bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Endonasal Management of Recurrent Maxillary Mucoceles Using Biliary T-Tube Stenting
Authors: Ono Noritsugu , Ito Shin , Homma Hirotomo , Okada Hiroko , Murata Junko , Ikeda Katsuhisa
Published: December 2018

Mucoceles of the paranasal sinus can be managed endoscopically with an extremely low recurrence rate. Frontal sinus mucoceles can sometimes be prevented from closing and reforming by stenting, which to the best of our knowledge has not yet been reported in the maxillary sinus. We describe the cases of 5 patients—3 men and 2 women, aged 47 to 75 years (mean; 59.6)—with a recurrent and intractable maxillary sinus mucocele that was managed with biliary T-tube stenting. The indications for stenting included recurrent episodes of mucocele with or without a lateral location with a relatively thick bony wall. A latex rubber pediatric biliary T-tube was endoscopically inserted through a window opening into the marsupialized mucocele. The stent was removed 6 to 14 months postoperatively in 4 cases; in the other case, the stent remained adequately positioned for 35 months. None of the patients experienced signs or symptoms of recurrence. We conclude that a T-tube stent can be used successfully to maintain long-term patency in patients with a recurrent and intractable maxillary mucocele, with patency being maintained even after removal of the stent.
Medical Malpractice and Transoral Robotic Surgery: Evaluation and Some Preemptive Thoughts
Authors: Lydiatt Daniel D. , Sewell Ryan
Published: December 2018

Medical malpractice is costly and disruptive, and it is important to prevent. We conducted a study with the objective to look at medical malpractice in robotic surgery overall, to evaluate reasons for litigation, and to comment on possible strategies to avoid litigation with transoral robotic surgery. We used the Westlaw computerized database to identify all state and federal verdict summaries in medical malpractice cases. We found 17 cases alleging malpractice that involved the use of robotic surgery. In all, the plaintiffs in 6 cases (35%) contended that an open rather than a robotic approach should have been used, 5 (29%) alleged negligent credentialing, 4 (24%) alleged training deficiencies, 2 (12%) alleged manufacturing problems, and 1 (6%) charged that robotic surgery should have been performed instead of open surgery (1 case involved two of these allegations). In 11 cases (65%), plaintiffs charged that robotic surgery contributed to an undesirable outcome, and in 6 cases (35%) they raised concerns about informed consent. In all, only 5 of the 17 lawsuits (29%) resulted in plaintiff verdicts or settlements; damages ranged from $95,000 to $7.5 million. We believe the courts should not play a major role in establishing safety guidelines for the introduction of new technology such as robotic surgery. Instead, training and credentialing guidelines should be established by appropriate national associations and societies to assist hospitals in doing so.
Risk of Posterior Semicircular Canal Trauma when using a Retrosigmoid approach for Acoustic Neuroma Surgery and role of Endoscopy: An Imaging Study
Authors: Kouhi Ali , Zarch Varasteh Vakili , Pouyan Ali
Published: December 2018

The rate of hearing preservation after vestibular schwannoma surgery is variable and is not as high as expected, possibly due to injuries to the posterior semicircular canal while exposing the tumor. The aim of this study was to estimate the risk of posterior semicircular canal injuries using temporal bone computed tomography (CT) scan findings. Temporal bone CT scans of 30 patients selected between 2013 and 2015 were studied. The median age of the patients was 40 years. Two planes were studied: (1) the axial plane that shows the common crus of the posterior semicircular canal and (2) the coronal plane that shows the two crura of the posterior semicircular canal. Five lines were drawn and four angles and three distances were measured. In this study, we divided the patients into three groups consisting of 10 patients each: (1) patients with no evidence of inflammatory or neoplastic disease, (2) those with chronic ear disease, and (3) those with vestibular schwannomas. The portion of the internal auditory canal that was exposed by drilling while preserving the posterior semicircular canal was 53 to 64% and 61 ± 9% in whole temporal bones in the three groups. The mean angle of vision with an endoscope was less than 105° in 56% of cases, which means even with a 30° endoscope, the fundus could not be visualized. Therefore, according to our data, it seemed impossible to expose the whole length of the internal auditory canal from the porus to the fundus without causing injury to the posterior semicircular canal. However, the use of endoscopes may help to prevent injury.
The Sensitivity and Specificity of Touch Preparation for Rapid Diagnosis of Invasive Fungal Sinusitis: A Pilot Study
Authors: Schuman Theodore A. , Nguyen Josephine H. , Yelverton Joshua C. , Almenara Jorge A. , Powers Celeste N.
Published: December 2018

Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; 2 of these patients underwent two and 1 patient had three separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23 to 0.85), specificity was 100% (95% CI: 0.60 to 1.00), positive predictive value was 100% (95% CI: 0.46 to 1.00), and negative predictive value was 67% (95% CI: 0.35 to 0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criterion for determining the need for surgical intervention.
A Case of Squamous Cell Carcinoma of the Nasal Cavity in a Patient with Granulomatosis with Polyangiitis (Wegener Granulomatosis)
Authors: Kuan Edward C. , Peng Kevin A. , Gonzalez Lyndon O. , Sercarz Joel A.
Published: December 2018

We report a rare case of squamous cell carcinoma (SCC) of the nasal cavity arising in a patient with granulomatosis with polyangiitis (GPA). The patient was a 35-year-old man who had been diagnosed 15 years earlier with GPA and treated medically for sinonasal, pulmonary, and renal involvement. He presented to us with left-sided orbital and cheek pain and nasal obstruction. Endoscopy detected a friable, exophytic mass that involved the left lateral nasal wall and septum. Biopsy analysis identified the mass as an SCC. A definitive endoscopic resection was performed, followed by chemoradiation, but the patient exhibited progression of disease 2 months after the cessation of therapy. He then underwent an open craniofacial resection and a second round of chemoradiation. At 7 months of follow-up, he remained disease-free. Sinonasal symptoms in GPA are consistent with those in chronic rhinosinusitis, but the presence of unilateral symptoms may suggest a neoplastic process. Immunosuppressants are implicated in the pathophysiology of this malignancy, but equally plausible is the oncogenic role of chronic inflammation.
“Split to Save”: Accessing Mandibular Lesions using Sagittal Split Osteotomy with Virtual Surgical Planning
Authors: Liu Stanley Yung-Chuan , Sidell Douglas , Huon Leh-Kiong , Torre Carlos
Published: December 2018

Large, benign intramandibular lesions are frequently removed by resection followed by extensive free tissue transfer or delayed bone grafting. We outline a protocol to remove benign mandibular lesions using sagittal split osteotomy (SSO) with virtual surgical planning (VSP) to mitigate risks involved with this effective, tissue-saving approach. Patients with benign mandibular lesions accessed by SSO with VSP during 2014 were included in this study. Computed tomographic data were imported into VSP software. Using VSP, the exact locations of mandibular lesions and the inferior alveolar nerve canal were delineated. SSO was designed virtually and provided surgeons exact measurements to gain access to lesions and to avoid vital structures intraoperatively. SSO with VSP preserved the cortical mandibular bone and the inferior alveolar neurovascular bundle in 3 patients with benign mandibular lesions. Twelve months after surgery, no patient had pathologic fracture, prolonged paresthesia (except for the patient who required inferior alveolar nerve resection), or malocclusion. No patient required bone grafting. There were no functional or aesthetic jaw deficits. SSO is an effective approach to access intramandibular lesions. The technique does not result in loss of mandibular bone, and patients return to full masticatory function compared with those who require resection and reconstruction. VSP may mitigate technical challenges associated with SSO.
Otosclerosis in a Nonendemic Population: Utility of CT Scan and Correlation with Audiometry and Surgical Outcome
Authors: Png Lu Hui , Pang Jing-Yin , Karandikar Amit , Goh Julian Park Nam , Yeo Seng Beng , Yuen Heng Wai
Published: December 2018

The incidence of otosclerosis in nonendemic patients is low, and preoperative diagnosis can be challenging. The aim of this study was to evaluate computed tomography (CT) findings in patients with otosclerosis and determine their correlation with audiometric findings and surgical outcome in a nonendemic population. We retrospectively reviewed 17 patients from August 2011 to August 2013 with surgically confirmed otosclerosis who underwent preoperative high-resolution CT scans and pre- and postoperative audiometry. Otosclerotic foci were identified on the scans. The density ratio of these foci was calculated and compared with pre- and postoperative audiometric parameters. One patient with Paget disease was excluded from the study. A total of 19 ears were operated on and included in the data analysis. CT scans were normal in 4 ears (21.1%). Hypodense lesions were detected in the remaining 15 (78.9%) ears and the region of interest mapped out. The density ratio was obtained between the hypodense area and adjacent normal labyrinthine bone. No statistically significant correlation was found between the density ratio and any of the audiometric parameters tested (p > 0.05). The diagnosis of otosclerosis in nonendemic areas is challenging. A preoperative CT scan can be useful when otosclerotic foci are present. However, the density ratio of the otosclerotic foci did not correlate with audiometric parameters or surgical outcome.
Antibiotics, Steroids, and Combination Therapy in Chronic Rhinosinusitis without Nasal Polyps in Adults
Authors: Liu Yuan F. , Richardson Clare M. , Bernard Stewart H. , Church Christopher A. , Seiberling Kristin A.
Published: December 2018

Despite a lack of robust data regarding their efficacy, oral antibiotics and steroids remain two of the most common treatments for chronic rhinosinusitis without nasal polyps (CRSsNP). We sought to objectively compare the efficacy of antibiotics and steroids, independently and in combination, for the initial treatment of CRSsNP. To that end, we conducted a retrospective chart review of 100 patients—51 men and 49 women, age 20 to 85 years (mean: 50)—who were treated for CRSsNP from January 2010 through January 2015. Of this group, 17 patients were treated with an antibiotic only, 28 with a steroid only, and 55 with both agents. All patients underwent computed tomography (CT) before and after treatment, and we compared the three groups’ pre- and post-treatment Lund-Mackay CT scores, symptom scores, and rates of surgery. The average time between the pre- and post-treatment visits was 4.4 weeks. The mean Lund-Mackay CT score for the entire study population was significantly lower after treatment than at baseline (6.3 vs. 9.1; p < 0.001); however, there were no significant differences among the three groups in either pre- or post-treatment scores. Symptom scores were significantly better in the combination therapy group than in the two monotherapy groups (p < 0.001). In all, 40 of the 100 patients underwent surgery; the difference in surgery rates among the three groups was not statistically significant (p = 0.884). Surgery was performed on 9 of the 52 (17.3%) patients who either were followed for at least 1 year or who had had surgery within the first year postoperatively; again, there were no significant differences among the three groups (p = 0.578). We conclude that although the Lund-Mackay CT scores decreased significantly in the antibiotic, steroid, and combination therapy groups, no one regimen was superior to any other for treating CRSsNP in our study.
Ocular Vestibular Evoked Myogenic Potentials and Intravestibular Intralabyrinthine Schwannomas
Authors: Ralli Massimo , Nola Giuseppe , Fusconi Massimo , Sparvoli Luca , Ralli Giovanni
Published: December 2018

Intravestibular intralabyrinthine schwannomas (ILSs) are uncommon benign tumors that arise from the sac-cular, utricular, and lateral and superior ampullary nerves. According to the literature, there is an average delay of 8 years between the onset of symptoms and diagnosis. Te diagnosis is based on an audiovestibular examination and magnetic resonance imaging (MRI). We describe a case of intravestibular ILS in which we included the ocular vestibular evoked myogenic potentials (oVEMPs) test in the diagnostic workup. The oVE-MPs test is a relatively new neurophysiologic diagnostic modality that evaluates the superior vestibular pathway and the ascending contralateral pathway through the vestibulo-ocular reflex. In our case, a 65-year-old man presented with progressive right-sided sensorineu-ral hearing loss, dizziness, and tinnitus and fullness in his right ear. Audiovestibular examination and MRI detected an intravestibular ILS on the right. We found that oVEMPs were absent on the contralateral side, which contributed to the diagnostic process. Te detection of oVEMPs can provide detailed information on the functionality of the macula of the utricle and the lateral and superior ampullary nerves, with a precise identification of the affected area. Based on our findings, we discuss the role of oVEMPs in the diagnosis of an intravestibular ILS.
Intraoperative Ultrasound-Guided Retrieval of an Extraluminal Pharyngoesophageal Foreign Body
Authors: Lee Janet W. , Randall Derrick R. , Kuhn Maggie A.
Published: December 2018

Pharyngoesophageal foreign bodies (FBs) are common otolaryngologic problems, but challenging cases cause significant patient and surgeon frustration. Extraluminal migration of an FB from the pharynx or esophagus is rare and usually necessitates external neck exploration. Approaching these complicated FBs endoscopically may avoid undue surgical morbidity. We present a case using real-time, intraoperative ultrasound (US) guidance for safe retrieval of a migrated submucosal FB. Intraoperative US is a widely available, powerful technology that can aid in the retrieval of difficult pharyngoesophageal FBs. In appropriate cases, this strategy may circumvent transcervical approaches and their associated risks.
Ancillary Medications and Outcomes in Post-Tonsillectomy Patients
Authors: Ferster Ashley P. O'Connell , Schaefer Eric , Schubart Jane R. , Carr Michele M.
Published: December 2018

To investigate the impact of medications on outcomes after tonsillectomy, a retrospective review using the Market Scan database was performed. A total of 306,536 privately insured children and adolescents (1 to 17 years old) who underwent tonsillectomy/adenoidectomy were identified from 2008 to 2012. Pharmaceutical claims identified patients who received outpatient prescriptions for ibuprofen, steroids, or topical anesthetics until discharge and for medications for the treatment of attention deficit hyperactivity disorder (ADHD) or montelukast up to 14 days postoperatively. Logistic regression compared prescription claims to outcomes, including postoperative bleeding, dehydration, emergency department visits, and readmissions. Ibuprofen was the only medication associated with increased odds of postoperative bleeding (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.07 to 1.95). Patients receiving steroids had lower odds of dehydration (OR: 0.74, 95% CI: 0.65 to 0.84) and emergency department visits (OR: 0.82, 95% CI: 0.76 to 0.88). Odds of dehydration were highest in patients taking ADHD medications (OR: 1.38, 95% CI: 1.15 to 1.66) and topical anesthetics (OR: 1.32, 95% CI: 1.10 to 1.59). Although causality cannot be assumed in observational studies, steroids and ibuprofen should be used judiciously.
Safety and Utility of Direct Laryngoscopy and Bronchoscopy in Patients Hospitalized with Croup
Authors: Fox Daniel P. , Ongkasuwan Julina
Published: December 2018

Acute croup is a common admitting diagnosis for pediatric patients. If a patient is not responding to medical management for presumed croup, the otolaryngology team is occasionally consulted for direct laryngoscopy and bronchoscopy (DLB) to rule out tracheitis or another airway pathology. We conducted a study to determine if inpatient DLB in acute croup is safe and efficacious and to correlate preoperative vital signs with intraoperative findings. We reviewed the charts of 521 patients with an admitting diagnosis of acute tracheitis, acute laryngotracheitis, or croup. Of this group, 18 patients—11 boys and 7 girls, aged 1 month to 3.3 years (mean: 1.3 yr)—had undergone inpatient DLB. Comorbidities, complications, and level of care were also analyzed. Five patients (28%) had gastrointestinal reflux disease (GERD), and 4 had previously undergone intubation (22%). Eleven patients (61%) had concurrent airway pathology, 7 of whom (39%) required operative intervention. Preoperative mean body temperature and the increase in mean temperature were significantly higher in tracheitis patients than in the non-tracheitis patients. Preoperative change in respiratory rate was elevated when another airway pathology was present (p = 0.047). Only patients who were in the intensive care unit (ICU) preoperatively were intubated in the operating room, and only 1 patient required a postoperative escalation in the level of care. Our study found that performing inpatient DLB in patients hospitalized with croup is reasonably safe and provides a sufficient yield for identifying tracheitis or other airway pathology in selected populations. Preoperative vital signs can be suggestive of tracheitis or additional unexpected airway pathology. Recurrent croup, a history of GERD or previous intubation, and preoperative admission to the ICU increase the yield of DLB.
Inflammatory Myofibroblastic Tumor of the Epiglottis Excised with a Carbon Dioxide Laser: Case Report and Literature Review
Authors: Raggio Blake , Chheda Neil
Published: December 2018

Inflammatory myofibroblastic tumor (IMT) is a benign neoplasm of intermediate biologic potential. It rarely occurs in the larynx, and it has not been previously reported in the epiglottis. We treated a 66-year-old woman who presented with progressive dysphonia and a mass on her suprahyoid epiglottis. The tumor was completely excised with a CO2 laser; no adjuvant therapy was administered. Histopathology revealed that the mass was an IMT. No evidence of recurrence was noted after 6 months of follow-up. We present what we believe is the first case of an epiglottic IMT to be reported in the literature, and we propose CO2 laser excision without adjuvant therapy as an acceptable treatment.
Dacryocystorhinostomy with a Thulium:YAG Laser—a Case Series
Authors: Tang Christopher , Rickert Scott , Mor Niv , Blitzer Andrew , Leib Martin
Published: December 2018

We conducted a retrospective chart review of 27 patients—7 men and 20 women, aged 47 to 94 years (mean: 71.3)—with symptomatic epiphora secondary to dacryostenosis who had undergone thulium:YAG (Tm:YAG) laser dacryocystorhinostomy (DCR). Among them, dacryostenosis had been documented in 35 eyes by dacryocystography. The Tm:YAG procedure involved the administration of local anesthesia, after which a 600-μm laser fiber was inserted into the lacrimal canaliculi and then into the nasolacrimal duct. Under endoscopic visualization, the DCR was performed anterior and inferior to the middle turbinate, which created an opening. Silicone stents were then inserted and tied intranasally. In the immediate postoperative period, all 27 patients noted initial improvement. During a follow-up of 22 days to 25 months (mean: 11.3 mo), 24 of the 27 patients (89%) remained symptom-free, while the remaining 3 patients (11%) experienced a treatment failure and required revision surgery. To the best of our knowledge, only two articles on thulium laser therapy for DCR have been previously published, both approximately 25 years ago; both involved the use of a thulium along with holmium and chromium in cadavers. As far as we know, our case series is the largest in the English-language literature that has documented the use of the thulium in laser therapy for DCR, and it is the only in vivo study. We found that DCR with the Tm:YAG laser was an effective and affordable option for patients with symptomatic epiphora secondary to lacrimal obstruction.
Upper Aerodigestive Tract Frostbite from Inhalation of Automotive Nitrous Oxide
Authors: Chan Stephen A. , Alfonso Kristan P. , Comer Brett T.
Published: December 2018

Nitrous oxide, a cryogenic gas, may be abused as an inhalant for its euphoric properties. If inhaled, nitrous oxide may cause frostbite to the oral cavity and upper aerodigestive tract, with possible airway compromise due to edema. In this article we describe what is, to the best of our knowledge, the first case of intentional inhalation of nitrous oxide from an automotive nitrous oxide canister and discuss the management and mechanism of the patient's injury.
Nondisseminated Rhinosporidiosis with Multisite Involvement in the Head and Neck
Authors: Devaraja K , Sagar Prem , Singh Chirom Amit , Kumar Rajeev
Published: December 2018

Rhinosporidiosis is a communicable disease prevalent in tropical countries that affects one or more mucocutaneous sites such as the nasal cavity, pharynx, skin, bronchus, genitals, and bone, in isolation or together. We report a case of multicentric rhinosporidiosis involving the nasal cavity, oropharynx, larynx, and cheek skin without disseminated disease outside the head and neck. Although the appearance of mucocutaneous lesions in our patient was similar to that of papilloma or neoplasm, the distinct clinicopathologic characteristics of the rhinosporidiosis guided us in managing the case successfully. In our own experience with 11 patients with rhinosporidiosis on whom we operated over the past 5 years, the nasal cavity and pharynx were the most commonly involved sites in the head and neck. Surgical excision of all lesions along with cauterization of the base and long-term dapsone therapy is the current standard of care for multicentric rhinosporidiosis.
Salivary α-Amylase Levels in Vertigo: Can it be an Autonomic Dysfunction?
Authors: Korkmaz Tanzer , Bicer Yusuf Ozgur , Serin Erdinc , Seyhan Sinan , Sanal Serap Koybasi
Published: December 2018

We aim to demonstrate possible autonomic dysfunction based on salivary α-amylase measurements during and after the vertigo attacks associated with Ménière disease (MD) and benign paroxysmal positional vertigo (BPPV). Patients admitted to the emergency room with a diagnosis of vertigo attacks caused by either MD (n = 15) or BPPV (n = 9) constituted the study groups. The control group (n = 10) consisted of volunteer patients admitted to the emergency department with minor soft-tissue trauma. The first saliva samples were obtained immediately during the attacks and the second and third samples were obtained on the third and fifteenth days of the attack, respectively. In the controls, the first sample was obtained after admission to the hospital and the second sample was obtained on the third day. Salivary α-amylase levels were evaluated. The difference between salivary α-amylase levels in patients with MD and BPPV was not significant. The amylase value measured early after the BPPV attack was significantly lower than that of the controls (p = 0.008). Although not significant, an undulating pattern of salivary α-amylase levels was observed with both diseases. An autonomic imbalance could be partly demonstrated by salivary α-amylase measurement early after the attack in patients with BPPV. Therefore, amylase may be a promising marker that is worth further investigation.
Positivity Rates of in Vitro Inhalant/ Respiratory and Food Allergy Tests in the Northern Midwestern United States
Authors: Benninger Michael S. , Daly Thomas , Graffmiller Kevin
Published: December 2018

Rates of allergy-test positivity vary by country and by regions within countries. Several studies have looked at allergy test results to determine the most common allergens. Many of these studies have been based on surveys or on studies of small numbers of tests. Positivity rates for allergy tests are poorly defined in the northern midwestern region of the United States. We conducted a study to identify the rates of positive allergy tests for both inhalant/respiratory allergens and food allergens in the upper Midwest. We extracted from our laboratory database the results of all test samples sent for one of eight allergen panels that had been analyzed between Sept. 1, 2014, and Sept. 1, 2015. All testing was performed at The Cleveland Clinic with the Phadia ImmunoCAP system. The percentage of positive tests, the distribution of the most frequently positive tests, and the class of in vitro responses were identified. A total of 148,628 test results for 63 different allergens were identified. Of the 125,190 tests for inhalant/respiratory allergens, the most frequently positive were dog dander (24% of tests), cat dander (23%), dust mites (23% for both Dermatophagoides pteronyssinus and Dermatophagoides farinae), and June grass (21%). Of the 23,438 food tests, the most frequently positive test results were for milk (18%), peanut (17%), wheat (16%), and egg white (15%). Most of the results fell into classes 1 through 3, although there was still a notable number of very high responses (class 5 and 6). These findings suggest that there is wide variability in the positivity of in vitro allergy tests and that the likelihood of a positive result in screening panels can be estimated. Evaluating such rates will help identify the most and least common allergens and will help to cost-effectively refine allergy screening panels.
Acute Infectious Laryngitis: A Case Series
Authors: Jaworek Aaron J. , Earasi Kranthi , Lyons Karen M. , Daggumati Srihari , Hu Amanda , Sataloff Robert T.
Published: December 2018

Although acute laryngitis is common, it is often managed by primary physicians. Therefore, video images documenting its signs are scarce. This series includes 7 professional voice users who previously had undergone baseline strobovideolaryngscopy (SVL) during routine examinations or during evaluations for other complaints and who returned with acute laryngitis. Sequential SVL showed not only the expected erythema, edema, cough, and dysphonia, but also new masses in 5 of the 7 subjects. All the signs returned to baseline. This series is reported to highlight the reversible structural changes that can be expected in patients with acute laryngitis and the value of conservative management.
No Difference in Disease-Free Survival after Oral Cancer Resection with Close Tumor Margins in Patients with and without Postoperative Radiotherapy
Authors: Welinder Britta Kaltoft , Lawaetz Mads , Dines Laura M. , Homøe Preben
Published: December 2018

We conducted a retrospective follow-up study to determine if adjunctive radiotherapy (RT) affected disease-free survival in patients with oral squamous cell carcinoma (SCC) who were found to have close surgical margins after tumor resection. Our study population was made up of 110 patients—72 men and 38 women, aged 30 to 94 years (median: 66) at the time of diagnosis. Their follow-up ranged from 12 days to 5.2 years (median: 3.6 yr). Of this group, 40 patients had free margins, 55 patients had close margins, and 15 had involved margins after surgery. Only 31 of these patients received postoperative RT, including 17 who had close margins. We would expect to find better postoperative local tumor control with combined surgery and RT, but we found no statistically significant difference in disease-free survival between the surgery-plus-RT group and the surgery-only group (p = 0.72). We also found no significant difference in disease-free survival between patients with a tumor of the floor of mouth and those with a tumor of the tongue (p = 0.34). In the study population as a whole, the disease-free survival rate was 81.0% and the overall survival rate was 78.2%. Our findings support the trend toward a watch-and-wait approach before initiating postoperative RT for patients with close surgical margins. The decision should be carefully discussed between the surgeon, the oncologic radiotherapist, and the patient.
Outcomes of Reapplication to Otolaryngology Residency: A Prospective Cohort Study
Authors: Fuller Colin , Byrd J. Kenneth , Groves Michael
Published: December 2018

Although the field of otolaryngology has experienced a decline in the number of applicants to our residency programs, otolaryngology remains a highly competitive field with an extremely strong applicant pool. Many highly qualified candidates cannot obtain a position in our field each year, and many of these candidates choose to reapply the next year. Data are lacking regarding reapplicants’ success rate and the best gap year employment and training options for these reapplicants. Reapplicants were studied prospectively via a two-stage survey during the 2014–2015 and 2015–2016 application cycles. Success rates for the overall group were compared to those from published data, and success rates between subgroups were also compared. First-time reapplicants in the study performed extremely well. Their match rate (19/22) was not significantly different from that of traditional otolaryngology applicants (551/619, p = 0.73) and was significantly higher than that of nontraditional applicants not in our cohort (23/62, p < 0.001). No significant difference was found between applicants by employment/training activities, with both researchers (11/12) and surgical interns (8/10, p = 0.57) performing well. Predictors of reapplicant success could not be assessed because only 3 reapplicants in the cohort were unsuccessful. First-time otolaryngology reapplicants remain a highly competitive group of applicants to our field, regardless of employment/training activities undertaken after graduating medical school.
In which cultural contexts do individual values explain entrepreneurship? An integrative values framework using Schwartz’s theories
Authors: Morales Carlos , Holtschlag Claudia , Masuda Aline D , Marquina Percy
Published: December 2018

Answering research calls for better contextualisation of entrepreneurial behaviour, we examine the cultural contexts in which individuals with entrepreneurial values (Schwartz’s self-enhancement- and openness-to-change values) are most likely to be entrepreneurs. Culture is assessed through Schwartz’s cultural dimensions of mastery and egalitarianism. The results of multilevel logistic regressions with more than 35,000 respondents nested in 28 European countries support the hypotheses that individual values are more important for explaining entrepreneurship in non-entrepreneurial cultures (low in mastery and egalitarianism). Our results indicate that mastery compensates for openness-to-change, whereas egalitarianism reduces the impact of both self-enhancement and openness-to-change values.
A study of the description of exercise programs evaluated in randomized controlled trials involving people with fibromyalgia using different reporting tools, and validity of the tools related to pain relief
Authors: Jo Donguk , Del Bel Michael J , McEwen Daniel , O’Neil Jennifer , Mac Kiddie Olivia S , Álvarez-Gallardo Inmaculada C , Brosseau Lucie
Published: December 2018

Rationale:

Exercise programs for the management of fibromyalgia are well recognized as being effective. However, the incomplete descriptions of exercise programs make replication and implementation difficult. Also, existing reporting tools have not been validated in relation to pain relief as well as with each other.

Objectives:

This study aimed to evaluate the description of exercise programs in randomized control trials for the management of fibromyalgia using different assessment tools, and the correlations of each tool in relation to effectiveness of pain relief of fibromyalgia, and the correlations between each tool.

Method/Results:

Through a consensus made by two different pairs of reviewers and an arbitrator, the mean total scores for the exercise programs were reported: 10.61/19 for Consensus on Exercise Reporting Template; 4.17/12 for Template for Intervention Description and Replication; 7.05/12 for the Consensus on Therapeutic Exercise Training; and 2.50/4 (aerobic) and 2.36/5 (flexibility and resistance) for the 2016 American College of Sports Medicine guidelines. This demonstrates generally low reporting scores (less than 60% out of the total number of items were reported). Overall, low correlations (Cohen’s kappa value, ranging from −0.47 (poor) to 0.313 (fair)) were found between all tools and pain relief. Good to excellent correlations (0.680–0.908) among the reporting tools were shown.

Conclusion:

Incomplete descriptions of exercise programs were consistently shown among the randomized clinical trials assessed in this study. The overall weak correlations demonstrated that the reporting tools have the limited ability to determine whether exercise programs were or were not effective for pain relief among individuals with fibromyalgia.
Community-led and/or focused initiatives to support family carers within a palliative care context: An integrative review
Authors: Chung Anita , Collier Aileen , Gott Merryn
Published: December 2018

Background:

Public health approaches to palliative care prioritise community-focused initiatives to support people with palliative care needs and their families. The nature and extent of these initiatives have not previously been reported.

Aim:

To identify community-led and/or focused initiatives that have been developed to support family carers of people with palliative care needs and for which evaluation information is reported in the empirical literature.

Design:

An integrative study design was undertaken using systematic methods.

Data sources:

CINAHL, Medline, PsycINFO, Embase, Cochrane, Sociological Abstracts, Proquest Social Science Database, and grey literature were searched using standardised search terms.

Results:

Two quantitative, two qualitative and two mixed method studies were identified ( n = 6). All community initiatives identified were professionally led, although three had consumer input. Most aimed to improve carer psychosocial well-being and all were reported to have been beneficial.

Conclusions:

This integrative review identified only six community-focused and evaluated initiatives supporting family carers in the international palliative care research literature. Further evaluation is needed. However, appropriate evaluation methods and reporting require further discussion and debate between all stakeholders. Service users and communities themselves must be central to this process.
Overexpression of LH3 reduces the incidence of hypertensive intracerebral hemorrhage in mice
Authors: Li Hao , Xu Haochen , Wen Hongyan , Liu Tianlong , Sun Yingying , Xiao Ning , Bai Congxia , Ge Jing , Wang Xuliang , Song Li , Song Yan , Zhang Yinhui , Chen Jingzhou
Published: December 2018

Hypertensive intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease with no effective treatment. Lysyl hydroxylase 3 (LH3) is essential for collagen IV intermolecular crosslinking and stabilization. Deficiency in LH3 affects the assembly and secretion of collagen IV and basement membrane (BM) integrity of vessels. Here, we investigated whether LH3 has significant implications for disease progression and therapeutic intervention. Spontaneous hypertensive ICH of mice was induced by angiotensin II and L-NAME treatment. The adeno-associated virus was delivered into brain by stereotactic injection to knockdown or overexpress LH3. We found LH3 levels were reduced in human patients with ICH and gradually decreased in mice before ICH. LH3 knockdown increased the incidence of hypertensive ICH in mice. The incidence, number, and size of ICHs in mice were markedly reduced by LH3 overexpression. RNA-seq revealed that LH3 overexpression significantly reversed the profound alterations in gene transcriptional profiles of cerebral vessels. LH3 overexpression was sufficient to enhance BM integrity, inhibit matrix metalloproteinase activity, attenuate microglial activation and leukocyte infiltration, and reduce VSMC apoptosis before ICH. These results indicate that LH3 overexpression attenuates susceptibility to hypertensive ICH. We emphasize that LH3 modulation may serve as a viable approach for future investigations of ICH prevention.
Harnessing Expert Judgment to Support Clinical Decisions When the Evidence Base Is Weak
Authors: Dolan James G. , Veazie Peter J.
Published: December 2018

Purpose. In the process of developing an evidence-based decision dashboard to support treatment decisions for patients with newly diagnosed prostate cancer, we found that the clinical evidence base is insufficient to provide high-quality comparative outcome data. We therefore sought to determine if clinically acceptable outcome estimates could be created using a modified version of the Sheffield Elicitation Framework (SHELF), a formal method for eliciting judgments regarding probability distributions of expected decision outcomes. Methods. We asked a panel of 3 urologists, 4 radiation oncologists, and 2 medical oncologists to estimate the probabilities of 11 treatment outcomes based on their clinical experience and an annotated evidence summary. The estimates were elicited using a Microsoft Excel spreadsheet containing a self-guided, adapted version of the SHELF Roulette method distributed via email. We created combined outcome estimates by taking the mean values of the panel members’ upper and lower 95% bounds for each outcome. The combined estimates were then distributed via email to the panel for final approval. Results. Eight of the 9 responses were judged to be correct applications of the SHELF method and included in the combined outcome estimates. The final set of outcome estimates was unanimously accepted by the clinician panel members and used to create a decision dashboard suitable for clinical use and evaluation. Conclusions. Many important health care decisions need to be made in situations where the evidence base is inadequate. Use of a formal protocol for eliciting expert judgments is feasible and can be used to promote evidence-based practice by providing a powerful tool to facilitate the combination of professional judgment with research evidence and patient preferences to guide clinical decisions.
A reconfiguration strategy for modular robots using origami folding
Authors: Yao Meibao , Belke Christoph H. , Cui Hutao , Paik Jamie
Published: December 2018

Reconfigurability in versatile systems of modular robots is achieved by changing the morphology of the overall structure as well as by connecting and disconnecting modules. Recurrent connectivity changes can cause misalignment that leads to mechanical failure of the system. This paper presents a new approach to reconfiguration, inspired by the art of origami, that eliminates connectivity changes during transformation. Our method consists of an energy-optimal reconfiguration planner that generates an initial 2D assembly pattern and an actuation sequence of the modular units, both resulting in minimum energy consumption. The algorithmic framework includes two approaches, an automatic modeling algorithm as well as a heuristic algorithm. We further demonstrate the effectiveness of our method by applying the algorithms to Mori, a modular origami robot, in simulation. Our results show that the heuristic algorithm yields reconfiguration schemes with high quality, compared with the automatic modeling algorithm, simultaneously saving a considerable amount of computational time and effort.
Effect of amantadine on vegetative state after traumatic brain injury: a functional magnetic resonance imaging study
Authors: Chen Xiaowei , Tang CheukYing , Zhou Hongwei , Li Zhenlan
Published: December 2018

Objective

We assessed the use of functional magnetic resonance imaging (fMRI) to observe residual brain function and responsiveness to amantadine in a patient in a vegetative state (VS) following traumatic brain injury.

Method

We observed cerebral cortex activation in a 52-year-old man in a VS, and in a healthy individual using fMRI during passive listening and motor-imagery tasks. The patient received oral amantadine for 3 months. fMRI was repeated after treatment.

Results

Activation around the left insular regions occurred during stimulation by a familiar voice, and activity in the left temporal and bi-occipital cortices occurred during stimulation by a familiar/unfamiliar voice. Activity in the bilateral frontal and parietal cortices occurred during the motor-imagination task. Brain cortex activation was reduced in the VS patient compared with the healthy volunteer. However, the patient responded to certain auditory stimuli and motor imagery, suggesting that he retained some intact auditory and motor cortical functions. fMRI scans after 3 months of treatment showed increased activation of brain areas corresponding to task instructions.

Conclusion

fMRI could be used to observe the effects of amantadine on brain function, and to aid the diagnosis and prognostic prediction in VS patients in terms of recovery and rehabilitation planning.
Effect of obturation technique with immediate and delayed post space preparation on apical voids and bond strength of apical gutta-percha
Authors: Long Weilin , Li Jing , Liu Yiwen , Jiang Hongwei
Published: December 2018

Objective

The purpose of this study was to evaluate the effect of immediate and delayed post space preparation on the sealing ability of two root canal obturation techniques by using micro-computed tomography imaging and a push-out test.

Methods

The root canals of 40 human maxillary premolar teeth were instrumented and divided into four groups: (A) single cone (SC) followed by immediate post space preparation, (B) continuous wave of condensation (CWC) followed by immediate post space preparation, (C) SC followed by delayed post space preparation, and (D) CWC followed by delayed post space preparation. Micro-CT scans were performed for volumetric analysis of voids and filling materials in the apical 4-mm portion. A push-out test was performed, and failure modes (adhesive, cohesive, or mixed) were assessed. Data were analyzed using the Kruskal-Wallis test and one-way analysis of variance.

Results

No significant differences were observed among the four groups in terms of the percentage volume of voids of the apical 4 mm or the bond strength of apical gutta-percha.

Conclusions

The percentage volume of voids and bond strength of apical gutta-percha were similar and were not significantly influenced by the timing of post space preparation or the obturation technique.
Sidney W Mintz: Charting an anthropology of the Caribbean
Authors: Yelvington Kevin A
Published: December 2018

The research program established by the anthropologist Sidney W Mintz (1922–2015) in a professional career spanning more than half a century was definitive in charting an anthropology of the Caribbean. Mintz’s family context and early training in anthropology provided the basis for a Marxist/materialist and dialectical theoretical approach that interpreted historical structures and specificities through the paradigm of North American cultural anthropology – and used the lens of cultural anthropology to understand historical processes. Mintz was part of a cohort of doctoral students at Columbia University in the late 1940s and early 1950s who would go on to become prominent within the discipline. Part of the pathbreaking The People of Puerto Rico project, Mintz developed a decidedly historical approach to Caribbean societies and cultures and understood them in relation to, and in interaction with, their imperial past and their contemporary locations within the capitalist world system. This informed his research and writing on comparative forms of slavery and their aftermath, the creolization of cultures in Caribbean history, and applied the insight acquired to the study of food and the complex systems by which it is produced and consumed. Mintz’s work has received great amount of attention, including critical evaluations. Mintz was an active participant in how his work and contributions would be assessed.
‘Not Twenty Feet Away’: The Caribbean – and Race – in Sidney W Mintz’s Puerto Rican Fieldwork
Authors: Giovannetti Jorge L
Published: December 2018

Focusing in the early years of Sidney W Mintz’s career and his ‘anthropological record’, this essay examines aspects of his legacy to the field of Caribbean studies. Using materials from Mintz’s fieldwork in Puerto Rico during the 1940s and 1950s, the author discusses experiences that may have influenced Mintz’s ideas and future scholarship in two specific areas. First, the localized fieldwork in the island’s southern town of Jauca (Santa Isabel), specifically on the plantation, is seen as a launching pad for scale-up thinking into large-scale analysis: from the Caribbean to hemispheric and Atlantic connections. Second, exposure to, and analysis of, complex issues of race during Mintz’s Puerto Rican fieldwork suggest the initial opening to future interventions he made on this topic.
Fruits of colonialism: The production of mangoes as commodities in northern Haiti
Authors: Jayaram Kiran C
Published: December 2018

After the 2010 earthquake, many stakeholders in Haiti and across the globe worked together to increase Haitian mango harvest for export, ostensibly as a way to improve people’s lives. To date, however, no study has examined how such an increase may be affecting the producers beyond statistical measures. Using archival research and fieldwork in the Artibonite Department in Haiti, this article examines the social consequences of the labour process of Haitian peasants as they pick and process mangoes for export. After describing the biogeography of the mango, I describe the different systems of labour used in mango harvesting. I argue that the growth and harvesting of Haitian mangoes for export reflects social differentiation between those who can organize labour according to monetized relations and those who incorporate the domestic unit into commodity production. Furthermore, as more production shifts to work based upon monetized relations, the balance of economic power shifts towards adult men.