bluuebunny/crossref_metadata_2025 huggingface dataset:
Acceptability and reliability of multiple mini interviews for admission to otolaryngology residency
Authors: Campagna‐Vaillancourt Maude , Manoukian John , Razack Saleem , Nguyen Lily H. P.
Published: October 2013

Objectives/Hypothesis

To evaluate the acceptability and reliability of the Multiple Mini Interview (MMI) for the selection of applicants to an Otolaryngology–Head and Neck (OTL–HNS) residency program.

Study Design

Prospective observational study.

Methods

Canadian medical graduates applying to the OTL–HNS residency program at McGill University in 2011 and 2012 underwent a 7‐station MMI. Upon completion, the major stakeholders commented on and rated various aspects of the MMI using a 7‐point Likert scale. Descriptive statistics were used to analyze the quantitative portion of the exit survey, while content analysis and thematic description was applied to qualitative data. Interrater reliability was examined with intraclass correlation coefficients.

Results

Data was collected from 45 applicants and 18 evaluators. The majority of applicants (>80%) felt that the MMI helped them present their strengths and was free of any gender, cultural, or age bias. Assessors (>85%) agreed the MMI evaluated a valid range of competencies, and that it tested more aspects of an applicant than did traditional interviews. Both applicants and assessors (>70%) agreed that the MMI was a fair process, and both preferred it over the traditional interview. Overall, interrater reliability of the MMI was good.

Conclusion

This is the first study to examine how the MMI interview process can be adapted for admission to an OTL–HNS residency program, while showing both good acceptability for all major stakeholders and good reliability.

Level of Evidence

N/A Laryngoscope, 124:91–96, 2014
Down syndrome: An electrophysiological and radiological profile
Authors: Saliba Issam , Sbeity Samer , El‐Zir Elie , Yammine Fady G. , Noun Carla T. , Haddad Antoine
Published: October 2013

Objectives/Hypothesis

To assess the hearing status of trisomy 21 patients by analyzing electrophysiological and radiological findings of any correlation between hearing impairment and major or minor inner ear malformations.

Study Design

Prospective radiological and electrophysiological study.

Methods

A group of 34 ears of Down syndrome subjects and 20 ears of a volunteer age‐ and sex‐matched control group of 10 normal subjects were studied electrophysiologically by means of otoacoustic emissions and auditory brainstem response. Temporal bone computed tomography (CT) scans were carried out in both groups; radiological findings were compared. Inner ear structure measurements were applied attempting to disclose subtle bony labyrinthine anomalies. The findings from both groups were statistically analyzed employing the t test.

Results

The rate of sensorineural hearing loss (SNHL) in Down syndrome group was 41%. Temporal bone CT scans showed no ossicular malformation in all Down syndrome cases. Major inner ear abnormalities were disclosed in 5.8%; they corresponded to two cases of lateral semicircular canal dysplasia detected on CT images by visual inspection. The application of various inner ear structure measurements increased the overall detection rate of common inner ear malformations to 47%. A statistically significant correlation was found between hearing level and vestibule length (P = .009) and internal auditory canal length (P = .028). Vestibular aqueduct width was correlated to different otic abnormalities.

Conclusions

SNHL is mainly secondary to the underestimated subtle inner ear malformations that are adequately demonstrated by adopting standardized inner ear structure measurements on petrous bone imaging. Vestibular height and internal auditory canal length were correlated to SNHL.

Level of Evidence

3b. Laryngoscope, 124:E141–E147, 2014
Septal perforation repair without intraoperative mucosal closure
Authors: Flavill Eric , Gilmore Jim E.
Published: October 2013

Objectives/Hypothesis

To report a technique for septal perforation repair that does not rely on intraoperative mucosal closure of the perforation defect.

Study Design

Case series with prospective and retrospective data collection.

Methods

Nine patients received multilayer interposition grafts and no attempt at intraoperative mucosal closure for repair of septal perforations. Eight patients received multilayer interposition grafts consisting of temporoparietal fascia on one side, polydioxanone plate in the middle, and deep temporal fascia on the other side. One patient received a variant graft consisting of acellular dermal matrix, polydioxanone plate, and full‐thickness temporal fascia. Silastic or silicone sheets were placed bilaterally for at least 12 weeks to protect the septum during healing. This technique was applied to a variety of challenging surgical candidates.

Results

The eight patients who received interposition grafts with bilateral temporal fascia had complete repair of septal perforation sites. The variant interposition graft had complete loss on the acellular dermal matrix side but good integration of temporal fascia on the contralateral side.

Conclusions

This tension‐free technique does not rely on intraoperative mucosal closure of the septal perforation. It has been used to successfully obtain complete repair in a variety of challenging surgical candidates when combined with temporal fascia autografts.

Level of Evidence

4. Laryngoscope, 124:1112–1117, 2014
Ten‐year health‐related quality of life in cochlear implant recipients
Authors: Arnoldner Christoph , Lin Vincent Y. , Honeder Clemens , Shipp David , Nedzelski Julian , Chen Joseph
Published: October 2013

Objectives/Hypothesis

To evaluate the long‐term impact of cochlear implantation on quality of life measured by the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36). Scores were also converted to the SF‐6D to derive health utility scores.

Study Design

Prospective cohort study.

Methods

Thirty‐two patients undergoing cochlear implantation completed the SF‐36 preoperatively, 1 year, and 10 years after cochlear implantation.

Results

SF‐36 results showed improvements in seven of the eight attributes when preoperative scores where compared with 1‐ and 10‐year results. Between 1 and 10 years postoperatively, six of eight domains deteriorated in scores. When converted to the SF‐6D, the mean preoperative utility scores were 0.592 for standard gamble, 0.636 using the ordinal health state paradigm, and 0.579 using the Bayesian technique. Ten years postoperatively, health utility scores were 0.643 (standard gamble), 0.684 (ordinal health state), and 0.6 (Bayesian). Between preoperatively and 10‐year postoperatively, improvements were therefore 0.051, 0.048, and 0.021 for standard gamble, ordinal health state, and Bayesian paradigm, respectively.

Conclusions

This study establishes the long‐term sustained benefits of cochlear implantation on quality of life. Nevertheless, both the SF‐36 and SF‐6D seem to underestimate the benefit accrued through this intervention. Our data are consistent with others regarding the unsuitability of the SF‐36 in benefit assessment, notwithstanding that conversion to the SF‐6D is feasible, and the SF‐6D seemed to better depict possible benefits from cochlear implantation as compared to the SF‐36.

Level of Evidence

4. Laryngoscope, 124:278–282, 2014
A pain in the neck
Authors: Sinha Parul , Grindler David J. , Haughey Bruce H.
Published: October 2013

A lateralized pain in the neck is a common symptom encountered by the otolaryngologist. This complaint, frequently caused by lateral thyrohyoid ligament syndrome, is often misdiagnosed. The pathophysiology of this syndrome may relate to overuse and inflammation. [change made here after initial online publication]. Typically, patients present with chronic unilateral neck pain often associated with odynophagia. The point of maximum tenderness localizes over the axis of the lateral thyrohyoid ligament. We present a series of 15 patients, in whom treatment with depot steroid and local anesthetic injection (n = 14) improved symptoms in 12 (86%), with complete resolution in nine (64%) patients. Laryngoscope, 124:116–118, 2014
Frontal sinus drillout (modified Lothrop procedure): Long‐term results in 204 patients
Authors: Ting Jonathan Y. , Wu Arthur , Metson Ralph
Published: October 2013

Objectives/Hypothesis

To determine the long‐term results of frontal sinus drillout (also known as modified Lothrop procedure) for the treatment of advanced frontal sinus disease.

Study Design

Retrospective review.

Methods

The records of patients who underwent frontal sinus drillout by a single surgeon at an academic medical center from June 1995 through November 2011 were reviewed. Patient demographics and perioperative clinical findings were analyzed for their impact on surgical outcome. Failure was defined as restenosis of the frontal drainage pathways, necessitating additional frontal sinus surgery.

Results

A total of 204 patients underwent frontal drillout surgery (143 bilateral procedures) over the 16‐year period. Mean follow‐up was 10.2 years (range 0.9–17 years). Symptomatic re‐obstruction of the frontal sinus requiring revision surgery occurred in 61 (29.9%) patients. Drillouts performed for a diagnosis of mucocele or tumor had significantly higher failure rate (38.9%, odds ratio [OR] = 2.9, P = 0.022 and 58.3%, OR = 5.3, P = 0.020, respectively). The majority of surgical failures (61%) occurred within 2 years of surgery, but delayed failures were observed up to 12 years after drillout. Clinical outcome did not correlate with a history of smoking, asthma, nasal allergy, aspirin sensitivity, prior sinus surgery, nasal polyposis, or the presence of eosinophilic mucin.

Conclusion

For the majority of patients who undergo frontal sinus drillout, patency of the frontal sinus outflow tract appears to be maintained for more than a decade; nevertheless, almost one‐third of patients who undergo this procedure will ultimately require additional frontal sinus surgery.

Level of Evidence

4. Laryngoscope, 124:1066–1070, 2014
Correlation between bacterial biofilms and osteitis in patients with chronic rhinosinusitis
Authors: Dong Dong , Yulin Zhao , Xiao Wang , Hongyan Zhang , Jia Liu , Yan Xie , Jia Wang
Published: October 2013

Objectives/Hypothesis

Bacterial biofilms (BBF) and osteitis are potential contributors to the local inflammatory load in chronic rhinosinusitis (CRS). This study investigated the relationship between BBF and osteitis status in CRS patients.

Study Design

Prospective cohort study.

Methods

Eighty‐four CRS patients undergoing endoscopic sinus surgery and 22 control patients were enrolled in this study. Mucosal and bony samples from ethmoid sinus were obtained for confocal scanning laser microscopy and microscopic examination. Biofilm volume (BV), biofilm score (BS), histopathologic bony grade, Global Osteitis Scoring Scale (GOSS) score, and Hounsfield unit (HU) value on computed tomography were recorded. Associations between these parameters describing BBF and osteitis were assessed.

Results

The histopathologic bony grade 2 (0–3) versus 0 (0–3) (P < 0.001), GOSS score 4.5 (0–31) versus 0 (0–26) (P = 0.014) and HU value 431.5 (310–509) versus 354 (288–499) (P < 0.001) in patients with BBF were greater than those without BBF. The bony grade (r = 0.683, P < 0.001 and r = 0.664, P < 0.001), GOSS score (r = 0.314, P = 0.004 and r = 0.312, P = 0.004), and HU value (r = 0.539, P < 0.001 and r = 0.520, P < 0.001) were significantly increased with higher BV and BS.

Conclusion

A total of 84.8% of the bone underlying mucosa with BBF had some form of osteitis in ethmoid sinus, and approximately 46.4% of CRS patients were from a subgroup with both BBF and osteitis. The volume of BBF correlated well with severity of osteitis in CRS patients.

Level of Evidence

3b. Laryngoscope, 124:1071–1077, 2014
Volumetric analysis of endoscopic and traditional surgical approaches to the infratemporal fossa
Authors: Fahmy Carol E. , Carrau Ricardo , Kirsch Claudia , Meeks Darlene , de Lara Danielle , Solares C. Arturo , Otto Bradley A. , Prevedello Daniel M.
Published: October 2013

Objectives/Hypothesis

In an effort to decrease morbidity, skull base surgeons have explored less invasive approaches to the infratemporal fossa, including endonasal‐endoscopy, minicraniotomies, and transantral endoscopic and microscopic corridors. This project presents quantitative data that assesses the practicality, and volumetric exposure afforded by endonasal and open approaches to the infratemporal fossa.

Study Design

First, the study defines the anatomy of endoscopic‐endonasal and preauricular approaches to the infratemporal fossa. Subsequently, the study involved the calculation of anatomical volumes using cadaveric and virtual models.

Methods

Computed tomography (CT) scanning of two anatomical specimens served to recreate computer simulations of the endonasal and preauricular approaches, allowing for the assessment of the infratemporal fossae volumes. In addition, the dissections served to identify and mark critical surgical landmarks and boundaries. A second CT scan, after the surgical dissection, allowed for a reanalysis of the data for a volumetric comparison of the surgical approaches.

Results

Pre‐ and postdissection CT scans and computer simulations revealed that volumes in the open and endonasal approaches to the infratemporal fossa are strikingly similar, suggesting that volumes of surgical instrumentation and visualization may also be comparable. However, the entry gate for instrumentation differed significantly for each approach.

Conclusion

This study suggests that, although the entry gate for instrumentation is greater during an open approach, contrary to intuition, an open approach does not create a substantially larger working space or visual field. Analysis of volumetric measurements facilitates a better understanding of the indications for each procedure.

Level of Evidence

N/A. Laryngoscope, 124:1090–1096, 2014
Hypocalcemia after total laryngectomy
Authors: Basheeth Naveed , O'Cathain Eadaoin , O'Leary Gerard , Sheahan Patrick
Published: October 2013

Objectives/Hypothesis

Hypocalcemia is common in the initial period after total laryngectomy. The purpose of the present study was to study the incidence of and risk factors for postlaryngectomy hypocalcemia at our institution.

Study Design

Retrospective review of 65 consecutive total laryngectomies.

Methods

Clinical data and calcium levels for the first postoperative week were collected. Biochemical hypocalcemia was defined as any corrected calcium level of < 2.0 mmol/l in the first postoperative week. Severe hypocalcemia was defined as a calcium of < 1.8 mmol/l, or symptoms of hypocalcemia. Risk factors for hypocalcemia were studied.

Results

Five cases were excluded due to concomitant abdominal surgery (3), preoperative hypocalcemia (1), and no postoperative calcium levels (1). A total of 43% of patients had postoperative biochemical hypocalcemia. On univariate analysis, bilateral neck dissection was significant for hypocalcemia (P = 0.02), with pT4 classification having borderline significance (P = 0.07). On multivariate analysis, bilateral neck dissection (P = 0.02) and salvage surgery were significant (P = 0.03), with pT4 stage again having borderline significance (P = 0.05). Extent of thyroidectomy, extent of pharyngectomy, and preoperative tracheostomy were not significant. Fifteen patients (25%) had severe hypocalcemia. There were no significant risk factors for severe hypocalcemia identified.

Conclusions

Hypocalcemia is common after total laryngectomy, particularly in the postradiotherapy setting and in patients undergoing bilateral neck dissection. Preservation of one thyroid lobe does not appear to significantly reduce the risk.

Level of Evidence

4. Laryngoscope, 124:1128–1133, 2014
Metastatic melanoma to the upper aerodigestive tract
Authors: Mifsud Matthew , Padhya Tapan A.
Published: October 2013

This study is a systematic review of the literature that was performed to clarify the natural history and treatment outcomes of upper aerodigestive tract metastases from cutaneous melanoma. A search of the MEDLINE database was undertaken from 1950 to 2013 to identify relevant manuscripts for this review. Article inclusion required cases with documentation of previous cutaneous melanoma primary lesions, adequate survival data, and description of metastatic treatment. Individual patient data were extracted from source articles for analysis of survival outcomes. A systematic search revealed 34 relevant articles with 37 cases for inclusion. Metastases were identified throughout the upper aerodigestive tract with a predilection for the oropharynx, larynx, and oral cavity. Treatment outcomes were estimated with the Kaplan‐Meier method, with survival of 37% and 16% at 1 and 5 years, respectively. As expected from previous reports, 73% presented with disseminated disease burden with almost universally poor prognosis despite locoregional or systemic therapy. Conversely, a group of patients with limited metastatic burden had improved treatment response with a 1‐year survival of 90%, denoting a hazard ratio of 9.7332 (95% confidence interval, 4.5–21.1) for disseminated disease in comparison. Upper aerodigestive tract metastases of melanoma thus are rare clinical entities that in general present in the setting of disseminated disease and evidently necessitate a focus on palliation. In contrast, for those with a limited metastatic burden, aggressive multimodality therapy including complete metastectomy can produce a significant survival advantage.

Level of Evidence

NA Laryngoscope, 124:1143–1149, 2014
Unravelling Robin sequence
Authors: van Lieshout Manouk J. S. , Joosten Koen F. M. , Hoeve Hans L. J. , Mathijssen Irene M. J. , Koudstaal Maarten J. , Wolvius Eppo B.
Published: October 2013

Objectives/Hypothesis

The airway management of children with Robin sequence is controversial. This study provides an overview of a single‐center experience with the diagnosis and treatment of 59 children with Robin sequence.

Study Design

Retrospective cohort study.

Methods

We conducted a retrospective cohort study of 59 children (<1 year old) with Robin sequence managed between 2000 and 2010. Robin sequence was defined as the presence of mandibular hypoplasia and clinical signs of airway obstruction. Data were collected on demographic characteristics, the presence of a syndrome, the perinatal period, and the management of airway and nutritional problems.

Results

Eighteen children (31%) needed respiratory support because of severe respiratory distress, and a sleep study found obstructive apneas in another eight children who had been managed by prone positioning and/or monitoring. In the isolated group significantly fewer children needed respiratory support compared to the nonisolated group. After the age of 1 year, 10% of the Robin sequence cohort was still in need of treatment for obstructive symptoms. Almost half (47%) needed temporary nutritional support.

Conclusions

The prevalence of respiratory distress in children with Robin sequence is high. In most children, treatment with prone positioning was sufficient to relieve the airway obstruction. Successful treatment with prone positioning was significantly more often seen in children with an isolated Robin sequence. About one‐third of all Robin sequence children needed respiratory support in the neonatal and/or infant period. However, in childhood, only 10% of the total Robin sequence cohort was still dependent on respiratory support.

Level of Evidence

4 Laryngoscope, 124:E203–E209, 2014
Is sex an independent prognostic factor in cutaneous head and neck melanoma?
Authors: Arce Paolo M. , Camilon P. Ryan , Stokes William A. , Nguyen Shaun A. , Lentsch Eric J.
Published: October 2013

Objectives/Hypothesis

To determine if sex independently affects disease‐specific survival (DSS) in patients with cutaneous head and neck melanoma.

Study Design

Retrospective analysis of a large population database.

Methods

Our study included patients in the Surveillance, Epidemiology, and End Results database with cutaneous head and neck melanoma diagnosed from 2004 to 2009. Any cases with a history of previous malignancy or with multiple primaries were excluded. We obtained data on stage, race, age at diagnosis, radiological treatment status, and surgical treatment status. Our analysis consisted of a Kaplan‐Meier analysis of DSS by sex [correction made here after initial online publication] that was supported by a multivariate Cox regression of all significant variables studied.

Results

There were 13,507 patients identified with cutaneous head and neck melanoma who were diagnosed between 2004 and 2009. We observed that female patients had a better prognosis than their male counterparts, with 5‐year DSS of 90.40% (95% confidence interval [CI], 89.03%‐91.72%) and 87.10% (95% CI, 86.12%‐88.08%), respectively. Multivariable analysis demonstrated a statistically significant decrease in disease‐specific hazard ratio due to female sex independent of stage, treatment, age, or race.

Conclusions

Our study concludes that female sex is an independent prognostic factor for cutaneous head and neck melanoma. We demonstrated better 5‐year DSS in female compared to male patients. Better prognosis could be due to multiple factors including differing hair, levels of sun exposure, and advanced male age.

Level of Evidence

2b Laryngoscope, 124:1363–1367, 2014
Patient‐based outcomes of in‐office KTP ablation of vocal fold polyps
Authors: Sridharan Shaum , Achlatis Stratos , Ruiz Ryan , Jeswani Seema , Fang Yixin , Branski Ryan C. , Amin Milan R.
Published: October 2013

Objectives/Hypothesis

Recent data have suggested that in‐office potassium titanyl phosphate (KTP) laser treatment for benign vocal fold lesions yields significant reduction in lesion size with favorable effects on both mucosal wave and glottic closure. However, these previous studies omitted voice‐related outcomes. We sought to compliment these previous data with voice‐related outcomes in a cohort of patients undergoing KTP ablation of vocal fold polyps.

Study Design

Retrospective outcomes study.

Methods

Voice Handicap Index (VHI)−10 and acoustic measures were reviewed for 31 consecutive patients with benign vocal fold polyps treated with in‐office KTP laser surgery. All data were analyzed statistically via a mixed model fit to analyze the data from each of three clinical visits.

Results

Across all patients, the mean VHI‐10 scores decreased at first follow‐up from 19.7 to 9.7 (P < .0001). At subsequent follow‐up visits, the VHI‐10 scores remained stable (mean, 8.3). This shift in VHI scores was accompanied by favorable improvements in both noise‐to‐harmonic ratio and speaking fundamental frequency in both males and females.

Conclusions

In‐office KTP ablation of vocal fold polyps had a favorable effect on patient‐reported handicap as determined by the VHI‐10. This treatment also slightly altered physiologic measures of voice; however, these measures did not achieve statistical significance.

Level of Evidence

4. Laryngoscope, 124:1176–1179, 2014
Superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries
Authors: Darr E. Ashlie , Tufano Ralph P. , Ozdemir Suleyman , Kamani Dipti , Hurwitz Shelley , Randolph Gregory
Published: October 2013

Objectives/Hypothesis

To report normative electromyography (EMG) data on the external branch of the superior laryngeal nerve (EBSLN) and to compare this to analogous data of the recurrent laryngeal nerve (RLN) and vagus nerve (VN) during intraoperative neural monitoring (IONM) using both the standard monopolar stimulator probe and a novel bipolar stimulator probe.

Study Design

Prospective multiple tertiary care center study.

Method

A prospective study of EBSLN, RLN and VN EMG data in 22 thyroid surgeries was performed. Subjects with preoperative vocal fold paralysis were excluded. Postoperative laryngoscopy was normal in all subjects. Normative EMG data were acquired using both a standard monopolar and a novel bipolar stimulator probe, as well as a novel endotracheal tube. Cricothyroid muscle (CTM) twitch response during EBSLN stimulation was analyzed.

Results

In 100% of cases, EBSLN was identified and quantifiable EMG response was observed. EMG amplitude did not change despite extensive nerve dissection and multiple nerve stimulations. EBSLN amplitude was similar for left and right sides for patients under age 50 and aged 50 or older, for both genders, and with monopolar and bipolar stimulators.

Conclusions

Intraoperative neural monitoring may be used to safely assist in EBSLN identification during thyroid surgery in 100% of patients. A novel endotracheal tube allows for quantifiable EBSLN EMG activity in 100% of cases. Monopolar and bipolar stimulator probes produce similar EMG data.

Level of Evidence

4. Laryngoscope, 124:1035–1041, 2014
The vestibulo‐ocular reflex and subjective balance after vestibular schwannoma surgery
Authors: Batuecas‐Caletrio Angel , Santacruz‐Ruiz Santiago , Muñoz‐Herrera Angel , Perez‐Fernandez Nicolas
Published: October 2013

Objectives/Hypothesis

To evaluate the vestibulo‐ocular reflex and its relationship with subjective balance in a long‐term follow‐up after vestibular schwannoma surgery.

Study Design

Retrospective cohorts study in a tertiary referral hospital. Forty‐nine consecutive patients on which vestibular schwannoma surgery was performed at least 1 year before.

Methods

Patients are classified in accordance with the morphology of the vestibulo‐ocular reflex (VOR) into two groups: Group A, in which covert and overt saccades always occur in an organized fashion; and group B, in which covert and overt saccades randomly occur during head impulse and once finished. We evaluate the presence of covert and overt saccades and the morphology of the VOR measured by the video head impulse test (vHIT) and its relationship with subjective balance measured by Dizziness Handicap Inventory (DHI).

Results

The group B patients returned a higher score in total DHI and all three subscales without any predominant subscale (P = 0,0002; t test). Group B patients were older than those in group A (P = 0,024; t test). No differences were found in sex distribution, tumor size, or side or time interval after surgery. Regarding the unaffected side, overt saccades were found to be more frequent in group B patients (P = 0.05; X2).

Conclusions

Long‐term follow‐up after vestibular schwannoma surgery has shown that 22% of the patients display a particular abnormality in the VOR because refixation saccades occur in a random fashion after elicitation of the reflex in the HIT test. These patients report the higher level of vestibular disability and handicap.

Level of Evidence

2b. Laryngoscope, 124:1431–1435, 2014
Outcome with immediate direct anastomosis of recurrent laryngeal nerves injured during thyroidectomy
Authors: Hong Jong W. , Roh Tai S. , Yoo Han‐Su , Hong Hyun J. , Choi Hong‐Shik , Chang Hang S. , Park Cheong S. , Kim Young S.
Published: October 2013

Objectives/Hypothesis

Management of unrecognized recurrent laryngeal nerve injury typically entails delayed phonosurgical intervention and laryngeal reinnervation, but in cases of recognized injury, nerve anastomosis has been considered standard management. However, the well‐organized outcome analysis of nerve anastomosis has been insufficient. We performed immediate direct anastomosis of recurrent laryngeal nerves injured during surgery for thyroid cancer, and subsequent patient outcomes were analyzed.

Study Design

A total 14 patients sustaining recurrent laryngeal nerve injury during thyroidectomy were recruited for the study. Patients undergoing immediate direct reparative anastomosis of the injured nerves constituted the test group, whereas the controls of group 2 (n = 4) did not.

Methods

At follow‐up, all patients submitted to rigid laryngoscopy at 3, 6, and 12 months postoperatively. Subjective and objective outcomes of the two groups were then compared.

Results

At 12 months postoperatively, group 1 showed greater improvement in maximum phonation time, glottic gap scores, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, aspiration scoring, and Voice Handicap Index than controls of group 2. Moreover, group 1 showed an improvement in all five categories at 12 months postoperatively, compared with status at 3 months. None of the patients in group 1 showed laryngoscopic evidence of vocal cord atrophy.

Conclusion

In this study, patients undergoing immediate direct recurrent laryngeal nerve anastomosis demonstrated better phonation and perceptually rated voice quality than those who did not undergo repair.

Level of Evidence

3b. Laryngoscope, 124:1402–1408, 2014
Vocal fold pseudocyst: Results of 46 cases undergoing a uniform treatment algorithm
Authors: Estes Christine , Sulica Lucian
Published: October 2013

Objectives/Hypothesis

To describe treatment results and identify predictors of the need for surgical intervention in patients with vocal fold pseudocyst.

Study Design

Retrospective cohort study with longitudinal followup via survey.

Methods

Clinical records were reviewed for demographic information, VHI‐10 score, and degree of severity of dysphonia. Videostroboscopic examinations were evaluated for presence of vocal fold pseudocyst, along with additional clinical variables, including laterality, reactive lesion, paresis, varix, and hemorrhage. Follow‐up surveys were sent to all participants to evaluate current VHI‐10 score and degree of vocal limitation. Results were analyzed to determine predictors of surgery and recurrence of pathology.

Results

Forty‐six patients (41F:5M) with pseudocyst (40 unilateral: 6 bilateral) were reviewed. Twenty‐three (50%) had reactive lesions, nineteen (41%) had paresis by clinical criteria, 10 (22%) had varices, and 6 (13%) had hemorrhage on examination. All underwent initial behavioral management (2–12 sessions of voice therapy; mean of 8 sessions). Seventeen (37%) eventually required surgical intervention. No demographic or clinical variables proved predictive of surgical intervention. Follow‐up surveys were completed by 63% of patients, and 79% agreed with the statement that they were not professionally limited by their voices.

Conclusion

This experience supports behavioral management as an initial intervention in patients with pseudocyst, sufficient by itself to restore vocal function in approximately two out of three patients. Neither initial severity nor any of the studied clinical findings predicted the need for surgery. The large majority of patients with pseudocyst are able to be treated effectively without impact in their professional function.

Level of Evidence

4 Laryngoscope, 124:1180–1186, 2014
FARMING SYSTEMS IN TWO LESS FAVOURED AREAS IN PORTUGAL: THEIR DEVELOPMENT FROM 1989 TO 2009 AND THE IMPLICATIONS FOR SUSTAINABLE LAND MANAGEMENT
Authors: Jones Nádia , de Graaff Jan , Duarte Filomena , Rodrigo Isabel , Poortinga Ate
Published: October 2013

Since the late 1980s, sustainable land management is one of the objectives of the European Commission in Less Favoured Areas. In this paper, we investigate the economic and environmental sustainability of farming systems in two less favoured areas in Centro and Alentejo areas of Portugal. The specific objectives were the following: (i) to characterise the farming systems; (ii) to analyse their development over a 20‐year period (1989–2009); and (iii) to investigate to what extent these farming systems contribute to sustainable land management. The diversity of the farming systems was identified through a survey and cluster analysis and compared with the Farm Accountancy Data Network classification on types of farming. Indicators on the economic and environmental sustainability were estimated, namely, farm net income, return to labour and rotation management, on the basis of a survey, Farm Accountancy Data Network database and Landsat imagery, respectively. Results indicate an increased focus on livestock in the past 20 years (1989–2009). In Centro, rotation management was not affected. The small ruminant farms have been able to retain a positive farm net income but that was only possible with a below average return to labour. In Alentejo, the increased focus on livestock, cattle in particular, led to an intensification of fodder production on certain plots. Mixed crop–livestock farms show a negative farm net income since 1995 and depend heavily on subsidies to remain viable. As other studies in southern Europe have shown, farm strategies have often been directed towards lowering labour inputs, lowering forage deficits through on‐farm produced resources and acquiring subsidies. Copyright © 2013 John Wiley & Sons, Ltd.
Hepatitis E infection in liver transplant recipients
Authors: Unzueta Alberto , Rakela Jorge
Published: October 2013

Hepatitis E virus (HEV) infection (genotype 3) has been described in developed countries as a cause of chronic hepatitis in recipients of solid organ transplantation (SOT), with the first cases reported in 2008. Immunosuppression seems to play a major role in the pathogenesis of chronic infections. The current gold standard for the diagnosis of HEV infection is the detection of HEV RNA in serum, stools, or both. In liver transplant recipients, HEV infection is considered an uncommon disease; however, a high index of suspicion is needed for patients with graft hepatitis of an unclear etiology. Liver transplant recipients seem more likely to develop chronic HEV after an acute infection, and there is accelerated progression to advanced fibrosis and cirrhosis. A decrease in immunosuppression is considered the first line of treatment, and pegylated interferon can be considered the second line of treatment for liver transplant recipients. At the present time, there are not enough data to recommend treatment with ribavirin for adult liver transplant recipients, although this has been tried in other SOT populations. Liver Transpl 20:15–24, 2014. © 2013 AASLD.
Stimuli‐Responsive SiO2‐graft‐Poly(sodium acrylate) Hybrid Nanoparticles via Cu2+‐Amine Redox‐Initiated Radical Polymerization
Authors: Tao Feng , Chen Xiaobo , Zhai Guangqun
Published: October 2013

A novel strategy is proposed to initiate radical graft polymerization of sodium acrylate (NaAAc) from amine‐functionalized SiO2 nanoparticles (SiO2‐NH2) to prepare hybrid SiO2 nanoparticles with NaPAAc chains (SiO2‐g‐NaPAAc). The polymerization is carried out in aqueous media at ca. 70–90 °C using CuSO4 as an oxidizing agent. Cu2+ oxidizes primary amine into aminyl radicals, initiating radical graft polymerization of NaAAc. The hybrid SiO2‐g‐NaPAAc nanoparticles are characterized by infrared spectroscopy, thermal gravimetric analysis, and X‐ray photoelectron spectroscopy. The morphology is observed by electron microscopy. NaPAAc chains are successfully grafted from SiO2‐NH2, and the grafting yield is as high as 59.46 wt%. SiO2‐g‐NaPAAc exhibits a lower degree of aggregation compared with SiO2‐NH2 when dispersed in aqueous media. SiO2‐g‐NaPAAc exhibits a more stable dispersion in deionized water than SiO2‐NH2, and addition of a low‐molecular‐weight electrolyte reduced the stability of SiO2‐g‐NaPAAc in aqueous dispersion, due to the pH‐sensitive polyelectrolyte effect of NaPAAc chains.

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Tuning the Refractive Index of Homopolymer Blends by Controlling Nanoscale Domain Size via RIR‐MAPLE Deposition
Authors: McCormick Ryan D. , Cline Eric D. , Chadha Arvinder S. , Zhou Weidong , Stiff‐Roberts Adrienne D.
Published: October 2013

Anti‐reflection (AR) coatings designed for glass and other rigid, inorganic substrates are commercially available; however, these inorganic AR coatings tend to crack or delaminate on flexible substrates. A polymeric film with a gradient refractive index (GRIN) profile would make an ideal AR coating for flexible substrates, but such coatings are challenging to fabricate using traditional, solution‐based techniques. Emulsion‐based resonant infrared, matrix‐assisted pulsed laser evaporation (RIR‐MAPLE) offers a straightforward approach to enabling the desired GRIN profile in polymeric materials. Two homopolymers (polystyrene (PS) and poly(methyl methacrylate) (PMMA)) are deposited as a blend and one component (PMMA) is dissolved, leaving behind a porous PS film. The porosity and refractive index (RI) are controlled by the volume ratio of the two homopolymers in the film. Structural and optical characterizations, as well as comparison to modeled optical properties, confirm that porous films fabricated from polymer blends deposited by RIR‐MAPLE behave as effective media over most of the visible spectrum. While evidence for the partial collapse of the porous polymer networks is observed, the RI of the porous films is reduced from that of the bulk material. Importantly, these studies demonstrate that RIR‐MAPLE should enable broadband, omnidirectional, polymeric AR coatings appropriate for flexible substrates.

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Spontaneous Formation of Colloidal Crystals of PLA Stereocomplex Microspheres and their Hierarchical Structure
Authors: Brzeziński Marek , Biedroń Tadeusz , Tracz Adam , Kubisa Przemysław , Biela Tadeusz
Published: October 2013

In this paper, the combined effect of the influence of polylactide (PLA) end‐group nature and PLA architecture on the morphology of stereocomplexes formed during precipitation from organic solvent is investigated. Stereocomplexation of star‐shaped poly(l‐lactide) and linear poly(d‐lactide) functionalized with imidazolium ionic liquid end groups in 1,4‐dioxane leads to the formation of uniform microspheres, which are able to crystallize in the form of colloidal crystals. Microscopic scanning electron microscopy (SEM) and atomic force microscopy (AFM) analysis show the hierarchical structure of the system starting from the nanometrical grains composed of a few stereocomplex macromolecules that aggregate in uniform microspheres finally forming colloidal crystals of microspheres.

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RAFT Polymerization of 4‐Vinylphenylboronic Acid as the Basis for Micellar Sugar Sensors
Authors: Maji Samarendra , Vancoillie Gertjan , Voorhaar Lenny , Zhang Qilu , Hoogenboom Richard
Published: October 2013

Well‐defined homo and mPEGylated block (co)polymers of the commercially available unprotected 4‐vinylphenylboronic acid (4‐VBA) monomer are reported based on reversible addition–fragmentation chain transfer (RAFT) polymerization. The polymerization kinetics are studied in detail for homo and block (co)polymerizations with different chain transfer agents (CTAs) to optimize the preparation of well‐defined polymer structures, eventually leading to comparatively low dispersities (Đ ≤ 1.25). Subsequently, block (co)polymers with methoxy poly(ethylene glycol) mPEG‐b‐P(4‐VBA) are prepared using a mPEG‐functionalized CTA. The formed block copolymer mPEG114‐b‐P(4‐VBA)30 is demonstrated to be pH and glucose responsive as its micellization behavior is dictated by pH as well as the presence of glucose. The glucose‐responsive pH window of mPEG114‐b‐P(4‐VBA)30 is found to be pH 9–10 based on the DLS and TEM measurement.

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The succinated proteome
Authors: Merkley Eric D. , Metz Thomas O. , Smith Richard D. , Baynes John W. , Frizzell Norma
Published: October 2013

The post‐translational modifications (PTMs) of cysteine residues include oxidation, S‐glutathionylation, S‐nitrosylation, and succination, all of which modify protein function or turnover in response to a changing intracellular redox environment. Succination is a chemical modification of cysteine in proteins by the Krebs cycle intermediate, fumarate, yielding S‐(2‐succino)cysteine (2SC). Intracellular fumarate concentration and succination of proteins are increased by hyperpolarization of the inner mitochondrial membrane, in concert with mitochondrial, endoplasmic reticulum (ER) and oxidative stress in 3T3 adipocytes grown in high glucose medium and in adipose tissue in obesity and diabetes in mice. Increased succination of proteins is also detected in the kidney of a fumarase deficient conditional knock‐out mouse which develops renal cysts. A wide range of proteins are subject to succination, including enzymes, adipokines, cytoskeletal proteins, and ER chaperones with functional cysteine residues. There is also some overlap between succinated and glutathionylated proteins, suggesting that the same low pKa thiols are targeted by both. Succination of adipocyte proteins in diabetes increases as a result of nutrient excess derived mitochondrial stress and this is inhibited by uncouplers, which discharge the mitochondrial membrane potential (ΔΨm) and relieve the electron transport chain. 2SC therefore serves as a biomarker of mitochondrial stress or dysfunction in chronic diseases, such as obesity, diabetes, and cancer, and recent studies suggest that succination is a mechanistic link between mitochondrial dysfunction, oxidative and ER stress, and cellular progression toward apoptosis. In this article, we review the history of the succinated proteome and the challenges associated with measuring this non‐enzymatic PTM of proteins by proteomics approaches. © 2013 Wiley Periodicals, Inc. Mass Spec Rev 33: 98–109, 2014.
Existence of a Glassy Layer in the Polymer‐Nanosheet Interface: Evidence from Molecular Dynamics
Authors: Gao Yangyang , Liu Jun , Zhang Liqun , Cao Dapeng
Published: October 2013

The interfacial polymer‐nanosheet behavior is investigated to fully understand the interfacial interaction mechanism. The emphasis is placed on the discussion whether a “polymer glassy layer” in the proximity of the nanosheet exists or not. Results indicate that a “polymer glassy layer” actually exists near the nanosheet surface for strongly attractive interfacial interaction. Moreover, the glass transition temperatures at different interfacial interactions are explored, and a gradient of polymer chain dynamics near the nanosheet surface is observed. In short, this work provides a valuable reference for understanding polymer‐nanosheet interfacial behavior.
Economic Downturn and Financing Innovative Startup Companies
Authors: Paik Yongwook , Woo Heejin
Published: October 2013

This study examines how fluctuations in the amount of capital flowing into venture funds affect the financing of innovative startup companies and how economic downturns affect such financing. We argue that the nature of the economic downturn can cause differential effects on the investment pattern. We find that venture capital firms invest more in early‐stage companies than in later‐stage companies when the amount of capital flowing into the market increases. We also find that venture capital firms invest less in early‐stage companies than in later‐stage companies during an economic downturn associated with the real sector, and that they invest more in early‐stage companies than in later‐stage companies during an economic downturn associated with the financial sector. This study contributes to the entrepreneurship literature by demonstrating how macroeconomic factors affect venture capital investment decisions. The study also delineates the implications of seeking market entry via venture capital financing by entrepreneurial companies. Copyright © 2013 John Wiley & Sons, Ltd.
Herpes simplex encephalitis relapse with chorea is associated with autoantibodies to N‐Methyl‐D‐aspartate receptor or dopamine‐2 receptor
Authors: Mohammad Shekeeb S. , Sinclair Kate , Pillai Sekhar , Merheb Vera , Aumann Tim D. , Gill Deepak , Dale Russell C. , Brilot Fabienne
Published: October 2013

Background

Movement disorder relapses after herpes simplex virus 1 (HSV1) encephalitis have been hypothesized to be secondary to postviral autoimmunity. Recently, a proportion of patients with HSV1 encephalitis (HSE) were shown to produce autoantibodies against N‐methyl‐D‐aspartate receptor (NMDAR).

Methods

We measured autoantibodies against NMDAR and dopamine‐2 receptor (D2R) expressed at the cell surface in the stored acute serum of 9 children with HSE, 3 of whom had a relapsing course with chorea.

Results

The 3 patients with chorea had elevated autoantibodies against NMDAR (n = 1), D2R (n = 1), or both (n = 1), whereas patients without chorea were negative (n = 6). The prospectively identified patient with chorea and NMDAR autoantibodies improved after early treatment with steroids, intravenous immunoglobulin, and cyclophosphamide, with reduction in serum NMDAR antibody titers.

Conclusions

These autoantibody findings lend support to the autoimmune hypothesis and the early use of immune suppression in post‐HSE chorea. © 2013 International Parkinson and Movement Disorder Society
Levodopa infusion improves impulsivity and dopamine dysregulation syndrome in Parkinson's disease
Authors: Catalán María José , de Pablo‐Fernández Eduardo , Villanueva Clara , Fernández‐Diez Servando , Lapeña‐Montero Teresa , García‐Ramos Rocío , López‐Valdés Eva
Published: October 2013

Background

Impulsivity and dopamine dysregulation syndrome are frequent complications of treatment in Parkinson's disease (PD).

Methods

We assessed the effect of jejunal levodopa infusion (JLI) on behavioral symptoms in 8 PD patients with motor complications and severe impulsivity and dopamine dysregulation syndrome (DDS), which had not be controlled before by adjusting oral medications. The infusion was delivered during 15 hours (daily dose 1007.2 ± 302.5 mg) and stopped at night time. Patients were reassessed after 25 ± 9 weeks of treatment with a stable dose of jejunal l‐dopa.

Results

Off periods and dyskinesias decreased by 27% and 20,7% respectively, compared to baseline. DDS and all types of impulse control disorders (ICDs) improved in all patients, with nearly complete symptom resolution. Punding improved in all 5 patients but disappeared completely in only 1.

Conclusions

Our experience suggests that l‐dopa infusion has a positive effect on both motor complications and behavioral disorders. This treatment approach deserves further controlled studies. © 2013 International Parkinson and Movement Disorder Society
Health‐related quality of life in early Parkinson's disease: The impact of nonmotor symptoms
Authors: Duncan Gordon W. , Khoo Tien K. , Yarnall Alison J. , O'Brien John T. , Coleman Shirley Y. , Brooks David J. , Barker Roger A. , Burn David J.
Published: October 2013

Nonmotor symptoms (NMS) are common in patients with established Parkinson's disease (PD) and have a major impact upon quality of life. We investigated the significance of NMS in relation to health‐related quality of life (HRQoL) in patients with newly diagnosed PD. Patients and healthy controls were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson's Disease Study. Prevalence of NMS was determined with the Non‐Motor Symptom Questionnaire. HRQoL was recorded with the 39‐item Parkinson's Disease Quality of Life Questionnaire (PDQ‐39). Further assessments included measures of motor disability, depression, sleep, and cognition. One hundred and fifty‐eight patients with newly diagnosed PD and 99 controls participated in this cross‐sectional study. Patients reported greater numbers of NMS than controls (mean 8.3 ± 4.3 versus 2.8 ± 2.5 symptoms; P < 0.001). Patients reported lowest HRQoL in the domains assessing bodily discomfort, mobility, and activities of daily living. Motor and nonmotor symptoms impacted negatively upon HRQoL scores. Patients with the postural instability and gait difficulty motor subtype reported worse HRQoL, compared with those with tremor‐dominant disease. Depression (P < 0.001), incomplete bowel emptying (P < 0.001), anxiety (P < 0.001), impaired concentration (P < 0.001), memory complaints (P < 0.001), and insomnia (P = 0.001) had the greatest negative impact upon HRQoL. NMS are common in patients with early PD and represent a significant cause of poorer health‐related quality of life. Cognitive, neuropsychiatric, and sleep disturbances are particularly associated with reduced well‐being. Screening and management of these symptoms should be prioritized at the time of diagnosis. © 2013 International Parkinson and Movement Disorder Society