in trainings delivered using remote learning modalities.

Design

This pre‐post study examined learning outcomes among 17 nursing students.

Methods

Participants completed the Opioid Overdose Attitude Scale and Opioid Overdose Knowledge Scale to assess attitudes and knowledge, respectively. Trainings were delivered to two separate groups, one via virtual reality immersive video and another over video conferencing.

Results

Attitude scores increased by an average of 12.2 points and knowledge scores increased by 1.65 points. Within the virtual reality group, attitude scores increased by an average of 10 points, while no significant changes were observed in knowledge scores. The video conferencing group improved in both attitude and knowledge scores, by an average of 16.2 points and 2.1 points, respectively.

Conclusions

These hypothesis generating results illustrate the utility of remote learning approaches to deliver trainings, while maintaining social distance during the ongoing COVID‐19 pandemic.
Prognostic role of EAONO/JOS, STAMCO, and ChOLE Staging for Exclusive Endoscopic and Endoscopic‐Microscopic Tympanoplasty
Authors: Fermi Matteo , Bassano Edoardo , Villari Domenico , Capriotti Vincenzo , Calvaruso Federico , Bonali Marco , Alicandri‐Ciufelli Matteo , Marchioni Daniele , Presutti Livio
Published: January 2023

Objective

The aim of the study is to evaluate cholesteatoma's surgical outcomes in patients treated with endoscopic ear surgery (EES) or a combined endoscopic‐microscopic approach (cEMA) according to STAM, STAMCO, ChOLE, and EAONO/JOS system (EJS) classifications and staging.

Study Design

Retrospective study.

Setting

Monocentric study in a tertiary referral center.

Methods

One‐hundred sixty‐eight patients who underwent EES or cEMA for cholesteatoma between 2010 and 2018 were classified according to the abovementioned classification and staging. Data on cholesteatoma's recurrence and residual rates were collected. Inferential statistical analysis was performed to evaluate surgical outcomes and the prognostic value of classifications and staging.

Results

The recurrence rate was significantly lower in cholesteatomas classified in EJS stage 1 (2.6%) and STAM stage 1 (0%). A comparison of the different stages of the disease showed a significantly lower recurrence only for stage 1 versus the superior stages of both classifications. Involvement of mastoid bone was associated with a higher risk of recurrence (odds ratio [OR]: 4.12; p = .031). Attical involvement was associated with a higher risk of residual cholesteatoma (OR: 1.165; p = .046).

Conclusion

EES or cEMA represents an effective treatment for middle ear cholesteatoma. The STAM classification and the EJS have shown a prognostic value, with STAM 1 and EAONO‐JOS 1 stages associated with a better prognosis. Mastoid involvement represents a risk factor for recurrence. Attic localization is associated with residual disease. Localization at difficult access sites did not implicate a higher risk for recurrence or residual. ChOLE classification, Ossicular chain status, and complication status did not provide prognostic information regarding recurrence or residual cholesteatoma.
Trends Following Implementation of an Otolaryngology Hospitalist Model in a Tertiary Care Setting
Authors: Willingham Elizabeth , Shelly Sandeep , Wise Sarah K.
Published: January 2023

Objectives

The otolaryngology hospitalist (OH) model is an emerging paradigm for inpatient and acute patient care. This study presents encounter volume before and after the implementation of an OH service. Postimplementation trends are evaluated.

Study Design

Retrospective administrative and clinical database review.

Setting

Tertiary care university hospital.

Methods

This review includes 2 distinct time frames (2008‐2012, 2014‐2018), representing periods before and after OH implementation. The number of billed patient encounters is compared between these 2 periods using the hospital data warehouse. Additional data is evaluated for the postimplementation period, using a clinical database. Encounter type, the reason for consultation, procedures, and requesting service/location are described.

Results

After the OH implementation, there was a 451% increase in evaluation and management encounters submitted for billing. Since the OH model inception, there was an overall increase in encounters (849‐910), procedures performed (319‐345), and operative cases (46‐54) per year. Each inpatient consultation request generates one or more procedures on average. Common reasons for consultation include sinonasal pathology (20.3%), dysphonia/dysphagia (17.5%), and airway evaluation (15%). Critical Care (24%), Emergency Medicine (21%), and Hospital Medicine (21%) requested most of the Otolaryngology consults. Most consults were seen on the inpatient medical/surgical floor (46%), with the ICU (27%) and the Emergency Department (22%) being the next most common locations.

Conclusions

The OH model is an evolving paradigm that is viable and offers timely, specialized care for patients in a hospital or acute care setting.
Frailty, Age, ASA Classification, and BMI on Postoperative Morbidity in Mandibular Fracture ORIF
Authors: Nguyen Theodore V. , Torabi Sina J. , Goshtasbi Khodayar , Lonergan Ashley R. , Salehi Parsa P. , Haidar Yarah M. , Tjoa Tjoson , Kuan Edward C.
Published: January 2023

Objective

To assess how traditional, simple markers of health independently affect postoperative morbidity of mandibular fracture open reduction‐internal fixations (ORIFs).

Study Design

Cohort study.

Setting

National Surgical Quality Improvement Project (NSQIP) Database.

Methods

The 2005 to 2017 NSQIP database was queried for patients who underwent mandibular ORIF. To control for the severity of the trauma, an additional “concurrent surgery” variable was created. A modified 5‐item frailty index was calculated based on the following: presurgery‐dependent functional status, chronic hypertension, diabetes mellitus, history of chronic obstructive pulmonary disease, and history of congestive heart failure.

Results

Among 1806 patients with mandibular ORIFs (mean age 34.8 ± 15.4 years), modified frailty index (mFI) was associated with 30‐day medical complications (p < .001), reoperation (p < .001), and readmission (p = .005) on univariate analysis. Increased age was associated with prolonged hospitalization (p < .001) and medical complications (p < .001). The increased American Society of Anesthesiologists (ASA) score was associated with all endpoints (p ≤ .003), while increased body mass index (BMI) was associated with none. On multivariate analysis, only increased ASA was associated with any adverse event (reference: ASA 1; ASA 2, odds ratio [OR]: 2.17 [95% confidence interval, CI: 2.17‐3.71],p = .004; ASA 3‐4, OR: 3.63 [95% CI: 1.91‐6.91],p < .001). Similarly, mFI and BMI were not independently associated with prolonged hospitalization (≥2 days) (p ≥ .015), but 65+ age (reference: 18‐49; OR: 2.33 [95% CI: 1.40‐3.86],p = .001) and ASA 3 to 4 groups (reference: ASA 1; OR: 3.26 [95% CI: 2.06‐5.14],p < .001) were.

Conclusion

ASA status and age are more useful modalities than mFI or BMI in predicting poor postoperative morbidity in mandibular ORIF. These simple metrics can assist with managing surgeons' expectations for mandibular ORIF patients.
Bell's Palsy in Pregnancy and Postpartum: A Retrospective Case‐Control Study of 182 Patients
Authors: Lansing Lovisa , Wendel Sophia B. , Hultcrantz Malou , Marsk Elin
Published: January 2023

Objective

To assess the incidence of Bell's palsy in pregnant and postpartum women. Additionally, to compare facial outcomes in terms of Sunnybrook score following Bell's palsy with regard to corticosteroid treatment and other confounding factors.

Study Design

Retrospective case‐control study.

Setting

University Hospital, Stockholm, Sweden.

Methods

All women with Bell's palsy in pregnancy or postpartum (6 weeks after birth) with a computerized medical chart in the Stockholm Region 2005 to 2015 were included. The total number of births in the region during this period was retrieved from the Swedish Medical Birth Register. Nonpregnant age‐matched women with Bell's palsy served as controls. Characteristics, medication, and Sunnybrook scores were collected. Risk factors for incomplete recovery (Sunnybrook score <96) at 3 months were calculated by logistic regression.

Results

In total, 182 pregnant and postpartum women with Bell's palsy were identified. The estimated incidence among pregnant and postpartum women was 60.5/100,000 person‐years. The mean Sunnybrook score at 3 months was 74 among pregnant and postpartum women and 83 for controls (p = .002). At 12 months, Sunnybrook score was 81 and 89, respectively (p = .017). Only one‐third of the pregnant women received corticosteroid treatment.

Conclusion

The incidence of Bell's palsy in pregnancy and postpartum was 60.5 per 100,000 women and year in the Stockholm Region. Sunnybrook score was poorer in pregnant women compared with postpartum and nonpregnant women throughout. Corticosteroid treatment had little effect on any patients, however, only one‐third of the pregnant women received this treatment.
Prognostic Assessment and Risk Stratification in Patients With Postoperative Major Salivary Acinar Cell Carcinoma
Authors: Zhang Di , Wei Yuce , Chai Yue , Qi Fei , Dong Mei
Published: January 2023

Objective

To investigate the clinicopathological features and prognosis of postoperative major salivary acinar cell carcinoma (MSACC) and develop a prognostic model.

Study Design

Retrospective cohort analysis of a public database.

Setting

Patients with MSACC were identified from the Surveillance, Epidemiology, and End Results database (1975‐2019).

Methods

Overall survival (OS) was evaluated using Kaplan‐Meier curves and a log‐rank test. Univariate and multivariate Cox analyses were performed to explore independent prognostic factors. The prognostic model was constructed using screened variables and further visualized with a nomogram and web calculator, and assessed by concordance index, the area under the curve, calibration curve, and decision‐making curve analysis.

Results

An upward trend in the incidence of MSACC was observed throughout the study period. A total of 1398 patients were enrolled (training cohort: 978; validation cohort: 420), and the 5‐ and 10‐year OS rates were 97.7% and 81.6%, respectively. Age, marital status, sex, histological grade, T stage, and lymph node status were identified as prognostic factors for OS. A novel nomogram was developed and showed excellent discrimination and clinical applicability. Additionally, a web calculator was designed to dynamically predict patient survival. Based on the nomogram‐based score, a risk stratification system was constructed to distinguish patients with different risks. The OS of high‐risk patients was significantly lower than that of the low‐risk subgroup.

Conclusion

Long‐term survival in postoperative MSACC was influenced by 6 prognostic factors. The proposed model enables individualized survival prediction and risk stratification, prompting us to be vigilant in high‐risk subgroups and consider timely adjustment of subsequent treatment.
The Clinical Impact of Vagal Nerve Stimulator Implantation on Laryngopharyngeal Function in Children: A Single‐Center Experience
Authors: Hazkani Inbal , Farje Doris , Alden Tord , DiPatri Arthur , Tennant Amy , Ghadersohi Saied , Thompson Dana M. , Rastatter Jeffrey
Published: January 2023

Objective

A vagal nerve stimulator (VNS) has been established as the treatment of choice for children with refractory epilepsy. The outcomes of the procedure have been well documented in adults but are less clear in children. The goal of our study was to review laryngopharyngeal (LP) function following VNS implantation in children.

Study Design

Case series with chart review.

Setting

Tertiary‐care children's hospital.

Methods

Voice, swallowing, and sleep apnea symptoms were extracted from the charts of children who underwent VNS implantation between 2013 and 2021. A questionnaire was sent to parents of implanted children to ascertain the degree of the social and functional impact of the implant.

Results

There were 69 patients, aged 2.3 to 21.4 years old, who met the inclusion criteria. LP symptoms were most common during the first year following implantation; 26 patients (37.6%) demonstrated at least 1 symptom (voice alteration, chronic cough, sleep‐disordered breathing, or dysphagia), and 15 patients required adjustments to their implant settings. The incidence of symptoms and the need to adjust VNS settings significantly dropped during years 2 to 5 and 6 to 8 (22% vs 7% and 5%, respectively, p = .0002). The mean score of the Pediatric Voice Handicap Index differed greatly from a normal control group on each subscale and the total score.

Conclusion

LP dysfunction in children following VNS implantation is comparable to adults, with the most burden noticed during the first year after implantation. The presence of voice alterations did not correlate with the presence of dysphagia and sleep‐disordered breathing. Thorough evaluation, preferably by a multidisciplinary team, is required to assess LP dysfunction postoperatively.
Surgical Treatment in Very Advanced (T4b) Adenoid Cystic Carcinoma of the Head and Neck
Authors: Papazian Michael R. , Chow Michael , Oliver Jamie , Gordon Alex J. , Jacobson Adam , Vaezi Alec , Tam Moses , Givi Babak
Published: January 2023

Objective

To compare treatment outcomes for T4b head and neck adenoid cystic carcinoma (ACC).

Study Design

Historical cohort study.

Setting

National Cancer Database (NCDB).

Methods

Identified all T4b ACC of head and neck origin diagnosed 2004 to 2019 in the NCDB. Demographics, clinical characteristics, treatment details, and survival were analyzed. Treatment outcomes were analyzed using univariable and multivariable Cox regression.

Results

We identified 606 cases of T4b ACC. Less than half (284, 47.0%) underwent curative‐intent treatment. Among these, most were treated with primary surgery: surgery + radiotherapy (RT) (122, 43.0%) or surgery + chemoradiotherapy (CRT) (42, 14.8%). The positive margin rate was 78.7%, and 90‐day postoperative mortality was zero. Nonsurgical patients were treated with definitive RT (60, 21.1%) or definitive CRT (60, 21.1%). The median follow‐up was 51.5 months. Overall survival was 77.8% at 3 years. Three‐year survival was higher for patients treated with surgery compared to those treated nonsurgically (84% vs 70%; p = .005). Surgical treatment remained associated with higher survival on multivariable analysis (hazard ratio [HR]: 0.47, p = .005). This effect was most pronounced for oral cavity tumors (HR: 0.17, p = .01). Among matched cohorts of surgically treated patients, there was no difference in 3‐year survival between clinical T4a and T4b tumors (83.3% vs 83.0%, p = .99).

Conclusion

Long‐term survival for T4b ACC of the head and neck could be expected. Primary surgical treatments can be performed safely and are associated with longer survival. A carefully selected subset of patients with very advanced ACC might benefit from the consideration of surgical treatments.
Single Versus Multigene Testing for Hereditary Hearing Loss: Use and Costs in a Commercially Insured Cohort
Authors: Moon Peter K. , Qian Z. Jason , Stevenson David A. , Chang Kay W.
Published: January 2023

Objective

The objectives of this study were to describe trends in single‐gene GJB2/6 (connexin 26/30) and multigene hearing loss panel (HLP) testing for hereditary hearing loss using real‐world evidence.

Study Design

Retrospective study using insurance claims data.

Setting

Optum Data Mart database from 2015 to 2020.

Methods

Rates of overall and hearing‐specific genetic testing and costs to insurers and patients were reported. Linear regression models were used to assess the proportion of single‐gene GJB2/6 testing over time. Additional linear regression models were used to assess changes in costs over time.

Results

From 2015 to 2020, 91,986 children received genetic testing for any indication, of which 601 (0.65%) received hearing‐specific tests. The proportion of single‐gene GJB2/6 testing remained similar over time (mean difference [MD]: −1.3% per year; 95% confidence interval [CI]: −4.3%, 1.7%), while multigene HLP use increased over time (MD: 4.0% per year; 95% CI: 0.4%, 7.5%). The median charge for single‐gene GJB2/6 testing remained constant during the study period (MD: −$34; 95% CI: −$86, $18), while the median charge for multigene HLP decreased during the study period (MD: −$145 per year; 95% CI: −$278, −$12).

Conclusion

Compared to molecular testing for GJB2/6, HLPs are becoming more common for hereditary hearing loss. The comprehensiveness of HLP and decreasing costs provide justification for its more widespread adoption moving forward.
Sensitivity and Specificity of US and CT as Diagnostic Tools for Pediatric Lateral Neck Abscesses
Authors: Ramazani Fatemeh , Yunker Warren K. , Liu Che Carrie
Published: January 2023

Objective

Ultrasound (US) and computed tomography (CT) are commonly used in the diagnosis of pediatric neck abscesses. The objective of this study is to determine the sensitivity and specificity of US and CT in the diagnosis of pediatric lateral neck abscesses, with a secondary objective of evaluating the association of specific clinical features with a positive US or CT scan.

Study Design

Retrospective review of pediatric patients admitted to a tertiary care center from January 1, 2011, to December 31, 2020, with neck abscesses.

Setting

Tertiary care center.

Methods

The sensitivity and specificity of US and CT were calculated by comparing imaging performed within 24 h of incision and drainage (I&D). Multiple regression was used to evaluate the association of clinical features with a true positive US or CT.

Results

There were 171 patients included in this study, with a median age of 1.5 years (interquartile range [IQR]: 1‐5 years). I&D was done in 156 patients (91.2%), while 15 (8.8%) were treated with antibiotics. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US were 69.5%, 80%, 96.6%, and 24.2%. The sensitivity, specificity, PPV, and NPV of neck CT were 95.5%, 80%, 95.5%, and 57.1%. Length of symptoms, skin erythema, and fluctuance were not significantly associated with a positive US (F(3, 82) = 0.24, p = .9, R2 = 0.01) or CT scan (F(3, 30) = 0.84, p = .5, R2 = 0.08).

Conclusion

Neck US has a low sensitivity for diagnosing pediatric neck abscesses, when compared to CT, but remains a useful initial investigation given its high PPV. Clinicians should have a low threshold for pursuing CT if there is a high suspicion of abscess formation.

Level of Evidence: Level 4.
The Nasogenital Reflex: Imprudence of the Past as a Lesson for a Wiser Future
Authors: Alrassi James , Islam Albina , Rosenfeld Richard M.
Published: January 2023

The history of the nasogenital reflex, a theory that purports a bidirectional pathway between the nose and genitalia, reveals a complex and diverse record spanning back to antiquity and across the Eurasian continent. This article examines how an antiquated medical theory made its way into early contemporary medicine, and the lesson this account serves as otolaryngology–head and neck surgery continues to work toward making all its interventions based on a hierarchy of evidence.
Metformin Reduces the Risk of Hearing Loss: A Retrospective Cohort Study
Authors: Tseng Chin‐Hsiao
Published: January 2023

Objective

To compare the risk of hearing loss with regard to metformin exposure.

Study Design

Retrospective cohort.

Setting

Taiwan's National Health Insurance database.

Methods

We enrolled 292,071 ever users and 18,200 never users of metformin with new‐onset diabetes mellitus from 1999 to 2005 and followed them for hearing loss from January 1, 2006, to December 31, 2011. Hazard ratios (HRs) weighted by propensity score were estimated.

Results

Hearing loss was newly diagnosed in 10,085 ever users and 1072 never users. Their respective incidence rates (per 100,000 person‐years) were 738.09 and 1366.83. The HR comparing ever‐to‐never users was 0.534 (95% confidence interval [CI]: 0.501‐0.569]. The HR (95% CI) for the first (<27.07 months), second (27.07‐59.13 months), and third (>59.13 months) tertiles of cumulative duration of metformin therapy were 0.912 (0.852‐0.975), 0.544 (0.508‐0.582), and 0.275 (0.255‐0.295), respectively; and were 0.900 (0.841‐0.962), 0.531 (0.496‐0.569), and 0.293 (0.273‐0.315), respectively, for the first (<796.70 g), second (796.70‐2020.15 g), and third (>2020.15 g) tertiles of cumulative dose. The magnitude of risk reduction became more remarkable in corresponding to the increasing tertiles of the defined daily dose prescribed. Subtype analyses suggested that the risk reduction was more significant for sensorineural than conductive hearing loss. Findings derived from a propensity score‐matched cohort did not substantially change the conclusions, and the risk reduction for mixed hearing loss was not statistically significant in the matched cohort as significantly observed in the unmatched cohort.

Conclusion

The risk of hearing loss is reduced in a dose‐response pattern in patients who use metformin.