bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequential chimeric fibula‐gracilis flap to salvage a complex orbitomaxillary defect: A case report
Authors: De Cicco Davide , Bottini Gian Battista , Gaggl Alexander
Published: January 2023

Extended maxillectomies with orbital exenteration and facial soft tissue resection need careful planning to achieve satisfactory functional and esthetic outcomes. Only a few solutions provide enough hard and soft tissue on a single pedicle, and only some reconstructive goals might be achievable with a single flap. This paper describes an original inset of the gracilis muscle free flap, used in a vessels depleted patient to salvage a partially failed multi‐flap reconstruction after an extensive maxillectomy. A 55‐years old man underwent a surgical intervention for a fibrosarcoma of the right maxilla. Due to the disease extension, the resection included right maxilla and palate, the overlying facial soft tissues (including the paranasal, cheek, and infraorbital regions), and the entire orbital content (orbital exenteration). A double flap reconstruction—a free fibula flap and a deep circumflex iliac artery flap—was carried out primarily. However, an intraoperative complication caused a partial flap loss, resulting in a complex tridimensional defect of the orbit and the oral cavity. Therefore, a 18 cm long gracilis muscle free flap was used to fill the defect and save the remaining bony reconstruction. The muscle was inset behind the transplanted bone to seal both the orbit and the oral cavity. No complications occurred after the salvage surgery, with a stable result at the 6‐months follow‐up. The designed gracilis muscle free flap proved a reliable option for this salvage surgery. However, it could be helpful also in the primary reconstruction of extended maxillectomies in combination with another composite free flap.
Digital mammography: The excitement of creating a new imaging modality
Authors: Yaffe Martin J.
Published: January 2023

Beginning around 1972 with the introduction of CT, a steady transition from analog to digital imaging in radiology took place. Here, I offer a personal perspective of the exciting multi‐institutional and multidisciplinary team effort of developing digital mammography. That effort required the collaboration of visionary individuals in academic research labs, industry, and the clinical arena, catalyzed by a focused commitment from government (NCI and The Office of Women's Health). This collaboration greatly accelerated the timeline from laboratory prototypes to clinical systems and evaluation, resulting in a new imaging modality and, later, several spinoff applications (CAD, contrast‐enhanced mammography, tomosynthesis) that provide improved earlier detection of breast cancer.
The use of a mini‐ridge filter with cyclotron‐based pencil beam scanning proton therapy
Authors: O'Grady Fionnbarr , Janson Martin , Rao Avani D. , Chawla Ashish K. , Stephenson Lisa , Fan Jiajin , Wang Peng
Published: January 2023

Background

Pencil beam scanning (PBS) proton therapy allows for far superior dose conformality compared with passive scattering techniques. However, one drawback of PBS is that the beam delivery time can be long, particularly when treating superficial disease. Minimizing beam delivery time is important for patient comfort and precision of treatment delivery. Mini‐ridge filters (MRF) have been shown to reduce beam delivery time for synchrotron‐based PBS. Given that cyclotron systems are widely used in proton therapy it is necessary to investigate the potential clinical benefit of mini‐ridge filters in such systems.

Purpose

To demonstrate the clinical benefit of using a MRF to reduce beam delivery time for patients with large target volumes and superficial disease in cyclotron‐based PBS proton therapy.

Methods

A MRF beam model was generated by simulating the effect of a MRF on our clinical beam data assuming a fixed snout position relative to the isocenter. The beam model was validated with a series of measurements. The model was used to optimize treatment plans in a water phantom and on six patient DICOM datasets to further study the effect of the MRF and for comparison with physician‐approved clinical treatment plans. Beam delivery time was measured for six plans with and without the MRF to demonstrate the reduction achievable. Plans with and without MRF were reviewed to confirm clinical acceptability by a radiation oncologist. Patient‐specific QA measurements were carried out with a two‐dimensional ionization chamber array detector for one representative patient's plan optimized with the MRF beam model.

Results

Results show good agreement between the simulated beam model and measurements with mean and maximum deviations of 0.06 mm (0.45%) and 0.61 mm (4.9%). The increase in Bragg peak width (FWHM) ranged from 2.7 mm at 226 MeV to 6.1 mm at 70 MeV. The mean and maximum reduction in beam delivery time observed per field was 29.1 s (32.2%) and 79.7 s (55.3%).

Conclusion

MRFs can be used to reduce treatment time in cyclotron‐based PBS proton therapy without sacrificing plan quality. This is particularly beneficial for patients with large targets and superficial disease such as in breast cancer where treatment times are generally long, as well as patients treated with deep inspiration breath hold (DIBH).
Influence of Synthesis Parameters on the Magnetic, Thermal, and Morphological Properties of Poly(Glycidyl Methacrylate‐co‐Divinylbenzene)/Magnetite
Authors: Queiroz Carla Nascimento , Cunha Henrique Almeida , Silva Manoel Ribeiro da , de Oliveira Márcia Gomes , Castanharo Jacira Aparecida , Ferreira Ivana Lourenço de Mello , Costa Marcos Antonio da Silva
Published: January 2023

In this work, polymeric microspheres based on glycidyl methacrylate and divinylbenzene with magnetic properties are synthesized by the suspension polymerization technique. To obtain magnetic properties, magnetite particles modified by oleic acid are synthesized in the laboratory. The effects of stirring speed, concentration of magnetite added, and concentration of stabilizer on the particles’ properties are studied. The magnetic microspheres are characterized according their morphology, magnetite incorporation, and magnetic and thermal properties. The incorporation of iron particles is mainly affected by stirring speed during synthesis and the amount of added magnetic material. The saturation magnetization of the microspheres is affected by the content of incorporated magnetic material. The modification with oleic acid is important for incorporation of the magnetic material in the copolymer matrix. Polymeric particles with superparamagnetic behavior are obtained with spherical morphology and saturation magnetization of 7.11 (emu g−1) when employing a monomer molar ratio of 50/50, 1% poly(vinyl alcohol), 20% magnetite particles modified by oleic acid, and stirring speed of 500 rpm.
Validation of an Extended Kinetic Model of Free‐RadicalN‐Vinylpyrrolidone Polymerization
Authors: Welzel Stefan , Burmeister Jule , Höppchen Oliver , Nieken Ulrich
Published: January 2023

To predict the polymer properties produced by free‐radical polymerization ofN‐vinylpyrrolidone (NVP) in aqueous solution a detailed kinetic model has been developed. The kinetic model allows to calculate the chain length distribution, the number of branching points, and the number of terminal double bonds (TDB). The latter is accounted for since TDBs are a precondition for branching. While monomer conversion can be predicted sufficiently using independently determined rate constants for propagation and termination, here the predictions of structural properties by a newly developed extended kinetic model to experimental findings are compared. Polymer produced in a continuous stirred tank reactor is analyzed by gel permeation chromatography (GPC), field flow fractionation (FFF), and high‐pressure liquid chromatography (HPLC).
Combining clinical practice and education in critical care nursing—A trainee program for registered nurses
Authors: Wallander Karlsen Marte‐Marie , Sørensen Anne Lene , Finsand Camilla , Sjøberg Mons , Lieungh Martin , Stafseth Siv Karlsson
Published: January 2023

Aim

The aim of this study was to describe the experiences of a master's‐level critical care nursing program for trainees in postoperative and intensive care units.

Design

An exploratory design with a multidimensional approach was chosen.

Methods

The study was conducted from 2018 to 2019 at a university hospital in southern Norway in collaboration with a university college of nursing. Data were collected through seven focus group interviews with trainees, preceptors, heads of departments, clinical nurse educators and professors (n = 26). The thematic analysis progressed from description to a deeper understanding, searching for manifest and latent patterns across the data. The COREQ checklist was used for reporting the study.

Results

The analysis resulted in one overarching theme: ‘To walk the critical care nursing pathway – balancing competency, time, and challenges to become proficient’. The subthemes were ‘expectations, obligations, and workload in unknown environments’, ‘constantly assessing while being assessed’, ‘continuous precepting and challenges’, ‘vulnerability and commitment’ and ‘thriving in the role, mastering new skills’. The study provides valuable insights into a complex learning environment and the importance of caring aspects for trainees during their critical care nursing education.

Conclusion

Precepting, continuous competence assessment and clear learning outcomes are necessary to create a safe environment for the trainees during their development.

Implications for the profession

The results advocate investing in inexperienced trainees' competency development to become proficient, creating a safe learning environment in a highly complex setting. This may also, as previous studies suggest, increase staff retention.
Effect of a mutual goal‐based continuous care program on self‐management behaviour and health outcomes in patients after percutaneous coronary intervention: A randomized controlled trial
Authors: Zhu Xuejiao , Yang Yiting , Cao Meijuan
Published: January 2023

Aims

To evaluate the effects of mutual goal‐based continuous care program on the outcomes of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

Design

A single‐blinded randomized controlled trial.

Methods

87 patients with CHD after PCI in Hangzhou, Zhejiang, China, were randomly divided into study (n = 42) and control (n = 45) groups. The control group received 12‐week cardiac rehabilitation and routine care. The study group received routine care and cardiac rehabilitation and the 12‐week intervention program developed according to the goal attainment theory, including the mutual goal‐based face‐to‐face guidance, and every‐2‐week telephone follow‐ups. The self‐management behaviour, quality of life, unscheduled readmission rate, and satisfaction of patients were examined.

Results

For the patients subjected to the developed continuous nursing program based on mutual goals, achievement rates of all dimension mutual goals were at high levels (from 80.21% to 98.41%), except for the weight control (60.94%). Moreover, according to the comparable base data, compared with the control group, the self‐management behaviour (study group 93.43 vs. control group 76.00), quality of life (QoL), and patients' satisfaction (study group 4.64 vs. control group 4.11) were higher, while the unscheduled readmission rate (study group 4.76% vs. control group 22.22%) was lower, in the study group, with statistically significant differences.
Nurses' healing presence: A panacea for the comfort of acute coronary syndrome patients in CCU, A qualitative study
Authors: Hojjatoleslami Simin , Sadeghi Amir , Negarandeh Reza , Soltanian Ali Reza , Borzou Seyed Reza
Published: January 2023

Aim

The study aimed to explain the acute coronary syndrome (ACS) patients' perception of the nurse's healing presence in their comfort in the critical care unit.

Design

This descriptive qualitative study was conducted from December 2020 to September 2021.

Methods

Twenty‐seven ACS patients were purposively selected from a cardiovascular university Hospital, Iran. Data were collected through semi‐structured interviews (45–60 min). Data analysis was performed based on the contractual content analysis method of Graneheim and Lundman.

Results

In the data analysis, the main theme ‘nurses' healing presence’ includes two categories: ‘Nurse–patient communication’ with two subcategories and the category ‘Compassionate care’ with three subcategories.
Reduced‐order extrapolation technique for coefficient vectors of numerical solutions about fluid mechanics equation
Authors: Luo Zhendong , Liu Xiangdong , Zeng Yihui , Li Yuejie
Published: January 2023

For convenience, this study mainly focuses on the reduced order of coefficient vectors for the classical finite spectral element Crank–Nicolson (CFSECN) solutions about the two‐dimensional (2D) nonstationary Stokes problem, resulting that the reduced order model can possess the same basis functions together with same precision as the CFSECN one. To this end, the CFSECN format of the 2D nonstationary Stokes problem about vorticity function and stream function and, the existence and stability as well as error estimations for the CFSECN solutions are first proposed. Afterwards, a reduced order extrapolation finite spectral element Crank–Nicolson (ROEFSECN) model is created by means of proper orthogonal decomposition method, and the existence together with stability as well as errors of the ROEFSECN solutions is analyzed by the matrix tool, resulting that the theory analysis turns into very simple. Finally, two numerical examples are provided to confirm the correctness for the theory consequences. Therefore, the study is absolutely distinguished from the existed ones.
Effect of Preoperative Weight Status and Disease Presentation on Postoperative Elevated Blood Pressure After Childhood Adenotonsillectomy
Authors: Hsieh Hui‐Shan , Chuang Hai‐Hua , Hsin Li‐Jen , Lin Wan‐Ni , Kang Chung‐Jan , Zhuo Ming‐Ying , Chuang Li‐Pang , Huang Yu‐Shu , Li Hsueh‐Yu , Fang Tuan‐Jen , Lee Li‐Ang
Published: January 2023

Objective

To investigate the risk factors of postoperative elevated blood pressure (BP) in children with childhood obstructive sleep apnea syndrome (OSAS) after adenotonsillectomy (AT).

Study Design

Case series with planned data collection.

Setting

Tertiary referral center.

Methods

Two hundred forty‐five consecutive children (180 boys and 65 girls, median age 6.6 years) with polysomnography‐diagnosed OSAS who underwent AT between January 2010 and August 2019. Clinical, polysomnographic, and evening BP data were assessed preoperatively and postoperatively (≥3 months after AT). Changes in the variables before and after AT and between individuals with and without hypertension were compared.

Results

Postoperatively, the median (interquartile range) apnea‐hypopnea index significantly decreased from 10.4 (5.3‐22.6) to 2.2 (1.0‐3.8) events/h. In addition, the mean (standard deviation) evening diastolic BP z‐score significantly decreased from 0.7 (0.94) to 0.5 (0.81) in the overall cohort, and both systolic (2.1 [0.94]‐1.0 [1.31]) and diastolic BP z‐scores (1.6 [0.98]‐0.7 [0.85]) significantly decreased in the preoperative elevated BP subgroup. Multivariate logistic regression analysis showed that preoperative obesity (adjusted odds ratio = 4.36, 95% confidence interval = 2.24‐8.49) and mean peripheral oxygen saturation <95% during sleep (adjusted odds ratio = 2.73, 95% confidence interval = 1.29‐5.79) were independently associated with postoperative elevated BP.

Conclusion

Preoperative obesity and mean peripheral oxygen saturation <95% during sleep were significantly associated with postoperative elevated BP in the children with OSAS, further indicating the importance of careful BP monitoring in this subgroup despite AT treatment.
Abnormal Subjective and Audiometric Auditory Function in Migraine
Authors: Wang Allan R. , Steenerson Kristen K. , Alyono Jennifer C.
Published: January 2023

Objective

To identify if migraine is associated with auditory deficits and if the auditory profile of migraine is distinct from other pain syndromes, such as chronic pain.

Study Design

Cross‐sectional, retrospective.

Setting

A total of 5273 respondents of the 1999 to 2004 National Health and Nutrition Examination Survey.

Methods

Regression analyses assessed the association between migraine (n = 1245) and chronic pain (n = 430) status with subjectively endorsed hearing loss, tinnitus, pure‐tone average (PTA) at 500, 1000, 2000, and 4000 Hz, and subjective‐audiometric hearing mismatch (endorsed hearing loss but with a PTA ≤ 25 dB), correcting for confounding factors.

Results

Migraine was associated with increased tinnitus (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI]: 1.47‐2.13, p < .001) and subjective hearing loss (aOR = 1.58, 95% CI: 1.29‐1.94, p < .001). Migraine was associated with higher PTA (β = .89, p = .023). Migraine decreased the PTA threshold at which individuals endorsed subjective hearing loss (β = −1.94, p = .013) and was associated with a more subjective‐audiometric hearing mismatch (aOR = 1.50, 95% CI: 1.18‐1.89, p < .001). Chronic pain was not associated with tinnitus (aOR = 1.26, 95% CI: 0.97‐1.63, p = 0.079), subjective hearing loss (aOR = 0.94, 95% CI: 0.71‐1.23, p = .64), changes in PTA (β = −.22, p = .69), altered PTA threshold for endorsing hearing loss (β = 1.40, p = .19), or subjective‐audiometric hearing mismatch (aOR = 0.98, 95% CI: 0.70‐1.34, p = .88).

Conclusion

Migraine is associated with both worse pure‐tone audiometry and higher sensitivity to changes in hearing ability, suggesting both peripheral and central auditory function abnormalities. In contrast, patients with chronic pain did not demonstrate these abnormalities. The etiology of abnormal auditory processing in migraine may be different from that of other pain syndromes.
Association Between Hearing Loss and Multiple Negative Emotional States in the US Hispanic Population
Authors: Grewal Maeher , Golub Justin
Published: January 2023

Objective

Hearing loss (HL) has been linked to commonly studied detrimental mood states, such as loneliness and depression. However, its relationship with other negative emotions remained largely unstudied. We explore the association between HL and anxiety, anger, hostility, poor self‐esteem, and pessimism in a national cohort of US Hispanic adults.

Study Design

Cross‐sectional study.

Setting

Multicentered US national epidemiologic study (Hispanic Community Health Study).

Methods

Subjects were ages 18 to 75 with completed audiometric and emotional survey data. Multivariable regressions controlling for age, gender, and education were conducted to analyze the association between HL, measured by 4‐frequency pure‐tone average (PTA), and emotional states. States included anxiety (Spielberger Trait Anxiety Scale‐10), anger (Spielberger Trait Anger Scale), hostility (Cook Medley Cynicism Scale‐13), poor self‐esteem (Self‐Esteem Scale‐10), and pessimism (Revised Life Orientation Test).

Results

A total of 4120 to 4341 participants met inclusion criteria, depending on the specific survey; the average age was 46.7 years (standard deviation [SD] = 13.7), and the average PTA was 13.8 dB (SD = 10.1). Controlling for age, gender, and education, HL was associated with all outcomes. Specifically, for every 10 dB worsening in HL, the anxiety score worsened by 0.41 (0.23‐0.60), the anger score worsened by 0.40 (0.22‐0.58), the hostility score worsened by 0.16 (0.04‐0.27), the self‐esteem score worsened by 0.25 (0.12‐0.38), and the pessimism score worsened by 0.17 (0.04‐0.30) (all p < .01).

Conclusion

HL is related to numerous negative mood states beyond loneliness and depression. This includes worse anxiety, anger, hostility, self‐esteem, and pessimism. Future studies should investigate whether treating HL improves negative emotional states.
Upper Airway Stimulation Therapy Effect on Blood Pressure
Authors: McKinlay Alex J. , Walters Benjamin K. , Aden James K. , Scalzitti Nicholas J.
Published: January 2023

Objective

Upper airway stimulation (UAS) therapy has become increasingly utilized to treat obstructive sleep apnea, which is an independent risk factor for the development of hypertension. This study examines the impact of this therapy on blood pressure (BP).

Study Design

Retrospective cross‐sectional cohort study.

Setting

Tertiary center, Military Health System.

Methods

Patients who underwent UAS implantation at Brooke Army Medical Center between July 2015 and July 2020 were included if they used their device for at least 25 h/wk. Pre‐ and postoperative systolic BP, diastolic blood pressure (DBP), calculated mean arterial pressure (MAP), and the apnea‐hypopnea index (AHI) were compared using paired t test or Wilcoxon's signed‐rank test.

Results

Thirty patients met the inclusion criteria. The median age was 60, and the median body mass index was 29.9 kg/m2. The mean time between pre‐ and postoperative BP measurements was 11.6 months. AHI decreased from 35.1 to 16.5 events/h (p < .001). DBP decreased from 78.5 (73.8, 85.0) to 74.5 mm Hg (68.8, 81.3), with a mean difference of −3.7 mm Hg (p = .002). MAP decreased from 94.8 (89.6, 100.6) to 90.2 mm Hg (84.3, 100.0), with a mean difference of −3.7 mm Hg (p = .004).

Conclusion

UAS therapy was associated with a significant reduction in DBP, MAP, and AHI. These reductions in BP could potentially lead to favorable decreases in cardiovascular morbidity.
Candidate Angiogenesis‐Related Biomarkers in Patients with Laryngeal Carcinoma (AngLaC): A Prospective Cohort Study
Authors: Pamuk A. Erim , Gedik M. Emre , Sutay Suslu Nilda , Gunaydin Gurcan
Published: January 2023

Objective

Angiogenesis is indeed a vital process in the progression of carcinomas, including that of larynx. Therefore, this study (AngLaC) aimed to identify candidate angiogenesis‐related biomarkers in laryngeal carcinoma patients.

Study Design

Prospective controlled cohort study.

Setting

Tertiary referral center.

Methods

In silico analyses of angiogenesis‐related genes in laryngeal carcinoma were performed to determine candidate biomarkers. Serum levels of candidate biomarkers were determined via enzyme‐linked immunosorbent assay in laryngeal carcinoma patients as well as in an age and gender‐matched control group. The associations of the biomarkers with clinical parameters were investigated.

Results

The study included 60 laryngeal carcinoma patients and 20 healthy controls. The serum levels of osteopontin, IGFBP‐3, VEGF, sVEGFR‐1, and VEGFR‐2 were significantly higher in the patient group (p < .001, p ≤ .001, p < .001, p < .01, p < .01, respectively). High osteopontin and sVEGFR‐1 levels were associated with locoregional‐recurrence (p = .024, p = .016, respectively). IGFBP‐3 had the highest diagnostic sensitivity (81.4%) and specificity (80%) among the molecules that were investigated (p < .001). High sVEGFR‐1 and low VEGFR‐2 levels were associated with poor overall‐survival (p = .037, p = .027, respectively). High osteopontin and sVEGFR‐1 levels were associated with poor disease‐specific survival rates (p = .035, p = .018, respectively).

Conclusion

High serum levels of sVEGFR‐1 and osteopontin as well as low serum levels of VEGFR‐2 proved to be poor prognostic in terms of survival in laryngeal carcinoma. VEGF, sVEGFR1, VEGFR2, IGFBP‐3, and osteopontin levels were found to be significantly increased in larynx cancer patients compared to the normal population. Further studies on osteopontin and sVEGFR‐1 are required in order to determine their associations with recurrence.
Postoperative Radiotherapy and Facial Nerve Outcomes Following Nerve Repair: A Systematic Review
Authors: Kenny Hannah L. , Jonas Rachel H. , Oyer Samuel L.
Published: January 2023

Objective

To compare outcomes of facial nerve repair or grafting following facial nerve‐sacrificing procedures among patients treated with and without postoperative radiotherapy (RT).

Data Sources

PubMed, OVID, Conference Papers Index, Cochrane Library, ClinicalTrials.gov.

Review Methods

Databases were searched using terms including “facial nerve,” “graft,” “repair,” and “radiotherapy.” Abstracts mentioning facial nerve repair and evaluation of facial nerve function were included for full‐text review. Studies that utilized the House‐Brackmann or similar validated scale for evaluation of postoperative facial nerve function were selected for review. All identified studies were included in a pooled t test analysis.

Results

Twelve studies with 142 patients were included in the systematic review. All 12 studies individually demonstrated no significant difference in facial nerve outcomes between patients who received postoperative radiation and patients who did not. A pooled t test of data from all studies also demonstrated no significant difference in postoperative facial nerve function between the postoperative RT and non‐RT groups (t stat = 0.92, p = .36).

Conclusion

This analysis, including 12 studies, demonstrated that among patients undergoing facial nerve grafting or repair, there was no significant difference in postoperative facial nerve function between postoperative RT and non‐RT patients. Due to the small sample size and variability in study methods, further studies directly comparing outcomes between patients with and without postoperative RT would be beneficial.
Association of Central Auditory Processing Dysfunction With Preclinical Alzheimer's Disease
Authors: Byun Min Soo , Chang Munyoung , Yi Dahyun , Ahn Hyejin , Han Dongkyun , Jeon Seulki , Jang Hyunsook , Lee Dong Young , Oh Seung Ha ,   For the KBASE Research Group
Published: January 2023

Objective

To investigate whether central auditory processing dysfunction measured by the dichotic digit test‐1 digit (DDT1) is present in preclinical Alzheimer's disease (AD) individuals who are cognitively normal (CN) older adults with the cerebral beta‐amyloid (Aβ) deposition and to explore the potential of the DDT1 as a screening test for preclinical AD.

Study Design

Cross‐sectional design.

Setting

A prospective observational cohort study.

Methods

CN older adults with a global clinical dementia rating score of 0 were included. The hearing test battery including pure‐tone audiometry, speech audiometry, distortion product otoacoustic emission, and DDT1 was administered to participants.

Results

Fifty CN older adults were included. Among them, 38 individuals were included in the Aβ deposition negative (AN) group and 12 were included in the Aβ deposition positive (AP) group. The DDT1 scores of both the better and worse ears were significantly lower in the AP group than in the AN group (p = .008 andp = .015, respectively). No significant differences were observed between the groups in tests of the peripheral auditory pathways. In multivariable logistic regression analysis adjusted for apolipoprotein E4 positivity, the DDT1 better ear score predicted the AP group (p = .036, odds ratio = 0.892, 95% confidence interval: 0.780‐0.985) with relatively high diagnostic accuracy.

Conclusion

Our findings suggest that Aβ deposition may affect the central auditory pathway even before cognitive decline appears. DDT1, which can easily be applied to the old‐age population, may have the potential as a screening tool for preclinical AD.
Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology
Authors: Butkus Joann M. , Awosanya Samiat , Scott Elizabeth Reilly , Perlov Natalie , Hannikainen Paavali , Tekumalla Sruti , Armache Maria , Stewart Matthew , Willcox Thomas , Chiffer Rebecca
Published: January 2023

Objective

This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology.

Study Design

Prospective cohort study.

Setting

Single tertiary‐care facility.

Methods

Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores.

Results

Eighty‐six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively).

Conclusion

The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery.
Endoscopic Management of Rhinolithiasis: A Systematic Review
Authors: Nguyen Julia , Omiunu Ariel , Patel Rushi , Patel Prayag , Fang Christina H. , Eloy Jean Anderson
Published: January 2023

Objective

This study reviews the presentation, management, and outcomes of patients with rhinolithiasis.

Data Sources

An electronic database search of PubMed, SCOPUS, CINAHL, and the Cochrane Library was performed in accordance with the PRISMA 2020 updated guidelines for reporting systematic reviews.

Review Methods

Case reports and case series published from 2004 to 2020 were included. Data collected included patient demographics, clinical symptoms at presentation, diagnosis, treatment, complications, and follow‐up. Relevant descriptive statistics were computed using Microsoft Excel 2013 (Microsoft Corp).

Results

Fifty‐five case reports and five case series were included (n = 122). The majority were female (60.7%). The mean age was 29.4 years (range, 4‐80 years). The most common symptoms were rhinorrhea (81.1%), nasal obstruction (79.5%), nasal malodor (38.5%), and headache (27.9%). Computed tomography imaging was obtained in 109 (91.5%) cases. Concurrent rhinosinusitis (35.2%) and deviated nasal septum (28.7%) were commonly identified. Rhinoliths were commonly found in the right nostril (52.5%) and in between the inferior turbinate and nasal septum (26.9%). All rhinoliths were fully excised using endoscopic sinonasal surgery, accompanied by a septoplasty (9.2%). The nidus was identified in 27 (22.2%) patients. There were no recurrences or complications over an average follow‐up of 8.5 months (range, 0.25‐36 months).

Conclusion

Rhinolithiasis is an uncommon entity of the nasal cavity and should be suspected in patients with long‐standing unilateral nasal obstruction, rhinorrhea, and nasal malodor. Rigid nasal endoscopy and endoscopic sinonasal surgery are the most important methods for diagnosis and treatment, respectively.
Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care Admission
Authors: Kirkham Erin M. , Puglia Michael P. , Haydar Bishr , Jewell Elizabeth S. , Leis Aleda M. , Peddireddy Nithin , Chervin Ronald D.
Published: January 2023

Objective

Few data are available to guide postadenotonsillectomy (AT) pediatric intensive care (PICU) admission. The aim of this study of children with a preoperative polysomnogram (PSG) was to assess whether preoperative information may predict severe respiratory events (SRE) after AT.

Study Design

Retrospective cohort study.

Setting

Single tertiary center.

Methods

Children aged 6 months to 17 years who underwent AT with preoperative polysomnography (2012‐2018) were identified by billing codes. Data were extracted from medical records. SRE were defined as any 1 or more of desaturations <80% requiring intervention; newly initiated positive airway pressure; postoperative intubation; pneumonia/pneumonitis; respiratory code, cardiac arrest, or death. We hypothesized that SRE would be associated with age <24 months, major medical comorbidity, obesity (>95th percentile), apnea‐hypopnea index (AHI) ≥ 30, and O2 nadir <70% on PSG. Analysis was performed with multivariable logistic regression.

Results

Of 1774 subjects, 28 (1.7%) experienced SRE. Compared to those without, children with SRE were on average younger (3 vs 5 years, p < .01) with a greater probability of medical comorbidities (59% vs 18%, p < .001). After adjustment for sex, black race, obesity, and age <24 months, children with major medical comorbidity were more likely than other children to have SRE (odds ratio [OR]: 14.2; 95% confidence interval [CI]: [5.7, 35.2]), as were children with AHI ≥ 30 (OR: 7.7 [3.0, 19.9]), or O2 nadir <70% (OR 6.1 [2.1, 17.9]). Age, obesity, sex, and black race did not independently predict SRE.

Conclusion

PICU admission may be most prudent for children with complex medical co‐morbidities, high AHI (>30), and/or low O2 nadir (<70%).
Integrated Health Maintenance Reminders for Improved HPV Vaccine Administration: Toward Improvements in Completion Disparities
Authors: Rames Jess D. , Frisco Nicholas A. , Jiang Rong , Shah Kevin P. , Kahmke Russel R. , Puscas Liana , Osazuwa‐Peters Nosayaba , Rocke Daniel J.
Published: January 2023

Objective

To evaluate the effect of a health maintenance reminder (HMR) on human papillomavirus (HPV) vaccine administration and completion across different age, insurance, and race cohorts.

Study Design

Retrospective pre‐post analysis.

Setting

Academic primary care.

Methods

Patients aged 9 to 26 who had initiated the HPV vaccine series from 2016 to 2021 were analyzed, based on current age‐based standards. The cohort was divided based on vaccine uptake before and after the implementation of the HMR program in February 2020. The multivariate analysis estimated the odds of vaccine completion based on sociodemographic factors, and variable interactions were investigated to determine independent associations between sociodemographic factors and HMR implementation.

Results

There were 7654 individual patients (mean age was 15.8 years; 46.7 were males; and 50.7% were white). HPV vaccine completion rates increased post‐HMR implementation by 59.2% (37% pre‐, and 58.9% post‐HMR; p < .001) in the entire cohort. Overall, black patients (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.60, 0.70) and patients ≥18 years (aOR = 0.13; 95% CI: 0.11, 0.15) were significantly less likely to complete their vaccine series; however, this improved significantly following HMR in these groups (p < .001). Post‐HMR, race, and insurance status were not independently associated with disparate vaccine completion rates, however, age was, and patients ≤14 or younger had higher odds of vaccine completion (aOR = 3.54; 95% CI: 2.91, 4.32).

Conclusion

The implementation of an HMR was associated with increased HPV vaccine uptake across age and race groups in this single‐institution study. Future research should explore barriers to implementing HMRs in different health care settings.
Speech Perception and Sound Localization Skills in Inner Ear Malformations: Children With Incomplete Partition Type‐II
Authors: Kocabay Aysun Parlak , Batuk Merve Ozbal , Sennaroglu Gonca , Sennaroglu Levent
Published: January 2023

Objective

The present study aimed to evaluate binaural auditory skills in bimodal and bilateral pediatric cochlear implant (CI) users with incomplete partition type‐II (IP‐II) and to reveal the effect of IP‐II on performance by comparing the results to pediatric CI users with normal cochlear morphology.

Study Design

Cross‐sectional study.

Setting

Tertiary referral center.

Methods

Forty‐one CI users (mean age 8.8 ± 1.9) were grouped as bimodal (BIM‐IP) and bilateral (BIL‐IP) users with IP‐II; bimodal (BIM‐N) and bilateral (BIL‐N) users with normal cochlear anatomy. Speech perception in noise and sound localization skills were compared under 2 conditions; binaural (bilateral or bimodal) and monaural (first CI alone).

Results

BIM‐IP and BIL‐IP showed no performance difference in binaural tasks. The BIM‐N group showed remarkably poor performance in comparison to the groups of BIL‐IP (p = .007), BIM‐IP (p < .001), and BIL‐N (p = .004) in terms of speech‐in‐noise skills. In sound localization abilities, similar significant differences were found between the group of BIM‐N and the groups of BIL‐IP (p = .001), BIM‐IP (p < .001), and BIL‐N (p = .004). All groups showed statistically significant improvements in binaural condition on both tasks (p < .05).

Conclusion

We revealed that bilateral and bimodal pediatric CI users with IP‐II benefitted from implantation as much as bilateral users with normal anatomy. Differences in residual hearing between groups may explain the poor performance of bimodal users with normal cochlear morphology. To the best of our knowledge, it is the first study to unveil binaural performance characteristics in children diagnosed with a specific inner ear malformation subgroup.
Relationship Between Alcohol Intolerance and Aspirin‐Exacerbated Respiratory Disease (AERD): Systematic Review
Authors: Candelo Estephania , McCalla Monet , Valderrama Oriana A. , Avila‐Castano Karol , Chelf Cynthia , Olomu Osarenoma , Donaldson Angela M.
Published: January 2023

Objective

Previous studies have suggested that patients with aspirin‐exacerbated respiratory disease (AERD) have a high likelihood of alcohol intolerance. The purpose of this systematic review is to identify if there is sufficient evidence to confirm this correlation and the impact of medical therapy on subsequent alcohol tolerance.

Data Sources

PubMed, EMBASE, SCOPUS, EBSCO, Google Scholar, Cochrane Library, and Grey literature. We also performed snowballing on the identified observational studies (OS) for additional data.

Review Methods

A systematic review was conducted from 1968 to 2022 to identify those studies describing AERD symptomatology triggered by alcohol intake. The primary outcome was to analyze the current literature for the association between alcohol intolerance and AERD symptoms. The secondary outcome looked for improvement in alcohol tolerance after aspirin desensitization or biological therapy.

Results

A total of 775 studies were identified and 40 abstracts were evaluated. From these, 5 studies met the inclusion criteria. Of the 5 manuscripts, there was 1 case‐control, 2 cohort, and 2 cross‐sectional studies. A total of 522 participants with AERD and a history of alcohol consumption were included, with 52.8% reporting at least 1 sinopulmonary exacerbation after alcohol intake. One of 3 studies noted improvement in alcohol tolerance after medical therapy with aspirin desensitization.

Conclusion

The current literature suggests that patients with AERD have a high risk of alcohol intolerance. Additionally, aspirin desensitization may improve alcohol tolerance in this patient population.
Providing Evidence for Dogma: Risk of Epistaxis After COVID‐19 Nasal‐Screening Swab
Authors: Block‐Wheeler Nikolas R. , Wei Julia , Weintraub Miranda R. , Liang Jonathan
Published: January 2023

Objective

There is anecdotal evidence SARS‐CoV‐2 (COVID) RT‐PCR screening nasal swabs confer an elevated epistaxis risk. We aimed to assess the association between epistaxis and exposure to a COVID nasal swab.

Study Design

A matched pairs design was used.

Setting

The study was performed in a single, integrated health care system.

Methods

All patients who received a single COVID nasal swab at our institution between April 2020 and March 2021 were included. McNemar's test was used to compare rates of epistaxis between the 7 days following the index COVID swab (hazard period), and the 7 days preceding the index COVID swab (control period). Conditional logistic regression was used to evaluate sociodemographic and clinical risk factors for epistaxis.

Results

A total of 827,987 participants were included, with 1047 epistaxis encounters. The prevalence of epistaxis during the hazard and control periods were 0.08% and 0.04%, respectively. Swab exposure was associated with 1.92‐fold odds of epistaxis during the hazard period (95% confidence interval [1.73, 2.12]). Older age, Asian/Pacific Islander (PI) (compared to white), male sex, hypertension, prior facial trauma, and warfarin or direct‐acting oral anticoagulant use were also associated with significantly increased odds of epistaxis (p ≦ 0.01).

Conclusion

COVID nasal swabs are associated with increased odds of epistaxis. Physicians should counsel patients, particularly those at the highest risk, including a history of prior facial trauma, anticoagulants/antiplatelets, or hypertension.
Objective Pharyngeal Phenotyping in Obstructive Sleep Apnea With High‐Resolution Manometry
Authors: Kent David T. , Scott William C. , Ye Cheng , Fabbri Daniel
Published: January 2023

Objective

Drug‐induced sleep endoscopy (DISE) is a commonly used diagnostic tool for surgical procedural selection in obstructive sleep apnea (OSA), but it is expensive, subjective, and requires sedation. Here we present an initial investigation of high‐resolution pharyngeal manometry (HRM) for upper airway phenotyping in OSA, developing a software system that reliably predicts pharyngeal sites of collapse based solely on manometric recordings.

Study Design

Prospective cross‐sectional study.

Setting

An academic sleep medicine and surgery practice.

Methods

Forty participants underwent simultaneous HRM and DISE. A machine learning algorithm was constructed to estimate pharyngeal level‐specific severity of collapse, as determined by an expert DISE reviewer. The primary outcome metrics for each level were model accuracy and F1‐score, which balances model precision against recall.

Results

During model training, the average F1‐score across all categories was 0.86, with an average weighted accuracy of 0.91. Using a holdout test set of 9 participants, a K‐nearest neighbor model trained on 31 participants attained an average F1‐score of 0.96 and an average accuracy of 0.97. The F1‐score for prediction of complete concentric palatal collapse was 0.86.

Conclusion

Our findings suggest that HRM may enable objective and dynamic mapping of the pharynx, opening new pathways toward reliable and reproducible assessment of this complex anatomy in sleep.
Experience With the New Active Transcutaneous Bone‐Conduction Implant With Smaller Dimensions
Authors: Brkic Faris F. , Baumgartner Wolf‐Dieter , Schlott Melina , Liu David T. , Thurner Thomas , Riss Dominik , Gstöttner Wolfgang , Vyskocil Erich
Published: January 2023

Objective

Recently, the Bonebridge 602 implant was introduced. Its smaller dimensions facilitate implantation even in surgically demanding cases. However, in extreme anatomical conditions, implant lifts are still required. We intended to report on the medical and audiological outcomes of all patients implanted with the implant with a secondary focus on the safety, efficacy, and feasibility of the use of 1‐mm lifts.

Study Design

Retrospective cohort study.

Setting

Tertiary academic center.

Methods

We retrospectively analyzed all patients implanted with the Bonebridge 602. Patient demographics and surgically‐specific data were collected from the medical charts. Furthermore, audiological results were assessed. Outcomes were compared between implantations with versus without lifts.

Results

Twenty‐one devices were implanted during the study period. Satisfactory audiological results were observed, while no intra‐ or postoperative adverse events occurred. The majority of patients were daily users at the end of the observation period (n = 20/21, 95.2%), and one patient (n = 1/21, 4.8%) was a nonuser after 6 months of use because of subjective dissatisfaction. Due to anatomical considerations, 1‐mm lifts were used in 4 implantations (19.0%). The application of lifts did not result in prolonged surgical times, complications, or shorter time of use, nor did it negatively affect audiometric results.

Conclusion

Implantations with the new and smaller Bonebridge were associated with gratifying medical and audiological outcomes. Still, in extreme anatomical conditions, 1‐mm lifts are necessary. Nonetheless, surgical placement with the help of lifts seems safe, effective, and feasible, and is a viable option in cases with challenging anatomies due to previous surgeries or anomalies.
Radiotherapy of early‐stage breast cancer
Authors: Yu Cedric X.
Published: January 2023

Breast cancer is the most prevalent disease for women. With advances in breast cancer screening, most breast cancers are now diagnosed in the early stages. With knowledge of different subtypes and their behavior, breast cancer treatment has become more individualized. Radiation therapy as one of the mainstays of breast cancer treatment has also been evolving. This review attempts to provide a summary of the most influential clinical studies that have driven the technological advances in radiation therapy for early‐stage breast cancer.
Recent trends in the spatial distribution of human capital: Are skill levels converging across regions in England and Wales?
Authors: Azpitarte Francisco
Published: January 2023

In modern knowledge‐based societies human capital is the single most important determinant of regional inequalities in productivity and standards of living. Using a newly constructed data set that allows the analysis of educational attainments at different levels of geography, this paper evaluates spatial inequalities and the degree of convergence in the distribution of human capital across areas in England and Wales during the second decade of the 21st century. Our results show this was a period characterised by a large increase in educational attainment and skill intensity. However, the growth in skill intensity was far from uniform across space. In particular, we find strong evidence of both absolute σ‐divergence and β‐convergence in the distribution of skills. Thus, even if low‐skill areas grew on average more than other areas with higher skill intensity at the start of the period, the stochastic dominance analyses provide strong evidence of an unambiguous increase in absolute inequalities so that by end of the decade the skill gap between low‐ and high‐skill areas had significantly widened. We present new spatial and aspatial evidence that sheds light on those inequalities and the changes in the spatial configuration of human capital over the last decade. Despite the implementation of policies aimed at reducing regional inequalities, many low skill areas struggled to attract talent so that the gap with most skilled areas widened over that period likely contributing to the persistence of the well‐documented large spatial economic inequalities in this country.