bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the Diurnal Radiation Contrast on the Contraction of Radius of Maximum Wind during Intensification of Hurricane Edouard (2014)
Authors: Tang Xiaodong , Tan Zhe-Min , Fang Juan , Munsell Erin B. , Zhang Fuqing
Published: December 2018

This work examines the impacts of the diurnal radiation contrast on the contraction rate of the radius of maximum wind (RMW) during intensification of Hurricane Edouard (2014) through convection-permitting simulations. Rapid contraction of RMW occurs both in the low and midlevels for the control run and the sensitivity run without solar insolation, while the tropical cyclone contracts more slowly in the low levels and later in the midlevels and thereafter fails to intensify continuously in the absence of the night phase, under weak vertical wind shear (~4 m s−1). The clouds at the top of the boundary layer absorb solar shortwave heating during the daytime, which enhanced the temperature inversion there and increased the convective inhibition, while nighttime destabilization and moistening in low levels through radiative cooling decrease convective inhibition and favor more convection inside the RMW than in the daytime phase. The budget analysis of the tangential wind tendency reveals that the greater positive radial vorticity flux inside of the RMW is the key RMW contraction mechanism in the boundary layer at night because of the enhanced convection. However, the greater positive vertical advection of tangential wind inside of the RMW dominates the RMW contraction in the midlevels.
Haematopoietic alterations in neonates with congenital diaphragmatic hernia receiving extracorporeal membrane oxygenation support
Authors: Dolscheid-Pommerich Ramona C , Kreuzer Alexander , Graeff Ingo , Stoffel-Wagner Birgit , Mueller Andreas , Kipfmueller Florian
Published: December 2018

Background

Extracorporeal membrane oxygenation procedure (ECMO) has been established in the therapy of respiratory insufficient infants with congenital diaphragmatic hernia. In congenital diaphragmatic hernia newborns, a delay in transfer to an ECMO centre is associated with a sharp increase in mortality. Predictive factors for ECMO support are urgently needed. We evaluated the routine parameters of the first blood withdrawal after birth in congenital diaphragmatic hernia infants, hypothesizing that early signs in bone marrow affecting haematology parameters for early regulation of potentially post birth hypoxia are predictive factors for ECMO support.

Materials and methods

In 44 patients born with congenital diaphragmatic hernia, differential blood cell count from the first blood withdrawal after birth was examined. Descriptive statistics included median, 95% confidence intervals, minimum and maximum differentiating ECMO/early mortality vs. no ECMO. Odds ratios with CI were calculated by binary logistic regression analysis. Best predictive markers were further checked in combination with the liver-up situation in two factorial regression models.

Results

In our cohort, the survival rate was 77.3% (34/44). While 18 neonates received ECMO support, 26 experienced no ECMO during hospital stay. Odds ratio calculations showed that risk for ECMO support increases with augmenting leukocytes, erythrocytes, haemoglobin, haematocrit, mean cell volume and absolute immature granulocytes. Further, the risk advanced in line with the severity of congenital diaphragmatic hernia assessed by prenatal ultrasound.

Conclusions

We conclude that these parameters are associated with disease severity in congenital diaphragmatic hernia newborns and may be considered potentially predictive biomarkers for the necessity of ECMO support.
The association of serum and vitreous adropin concentrations with diabetic retinopathy
Authors: Li Shipeng , Sun Jianling , Hu Wenchao , Liu Yan , Lin Dan , Duan Haiping , Liu Fengting
Published: December 2018

Objective

Adropin, a newly identified regulatory protein encoded by Enho gene, is correlated with insulin sensitivity and diabetes. The aim of this study is to determine whether serum and vitreous adropin concentrations are correlated with the presence of diabetic retinopathy.

Methods

A population of 165 patients with type 2 diabetes mellitus (52 without diabetic retinopathy, 69 with non-proliferative diabetic retinopathy and 44 patients with proliferative diabetic retinopathy) was enrolled in this study. The control group enrolled 68 healthy subjects who had underwent vitrectomy for retinal detachment. Serum and vitreous adropin concentrations were examined using enzyme-linked immunosorbent assay method.

Results

Control subjects had significantly higher serum and vitreous adropin concentrations compared with diabetic patients. Serum and vitreous adropin concentrations in proliferative diabetic retinopathy patients were significantly reduced compared with those in non-proliferative diabetic retinopathy patients and type 2 diabetes mellitus patients without diabetic retinopathy. In addition, there were lower serum and vitreous adropin concentrations in non-proliferative diabetic retinopathy patients compared with type 2 diabetes mellitus patients without diabetic retinopathy. Logistic regression analysis revealed that serum and vitreous adropin were associated with a decreased risk of type 2 diabetes mellitus and diabetic retinopathy.

Conclusion

Serum and vitreous adropin concentrations are negatively associated with the presence of diabetic retinopathy.
Use of Pediatric Primary Care Telephone Advice by Families Whose Usual Language Spoken at Home Is Not English
Authors: Watts Delma-Jean , Hajjar Maurice , Dowla Nizar , Hirway Priya , Kamath Shuba
Published: December 2018

Language barriers and access to telephone advice have been shown to affect patient care. Less is known about access to telephone advice for families whose usual language is not English. The objective was to characterize the use of pediatric primary care telephone advice by families based on usual language spoken at home. A total of 277 surveys were completed by families presenting for sick visits at an academic pediatric primary care practice. No meaningful differences in the use of telephone advice when a child was sick were found by language category. Overall, 80.5% reported calling the clinic first when the clinic was open, but 77.6% went to the emergency department when the clinic closed. In conclusion, use of telephone advice was similar among families regardless of usual language. Most families reported going to the emergency department when the clinic was closed. More research is needed to identify barriers to the use of telephone advice, particularly after hours.
Comparing how peace operations enable or restrict the influence of national staff: Contestation from within?
Authors: Eckhard Steffen
Published: December 2018

A large share of civilian staff working in international peace operations are nationals of the host state. Academic research has not yet investigated the effect of these locally recruited bureaucrats on peacebuilding. Theoretically, it is argued that to accomplish their missions in complex environments, peace operations require crucial knowledge about local perceptions, politics, and customs. Local staff can have a positive performance impact by soliciting such knowledge. But information advantages create new principal-agent problems. Peace operations have a hard time scrutinizing their employees’ allegiances, and they risk sabotage from within. Empirically, it is shown that peace operations conducted by the United Nations (UN), the Organization for Security and Co-operation in Europe (OSCE), and the European Union (EU) differ significantly in how they navigate the ensuing tension by enabling or restricting the influence of their local staff. A new data set on the staffing of 52 peace operations as well as analysis of internal staff policies yields significant variance in the potential of local staff to influence peacebuilding policy implementation, which is most extensive in the OSCE, followed by the UN and the EU. This finding warrants more attention on the role of local staff as information gatekeepers who could be at the center of potential frictions between international and local norms and knowledge.
Economic Globalization and Democratic Development in East Asia: The Indirect Link
Authors: Kim Hayam , Heo Uk
Published: December 2018

Over the past decades, East Asian states have enjoyed economic development and progress toward democracy through extensive economic transformation: trade and financial liberalization. To explain the theoretical mechanism of these variables, we investigate the direct and indirect effects of globalization on democratic development via economic development. To this end, a two-equation model is specified and estimated using data from 1972 to 2010 for 12 East Asian countries. The results show that globalization has not only a direct effect, but also an indirect effect on democracy via economic development.
Monitoring Moral Virtue: When the Moral Transgressions of In-Group Members Are Judged More Severely
Authors: Bettache Karim , Hamamura Takeshi , Amrani Idrissi Joubyr , Amenyogbo Ruben George Jonathan , Chiu Chi-yue
Published: December 2018

Literature indicates that people tend to judge the moral transgressions committed by out-group members more severely than those of in-group members. However, these transgressions often conflate a moral transgression with some form of intergroup harm. There is little research examining in-group versus out-group transgressions of harmless offenses, which violate moral standards that bind people together (binding foundations). As these moral standards center around group cohesiveness, a transgression committed by an in-group member may be judged more severely. The current research presented Dutch Muslims (Study 1), American Christians (Study 2), and Indian Hindus (Study 3) with a set of fictitious stories depicting harmless and harmful moral transgressions. Consistent with our expectations, participants who strongly identified with their religious community judged harmless moral offenses committed by in-group members, relative to out-group members, more severely. In contrast, this effect was absent when participants judged harmful moral transgressions. We discuss the implications of these results.
Anaesthetics and analgesics used in adult fish for research: A review
Authors: Martins Tânia , Valentim Ana , Pereira Nuno , Antunes Luis Marques
Published: December 2018

The number of fish used in research has increased in the last decades. Anaesthesia is required when fish must be held immobile and it is crucial to promote fish welfare, because these vertebrates can show signs of stress and/or pain during handling, transport, tagging, sampling and invasive procedures. The use of an inadequate anaesthetic protocol can compromise not only the welfare of the fish, but also the reliability of the research results. Thus, the development of suitable anaesthetic regimes for each fish species is important. This article reviews the main anaesthetic and analgesic agents used in adult fish in a research setting.
When (not) to Look for Contrastive Alternatives: The Role of Pitch Accent Type and Additive Particles
Authors: Braun Bettina , Asano Yuki , Dehé Nicole
Published: December 2018

This study investigates how pitch accent type and additive particles affect the activation of contrastive alternatives. In Experiment 1, German listeners heard declarative utterances (e.g., The swimmer wanted to put on flippers) and saw four printed words displayed on screen: one that was a contrastive alternative to the subject noun (e.g., diver), one that was non-contrastively related (e.g., pool), the object (e.g., flippers), and an unrelated distractor. Experiment 1 manipulated pitch accent type, comparing a broad focus control condition to two narrow focus conditions: with a contrastive or non-contrastive accent on the subject noun (nuclear L+H* vs. H+L*, respectively, followed by deaccentuation). In Experiment 2, the utterances in the narrow focus conditions were preceded by the unstressed additive particle auch (“also”), which may trigger alternatives itself. It associated with the accented subject. Results showed that, compared to the control condition, participants directed more fixations to the contrastive alternative when the subject was realized with a contrastive accent (nuclear L+H*) than when it was realized with non-contrastive H+L*, while additive particles had no effect. Hence, accent type is the primary trigger for signaling the presence of alternatives (i.e., contrast). Implications for theories of information structure and the processing of additive particles are discussed.
Correlation of height and maximum overhead reach of a person in the forensic scenario: A study among the North Indian population
Authors: Kumar Sikary Asit
Published: December 2018

This study formulated a regression equation to estimate the maximum overhead reach of a person using his/her height. Height and maximum overhead reach of participants aged 21–30 years were measured. A regression equation was formulated to find the relation between height and maximum overhead reach. The regression equation to estimate maximum overhead reach from height for all the participants was calculated to be 1.46× h+0.02. Based on sex, for males, the equation was 1.40× h+11.22, and for females it was 1.22× h+33.34. Coefficients of determination for these equations were 0.89, 0.76 and 0.80, respectively, with a p-value of <0.001 for all of them. This study showed that there is a positive correlation between height and maximum overhead reach. The formulated equation can estimate maximum overhead reach within ±6 cm for 80% of all the participants and, based on sex, within ±6 cm for 80% of males and within ±5 cm for 80% of females. This estimation is useful in scenarios, such as hanging, where the maximum overhead reach of a person is in question.
Ultrasonic modification of polylactic acid and polyglycolic acid acupoint catgut embedding monofilaments for juvenile pseudomyopia
Authors: Fu Shaoju , Yang Dongchao , Zhao Cunyi , Zhang Peihua
Published: December 2018

Acupoint catgut embedding therapy (ACET) has become the most promising method for treatment of juvenile pseudomyopia due to its advantages of lasting effect, high efficiency, safety and no side effects. However, poor hydrophilicity and biocompatibility are the main disadvantages, preventing ACET materials from having wide applications. This work fabricated four types of polylactic acid (PLA) and polyglycolic acid (PGA) monofilaments from their polymer chips, and then the prepared monofilaments were treated ultrasonically by dipping them in a mixed solution composed of ethyl alcohol and H2O2 (volume ratio 1:1) at 250 W ultrasonic power for 30 min. Afterwards, the PLA and PGA groups were fully characterized with respect to structure characterizations, mechanical properties and in vitro properties. The results showed that the surface roughness of the monofilaments had been greatly enhanced by ultrasonic modification. The PLA groups’ molecular structures changed little, while those of the PGA group emerged with some polar hydrophilic bonds. By deionized water measurement of contact angle values, the ultrasound modified PLA monofilaments (UMPLA1 = 87.2 ± 2.5°, UMPLA2 = 83.6 ± 3.5°) presented a decrease compared to that of untreated PLA ones (PLA1 =103.5 ± 3.4°, PLA2 = 108.4 ± 1.2°), while that of ultrasound modified PGA monofilaments (UMPGA1 = 75.6 ± 4.3°, UMPGA2 =70.5 ± 3.1°) was smaller than untreated PGA ones (PGA1 = 97.3 ± 1.7°, PGA2 = 95.8 ± 2.6°). Based on the measurement of the mechanical properties, the tensile properties and bending stiffness of the PLA and PGA groups changed little, and their swelling ratios were greatly improved after modification. All the prepared monofilaments presented non-toxicity with good cell viability (more than 75%), and samples UMPGA2 (81.4 ± 3.1%) and UMPLA2 (65.8 ± 0.8%) exhibited the largest cell attachment ratio values among their groups. In conclusion, these findings present important clinical implications regarding the ACET materials manufacturing process, which warrant further study.
Transformative urbanism and reproblematising land scarcity in Hong Kong
Authors: Ng Mee Kam
Published: December 2018

An ecological and humane urbanism is required to combat resource degradation and socio-economic polarisation. UN-Habitat’s New Urban Agenda calls for a paradigm shift to ‘leave no one, no place and no ecology behind’ through sustainable development. However, this article argues that a ‘sustainability fix’, while necessary, is insufficient to counter the hegemonic growth-orientated culture and it is important to re-embed economic activities in ethical socio-ecological relationships for people and place well-being. These require critical scholarship to reproblematise issues and present prescriptive approaches for resolving them. Reproblematisation of Hong Kong’s alleged land scarcity problem reveals a property-dominant urban-biased political economy that sustains a high land price policy through suppressing development of massive rural land resources, resulting in ecological and socio-spatial disparities. Reimagining the development of rural Hong Kong based on the principles of nature conservation and place-making for conviviality and human flourishing could be a potential pathway towards a transformative urbanism.
“Simple, clear, and easily understood by the farmer…”: On expert–layman communication in American soil science, 1920s–50s
Authors: Arend Jan
Published: December 2018

This article presents a case study of how American soil scientists encountered the increasing demands to prove the social utility of their scientific work in the first half of the twentieth century and how this influenced the professional rivalry and competition among them. Previous historical studies of agricultural science in the period have not overlooked the increasing demands for applicability that agricultural scientists were faced with at the time. However, in describing the response of agricultural scientists to these demands, research has focused on the content of their scientific work, that is, their methods, empirical interests, and theories. This study, by contrast, explores how the debates on applied vs. fundamental/basic research in American agricultural science were closely linked to the question of how scientific knowledge could be made understood to laymen and practitioners.
Comparison of mechanical vapor recompression technology for solution regeneration in heat-source tower heat pumps
Authors: Ai Songhui , Wang Baolong , Li Xianting , Shi Wenxing
Published: December 2018

Solution regeneration of the heat-source tower is significant to guarantee the normal operation of the heat-source tower. Mechanical vapor recompression system is an efficient system for evaporation of solution. In this paper, mechanical vapor recompression system is applied to regenerate solution of heat-source tower. To clarify the merits of mechanical vapor recompression solution regeneration system, several typical solution regeneration systems are modelled. As a result, mechanical vapor recompression shows 35.7%, 73.5% and 91.2% energy saving compared to air-driven heat pump, three-effect evaporating system, and single effect evaporating system, respectively. Furthermore, a heat-source tower heat pump with solution generation system is installed in a typical building in Yangtze river region. The whole heating season performance is simulated to find the effects of different solution regeneration system on the whole heat pump system. As a conclusion, the seasonal coefficient of performance of heat pump is decreased 1.6% by mechanical vapor recompression regeneration system. Comparatively, the seasonal coefficient of performance of heat pump is decreased 2.6%, 4.2% and 10.0% by air-driven heat pump, three-effect evaporating system, and single effect evaporating system, respectively.

Practical application: Solution regeneration systems for heat-source tower heat pump systems have been applied in building projects especially in hot summer and cold winter zone in China based on previous investigation. A heat-source tower heat pump system combined with heat pump solution regeneration system has been applied in an office building in Changsha, Hunan Province in China. And its practical operation energy consumption has been reduced obviously compared with traditional single effect evaporation system. Therefore, it is of vital importance to demonstrate the operating performance of different solution regeneration systems applied in heat-source tower heat pump systems in building.
Acetylcysteine in the treatment of subacute sinusitis: A double-blind placebo-controlled clinical trial
Authors: Bahtouee Mehrzad , Monavarsadegh Gholamhosein , Ahmadipour Mohammadjavad , Motieilangroodi Mazyar , Motamed Niloofar , Saberifard Jamshid , Eghbali Seyyedsajjad , Adibi Hooman , Maneshi Hesam , Malekizadeh Hasan
Published: December 2018

Sinusitis is a common disease with harmful effects on the health and finances of patients and the economy of the community. It is easily treated in most of its acute stages but is associated with some management difficulties as it goes toward chronicity. Therefore, we tried to improve the treatment of subacute sinusitis by using acetylcysteine, which is a safe mucolytic and antioxidant agent. Thirty-nine adult patients with subacute sinusitis proved by computed tomography (CT) were enrolled in a double-blind, placebo-controlled trial. They received oral amoxicillin-clavulanic acid and normal saline nasal drops for 10 days and oral pseudoephedrine for 7 days. In addition, the patients received acetylcysteine (600 mg orally, once daily) in the intervention group or placebo in the control group for 10 days. A paranasal CT scan was taken at baseline and 30 days after patients finished the treatment and was evaluated quantitatively by Lund-Mackay (LM) score. Symptoms and some aspects of quality of life also were assessed at baseline and 14 days after initiation and 30 days after termination of the treatment via the Sino-Nasal Outcome Test questionnaire. The groups showed no significant difference in LM score after treatment. A positive correlation was observed between the LM and SNOT-20 scores. We concluded that adding oral acetylcysteine to amoxicillin-clavulanic acid, pseudoephedrine, and intranasal normal saline has no benefit for the treatment of subacute sinusitis.
Extraosseous Ewing Sarcoma: Expanding the Differential Diagnosis of Supraclavicular Fossa Tumors
Authors: Rama-López Julio , Asensio Rafael Ramos , García-Garza Cesar , Fra Pablo Luna , Balaguer Maria del Carmen Gassent , Salva Jos& Fuster
Published: December 2018

A broad spectrum of diseases can be included in the differential diagnosis of neck masses. We report a case of extraosseous Ewing sarcoma that presented as a neck mass in a 70-year-old man. To the best of our knowledge, this is the first reported case of extraosseous Ewing sarcoma of the supraclavicular fossa. Published cases of extraosseous Ewing sarcoma in the neck have been described in other age groups, but those tumors were confined to the parapharyngeal space. Also, there have been reported cases in patients older than 70 years in which Ewing sarcoma affected other structures such as the larynx and the pelvis, but none in the soft tissues of the neck. This case adds extraosseous Ewing sarcoma as a possible diagnosis to consider when evaluating a neck mass in the supraclavicular fossa.
Obstructing in Utero Oropharyngeal Mass: Case Report of a Lymphatic Malformation Arising within an Oropharyngeal Teratoma
Authors: Wannemuehler Todd J. , Deig Christopher R. , Brown Brandon P. , Morgenstein Stuart A.
Published: December 2018

An ex utero intrapartum treatment procedure was performed to deliver a fetus with a multiseptated, entirely cystic, 4.5 × 5.0 × 4.0-cm mass occupying the oropharynx and oral cavity with protrusion from the mouth. Surgical excision was performed, and final pathologic diagnosis revealed a lymphatic malformation arising within a cystic oropharyngeal teratoma. Lymphatic malformations are virtually indistinguishable radiologically from rare, purely cystic teratomata, and efforts have been made to distinguish between the two in utero because of differing available treatment modalities. This represents the first documented case in the literature of a lymphatic malformation arising from within an oropharyngeal teratoma.
Analysis of Caloric Test Responses in Sudden Hearing Loss
Authors: Shih Cheng-Ping , Chou Yu-Ching , Chen Hsin-Chien , Lee Jih-Chin , Chu Yueng-Hsiang , Wang Chih-Hung
Published: December 2018

Sudden sensorineural hearing loss is characterized by a rapid-onset hearing loss that develops within 3 days. Vertigo may also be present. We conducted a retrospective study to investigate whether the severity of a loss of caloric function is associated with the initial hearing loss and with hearing recovery. Our study population was made up of 135 patients—67 men and 68 women, aged 25 to 71 years (mean: 50.9)—with sudden sensorineural hearing loss who had undergone bithermal caloric testing. We compared various patient factors according to patients’ hearing level and their response to caloric testing. We also analyzed the canal paresis (CP) value in patients with an abnormal caloric response according to three factors: disease severity, vertigo, and hearing recovery, and we evaluated the correlation between the loss of caloric function and hearing outcomes. We found that an abnormal caloric response was significantly associated with a profound hearing loss at presentation, the presence of vertigo, and poor hearing recovery. Among patients with an abnormal caloric response, the CP value was significantly correlated with hearing recovery (r = 0.503, p = 0.001). Poor hearing recovery was seen in 80% of patients with a CP value of ≥40% but in only 25% of patients with a value of <40%; in addition, the degree of hearing recovery was worse in the patients with a CP value of ≥40% (p = 0.002). We conclude that a CP value of ≥40% is a significant prognostic factor for an unfavorable treatment outcome.
Comparison of Cidofovir and the Measles, Mumps, and Rubella Vaccine in the Treatment of Recurrent Respiratory Papillomatosis
Authors: Meacham Ryan Kent , Thompson Jerome W.
Published: December 2018

We conducted a retrospective study of the use of cidofovir and the measles, mumps, and rubella (MMR) vaccineas adjunctive treatments to lesion debridement in patients with recurrent respiratory papillomatosis (RRP). Our study population was made up of 15 children—7 boys and 8 girls, aged 1 to 16 years at diagnosis (mean: 6.2)—with pathologically confirmed RRP who had been followed for at least 1 year. In addition to demographic data, we compiled information on disease severity, the type of adjunctive treatment administered to each patient, the frequency of debridements, the length of observation, and remission rates. Of the 15 patients, 5 had been treated with cidofovirafter debridement (cidofovir-only group), 6 were treated with MMR vaccine after debridement (MMR-only group), 3 were treated with one and later switched to the other based on parental preference, and 1 received neither treatment, only debridement. The initial mean Derkay disease severity scores were 12.6 for the cidofovir-only group and 11.0 for the MMR-only group (p = 0.61). The cidofovir-only patients underwent an average of 11.8 adjunctive treatments and the MMR-only patients an average of 17.7 (p = 0.33). The average duration of observation was 44.0 months in the cidofovir-only group and 64.7 months in the MMR-only group (p = 0.29). Remission rates were 20% in the cidofovir-only group and 50% in the MMR-only group (p = 0.54). Our study found insufficient evidence of any significant differences between cidofovir and the MMR vaccinein terms of the number and frequency of adjunctive treatments and the rates of remission.
Significance of Imaging in the Diagnosis of Olfactory Disorder
Authors: Harju Teemu , Rautiainen Markus , Kivekäs Ilkka
Published: December 2018

The aim of this retrospective analysis was to examine olfactory disorders among the patients in the Ear, Nose, and Throat Clinic of Tampere University Hospital, Finland, from 2001 to 2011, and to evaluate the necessity of imaging in the examination of patients with olfactory disorders. Charts of 143 consecutive patients with a primary olfactory disorder were examined, and 69 patients who had undergone the necessary testing were included in the study. The most common causes of olfactory disorder were upper respiratory infection (23%), chronic rhinosinusitis (19%), head trauma (17%), and allergic or nonallergic rhinitis (6%). In 25% of the patients, no obvious cause for the symptoms was found. Computed tomography (CT) scans were normal in 37 of 52 (71%) patients and magnetic resonance imaging was normal in 21 of 25 (84%) patients. No intracranial or intranasal tumors were found in the overall cohort. Of the patients with additional symptoms (facial pain, headache, nasal discharge, or stuffiness), 58% had chronic rhinosinusitis. Of the patients with no additional symptoms or signs associated with chronic rhinosinusitis on clinical evaluation, only 2% had chronic rhinosinusitis on imaging. Only the detection of chronic rhinosinusitis and head trauma had clinical value in the determination of the etiology. A sinonasal CT scan should be considered in patients who have at least one symptom associated with sinusitis in addition to an olfactory disorder to confirm the etiology and to find those patients who may benefit from medical therapy or surgical treatment.
Auricular Complications in Parotid, Temporal Bone, Infratemporal Fossa, and Lateral Skull Base Surgery
Authors: Carpenter Patrick S. , Burgette Ryan C. , Leonetti John P. , Marzo Sam J.
Published: December 2018

Neoplasms located in the parotid region, temporal bone, infra-temporal fossa, and lateral skull base represent a challenge due to their difficult anatomic location and surrounding neurovascular structures. A variety of surgical approaches are appropriate to access this area, although several of them can place the auricular blood supply in danger. If the auricular blood supply is compromised, ischemia and, eventually, avascular necrosis of the auricle can occur. Auricular necrosis often can cause patients a delay in adjuvant radiation therapy and result in the need for additional reconstructive procedures. There-fore, it is imperative to identify risk factors associated with the development of this disabling complication. We conducted a retrospective review of 32 individuals undergoing treatment of benign and malignant lesions in the parotid gland, infratemporal fossa, and lateral skull base. To identify potential risk factors for auricular necrosis, the patients were analyzed based on the type of neoplasm (malignant or benign), risk factors affecting blood flow (diabetes mellitus, smoking history, prior radiation, prior surgery), body mass index, and the length of surgery. In our population examined, 3 instances of auricular necrosis occurred. None of the potential risk factors proved to be statistically significant (although malignant pathology approached significance at p = 0.07). Two of the patients required an auriculectomy with reconstruction. The third had multiple postoperative clinic visits for surgical debridement. Although no potential risk factors were statistically significant, surgeons should remain cognizant of the auricular blood supply while performing surgery via preauricular and postauricular approaches to this area.
Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006–2011 National Surgical Quality Improvement Program (NSQIP) Database
Authors: Jain Umang , Somerville Jessica , Saha Sujata , Halen Jon P. Ver , Antony Anuja K. , Samant Sandeep , Kim John Y.S.
Published: December 2018

While neck dissection is an important primary and adjunctive procedure in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed to identify factors associated with adverse events (AEs) in patients undergoing neck dissection. A total of 619 patients were identified, using CPT codes specific to neck dissection. Of the 619 patients undergoing neck dissection, 142 (22.9%) experienced an AE within 30 days of the surgical procedure. Risk factors on multivariate regression analysis associated with increased AEs included dyspnea (odds ratio [OR] 2.57; 95% confidence interval [CI] 1.06 to 6.22; p = 0.037), previous cardiac surgery (OR 3.38; 95% CI 1.08 to 10.52; p = 0.036), increasing anesthesia time (OR 1.005; 95% CI 1 to 1.009; p = 0.036), and increasing total work relative value units (OR 1.09; CI 1.04 to 1.13; p < 0.001). The current study is the largest, most robust analysis to identify specific risk factors associated with AEs after neck dissection. This information will assist with preoperative optimization, patient counseling, and appropriate risk stratification, and it can serve as benchmarking for institutions comparing surgical outcomes.
Initial Experience of a Hereditary Hemorrhagic Telangiectasia Center of Excellence
Authors: Thompson Christopher F. , Suh Jeffrey D. , McWilliams Justin , Duckwiler Gary , Wang Marilene B.
Published: December 2018

Our objectives in reviewing the initial experience of a hereditary hemorrhagic telangiectasia center of excellence (HHT COE) were to better understand the interventions being performed in the comprehensive care of these patients and to present the early data as a reference for other tertiary centers considering starting an HHT COE. We conducted a retrospective review of consecutive patients referred to our newly developed HHT COE for evaluation and treatment between May 2010 and June 2013. Clinical presentation, otolaryngologic treatments, and other operative interventions were analyzed. One hundred forty-four of the 198 patients (73%) evaluated at the HHT COE had definite HHT based on the Curaçao diagnostic criteria, with 20 additional patients possibly having HHT and undergoing further evaluation to confirm the diagnosis. Sixteen of the 31 patients (52%) referred to otolaryngology required intervention in the operating room for epistaxis. Seventy-two of the 164 (44%) patients with definite or possible HHT required other interventions for internal organ arteriovenous malformations (AVMs), with interventional radiology embolization of pulmonary AVMs being the most common procedure. An HHT COE is important in providing comprehensive care for patients with this rare disease, which has significant clinical sequelae. Having an HHT COE allows for early screening and subspecialty referral within a system of specialists experienced in preventing the morbidity and mortality associated with severe epistaxis and internal organ AVMs.
Correlation among External Auditory Canal Anomaly, Temporal Bone Malformation, and Hearing Levels in Patients with Microtia
Authors: Chen Kun , Liu Liu , Shi Runjie , Wang Peihua , Chen Dong , Xiao Hua
Published: December 2018

We conducted a retrospective study to evaluate the relationship between external auditory canal (EAC) anomaly, temporal bone abnormality, and hearing levels using objective scoring systems in Chinese patients with microtia. The study population consisted of 106 ears of 94 Chinese patients (67 male and 27 female) aged 5 to 45 years (mean: 12.6) with microtia. The EAC abnormalities were classified into 4 types according to Schuknecht's criteria: type A, type B, type C, and type D. Developmental anomalies of the temporal bone were evaluated by Jahrsdoerfer computed tomography (CT) scoring system using high-resolution CT scans of the temporal bone. Temporal bone malformation parameters were divided into 4 subgroups: ossicular chain development, windows connected to the cochlea, aeration development of the middle ear, and facial nerve aberration. Hearing levels (air conduction and bone conduction) were examined. Outcomes parameters included correlation coefficients (r) and a number of other variables. The total points (10 points) and subtotal points related to ossicles (4 points), windows (2 points), aeration (2 points), and facial nerve (1 point) correlated inversely with the EAC abnormalities. The hearing levels (air conduction, r = 0.396, p < 0.01; bone conduction, r = 0.21, p = 0.03) correlated significantly with the EAC abnormalities of Schuknecht's classification. We conclude that the better developed the external auditory canal, the better developed the temporal bone and the better developed the external auditory canal, the better hearing level. The hearing level also can serve as an indicator to determine whether a patient will be suitable for reconstructive surgery.
Post-Tonsillectomy Hemorrhage Rates in Children Compared by Surgical Technique
Authors: Reusser Nicole M. , Bender Robert W. , Agrawal Nikhil A. , Albright James T. , Duncan Newton O. , Edmonds Joseph L.
Published: December 2018

Despite the sheer number of pediatric tonsillectomies performed in the United States annually, there is no clear consensus as to which surgical technique is superior. One way to compare surgical techniques is to study the morbidity associated with each. We report postoperative hemorrhage rates, one of the frequently encountered major adverse events, as part of a retrospective chart review across four different surgical techniques. These surgeries involved either (1) Coblation, (2) Coblation with partial suture closure of the tonsillar fossa, (3) diathermy, or (4) partial intracapsular tonsillectomy (PIT). Of the 7,024 children we evaluated, 99 (1.4%) experienced a postoperative hemorrhage that required a second surgery; hemorrhage occurred after 33 of the 3,177 Coblation-alone procedures (1.04%), 28 of the 1,633 Coblation with partial suture closure procedures (1.71%), 29 of the 1,850 diathermies (1.57%), and 9 of the 364 PIT procedures (2.47%). Statistical analysis of hemorrhage rates with each surgical technique yielded p values > 0.05 in each case (Coblation alone and Coblation with partial suture closure: p = 0.29; diathermy: p = 0.47; PIT, p = 0.20). Based on these data, we conclude that none of these techniques is significantly superior in terms of decreasing the risk of post-tonsillectomy hemorrhage in children. Therefore, surgeons should continue to use the surgical procedure they are most familiar with to optimize recovery in the postoperative period.
Audiometry Results and TEOAE and DPOAE Amplitudes in Men Taking a Phosphodiesterase Type 5 Inhibitor for Erectile Dysfunction
Authors: Öntepeli Sertan , Muluk Nuray Bayar , Tuğlu Devrim , Şipal Timuçin
Published: December 2018

We conducted a prospective study of transient evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs) in men who were taking an oral phosphodiesterase type 5 (PDE5) inhibitor for erectile dysfunction. Our study group was made up of 30 men (60 ears), aged 34 to 60 years (mean: 50.9). They were randomly divided into three groups; 10 men were given sildenafil (Viagra) at 50 mg twice a week, 10 were given tadalafil (Cialis) at 20 mg twice a week, and 10 were given vardenafil (Levitra) at 20 mg twice a week. All patients took their drug for 3 weeks, for a total of 6 tablets for each patient. Audiometric tests and TEOAE and DPOAE measurements were performed before and after treatment. Post-treatment audiometry demonstrated improvement in hearing in all three groups. However, post-treatment TEOAE amplitudes and DPOAE amplitudes differed among the three groups; they were significantly higher in the sildenafil group at 1.0 kHz and the same in the tadalafil group; in the vardenafil group, the DPOAE amplitude was significantly lower at 3.0 kHz while there was no change in the TEOAE amplitude. We speculate that the possible mechanism for these findings is that PDE5 inhibitors block degradation of cyclic guanosine monophosphate (cGMP) and induce dilation of the cochlear microcirculation, resulting in an increase in cochlear blood flow. We also believe that the decrease in DPOAE amplitudes at 3.0 kHz seen in the vardenafil group may be related to an accumulation of nitric oxide/cGMP complex, which is toxic to the cochlea; however, since there was no change in TEOAE amplitude in the vardenafil group, this influence may be minimal. Further studies are needed to obtain a more comprehensive assessment of the effects of PDE5 inhibitors on hearing with the use of higher doses and longer durations of therapy.
Conservative Management of Postoperative Chylous Fistula with Octreotide and Peripheral Total Parenteral Nutrition
Authors: Chan Jason Y.K. , Wong Eddy W.Y. , Ng S.K. , van Hasselt C. Andrew , Vlantis Alexander C.
Published: December 2018

Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted. Ten patients, all men, were identified as having a postoperative chylous fistula after a neck dissection. All patients were treated with peripheral TPN and intravenous octreotide. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. The results of this case series suggest that chylous fistulae may be managed conservatively with octreotide and TPN. However, long-term evaluation is needed to define if and when surgical intervention is required for control.
Comparison of Clinical Outcomes using a Piezosurgery Device Vs. A Conventional Osteotome for Lateral Osteotomy in Rhinoplasty
Authors: Koc Bulent , Koc Eltaf Ayca Ozbal , Erbek Selim
Published: December 2018

Our aim for this study was to evaluate and compare the clinical outcomes in patients who underwent lateral osteotomy with a Piezosurgery device or a conventional osteotome in open-technique rhinoplasty. This cohort trial involved 65 patients (36 women and 29 men; average age: 23.6 ± 5.71 yr) who underwent surgery between May 2015 and January 2016. Piezo-surgery was used for lateral osteotomy in 32 patients, whereas 33 patients underwent conventional external osteotomy. These 2 groups were compared for duration of surgery, perioperative bleeding, postoperative edema, ecchymosis, pain, and patient satisfaction on the first and seventh postoperative days. The Piezosurgery group revealed significantly more favorable outcomes in terms of edema, ecchymosis, and hemorrhage on the first day postoperatively (p < 0.001 for all). Similarly, edema (p = 0.005) and ecchymosis (p < 0.001) on the seventh postoperative day also were better in the Piezosurgery group. Hemorrhage was similar in both groups on the seventh postoperative day (p = 0.67). The Piezosurgery group not only experienced less pain on the first postoperative day (p < 0.001), but these patients also were more satisfied with their results on both the first and seventh postoperative days. Results of the present study imply that Piezosurgery may be a promising, safe, and effective method for lateral osteotomy, a critical step in rhinoplasty. The time interval necessary for the learning curve is counteracted by the comfort and satisfaction of both patients and surgeons.
Clinical Application of Nasometry in Patients with Nasal Obstruction
Authors: Ziade Georges , Kasti Maher , Sarieddine Doja , Saadeddine Zein , Hamdan Abdul-Latif
Published: December 2018

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.
Guidelines for Radiographic Imaging of Cranial Neuropathies
Authors: Khaku Aliasgher , Patel Vijay , Zacharia Thomas , Goldenberg David , McGinn Johnathan
Published: December 2018

Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radio-graphic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles’ results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.
A Novel Etiology for Pneumolabyrinth after Temporal Bone Fracture without Otic Capsule Involvement
Authors: Muelleman Thomas J. , Bhalla Vidur , Staecker Hinrich
Published: December 2018

Pneumolabyrinth has been considered an indicator of otic capsule involvement in temporal bone fractures. We present a novel theory for the etiology of pneumolabyrinth in a trauma patient without an otic capsule fracture: passage of intrathecal air into the labyrinth. Our patient experienced transient bilateral pneumolabyrinth after head trauma due to a motor vehicle collision. The patient was noted to have extensive pneumocephalus and a unilateral temporal bone fracture that spared the otic capsule. Initial computed tomography (CT) scans demonstrated air in the cochlea and both internal auditory canals. A high-resolution CT scan 6 hours later showed resolution of this air. Pneumolabyrinth may not be a sensitive indicator of otic capsule involvement in temporal bone fractures. In addition to middle ear sources, air in the labyrinth can also plausibly originate intrathecally, especially in the setting of pneumocephalus.