bluuebunny/crossref_metadata_2025 huggingface dataset:
First Branchial Cleft Anomalies: Report of 12 Cases
Authors: Leu Yi-Shing , Chang Ko-Chang
Published: May 2019

First branchial cleft anomalies account for only 1-8% of all branchial anomalies. Several classification systems have been proposed to aid in the diagnosis of these defects. We present a series of 12 patients with first branchial cleft anomalies classified according to anatomic criteria. The preferred treatment is complete excision. For patients with acutely inflamed masses, surgery should be performed only after resolution of the infection has been achieved with adequate drainage in combination with antibiotic therapy.
Sarcoidosis with Nasal Obstruction and Septal Perforation
Authors: Baum Eric D. , Boudousquie Alan C. , Li Shiyong , Mirza Natasha
Published: May 2019

Although sarcoidosis is predominantly a pulmonary disorder, it often produces disease in the head and neck. For this reason, otolaryngologists should be comfortable in evaluating and treating the disease. The diagnosis of sarcoidosis often can be made with a biopsy of conjunctival or oral mucosa, even when disease manifestations are not apparent in those parts of the body.

In a case of sarcoidosis involving the nose, a 54-year-old black man had a pro life ration of small lumps on the tip of his nose. For many years, he had had daily epistaxis, anosmia and severe difficulty breathing through his nose. The bridge of his nose was deformed, and he had a large anterior septal perforation. Physical examination revealed palpable bilateral cervical lymphadenopathy. Laboratory test results were, for the most part, normal; however, fine-needle aspiration of one of the cervical lymph nodes showed multiple epithelioid granulomas with interspersed lymphocyte, and an incisional biopsy of the nasal tissue was highly suggestive of sarcoidosis. Unenhanced computed tomography also revealed widespread nasal inflammation and an abnormal soft tissue mass anterior to the maxilla consistent with chronic osteomyelitis. The patient's condition dramatically improved following treatment with oral prednisone; however, he considered undergoing reconstructive surgery for the noticeable nasal septal deformity.
Cholesteatoma of the Cerebellopontine Angle
Authors: Pulec Jack L.
Published: May 2019

Congenital cholesteatoma is the third most common tumor found in the cerebellopontine angle. It must be differentiated from acoustic neuromas, meningiomas, metastatic tumors, arachnoid cysts and lipomas. Symptoms include hemifacial spasm, progressive facial paralysis, hearing loss, tinnitus, vertigo, pain and otorrhea. Radiologic and magnetic resonance imaging frequently can be useful to establish a preoperative diagnosis. The treatment of choice is total removal of the lesion. Complete removal with preservation of normal structures is the most difficult and technically exacting procedure performed by the neurotologic surgeon. The clinical features and results from a series of 19 cases, nine of which extended into the cerebellopontine angle, are discussed.
Oral Candida albicans in Patients with Sjögren's Syndrome
Authors: Rhodus Nelson L. , Bloomquist Cynthia , Liljemark William , Bereuter Janna
Published: May 2019

Candida species are common inhabitants of the oral cavity of patients with salivary gland dysfunction. The purpose of this study was to determine the prevalence and density of oral Candida albicans in patients with Sjögren's syndrome, to assess the infectious agent's oral manifestations and to compare the number of colony-forming units (CFU) of C. albicans in patients with primary (n=9) and secondary Sjögren's (n=18) with the whole unstimulated salivary flow rate in each group. An age- and sex-matched group of control subjects (n=14) was selected for comparison.

An oropharyngeal collection of samples was taken from each subject and cultured. Quantitative cultures specific for C. albicans were obtained. The frequency distribution showed that more than 80% of all research subjects had positive results for C. albicans whereas the control subjects had no positive results. The most common lesion was erythematous candidiasis, followed by angular cheilitis. The Sjögren's subjects also demonstrated significantly higher numbers of C. albicans CFU than controls. Findings from this study demonstrate that patients with primary or secondary Sjögren's syndrome had significantly greater C. albicans colonization compared with the control population. C. albicans colonization was greater in primary Sjögren's patients than in secondary Sjögren's patients; however, the quantity of C. albicans found in each population was not universally relative to salivary flow.
Imaging in Neurofibromatosis Type 2: Screening Using Magnetic Resonance Imaging
Authors: Gillespie James E.
Published: May 2019

NF2 is a distinct entity characterized by bilateral eighth-nerve schwannomas, other intracranial schwannomas and meningiomas, and multiple spinal canal schwannomas, meningiomas and gliomas. Screening of the entire neural axis is mandatory because of the incidence of asymptomatic lesions. MRI is the technique of choice, particularly employing contrast-enhanced, T1-weighted sequences in multiple image planes.
Central Electrical Stimulation of the Auditory Pathway in Neurofibromatosis Type 2
Authors: Laszig Roland , Marangos Nicolas , Sollmann Wolf-Peter , Ramsden Richard T.
Published: May 2019

The auditory brainstem implant (ABI) is a viable treatment option for patients with neurofibromatosis type 2 (NF2) whom either vestibular schwannomas or the surgery used to remove them has rendered totally deaf. This device stimulates the central auditory pathways in a manner similar to the cochlear implant in individuals with a total hearing loss. A multichannel model with transcutaneous signal transmission is in use experimentally in both the United States and Europe. Of 14 patients implanted with the ABI in a European pilot study, 13 received auditory sensations at initial tuning.

Surgical implantation of the ABI is generally, but not always, performed at the same time as tumor removal, with the preferred route being the transmastoid-translabyrinthine approach. After insertion, monitoring of the device is required to optimize the location of its electrode on the cochlear nucleus complex.
The Distribution of Nasal Erectile Mucosa as Visualized by Magnetic Resonance Imaging
Authors: Ng Bernard A. , Ramsey Ruth G. , Corey Jacquelynne P.
Published: May 2019

We analyzed the distribution of nasal erectile tissue by reviewing five sets of magnetic resonance imaging scans that were obtained pre- and post-decongestion. We found that cavernous tissues were located at three sites: the inferior turbinate, the middle turbinate, and the nasal septum. This study reaffirms the findings of previous studies that were performed with other modalities such as computed tomography scanning and cadaver dissections.
Neurotologic Evaluation of Facial Nerve Paralysis Caused by Gunshot Wounds
Authors: Qiu William W. , Yin Shengguang S. , Pate William E. , Hardjasudarma M. , Stucker Fred J.
Published: May 2019

Facial nerve injury is one of the most common neurotologic sequelae of a gunshot wound (GSW) to the head or neck. However, few neurotologic studies have been performed on the nature and time course of such facial nerve impairments. This study was designed to characterize the neurotologic manifestations and time course of facial nerve paralysis caused by GSWs to the head and neck.

We conducted a battery of electrodiagnostic tests on 10 patients who had experienced traumatic facial paralysis due to a GSW to the head or neck. The etiologies of facial nerve paralysis—including direct injury, compression, fracture, and concussion of the temporal bone—were demonstrated by audiologic, radiologic, and surgical findings. Hearing loss and other cranial nerve injuries were also seen. Six of the 10 patients experienced a complete paralysis of the facial nerve and a poor recovery of its function. We also present a comprehensive case report on 1 patient as a means of discussing the evaluation of facial nerve function during the course of management.
Rheumatoid Pannus of the Cervical Spine: A Case Report of an Unusual Cause of Dysphagia
Authors: Kinney William C. , Scheetz Raymond J. , Strome Marshall
Published: May 2019

Dysphagia as an initial complaint in rheumatoid arthritis is rare. We describe the case of a 69-year-old woman with rheumatoid arthritis who presented with a 2-day history of acute dysphagia. Our evaluation revealed the cause of the dysphagia was the presence of rheumatoid pannus that involved the anterior cervical spine and compressed the esophagus. Although the otolaryngologic manifestations of rheumatoid arthritis usually relate to synovial involvement of the temporomandibular and cricoarytenoid joints, our case establishes that a rheumatoid pannus on the anterior cervical spine can cause dysphagia. We believe that this may be the first reported case of this clinical entity.
Mirror-Focused Handpiece for Laser-Assisted Uvulopalatoplasty for the Treatment of Snoring and Sleep Apnea
Authors: Wong Brian J.F. , Scott Geoffrey , Daly Cindy R.
Published: May 2019

We describe how a novel mirror-based laser handpiece device allows for the pinpoint coincidence of aiming and surgical beams during uvulopalatoplasty and other laser ablation procedures.
Multifocal Angiosarcoma of the Scalp: A Case Report and Review of the Literature
Authors: Kacker Ashutosh , Antonescu Cristina R. , Shaha Ashok R.
Published: May 2019

Multifocal angiosarcoma of the scalp is uncommon. Its risk factors include a history of radiotherapy and possibly sun exposure. Angiosarcoma is an aggressive tumor with a high propensity for both local recurrence and distant metastasis. Overall, the prognosis is poor. The size of the lesion is an important prognostic factor. Treatment modalities include surgery with wide margins (with or without adjuvant therapy) and multidrug chemotherapy, followed by radiotherapy. The local failure rate is high.
Approach to Surgery in the Middle Ear without the Need for an Aural Speculum
Authors: Raman R.
Published: May 2019

This article describes a new approach to permeatal surgery in the middle ear that does not require the use of an aural speculum.
Initial Report of Primary Sinusitis caused by an Atypical Pathogen (Mycobacterium Chelonae) in an Immunocompetent Adult
Authors: Spring Paul M. , Miller Robert H.
Published: May 2019

Primary sinonasal infections caused by atypical mycobacteria are rare. In fact, only four examples of a primary nontuberculous mycobacterial etiology of paranasal sinusitis have been cited in the literature. The patients in all these cases were infected with the human immunodeficiency virus and, by definition, they all had acquired immunodeficiency syndrome.

We present a report of an immunocompetent adult with a history of chronic sinusitis who consistently and repeatedly manifested a fast-growing, nonpigmented, atypical mycobacterium of the Runyon group IV category: Mycobacterium chelonae. The patient was successfully treated over a 3-year period with a combination of antimicrobial agents, multiple limited endoscopic sinus surgeries, and eventually a total globe-sparing maxillectomy. At this time, the patient is disease-free and has received no further treatment.

This case represents the first report of an immunocompetent adult host with a primary atypical mycobacterial infection of the paranasal sinuses. It also demonstrates the multimodal nature of the treatment of atypical mycobacterial infections. We also discuss the Byzantine classification scheme relative to atypical mycobacteria, the disease process in the immunocompromised host, and the various treatment options.
Endodermal sinus tumor of the maxillary sinus: A case report
Authors: Gangopadhyay Kunal , McArthur Peter D. , Martin Justin M. , Saleem Muhammad
Published: May 2019

Endodermal sinus tumor is an uncommon malignant germ cell tumor that occurs in both gonadal and extragonadal tissues. Endodermal sinus tumors of the head and neck, exclusive of the central nervous system, are rare. We report a case of endodermal sinus tumor arising from the maxillary sinus in a 4-year-old boy. Combined treatment with radiation therapy and chemotherapy resulted in complete tumor regression.
Vestibular surgery for Ménière's disease in the elderly: A review of techniques and indications
Authors: Rosenberg Seth I.
Published: May 2019

There are several safe and effective surgical options for the treatment of vertigo associated with Ménière's disease in the elderly patient. The choice of procedure depends on the patient's hearing status and overall health. Since 1987, combined retrolabyrinthine-retrosigmoid posterior fossa vestibular neurectomy was performed on 29 older patients who were in good physiologic health and whose hearing was better than 80 dB pure-tone average and 20% speech discrimination. Patients whose hearing is worse are offered transmastoid labyrinthectomy or transmeatal cochleovestibular neurectomy, barring contraindications. When extensive surgery is medically contraindicated and hearing is not a significant concern, cochleosacculotomy is preferred; this procedure has been performed with minimal morbidity on patients as old as 85. Finally, over the past several years, patients have been treated with transtympanic placement of gentamicin. Early results with this office-based local procedure demonstrate a high cure rate, but also a high incidence of sensorineural hearing loss.
Age as a Factor in the Success of Tympanoplasty: A Comparison of Outcomes in the Young and Old
Authors: Emmett John R.
Published: May 2019

In order to determine if age is a factor in healing after tympanic membrane grafting, the author compared the results of 163 consecutive type I tympanoplasties performed on patients aged 20 to 40 with those of 97 consecutive type I tympanoplasties performed on patients aged 65 and older. The tympanoplasties were performed over a 5-year period. The postoperative followup period ranged from 6 to 10 years. The author found no difference in the success or failure of the graft-take rates between the two groups. Therefore, it would appear that in general, age is not a factor in the success or failure of healing following tympanoplasty surgery.
Management of Anesthesia in Geriatric Patients Undergoing Head and Neck Surgery
Authors: Moorthy S.S. , Radpour Shokri
Published: May 2019

Surgical outcomes of patients aged 65 and older depend in part on the patient's physiologic status and coexisting disease and whether the surgery is elective or urgent. As our overall population continues to grow older, more elderly patients with head and neck cancers are being scheduled for surgery. In addition to the usual problems of aging, older head and neck surgery patients have unique airway issues that must be addressed preoperatively. Likewise, thorough planning for perioperative management is imperative to reduce morbidity and mortality. Because pharmacokinetics and pharmacodynamics are different in older patients than in younger patients, the administration of anesthesia must be adjusted accordingly.
The Impact of Comorbidity and Age on Survival with Laryngeal Cancer
Authors: Sabin Steven L. , Rosenfeld Richard M. , Sundaram Krishnamurthi , Har-El Gady , Lucente Frank E.
Published: May 2019

Previous studies have evaluated the effects of comorbidity on survival in patients with cancer. We applied the Charlson comorbidity index (CCI) to a cohort of patients with laryngeal cancer to validate its use and to assess the prognostic impact of age. Our study population consisted of 152 patients with laryngeal cancer who were seen over a 10-year period. Patients were assigned CCI scores and were categorized into low- and high-grade comorbidity groups for comparison. Age adjustments were performed by adding 1 point to the Charlson score for each decade over the median age.

Low- vs. high-grade comorbidity was a valid predictor of survival independent of TNM (tumor, nodes, and metastases) stage. Low-grade comorbidity was present in 126 patients; their median survival was 41 months. High-grade comorbidity was present in 26 patients; their median survival was 8 months (p = 0.0002). The addition of the age factor to the CCI did not improve our prognostic ability. There was no difference in CCI groups with respect to tobacco and alcohol use, gender, treatment modality, or mean time to recurrence. The incidence and severity of complications were also similar in the two groups.

We conclude that the CCI is a strong predictor of survival inpatients with laryngeal cancer. The confounding effects of comorbidity should be considered in the TNM staging of laryngeal cancer to improve our prognostic ability. Further investigations are necessary to assess the validity of this index inpatients with other head and neck cancers.
Nasal Mucociliary Clearance and Nasal and Oral pH in Patients with Insulin-Dependent Diabetes
Authors: Selimoglu Mukadder Ayse , Selimoglu Erol , Kurt Aynur
Published: May 2019

We studied 32 patients with insulin-dependent diabetes mellitus to determine how their rate of mucociliary clearance and their levels of nasal and oral pH compared with those of 10 nondiabetic controls and how these rhinologic measurements varied within different subsets of diabetic patients. Although we found very few statistically significant differences in all our comparisons, we did find that nasal mucociliary clearance and oral pH levels in the diabetic patients were significantly different from those of healthy subjects.
The Use of ENT-Prescribed Home Sleep Studies for Patients with Suspected Obstructive Sleep Apnea
Authors: Davidson Terence M. , Do Katherine L. , Justus Susan
Published: May 2019

Sleep disordered breathing, including obstructive sleep apnea, is a common and morbid health problem. Traditionally, sleep disordered breathing is diagnosed by complex sleep studies. However, newer, easy-to-use, highly sensitive, and highly specific home sleep study equipment is now available. The present study was undertaken to determine whether an otolaryngologist could easily and effectively dispense home sleep equipment from the office. We used a portable AutoSet home sleep machine. Our experience with the first 100 consecutively presenting patients was recorded and analyzed under institutional review board approval.

Ninety-nine of the 100 tests were completed successfully on the first attempt; the one failure was successful on the second attempt. Our results were consistent with those reported from in-house polysomnogram sleep studies; 71 % of our patients had an apnea-hypopnea index (AH1) of 15 or higher, and 93% had an AHI of at least 5. We conclude that an otolaryngologist, using state-of-the-art home sleep testing equipment, can accurately and cost-effectively prescribe home sleep studies.
Predicting which Patients will Benefit from Surgery for Obstructive Sleep Apnea: The ENT Exam
Authors: Woodson B. Tucker
Published: May 2019

Airway evaluation is critical for surgical decision making. In patients with obstructive sleep apnea (OSA), a minimal evaluation should include a basic head and neck physical examination to evaluate for overt pathology. An upper airway examination will also provide insight into identifying patients with a higher risk of OSA. For patients who are evaluated for surgery, endoscopy combined with cephalometrics is the most accepted method of identifying patients with retroglossal collapse and obstruction. A new paradigm suggests that most patients have multilevel obstruction, so examination should be directed at assessing risk factors to direct the aggressiveness of surgical intervention.
Operative Techniques of Uvulopalatopharyngoplasty
Authors: Fairbanks David N. F.
Published: May 2019

Uvulopalatopharyngoplasty is, for the most part, both safe and effective as a surgical treatment for obstructive sleep apnea and severe snoring. Most complications can be avoided with proper surgical technique. Palatal dysfunction can be avoided if the shortening of the soft palate in the midline (uvula) area is minimized. Nasopharyngeal stenosis can be avoided with minimization of the posterior pillar resection and by avoidance of pharyngeal undermining. The effectiveness of surgery can be improved by placing emphasis 1) on opening the nasopharynx widely in the lateral port areas and 2) on tissue removal deep in the inferior tonsillar poles (and hypopharynx) with mucosal advancement and suturing.
Safety of Endoscopic Sinus Surgery in a Residency Training Program
Authors: Nguyen Quoc A. , Cua David J. , Ng Matthew , Rice Dale H.
Published: May 2019

Over the past decade, endoscopic sinus surgery has become one of the most frequently performed operations in otolaryngology. Nevertheless, concerns have been raised about the safety of this procedure in a residency training program. To address this issue, we carried out a retrospective review to assess the complications of endoscopic sinus surgery performed by otolaryngology residents under close supervision. We reviewed the medical records of 597 patients who had undergone 719 operations performed by residents in the Department of Otolaryngology–Head and Neck Surgery at the University of Southern California–Los Angeles County Medical Center and at the University Hospital between June 1988 and December 1995. Most of these procedures were performed by junior residents under the supervision of either a senior resident or faculty member.

We found that the incidence of minor and major complications was 12.2 and 0.4%, respectively. The most common minor complications were vascular. The only major complication was excessive bleeding that required transfusion. There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. We conclude that endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.
Clinical Impact of Sonographically Guided Biopsy of Salivary Gland Masses and Surrounding Lymph Nodes
Authors: Feld Rick , Nazarian Levon N. , Needleman Laurence , Lev-Toaff Anna S. , Segal Sharon R. , Rao Vijay M. , Bibbo Marluce , Lowry Louis D.
Published: May 2019

Although fine-needle aspiration biopsy of salivary gland masses has been reported in the otolaryngology literature, the use of sonography to guide the biopsy of nonpalpable masses and masses seen on other cross-sectional imaging studies has not been described. Our goal was to evaluate sonographically guided biopsy of masses and lymph nodes related to the salivary glands.

We analyzed the records of 18 patients who had undergone fine-needle aspiration biopsy of a salivary gland mass or lymph node with a 25-, 22-, or 20-gauge needle. A definitive cytologic diagnosis was made for 13 of the 18 patients (72%); cytology was suggestive but not definitive in three patients (17%) and insufficient in two (11%). Definitive diagnoses were made in three cases of reactive lymph node, in two cases each of lymph node metastasis and Warthin's tumor, and in one case each of pleomorphic adenoma, adenoid-cystic carcinoma, schwannoma-neurofibroma, parotid metastasis, parotid lymphoma, and Sjögren ‘s-related lymphoid-epithelial lesion.

Sonographically guided biopsy allows for confident needle placement in masses seen on computed tomography and magnetic resonance imaging. Sonography can usually distinguish a perisalivary lymph node from true intrasalivary masses, and it can help the surgeon avoid the pitfall of a nondiagnostic aspiration of the cystic component of masses. We conclude that sonographically guided biopsy of salivary gland masses can provide a tissue diagnosis that can have a direct impact on clinical decision making.
Time and Organization Studies
Authors: Holt Robin , Johnsen Rasmus
Published: May 2019

We argue that the more time is being attended to in organization studies, the more it is concealed. The time being concealed is not the time of clocks or the linear passage of past, present and future, it is not the time of temporal structures, and it is not the time of processual flow by which all substance is held as little more than a temporary arrest. In all these understandings time is treated as something available and, potentially, affirmative. Rather, it is a time that barely a few hundred years ago was considered a force always present and yet always against us. What, we ask, has happened to this time, the time beyond organization?
Shared Medical Appointments: An Innovative Model to Reduce Health Disparities Among Latinxs With Type-2 Diabetes
Authors: Noya Carolina Espinosa , Chesla Catherine , Waters Catherine , Alkon Abbey
Published: May 2019

In the United States, diabetes is epidemic. A study of Latinxs with diabetes evaluated a behavioral shared medical appointment (SMA) intervention. This quasi-experimental study included nonrandomized matched control group participants receiving usual care. The nonprobability convenience sample consisted of 90 participants (SMA = 30; control = 60) receiving primary care at an FQHC (Federally Qualified Health Center) clinic. At 6 months, the percentage of participants achieving target A1C goals was greater in the intervention group (59%) than in the control group (31%; χ2 = 4.462, p ≤ .05). In a multiple regression model, the SMA intervention group, compared to the control group had an A1C decline at 3 months of 0.55% ( b = - 0.55, t = - 1.48, p=.14) and an A1C decline at 6 months of 0.83% ( b= - 0.83, t= - 2.25, p = .03). Therefore, the results showed 3- and 6-month declines that were greater in the SMA group than in the control group. Underserved, underinsured Latinxs in the ALDEA program achieved significant A1C reductions; the program succeeded in empowering Latino patients and improving glycemic control.
Impact of Distraction Osteogenesis Maxillary Expansion on the Internal Nasal Valve in Obstructive Sleep Apnea
Authors: Abdelwahab Mohamed , Yoon Audrey , Okland Tyler , Poomkonsarn Sasikarn , Gouveia Chris , Liu Stanley Yung‐Chuan
Published: May 2019

Objective

To assess the effect of distraction osteogenesis maxillary expansion (DOME) on objective parameters of the internal nasal valve and correlate findings with subjective outcomes.

Study Design

Retrospective cohort study.

Setting

Tertiary referral center.

Subjects and Methods

After Institutional Review Board approval, included subjects were those with obstructive sleep apnea, had undergone DOME from September 2014 to April 2018, and had cone beam computed tomography scans available before and after expansion. Measurement of the internal nasal valve parameters was performed with Invivo6 Software (version 6.0.3). Interrater reliability of all pre‐ and postexpansion parameters was measured. Patient‐reported outcome measures included the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) and Epworth Sleepiness Scale scores, and correlation between objective and subjective outcomes were evaluated by Spearman correlation analysis.

Results

Thirty‐two subjects met inclusion criteria. All showed significant improvement in their subjective outcomes as well as an increase in their internal valve parameters. Significant correlation was observed between increased angles and improvement in postexpansion NOSE score (right angle, P =. 024; left angle, P =. 029).

Conclusion

DOME widens the internal nasal valve objectively (dimensions), which correlates significantly with subjective improvement (NOSE scores).
Upper Airway Stimulation Response in Older Adults with Moderate to Severe Obstructive Sleep Apnea
Authors: Withrow Kirk , Evans Sean , Harwick John , Kezirian Eric , Strollo Patrick ,   ADHERE Registry Investigators
Published: May 2019

Objective

To evaluate the impact of age on safety, efficacy, and usage of upper airway stimulation (UAS).

Study Design

Multicenter observational study.

Setting

Thirteen US hospitals and 3 German hospitals.

Subjects and Methods

The ADHERE registry is a multicenter database enrolling patients undergoing UAS implantation from October 2016 to April 2018. Outcome measures included the Epworth Sleepiness Scale, apnea‐hypopnea index (AHI), therapy usage, and complications. Data were segmented by age (<65 vs ≥65 years).

Results

Younger adults (n = 365) were a mean ± SD 52.7 ± 7.9 years old and 82% male, with a body mass index of 29.6 ± 3.8. Older adults (n = 235) were 71.1 ± 4.8 years old and 71% male, with a body mass index of 28.8 ± 3.8. Baseline AHI was similar (younger, 36.2 ± 15.9; older, 36.1 ± 14.8). Both groups had lower AHI at 12 months versus baseline (P <. 001), but the older group showed a greater reduction (7.6 ± 6.9 vs 11.9 ± 13.4, P =. 01). The Epworth Sleepiness Scale score decreased from 12.3 ± 5.4 to 7.1 ± 4.8 (P <. 001) among younger adults and from 10.7 ± 5.7 to 6.3 ± 4.4 (P <. 001) among older adults. Usage was slightly higher among older adults (6.0 ± 2.0 vs 5.4 ± 2.1 hours/night, P =. 02). Surgical time was similar between younger patients (2.4 ± 0.7 hours) and older patients (2.3 ± 0.7 hours, P =. 40), with comparably low complications.

Conclusion

AHI reduction and therapy usage were found to be somewhat higher among patients aged ≥65 years who were treated with UAS. Surgical complications were low, in contrast to traditional sleep surgery.
High‐Frequency Ultrasound: A Novel Diagnostic Tool to Measure Pediatric Tonsils in 3 Dimensions
Authors: Kay‐Rivest Emily , Saint‐Martin Christine , Daniel Sam J.
Published: May 2019

Objective

A wide variety of pathologies can affect the palatine tonsils. Ultrasound is a commonly used modality for assessing head and neck masses in children; however, its use in tonsillar evaluation has not been widely explored. The objective of this study was to measure 3‐dimensional tonsillar size with ultrasound, in centimeters, and correlate these measurements with actual ex vivo dimensions on pathology specimens.

Study Design

We performed a prospective cohort study.

Setting

The study was set in a tertiary care children’s hospital.

Subjects and Methods

Children undergoing tonsillectomy were included in the study. Transcervical high‐frequency ultrasonography (HFU) was performed prior to surgery to obtain 3‐dimensional measurements of the right and left palatine tonsils. Mean sizes were compared to ex vivo tonsil measurements and correlations were obtained.

Results

Seventy‐five consecutive children underwent a transcervical HFU, with a total of 150 tonsils analyzed. The mean differences between HFU and pathology measurements were −0.08 cm and −0.24 cm for the right and left craniocaudal axes, −0.19 cm and −0.18 cm for the right and left mediolateral axes, and 0.05 cm and 0.03 cm for the right and left anteroposterior axes. Correlation coefficients between ultrasound and pathology measurements were all above 0.5.

Conclusion

HFU can accurately measure the size of pediatric tonsils in 3 dimensions.
Using Interpretative Phenomenological Analysis in music education research: An authentic analysis system for investigating authentic learning and teaching practice
Authors: Crawford Renée
Published: May 2019

Interpretative Phenomenological Analysis (IPA) is an experiential research methodology that aims to rigorously investigate personal meaning and lived experience. Informed by phenomenological philosophy, hermeneutics and idiography, IPA allows researchers to conduct a detailed exploration of how participants construct meaning from their personal and social contexts. The method has been applied further afield in social science disciplines such as education. This article provides insight into the process of conducting IPA in music education research, which is illustrated by material taken from studies conducted by the author who began using the analysis system in 2005. In this context IPA is regarded as an authentic approach situated in constructivism for exploring and interpreting authentic learning and teaching practice. It is proposed that such an approach can be used in music education qualitative research studies to provide an evidence-base for practice.
Looking at the World in the Light of Jubilee
Authors: Swithinbank Hannah J
Published: May 2019

This article provides an introduction to the topic of reflection in this special issue – jubilee – and to the value of thinking theologically about the ways in which jubilee illuminates and provides Christian responses to the poverty and inequalities being faced by churches around the world. It also provides an introduction to the articles included in this special issue, which is edited by Tearfund in honour of its 50th anniversary.
Jubilee, Discipleship and Social Rest
Authors: Tiessen Calvin
Published: May 2019

As we structure the economic and social practices of the communities, institutions and nations of which we are all a part, jubilee calls us to discipleship. Jubilee speaks to the creation of societies of hope, of celebration and of prosperity. It is about the creation of social rest as we rest in God. This requires the careful and intentional formation of agents of social rest. Jubilee clearly advocates for proactive rather than reactive social practices in relation to immediate needs as well as long-term social legacy. Jubilee clearly addresses six of the 10 principles for just peacemaking.
Dance of the New Beginning: Jubilee as a Vision for New Community
Authors: Jakawa Rahila L.
Published: May 2019

God’s purposeful design is for humanity to flourish. Over the years, one of the greatest problems confronting Nigeria, and indeed Africa, has been poverty. Poverty has denied many the right to enjoy the life God designed for them. It has brought untold misery to many people. Many have been enslaved even in their ancestral lands by the rich because of poverty induced by injustice. Poverty, especially in Nigeria, is not due to lack of human and natural resources but to sheer greed leading to unequal distribution of wealth, imbalanced opportunities for empowerment and corruption. As a result, the scourge of poverty continues to affect people. This article looks at ways of interpreting and using the principles of jubilee in Leviticus 25 to build a new community that transforms humanity. It argues that the principles of jubilee, which include an invitation to partnership with God and humanity, faithful stewardship, equal economic and political opportunities, forgiveness of debts, love and concern for ecology, are germane in addressing the problem of poverty.
Cannabidivarin completely rescues cognitive deficits and delays neurological and motor defects in male Mecp2 mutant mice
Authors: Zamberletti Erica , Gabaglio Marina , Piscitelli Fabiana , Brodie James S , Woolley-Roberts Marie , Barbiero Isabella , Tramarin Marco , Binelli Giorgio , Landsberger Nicoletta , Kilstrup-Nielsen Charlotte , Rubino Tiziana , Di Marzo Vincenzo , Parolaro Daniela
Published: May 2019

Background:

Recent evidence suggests that 2-week treatment with the non-psychotomimetic cannabinoid cannabidivarin (CBDV) could be beneficial towards neurological and social deficits in early symptomatic Mecp2 mutant mice, a model of Rett syndrome (RTT).

Aim:

The aim of this study was to provide further insights into the efficacy of CBDV in Mecp2-null mice using a lifelong treatment schedule (from 4 to 9 weeks of age) to evaluate its effect on recognition memory and neurological defects in both early and advanced stages of the phenotype progression.

Methods:

CBDV 0.2, 2, 20 and 200 mg/kg/day was administered to Mecp2-null mice from 4 to 9 weeks of age. Cognitive and neurological defects were monitored during the whole treatment schedule. Biochemical analyses were carried out in brain lysates from 9-week-old wild-type and knockout mice to evaluate brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) levels as well as components of the endocannabinoid system.

Results:

CBDV rescues recognition memory deficits in Mecp2 mutant mice and delays the appearance of neurological defects. At the biochemical level, it normalizes BDNF/IGF1 levels and the defective PI3K/AKT/mTOR pathway in Mecp2 mutant mice at an advanced stage of the disease. Mecp2 deletion upregulates CB1 and CB2 receptor levels in the brain and these changes are restored after CBDV treatment.

Conclusions:

CBDV administration exerts an enduring rescue of memory deficits in Mecp2 mutant mice, an effect that is associated with the normalization of BDNF, IGF-1 and rpS6 phosphorylation levels as well as CB1 and CB2 receptor expression. CBDV delays neurological defects but this effect is only transient.
Exploring the Impact of Adding a Respiratory Dimension to the EQ-5D-5L
Authors: Hoogendoorn Martine , Oppe Mark , Boland Melinde R. S. , Goossens Lucas M. A. , Stolk Elly A. , Rutten–van Mölken Maureen P. M. H.
Published: May 2019

Objectives. To evaluate the impact of adding a respiratory dimension (a bolt-on dimension) to the EQ-5D-5L health state valuations. Methods. Based on extensive regression and principal component analyses, 2 respiratory bolt-on candidates were formulated: R1, limitations in physical activities due to shortness of breath, and R2, breathing problems. Valuation interviews for the selected bolt-ons were performed with a representative sample from the Dutch general public using the standardized interview protocol and software of the EuroQol group. Hybrid models based on the combined time-tradeoff (TTO) and discrete choice experiment (DCE) data were estimated to assess whether the 5 levels of the respiratory bolt-on led to significant changes in utility values. Results. For each bolt-on candidate, slightly more than 200 valuation interviews were conducted. Mean TTO values and DCE choice probabilities for health states with a level 4 or 5 for the respiratory dimension were significantly lower compared with the same health states in the Dutch EQ-5D-5L valuation study without the respiratory dimension. Results of hybrid models showed that for the bolt-on “limitations in physical activities,” the utility decrements were significant for level 3 (–0.055), level 4 (–0.087), and level 5 (–0.135). For “breathing problems,” the utility decrements for the same levels were greater (–0.086, –0.219, and –0.327, respectively). Conclusions. The addition of each of the 2 respiratory bolt-ons to the EQ-5D-5L had a significant effect on the valuation of health states with severe levels for the bolt-on. The bolt-on dimension “breathing problems” showed the greatest utility decrements and therefore seems the most appropriate respiratory bolt-on dimension.
First experiences of a low-dose protocol for CT-guided musculoskeletal biopsies combining different radiation dose reduction techniques
Authors: Alagic Zlatan , Alagic Haris , Bujila Robert , Srivastava Subhash , Jasim Saif , Lindqvist Maria , Wick Marius C
Published: May 2019

Background

The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator.

Purpose

To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting.

Material and Methods

Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow.

Results

In group A, the mean total dose-length product (DLP) was 41.2 ± 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 ± 22.0 mGy*cm), corresponding to a mean dose reduction of 84% ( P<0.001). The mean CTDIvol for the control scans were 1.88 ± 0.09 mGy and 13.16 ± 0.40 mGy for groups A and B, respectively ( P < 0.001). The success rate in group A was 91.2% and 87.9% in group B ( P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found.

Conclusion

We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.
Comparison of ultrasonography and CT for preoperative nodal assessment of patients with papillary thyroid cancer: diagnostic performance according to primary tumor size
Authors: Yang So Yeon , Shin Jung Hee , Hahn Soo Yeon , Lim Yaeji , Hwang Seok Young , Kim Tae Hyuk , Kim Jee Soo
Published: May 2019

Background

Indications for computed tomography (CT) in preoperative patients with thyroid cancer are still controversial.

Purpose

To determine the value of CT and ultrasonography (US) in preoperative lymph node assessment of patients with papillary thyroid carcinoma (PTC) according to primary tumor size.

Material and Methods

A total 453 patients with surgically proven PTC who underwent US and CT for preoperative evaluation in 2010 at our tertiary referral center were included. The diagnostic sensitivity, specificity, and accuracy of US, CT, and the combination of US and CT (US/CT) in the preoperative nodal assessment were compared. We performed subgroup analysis to compare the findings according to primary tumor size.

Results

In overall tumors, adding CT to US had greater sensitivity, lower specificity, and greater accuracy in predicting central lymph node metastasis (LNM) but lower accuracy in prediction of lateral LNM. In smaller cancers (≤1 cm), US alone had greater specificity and accuracy than CT alone or US/CT in predicting lateral LNM. In larger cancers (>1 cm), CT had greater sensitivity and accuracy than US in predicting central LNM, while US had greater specificity and accuracy than CT in predicting lateral LNM. There were no patients with smaller tumors who showed retropharyngeal and superior mediastinal LNM diagnosed by CT alone.

Conclusion

CT is superior to US for detecting central LNM in preoperative patients with PTCs > 1 cm. However, there are no benefits to adding CT to US to predict lateral LNM in small cancers (≤1 cm).
Quantitative PET/MR imaging of lung cancer in the presence of artifacts in the MR-based attenuation correction maps
Authors: Kuttner Samuel , Lassen Martin Lyngby , Øen Silje Kjærnes , Sundset Rune , Beyer Thomas , Eikenes Live
Published: May 2019

Background

Positron emission tomography (PET)/magnetic resonance (MR) imaging may become increasingly important for assessing tumor therapy response. A prerequisite for quantitative PET/MR imaging is reliable and repeatable MR-based attenuation correction (AC).

Purpose

To investigate the frequency and test–retest reproducibility of artifacts in MR-AC maps in a lung cancer patient cohort and to study the impact of artifact corrections on PET-based tumor quantification.

Material and Methods

Twenty-five lung cancer patients underwent single-day, test–retest, 18F-fluorodeoxyglucose (FDG) PET/MR imaging. The acquired MR-AC maps were inspected for truncation, susceptibility, and tissue inversion artifacts. An anatomy-based bone template and a PET-based estimation of truncated arms were employed, while susceptibility artifacts were corrected manually. We report the frequencies of artifacts and the relative difference (RD) on standardized uptake value (SUV) based quantification in PET images reconstructed with the corrected AC maps.

Results

Truncation artifacts were found in all 50 acquisitions (100%), while susceptibility and tissue inversion artifacts were observed in six (12%) and 26 (52%) of the scans, respectively. The RD in lung tumor SUV was < 5% from bone and truncation corrections, while up to 20% RD was introduced after susceptibility artifact correction, with large inconsistencies between test–retest scans.

Conclusion

The absence of bone and truncation artifacts have limited effect on the PET quantification of lung lesions. In contrast, susceptibility artifacts caused significant and inconsistent underestimations of the lung tumor SUVs, between test–retest scans. This may have clinical implications for patients undergoing serial imaging for tumor therapy response assessment.
The accuracy of elastographic strain ratio and ultrasound thickness in the differentiation of thin and thick cutaneous melanoma
Authors: Berghe Alexandra S , Şenilă Simona C , Rogojan Liliana , Lenghel Lavinia M , Bolboacă Sorana D , Solomon Carolina M
Published: May 2019

Background

Cutaneous melanoma is the most deadly of skin neoplasms. Few studies have investigated the role of elastography characteristics so the ability of elastography in the differentiation of thin and thick cutaneous melanoma is still narrow.

Purpose

To investigate the accuracy of elastography in differentiating thin and thick melanoma, by measuring strain ratio (SR) between the lesion and adjacent dermis and hypodermis.

Material and Methods

We investigated by ultrasound and elastography 52 melanoma lesions in 49 patients. The receiver operating characteristic (ROC) curve method was used to investigate the accuracy of ultrasound and elastographic measurement of SR to surrounding tissue, in the differentiation of thin and thick melanomas. The histopathological measurement of lesions depth called Breslow index was the golden standard test.

Results

Areas under the curve (AUC) showed low accuracy for SR to hypodermis in distinguishing between thin melanomas and others (AUC = 0.739, 95% confidence interval [CI] = 0.508–0.970]) with a cut-off value of 0.950, being the only statistically significant result in matter of elastographic measurements. Highly statistically significant results were obtained for B-mode ultrasound depth measurements of the lesion, with an AUC = 0.970 (95% CI = 0.927–1.0) in discriminating thin melanomas of others and 0.951 (95% CI = 0.869–1.0) in discriminating thick melanomas of other types.

Conclusion

Despite the appearance that SR may correlate with the depth of the lesion, elastography, by measuring the SRs to dermis and hypodermis, does not have enough accuracy in distinguishing thin and thick melanoma.
Transit Route Origin–Destination Matrix Estimation using Compressed Sensing
Authors: Kumar Pramesh , Khani Alireza , Davis Gary A.
Published: May 2019

The development of an origin–destination (OD) demand matrix is crucial for transit planning. With the help of automated data, it is possible to estimate a stop-level OD matrix. We propose a novel method for estimating transit route OD matrix using automatic passenger count (APC) data. The method uses [Formula: see text] norm regularizer, which leverages the sparsity in the actual OD matrix. The technique is popularly known as compressed sensing (CS). We also discuss the mathematical properties of the proposed optimization program and the complexity of solving it. We used simulation to assess the accuracy and efficiency of the method and found that the proposed method is able to recover the actual matrix within small errors. With increased sparsity in the actual OD matrix, the solution gets closer to the actual value of the matrix. The method was found to perform more efficiently even for different demand patterns. We also present a real numerical example of OD estimation of the A Line Bus Rapid Transit (BRT) route in Twin Cities, MN.