bluuebunny/crossref_metadata_2025 huggingface dataset:
Noninvasive Prediction of IDH1 Mutation and ATRX Expression Loss in Low‐Grade Gliomas Using Multiparametric MR Radiomic Features
Authors: Ren Yan , Zhang Xi , Rui Wenting , Pang Haopeng , Qiu Tianming , Wang Jing , Xie Qian , Jin Teng , Zhang Hua , Chen Hong , Zhang Yong , Lu Hongbing , Yao Zhenwei , Zhang Junhai , Feng Xiaoyuan
Published: September 2018

Background

Noninvasive detection of isocitrate dehydrogenase 1 mutation (IDH1(+)) and loss of nuclear alpha thalassemia/mental retardation syndrome X‐linked expression ((ATRX(–)) are clinically meaningful for molecular stratification of low‐grade gliomas (LGGs).

Purpose

To study a radiomic approach based on multiparametric MR for noninvasively determining molecular status of IDH1(+) and ATRX(–) in patients with LGG.

Study Type

Retrospective, radiomics.

Population

Fifty‐seven LGG patients with IDH1(+) (n = 36 with 19 ATRX(–) and 17 ATRX(+) patients) and IDH1(–) (n = 21).

Field Strength/Sequence

3.0T MRI / 3D arterial spin labeling (3D‐ASL), T2/fluid‐attenuated inversion recovery (T2FLAIR), and diffusion‐weighted imaging (DWI).

Assessment

In all, 265 high‐throughput radiomic features were extracted on each tumor volume of interest from T2FLAIR and the other three parametric maps of ASL‐derived cerebral blood flow (CBF), DWI‐derived apparent diffusion coefficient (ADC), and exponential ADC (eADC). Optimal feature subsets were selected as using the support vector machine with a recursive feature elimination algorithm (SVM‐RFE). Receiver operating characteristic curve (ROC) analysis was employed to assess the efficiency for identifying the IDH1(+) and ATRX(–) status.

Statistical Tests

Student's t‐test, chi‐square test, and Fisher's exact test were applied to confirm whether intergroup significant differences exist between molecular subtypes decided by IDH1 and ATRX.

Results

Optimal SVM predictive models of IDH1(+) and ATRX(–) were established using 28 features from T2Flair, ADC, eADC, and CBF and six features from T2Flair, ADC, and CBF. The accuracies/AUCs/sensitivity/specifity/PPV/NPV of predicting IDH1(+) in LGG were 94.74%/0.931/100%/85.71%/92.31%/100%, and those of predicting ATRX(–) in LGG with IDH1(+) were 91.67%/0.926/94.74%/88.24%/90.00%/93.75%, respectively.

Data Conclusion

Using the optimal texture features extracted from multiple MR sequences or parametric maps, a promising stratifying strategy was acquired for predicting molecular subtypes of IDH1 and ATRX in LGGs.

Level of Evidence: 3

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019;49:808–817.
Economic Evaluation of Nutrition Support in the Prevention and Treatment of Pressure Ulcers in Acute and Chronic Care Settings: A Systematic Review
Authors: Wong Alvin , Goh Geraldine , Banks Merrilyn D. , Bauer Judith D.
Published: September 2018

Background

Recent developments in nutrition intervention indicated clinical effectiveness for pressure ulcer (PU) prevention and treatment, but it is important to assess whether they are cost‐effective. The aims of this systematic review are to determine the cost‐effectiveness and clinical outcomes of nutrition support in PU prevention and treatment.

Methods

A systematic search of randomized controlled trials, observational studies, and statistical models that investigated cost‐effectiveness and economic outcomes for prevention and/or treatment of PUs were performed using standard literature and electronic databases.

Results

Fourteen studies met the inclusion criteria, which included 3 randomized controlled trials with their companion economic evaluations, 4 model‐based, 2 cohort, 1 pre and post, and 1 prospective controlled trial. Risk of bias assessment for all of the uncontrolled or observational trials revealed high or serious risk of bias. Interventions that incorporated specialized nursing care appeared to be more effective in prevention and treatment of PUs, compared with single intervention studies. There is a trend of improved PU healing when additional energy/protein are provided. PU prevention ($250–$9,800) was less expensive than treatment ($2,500–$16,000). Nutrition intervention for PU prevention was cost‐effective in 87.0%–99.99% of the simulation models.

Conclusions

There is potential cost‐saving and/or cost‐effectiveness of nutrition support in the long term, as predicted by the model‐based PU prevention studies in the review. Prevention of PU also appears to be more cost‐effective than treatment. A multidisciplinary approach to managing PU is more likely to be cost‐effective.
Preparative and capillary isoelectric focusing for detection and identification of Aspergillus conidia in complex sample matrices
Authors: Horká Marie , Šalplachta Jiří , Růžička Filip , Šlais Karel
Published: September 2018

This study describes a new method for fast identification of highly hydrophobic conidia of Aspergillus species from both simple and complex matrices. The method is based on recently developed preparative isoelectric focusing in a cellulose‐based separation medium which had to be modified with respect to the highly hydrophobic surface of the conidia. Although Aspergillus conidia are colored, their zones in the cellulose bed were indicated by colored isoelectric point markers. The isoelectric point values of Aspergillus conidia were determined by capillary isoelectric focusing. Preparative isoelectric focusing was successfully used for preconcentration of individual conidia of cultivated strains of Aspergillus niger, Aspergillus fumigatus, Aspergillus flavus, and Aspergillus parasiticus, and also for separation of the conidia in a mixture. Subsequently, red pepper powder and peanuts spiked with Aspergillus niger and Aspergillus flavus conidia, respectively, were used as complex matrices. The detection limit for identification of the conidia in these complex matrices is 104 conidia mL−1. The presence of conidia in the focused zones was confirmed by their subsequent analysis by capillary isoelectric focusing. Their viability was confirmed by a cultivation of the conidia extracted from the collected fractions after preparative isoelectric focusing.
Rapid discovery and global characterization of multiple components in corn silk using a multivariate data processing approach based on UHPLC coupled with electrospray ionization/quadrupole time‐of‐flight mass spectrometry
Authors: Liu Qi , Liu Jianhua , Fan Songjie , Yang Dezhu , Wang Huimin , Wang Yumei
Published: September 2018

Corn silk is an important traditional Chinese medicine which has been widely used as diuretic, antilithiasic, uricosuric, antiseptic, etc. for thousands of years. However, it is a pity that the chemical ingredients in corn silk, especially the constituents absorbed into blood, are unclear up to now. The aim of our study was to investigate the multiple components of corn silk in vitro and in vivo. In this present study, a sensitive and rapid method using ultra high performance liquid chromatography coupled with electrospray ionization/quadrupole time‐of‐flight tandem mass spectrometry and a multivariate data processing approach was established to detect the constituents of corn silk in vitro and in vivo. Consequently, total 41 ingredients in vitro and 19 of them absorbed into blood including luteolin, various C‐glycosyl flavones, jasmonic acid, abscisic acid, gibberellin A, etc. were tentatively characterized in sequence. Furthermore, of particular importance, a kind of stable compound named C‐glycosyl flavones is a great discovery in vivo, which can point the further pharmacological study target in future. In a word, this is the first serum pharmacochemistry study of corn silk, which played a critical role in exploring the pharmacological and effective data for further research.
A novel strategy for evaluation of natural products acting on the myeloperoxidase/hypochlorous acid system by combining high‐performance liquid chromatography‐photodiode array detection‐chemiluminescence and ultrafiltration‐mass spectrometry techniques
Authors: Wang Ying , Hong Fang , Li Dapeng , Qi Jin , Liu Xuming
Published: September 2018

Myeloperoxidase and its product hypochlorous acid are endogenous substances that are involved in the pathogenesis of many inflammatory diseases. In the present study, a novel evaluation strategy has been developed to screen for myeloperoxidase inhibitors and hypochlorous acid scavengers in natural products. The evaluation strategy uses two methods: a multi‐hyphenated high‐performance liquid chromatography‐photodiode array detection‐chemiluminescence online method, and an ultrafiltration‐high‐performance liquid chromatography‐mass spectrometry method. Both were used for screening hypochlorous acid scavengers and myeloperoxidase inhibitors. After optimization of operating conditions, including pH of mobile phase and concentrations of myeloperoxidase, hypochlorous acid and luminol, the evaluation strategy was applied to Gardenia jasminoides Ellis (Rubiaceae) extract. Gardenia jasminoides Ellis (Rubiaceae) extract was found to both scavenge hypochlorous acid and inhibit myeloperoxidase. These different bioactivities originate from iridoid glycosides and quinic acid derivatives (25 hypochlorous acid scavengers) and crocetin derivatives (4 myeloperoxidase inhibitors). In a mouse model of acute lung injury, pulmonary histopathology showed that different constituents of Gardenia jasminoides Ellis (Rubiaceae) extract could also attenuate lung injury. Although the screening strategy has two arms, it is still simple, rapid, and effective. The strategy can also potentially be used to discriminate different activities of different constituents contained in the same natural product.
Ultrasound Characteristics of Foot and Ankle Structures in Healthy, Coper, and Chronically Unstable Ankles
Authors: Abdeen Rawan , Comfort Paul , Starbuck Chelsea , Nester Christopher
Published: September 2018

Objective

Ankle sprains constitute approximately 85% of all ankle injuries, and up to 70% of people experience residual symptoms. While the injury to ligaments is well understood, the potential role of other foot and ankle structures has not been explored. The objective was to characterize and compare selected ankle structures in participants with and without a history of lateral ankle sprain.

Methods

A total of 71 participants were divided into 31 healthy, 20 coper, and 20 chronic ankle instability groups. Ultrasound images of the anterior talofibular and calcaneofibular ligaments, fibularis tendons and muscles, tibialis posterior, and Achilles tendon were obtained. Thickness, length, and cross‐sectional areas were measured and compared among groups.

Results

When under tension, the anterior talofibular ligament (ATFL) was longer in copers and chronic ankle instability groups compared to healthy participants (P < .001 and P = .001, respectively). The chronic ankle instability group had the thickest ATFL and calcaneofibular ligament among the 3 groups (p < 0.001). No significant differences (P > .05) in tendons and muscles were observed among the 3 groups.

Conclusions

The ultrasound protocol proved reliable and was used to evaluate the length, thickness, and cross‐sectional areas of selected ankle structures. The length of the ATFL and the thickness of the ATFL and calcaneofibular ligament were longer and thicker in injured groups compared to healthy.
Z Score Reference Ranges of Fetal Cardiothoracic Diameter Ratio
Authors: Sirilert Sirinart , Tongprasert Fuanglada , Srisupundit Kasemsri , Tongsong Theera , Luewan Suchaya
Published: September 2018

Objective

This study aims to establish the z score reference ranges of cardiothoracic diameter ratio (CTR) of normal fetuses from 14 to 40 weeks’ gestation.

Method

A cross‐sectional study was conducted on low‐risk singleton pregnancies with healthy fetuses. The CTR was performed using simple 2‐dimensional sonography on the typical fetal 4‐chamber view. The reference ranges were constructed according to gestational age (GA), biparietal diameter (BPD), and head circumference (HC) as independent variables based on the best‐fit models, both mean and standard deviation (SD).

Results

A total of 683 fetuses were measured for CTR. The best‐fit equations for the mean and SD as a function of GA, BPD, and HC are as follows: (1) CTR = 0.365 + 0.004 × GA in weeks (SD = 0.031 + 0.001 × GA); (2) CTR = 0.373 + 0.014 × BPD in cm (SD = 0.034 + 0.004 × BPD); and (3) CTR = 0.373 + 0.004 × HC in cm (SD = 0.032 + 0.001 × HC). The CTR was slightly increased with advanced GA, BPD, and HC.

Conclusion

Complete nomograms with z score reference ranges of CTR were established throughout pregnancy. These nomograms may be useful to detect cardiac abnormalities.
Shear Wave Elastography on the Uterine Cervix: Technical Development for the Transvaginal Approach
Authors: O'Hara Sandra , Zelesco Marilyn , Sun Zhonghua
Published: September 2018

Objectives

This research aimed to identify biological and technical confounders in the nonpregnant cervix when applying shear wave elastography with an endovaginal transducer.

Methods

Cervical speed measurements were obtained at the internal and external os in the anterior and posterior portions of the cervix using a transvaginal approach in 69 nongravid patients.

Results

Reliable measurements were obtained at the external os and internal os, anteriorly and posteriorly, in 63, 55, 55, and 26 patients, respectively. The mean speed obtained at the external os, anteriorly and posteriorly, was 2.52 ± 0.49 m/s and 2.87 ± 0.63 m/s, respectively, and at the internal os, anteriorly and posteriorly, 3.29 ± 0.79 m/s and 4.10 ± 1.11 m/s, respectively. The difference in speed between all regions was statistically significant (P < .05).

Conclusion

Ultrasound‐induced artifacts appear to affect the transmission of the elastographic main pulse, with cervical position contributing to suboptimal shear wave production in the posterior cervix. Reliable shear wave propagation can be achieved in the anterior cervix in most patients.
Positive surgical margins in parotid malignancies: Institutional variation and survival association
Authors: Morse Elliot , Fujiwara Rance J. T. , Judson Benjamin , Prasad Manju L. , Mehra Saral
Published: September 2018

Objectives/Hypothesis

To establish benchmarks for positive margin incidence in parotid cancers, associate positive margin status with patient, tumor, and institutional factors and overall survival, and characterize institutional variation in positive margin incidence.

Study Design

Retrospective database analysis.

Methods

We identified patients surgically treated for a parotid malignancy 2004 to 2013 in the National Cancer Database. We associated positive margins with patient, tumor, and treatment factors by multivariable logistic regression and with overall survival by Cox proportional hazards regression. We characterized institutional variation in positive margin rates by facility type and volume.

Results

A total of 5,639 patients were identified. The overall positive margin rate was 31%. By institution, positive margin rates varied from 0% to 100%, with a median rate of 31% (interquartile range = 18%–43%). Adenoid cystic carcinoma was associated with increased, and low‐grade mucoepidermoid carcinoma with decreased, odds of positive margins, (odds ratio [OR] = 1.91 [95% confidence interval {CI}: 1.54‐2.38], P < .001 and OR = 0.68 [95% CI: 0.53‐0.87], P = .002, respectively). Treatment at academic or high‐volume facilities was associated with decreased odds of positive margins (OR = 0.79 [95% CI: 0.68‐0.91], P = .001 and OR = 0.76 [95% CI: 0.63‐0.91], P = .004). Positive surgical margins were associated with decreased overall survival (62% vs. 79% 5‐year overall survival, hazard ratio [HR] = 1.34 [95% CI: 1.20‐1.49], P < .001). Upon stratification by histology, this association was maintained for high‐grade, but not low‐grade, mucoepidermoid carcinoma (52% vs. 74%, HR = 1.56 [95% CI: 1.31‐1.86], P < .001 and 89% versus 91%, HR = 1.05 [95% CI: 0.60‐1.83], P = .874, respectively).

Conclusions

Tumor and institutional factors are associated with positive surgical margins. Positive margin rates vary substantially between facilities and are less likely at academic and high‐volume facilities. Positive surgical margins are associated with decreased overall survival and could be considered quality indicators in parotid malignancies.

Level of Evidence

2c Laryngoscope, 129:129–137, 2019
Human laryngeal sensory receptor mapping illuminates the mechanisms of laryngeal adductor reflex control
Authors: Sinclair Catherine F. , Téllez Maria J. , Ulkatan Sedat
Published: September 2018

Objective

The laryngeal adductor reflex (LAR) is an airway protective response triggered by sensory laryngeal receptors. It is unknown whether different glottic and supraglottic subsites vary in their reflex elicitation abilities. The recent discovery that a bilateral LAR is present in humans under general anesthesia upon laryngeal mucosal stimulation has enabled us to map the sensory receptor density for LAR elicitation at different laryngeal subsites. Our findings expose the likely mechanisms of LAR control.

Methods

Prospective series of 10 patients undergoing laryngoscopy. Laryngeal subsites (epiglottic tip, membranous vocal fold, midventricular vocal fold, posterior supraglottis, epiglottic petiole) were stimulated via direct laryngoscopy with a bipolar probe. Vocal fold responses were recorded by endotracheal tube and hook wire electrodes, and visual observation.

Results

Posterior supraglottic stimulation elicited bilateral LARs in all patients at all intensities. Membranous vocal folds, epiglottic petiole, and subglottis elicited no LAR. Ventricular fold and epiglottic tip responses converted from ipsi‐ to bilateral at high intensities.

Conclusion

There are likely three checkpoints for control of the LAR in humans. These checkpoints protect against inappropriate LAR activation during volitional tasks without compromising airway protection: 1) topographical differences in receptor density with the highest density in subsites most likely to contact foreign substances; 2) absence of receptors in membranous vocal folds; and 3) central summation threshold for crossed interneuron activation at brainstem level where only strong intensity stimuli will elicit bilateral responses. Checkpoint dysfunction provides a novel framework to diagnose and treat disease processes, including aspiration, laryngospasm, and sudden infant death.

Level of Evidence

4. Laryngoscope, E365–E370, 2018
The effect of aging on drug‐induced sleep endoscopy findings
Authors: Zhao Chen , Viana Alonço , Ma Yifei , Capasso Robson
Published: September 2018

Objectives/Hypothesis

To evaluate the correlation of aging and upper airway collapse characteristics observed by drug‐induced sleep endoscopy (DISE), and report the observed differences on obstructive sleep apnea (OSA) subjects, older and younger than 60 years.

Study Design

Case series.

Methods

This study analyzed the data of 200 OSA patients who underwent DISE between January 1, 2013 and June 30, 2017. The variables sex, body mass index (BMI), Epworth Sleepiness Scale score, tonsil size, modified Mallampati (MM) classification, apnea‐hypopnea index (AHI), oxygen desaturation index (ODI), lowest oxygen saturation, and VOTE (velum, oropharynx, tongue base, epiglottis) classification were compared between two groups: <60 and ≥60 years old.

Results

Older age had significant correlation with higher AHI, ODI, lower O2 nadir, multisite obstruction, combined upper (palatopharyngeal) + lower (hypopharyngeal) level obstructions, and complete anterior‐posterior (AP) velum collapse pattern. Lateral oropharyngeal wall collapse was significantly lower in the older group. Findings remained statistically significant when adjusted for sex, BMI, tonsil size, and MM.

Conclusions

Aging was an independent factor that directly correlated with increased AHI and hypoxemia, multisites, combined levels of obstruction, and complete AP velum collapse pattern. Being older than 60 years had higher of complete AP velum collapse and lower incidence of lateral oropharyngeal wall collapse, regardless of OSA severity and tonsil size.

Level of Evidence

4 Laryngoscope, 2644–2650, 2018
Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice
Authors: Tao Xiaoyao , Chen Fenghong , Sun Yueqi , Wu Shulian , Hong Haiyu , Shi Jianbo , Xu Rui
Published: September 2018

Objectives/Hypothesis

The European Position Paper on Rhinosinusitis and Nasal Polyps proposes an assessment of clinical control of chronic rhinosinusitis (CRS). However, there are limited data about the percentage of postoperative control, and no prediction models for uncontrolled CRS have been reported. The aim of the study was to develop prediction models for postoperative uncontrolled CRS.

Study Design

Retrospective case series.

Methods

Patients (n = 136) who had undergone endoscopic sinus surgery at least 1 year prior to the study were recruited to assess the clinical control. Risk factors were determined by logistic models and presented as odds ratio (OR) with a 95% confidence interval. Receiver operating characteristics curves were constructed to set the cutoff points and create predictive models.

Results

Approximately 47.8% of patients had controlled, 22.1% partially controlled, and 30.1% uncontrolled CRS. Univariate regression models revealed the risk factors for uncontrolled CRS: tissue eosinophilia, blood eosinophilia, high computed tomography (CT) score, bilateral disease, asthma, and allergic rhinitis. Multiple regression models found tissue eosinophil ratio >0.206 (OR: 12.96, P = .001) or blood eosinophil ratio >0.025 (OR: 4.56, P = .003), Lund‐Mackay (LM) score ≥ 15 (OR: 15.50, P < .001) and CT ethmoid (E) score ≥ maxillary (M) score (OR: 3.51, P = .037) were independent risk factors. We generated a pathological model (tissue eosinophil ratio and LM score) and a clinical model (blood eosinophil ratio, LM score and E ≥ M score) to categorize CRS into mild, moderate, and severe.

Conclusions

This research provides simplified and efficient prediction models for uncontrolled CRS. It may help otolaryngologists to predict the prognosis before surgery in daily practice.

Level of Evidence

2b Laryngoscope, 128:2673–2680, 2018
Perceptions of Electronic Health Records Within Otolaryngology Residents Compared to Practicing Otolaryngologists
Authors: Harrill Peter A. , Melon David E. , Seshul Merritt J. , Zanation Adam
Published: September 2018

Objective

This study investigated the perceived impact of electronic health records (EHR) on otolaryngology residents with regard to education, patient care, and workflow, and then compared the trends with those of practicing otolaryngologists.

Methods

A descriptive, cross‐sectional survey was developed for each core study group: the otolaryngology resident group (ORG) and the practicing otolaryngologist group (POG). In total, 536 surveys were submitted: 33 from the ORG survey and 510 from the POG survey. Response rates were 51.5% and 21.3%, respectively.

Results

Within the two study groups, ORG reported a predominately neutral response relating to the impact of EHR on experience compared with the POG, which reported far more negative responses. The most negative reported change in the ORG related to feeling more like a passive observer and scribe in terms of how EHR negatively impacted the role of resident. Within the POG group, the majority of negative responses were recorded on the impact of EHR on practice efficiency, practice overhead, and number of employees required to maintain practice function.

Conclusion

With otolaryngologists making up 1.1% of the U.S. physician workforce in 2015, it is likely that software programing of EHR underrepresents the workflow needs of otolaryngologists at this time. Future studies investigating the impact of EHR on otolaryngology patient care and resident education are needed in the future.

Laryngoscope, 128:2726–2731, 2018
Oropharyngeal Injury From Spontaneous Combustion of a Lithium‐ion Battery: A Case Report
Authors: Morse Justin , Tittman Sarah , Gelbard Alexander
Published: September 2018

Lithium‐ion batteries have been used for more than 20 years, most recently to power handheld devices including cellphones and electronic nicotine‐delivery systems. They have garnered significant media attention due to thermal‐related injuries occurring after spontaneous combustion. Spontaneous combustion of a lithium‐ion battery occurs due to a process that is referred to as the thermal runaway effect. Here, we review the case of a 25‐year‐old female with severe oropharyngeal and upper aerodigestive thermal injuries after spontaneous combustion of a lithium‐ion battery in a flashlight. We discuss the associated management and provide a review of the literature detailing similar injuries.

Laryngoscope, 129:45–48, 2019
Wound healing after transoral angiolytic laser surgery for early glottic carcinoma
Authors: Tracy Lauren F. , Hron Tiffiny A. , Van Stan Jarrad H. , Burns James A.
Published: September 2018

Objectives/Hypothesis

Wound healing after transoral angiolytic laser surgery for early glottic carcinoma was analyzed to identify factors influencing healing and clinical significance of persistent granulation tissue.

Study Design

Retrospective review.

Methods

A retrospective review of 100 consecutive patients undergoing endoscopic angiolytic laser surgery for T1 and T2 glottic carcinoma was performed. Patients with prior radiation or incomplete data were excluded. Postoperative endoscopic images were analyzed for time to healing, size and location of wound, and presence of granulation tissue. Three blinded, independent raters graded wound appearance and presence of granulation tissue.

Results

Seventy‐nine patients healed without need for intervention at a median of 3.5 months. Two patients had office‐based ablation of granulation without biopsy and healed. The remaining 19 patients had biopsy for granulation tissue. Wounds that underwent biopsy at >3 months were more likely to contain carcinoma (5/6 patients, 83%) than wounds that were biopsied <3 months (2/13 patients, 15%) (P = .004). Presence of granulation significantly correlated with resection involving anterior commissure (P = .01), > 75%vocal fold length (P = .006), and depth into muscle (P = .001). Delayed healing (>3 months) correlated with T2b tumors (P = .02), depth into ligament (P = .002) and anterior commissure involvement (P = .04). T1a carcinomas more commonly healed in <3 months (P = .005).

Conclusions

Many vocal fold wounds heal completely within 3.5 months after angiolytic laser surgery for early glottic carcinoma. Larger and deeper wounds are more likely to heal with granulation tissue. Granulation can resolve without surgical intervention; however, granulation present > 3 months warrants biopsy due to increased risk of malignancy.

Level of Evidence

4 Laryngoscope, 129:435–440, 2019
The Effect of Sedating Agents on Drug‐Induced Sleep Endoscopy Findings
Authors: Viana Alonço , Zhao Chen , Rosa Talita , Couto Arnaldo , Neves Denise Duprat , Araújo‐Melo Maria Helena , Capasso Robson
Published: September 2018

Objective

Drug‐induced sleep endoscopy (DISE) has gained interest for upper airway evaluation in patients with snoring and obstructive sleep apnea (OSA), and different drugs have been used to induce sedation. Nevertheless, all drugs have presented specific advantages and disadvantages with differential effects on respiratory physiology. This study evaluated and compared the effects of midazolam, propofol and dexmedetomidine on DISE findings, O2 nadir, and bispectral index (BIS) in the same sample of patients.

Study Design

Case series prospective study.

Methods

Consecutive patients who elected to undergo surgery for OSA treatment and were intolerant to conservative therapies underwent DISE with propofol, dexmedetomidine, and midazolam between July 2015 and July 2016.

Results

Fifty‐two patients were analyzed, and 43 (82.7%) were men. Agreement among drugs for both degree and patterns of obstruction was excellent at all sites (velum, oropharynx, and epiglottis) except for the tongue base. Dexmedetomidine had the least complete collapse sites and highest O2 nadir and was the only drug for which apnea severity and obstruction levels (upper, lower, or combined) were correlated. The variability among drug treatments for the BIS index was considerable, and propofol had the lowest variability and average value.

Conclusion

Drug selection had a relevant influence in DISE findings. Compared with dexmedetomidine, midazolam and propofol presented higher incidence of tongue base collapse, lower O2 levels, and lower BIS index values. Propofol resulted in an O2 nadir that most resembled that observed during polysomnography. The BIS index variability differed among drugs, and its use was considered relevant for sedation orientation.

Level of Evidence

4 Laryngoscope, 129:506–513, 2019
Clinical and Economic Impact of Time From Admission for CSF Rhinorrhea to Surgical Repair
Authors: Villwock Jennifer A. , Villwock Mark R. , Deshaies Eric M. , Goyal Parul
Published: September 2018

Background

If conservative management of CSF leak is unsuccessful, surgical repair is indicated for the prevention of severe complications such as meningitis. This study investigated the influence of surgical timing on clinical and economic outcomes.

Methods

Retrospective review of the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2002–2011) for nonelective admissions with a principal diagnosis of CSF rhinorrhea treated with surgical repair of the meninges. Demographics and outcomes of patients undergoing meningeal repair for CSF rhinorrhea were analyzed. Cases were classified into four groups based on timing of surgical intervention: 1) performed on the day of admission (day 0), 2) performed between days 1 and 3, 3) performed between days 4 and 7, and 4) performed between days 8 and 14.

Results

A total of 1,088 emergent admissions were analyzed. On average, patients underwent surgical repair between the second and fourth day of admission. Lowest rates of meningitis were in patients treated on the day of admission (6.1%); those treated at 2 weeks had a 34.7% incidence. Multivariate analysis controlling for comorbidity burden, gender, and surgical timing found the highest odds of meningitis in patients treated with surgical repair during the second week of admission compared to repair on the day of admission (OR 8.2, P < .001). Length of stay (LOS) and hospital costs increased as time to repair increased.

Conclusion

Multiple factors influence outcomes in patients with CSF rhinorrhea. Early surgical repair was significantly associated with decreased rates of meningitis, LOS, and hospital costs. Expedient treatment of patients admitted for CSF rhinorrhea may prove to be both a cost‐ and morbidity‐saving measure.

Level of Evidence

2C Laryngoscope, 129:539–543, 2019
A Population‐Based Analysis of Nodal Metastases in Esthesioneuroblastomas of the Sinonasal Tract
Authors: Kuan Edward C. , Nasser Hassan B. , Carey Ryan M. , Workman Alan D. , Alonso Jose E. , Wang Marilene B. , John Maie A. St. , Palmer James N. , Adappa Nithin D. , Tajudeen Bobby A.
Published: September 2018

Objective

Esthesioneuroblastoma is an uncommon malignancy of the sinonasal tract arising from the olfactory epithelium. Surgical management of the primary site, often via an endoscopic approach, with or without adjuvant radiation, is often curative. There is growing but ultimately limited data regarding management of the neck and the risk of nodal metastases. In this study, we examine the incidence and patterns of esthesioneuroblastoma‐related cervical nodal metastases using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

The SEER registry was queried for all patients with esthesioneuroblastomas diagnosed between 1973 and 2012. Patient data was then analyzed with respect to age, sex, race, modified Kadish stage, grade, survival functions, and nodal disease including specific nodal basins.

Results

Three hundred and eighty‐one cases of esthesioneuroblastoma with information on nodal metastases were identified. The overall cervical nodal metastasis rate was 8.7%. Level II metastases were most common (6.6%). A total of 4.5% of cases presented with multiple positive nodal basins. Male sex (P = 0.009) and higher tumor grade (P = 0.009) correlated with the presence of level II metastases. There was no association of primary tumor site to the presence of nodal metastases (P > 0.05). The presence of nodal disease significantly predicted poorer overall (P = 0.001) and disease‐specific survival (P = 0.017).

Conclusion

The incidence of nodal metastases in esthesioneuroblastoma at diagnosis is rare, and elective management of the neck remains controversial. Primary tumor site does not appear to predict metastases at specific nodal basins. Higher tumor grade may be a harbinger of eventual nodal metastases.

Level of Evidence

NA Laryngoscope, 129:1025–1029, 2019
Disparities in Postoperative Therapy for Salivary Gland Adenoid Cystic Carcinomas
Authors: Cassidy Richard J. , Switchenko Jeffrey M. , El‐Deiry Mark W. , Belcher Ryan H. , Zhong Jim , Steuer Conor E. , Saba Nabil F. , McDonald Mark W. , Yu David S. , Gillespie Theresa W. , Beitler Jonathan J.
Published: September 2018

Objectives

The patterns of care for salivary gland adenoid cystic carcinomas (ACC) are unknown. We sought to assess predictors of receiving postoperative radiation and/or chemotherapy for patients with nonmetastatic, definitively resected ACC, as well as report unexpected nodal disease.

Methods

The National Cancer Data Base was queried for definitively resected nonmetastatic ACC from 2004 to 2014. Logistic regression, Kaplan‐Meier, and Cox proportional‐hazard models were utilized. Propensity‐score matched analysis was employed to reduce confounding variables.

Results

A total of 3,136 patients met entry criteria: 2,252 (71.8%) received postoperative radiation, with 223 (7.4%) also receiving concurrent chemotherapy. Median follow‐up was 4.87 years. In clinically lymph node negative (cN0) patients, 7.4% had pathologically positive lymph nodes (pN) + after elective neck dissection. Patients who lived closer to their treatment facility and had positive margins were more likely to receive postoperative radiation. Black patients and uninsured patients were less likely to receive radiation. Older age, male sex, advancing stage, and positive surgical margins were associated with worse overall survival (OS). With limited follow‐up, receipt of radiation or chemotherapy was not associated with OS.

Conclusion

Postoperative radiation was frequently given for resected ACC, with a minority receiving chemotherapy. Black patients and uninsured patients were less likely to receive radiation. Postoperative radiation and/or chemotherapy had no association with OS but were given in greater frequency in more advanced disease, and our series is limited by short follow‐up. The disparity findings for this rare disease need to be addressed in future studies.

Level of Evidence

2c Laryngoscope, 129:377–386, 2019
Snoring and carotid artery disease: A new risk factor emerges
Authors: Deeb Robert , Smeds Matthew R. , Bath Jonathan , Peterson Edward , Roberts Matthew , Beckman Nanette , Lin Judith C. , Yaremchuk Kathleen
Published: September 2018

Objectives/Hypothesis

Previous studies have identified a relationship between snoring, carotid intima media thickening, and the presence of atherosclerosis. This study examines the correlation between snoring and carotid artery disease through use of duplex ultrasound identifying greater than 50% internal carotid artery stenosis.

Study Design

Prospective cohort study.

Methods

Patients presenting to three academic vascular laboratories for carotid duplex examination completed the following surveys: demographic information, assessment of risk factors for carotid stenosis, assessment of history of obstructive sleep apnea, or continuous positive airway pressure use and Snoring Outcomes Survey. Patients were categorized into 2 groups based on the presence or absence of carotid disease. Data were analyzed by univariate contingency tables and logistic regression analysis.

Results

Five hundred one patients completed the survey, of whom 243/501 (49%) had evidence of carotid occlusive disease. On univariate analysis, smoking, hypertension, heart disease, hypercholesterolemia, diabetes, and stroke all correlated with greater than 50% carotid stenosis. Multivariate analysis indicated that snorers were significantly more likely to have carotid disease. Three hundred twenty‐seven participants were thought to have primary snoring. On univariate analysis, snorers were found to be significantly more likely to have carotid disease. After adjustment for covariates, snoring was not significant for carotid disease. However, multivariate analysis showed snorers to be significantly more likely to have bilateral carotid disease.

Conclusions

This study shows a potential relationship between snoring and bilateral carotid artery stenosis greater than 50%; snorers have risk of carotid stenosis twice that of nonsnorers. Further investigation is warranted to better elucidate this relationship.

Level of Evidence

2b Laryngoscope, 129:265–268, 2019
Social isolation alters ultrasonic vocalizations but not thyroarytenoid neuromuscular junctions in old rats
Authors: Johnson Aaron M.
Published: September 2018

Objective

Age‐related muscle atrophy of the laryngeal muscles contributes to presbyphonia. Remodeling of the neuromuscular junction is one aspect underlying age‐related muscle atrophy. Although muscle disuse has been shown to exacerbate age‐related neuromuscular changes in the limb muscles, it is unknown if reduced vocal use has a similar effect in the laryngeal muscles. The objective of this study was to examine the use of social isolation as a novel method to reduce vocal use in old rats—and the impact of that reduced vocal use on ultrasonic vocalization acoustics and neuromuscular junction morphology in the thyroarytenoid muscle.

Study Design

Animal group comparison.

Methods

Old F344/BN rats (31 months of age) were socially isolated (n = 8) or communally housed (n = 8) for 8 weeks. Effect of housing condition on ultrasonic vocalization acoustics was assessed by calculating the changes in vocalization fundamental frequency and amplitude from baseline to 8 weeks. Neuromuscular junction morphology was measured in the lateral and medial portions of the thyroarytenoid muscle at the conclusion of the experiment.

Results

Vocalization amplitude decreased by a mean of −4.4 dB (standard deviation [SD], 4.49) after social isolation, whereas amplitude increased by a mean of 5.7 dB (SD, 5.07) in the communally housed rats (P = 0.002). There was no significant difference in the change in fundamental frequency between groups. Furthermore, there were no group differences in any measure of neuromuscular junction morphology.

Conclusion

These results suggest that neuromuscular junctions in the thyroarytenoid muscle of old rats are unaffected by 8 weeks of social isolation, despite functional changes in vocalizations.

Level of Evidence

NA Laryngoscope, 129:E9–E14, 2019
Does Medical Therapy Improve SinoNasal Outcomes Test–22 Domain Scores? An Analysis of Clinically Important Differences
Authors: Chowdhury Naweed I. , Mace Jess C. , Bodner Todd E. , Alt Jeremiah A. , Deconde Adam S. , Levy Joshua M. , Smith Timothy L.
Published: September 2018

Objectives/Hypothesis

Minimum clinically important differences (MCIDs) for the 22‐item SinoNasal Outcomes Test (SNOT‐22) in patients with chronic rhinosinusitis (CRS) electing endoscopic sinus surgery (ESS) are well described. However, similar estimations for the MCID have not been investigated for patients electing continued appropriate medical therapy (CAMT). We sought to determine MCID values for a medically treated CRS cohort and compare them to historical MCIDs associated with ESS.

Study Design

Prospective observational cohort study.

Methods

One hundred twenty patients with refractory CRS electing CAMT were prospectively enrolled from academic referral clinics into an observational cohort study. Baseline and posttreatment SNOT‐22 survey responses were collected. Four distribution‐based methods for calculating MCIDs (e.g., half‐standard deviation, Cohen's d, standard error of measurement, and minimum detectable change) were used to identify a range of MCID values for SNOT‐22 total and domain scores.

Results

The average MCID value for SNOT‐22 total scores was 8.0, whereas mean MCID values for rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep symptom domain scores were 3.9, 2.5, 3.3, 3.4, and 2.9, respectively, comparable to previously reported values for patients electing ESS. Although change in SNOT‐22 total scores following CAMT exceeded the MCID, none of the average SNOT‐22 domain score improvements surpassed their respective MCID thresholds.

Conclusions

MCID values for SNOT‐22 total and domain scores in patients electing CAMT are similar to previously published MCID values associated with ESS, indicating that MCID values are independent of treatment modality selection. Therefore, despite evidence of statistical significance, CAMT for CRS may not be associated with clinically discernable improvements in average SNOT‐22 domain scores.

Level of Evidence

2c Laryngoscope, 129:31–36, 2019
Granulomas of the membranous vocal fold after intubation and other airway instrumentation
Authors: Sadoughi Babak , Rickert Scott M. , Sulica Lucian
Published: September 2018

Objectives/Hypothesis

We describe the clinical features of granulomas of the membranous vocal fold secondary to endotracheal intubation, bronchoscopy or esophagogastroduodenoscopy.

Study Design

Retrospective case series.

Methods

Review of cases at a single tertiary institution with evaluation of patient demographic characteristics, time to presentation, time to treatment, and clinical outcomes.

Results

Thirteen adult patients were identified with postintervention granuloma of the membranous vocal fold. All patients were female, with a mean age of 60 years (range, 28–81 years). None noted hoarseness prior to the intervention, and all noted significant hoarseness postoperatively. Conservative treatment with proton pump inhibitors and vocal rest was initially implemented in all patients. Four cases resolved without further intervention. Nine underwent surgical management because of airway symptoms, failure to improve, or patient request. One patient had injury to the contralateral vocal fold upon intubation. None experienced recurrence. Five had complete recovery of voice postoperatively, four did not.

Conclusion

Iatrogenic granulomas of the membranous vocal fold after intubation or other upper airway instrumentation are rare complications presenting in the early postprocedure period with worsening hoarseness. Initial conservative treatment may be sufficient to yield resolution, and surgical treatment is effective for those failing medical management. Permanent voice damage may result from the original injury.

Level of Evidence

4 Laryngoscope, 129:441–447, 2019
Relationships between aboveground and belowground trait responses of a dominant plant species to alterations in watertable depth
Authors: Mao Wei , Felton Andrew J. , Ma Yunhua , Zhang Tonghui , Sun Zhibin , Zhao Xueyong , Smith Melinda D.
Published: September 2018

Drought impacts to plant growth can be indicated by changes in key functional traits. However, previous research has focused on aboveground trait responses to precipitation deficits, with less emphasis on concomitant belowground impacts and deep soil drought from groundwater depletion. We assessed changes in a suite of aboveground and belowground traits of a dominant plant, Phragmites communis, in response to an experimental gradient of underground watertable depth. Our study occurred within the northeastern Inner Mongolia region, where changes to groundwater tables have been pervasive in recent years. In general, the results indicate that both aboveground and belowground traits responded positively, yet eventually negatively, to continual increases in watertable depth, indicative of reduced access to soil moisture as watertable depths increased. Key adjustments include changes to the ratio of coarse roots to fine roots, and the distribution of fine roots within the soil profile. These changes in belowground traits had strong correlations with changes in aboveground traits. In particular, specific root length of fine roots was positively correlated with leaf area, height, and aboveground biomass, whereas root biomass was linked to leaf area, specific root length of coarse roots, and root length density. Fine and coarse root production also had positive and negative relationships with aboveground biomass, respectively, suggestive of biomass allocation tradeoffs. We suggest that biomass production responses of this species to changes in watertable depths may largely be driven by interactions between the distribution of fine and coarse roots in the soil profile and changes to leaf area.
CEST imaging at 9.4 T using adjusted adiabatic spin‐lock pulses for on‐ and off‐resonant T1⍴‐dominated Z‐spectrum acquisition
Authors: Herz Kai , Gandhi Chirayu , Schuppert Mark , Deshmane Anagha , Scheffler Klaus , Zaiss Moritz
Published: September 2018

Purpose

The CEST experiment, with its correlation to rare proton species that are in exchange with the water pool, is very similar to the off‐resonant water spin‐lock (SL) experiment. In particular, low‐power SL Z‐spectrum acquisition allows insight into T1ρand exchange effects with decreased direct water saturation. Because the available SL methods either require high B1power or are instable in the presence of strong B1and B0inhomogeneity present at ultra‐high fields, the goal of this study was to find a robust adiabatic SL pulse for on‐ and off‐resonant application in the human brain at 9.4 T.

Methods

A series of Bloch simulations were used to find optimal pulse shape parameters of an adjusted hyperbolic secant pulse applicable in the low power regime typically used for exchange‐weighted SL experiments. The optimized pulse was implemented and tested in phantom and in vivo experiments on a 9.4 T human scanner for on‐ and off‐resonant T1ρ‐ and Z‐spectrum measurements.

Results

The simulation yielded a feasible pulse shape, which yielded robust images, less sensitivity to B1and B0inhomogeneity compared with previous SL approaches and less direct water saturation, as well as a higher chemical exchange weighting compared with conventional CEST approaches.

Conclusion

By adapting a pulse shape for low‐power SL experiments, we were able to acquire robust on‐ and off‐resonant adiabatic SL prepared images in vivo at 9.4 T. This development leads directly to SL Z‐spectrum acquisition, beneficial for chemical‐exchange‐weighted MRI.
Reproducibility of motor unit number index and multiple point stimulation motor unit number estimation in controls
Authors: Higashihara Mana , Menon Parvathi , van den Bos Mehdi , Geevasinga Nimeshan , Vucic Steve
Published: September 2018

Introduction: Reproducibility of the multiple point stimulation motor unit number estimation (MPS‐MUNE) technique was compared with the recently developed motor unit number index (MUNIX) technique. Methods: MPS‐MUNE and MUNIX were performed on 15 healthy subjects at 3 different time‐points by the same examiner. Reproducibility was analyzed using intraclass correlation coefficient (ICC) and coefficient of variation (CV). Results: ICC values for MUNIX and MPS‐MUNE were excellent across 3 tests (0.80 and 0.77, respectively), although CV values were significantly lower for MUNIX than MPS‐MUNE (P < 0.01). In addition, test‐retest reproducibility was better for MUNIX, a finding largely attributable to poor reproducibility of the single motor unit action potential area. MUNIX (R = −0.48, P < 0.05) and MPS‐MUNE (R = −0.53, P < 0.05) were significantly correlated with age. Discussion: MUNIX demonstrated better intrarater reproducibility and may be a more reliable neurophysiological biomarker than MPS‐MUNE. Muscle Nerve 58: 660–664, 2018