bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of BRAF c.1799T > A (p.V600E) mutation using residual routine fine‐needle aspiration specimens of papillary thyroid carcinoma
Authors: Zhao Huan , Zhang Zhi‐hui , Zhou Bin , Xiao Ting , Pan Qin‐jing , Guo Hui‐qin
Published: July 2015

Background

BRAF p.V600E mutation is the most common genetic alteration in papillary thyroid cancer (PTC) and has been used as a diagnostic and prognostic marker in PTC. The aim of this study was to investigate the utility of preoperative BRAF p.V600E mutation analysis as an adjunctive diagnostic and prognostic tool to routine fine‐needle aspiration (FNA).

Methods

Specimens were collected from thyroid nodules by FNA. Cytology diagnosis and BRAF p.V600E testing were performed on these specimens. Molecular and cytological results were correlated with histology outcomes.

Results

A total of 195 patients with thyroid nodules were enrolled, including 25 benign lesions and 170 PTCs. BRAF p.V600E testing was successfully performed in all specimens. The combination of BRAF p.V600E testing and cytology improved the sensitivity of cytology from 70% to 85.3% (P = 0.001). This significant increase in sensitivity was due to the detection of PTC by BRAF p.V600E testing in the nodules with atypical or suspicious PTC cytology results. Patients with BRAF p.V600E‐positive tumors were significantly older than those who did not harbor mutations (45.6 years vs. 39.8 years, P = 0.002). No correlations between BRAF p.V600E mutation and other clinical‐pathology parameters were observed.

Conclusions

Detection of BRAF p.V600E mutation can be successfully carried out using residual liquid‐based materials. It can be performed as a diagnostic tool to supplement traditional thyroid FNA, especially in cases with atypical or suspicious PTC. However, the role of BRAF p.V600E in guidance of the extent of thyroidectomy and nodal clearance requires further study. Diagn. Cytopathol. 2015;43:786–790. © 2015 Wiley Periodicals, Inc.
Interobserver reproducibility and agreement with original diagnosis in the categories “atypical” and “suspicious for malignancy” for bile and pancreatic duct brushings
Authors: Layfield Lester J. , Schmidt Robert L. , Chadwick Barbara E. , Esebua Magda , Witt Benjamin L.
Published: July 2015

Background

The Papanicolaou Society of Cytopathology has developed a set of guidelines which include a diagnostic scheme with the categories “atypical” and “suspicious for malignancy.” These intermediate categories may help stratify risk of malignancy for samples obtained from the bile and pancreatic ducts. However, the reproducibility of these intermediate categories is currently unknown.

Methods

Twenty sequential brushing specimens of bile or pancreatic ducts from each of the categories “atypical” and “suspicious for malignancy” were identified and the slides retrieved. All 40 cases were reviewed independently by four cytopathologists blinded to the original diagnoses. Resulting review diagnoses were statistically analyzed for agreement and the Kappa statistic calculated. Agreement of the observers’ diagnoses with original diagnoses was also evaluated.

Results

Interobserver agreement was graded as slight to fair with observers agreeing in about 50% of cases. The corresponding kappa statistic for the category “atypical” was 0.21 and 0.18 for the category “suspicious for malignancy.” Reviewer agreement with the original reference diagnosis occurred in approximately one half of review diagnoses.

Conclusion

Analysis of agreement shows that interobserver agreement was only slight to fair. Despite the categories “atypical” and “suspicious for malignancy” having distinct risks of malignancy (62% versus 74%), the reproducibility of these categories is relatively poor. A single intermediate category may improve reproducibility over the scheme proposed by the Papanicolaou Society of Cytopathology while maintaining an ability to stratify risk of malignancy. Diagn. Cytopathol. 2015;43:797–801. © 2015 Wiley Periodicals, Inc.
ALK and ROS1 rearrangements tested by fluorescence in situ hybridization in cytological smears from advanced non‐small cell lung cancer patients
Authors: Bozzetti Cecilia , Nizzoli Rita , Tiseo Marcello , Squadrilli Anna , Lagrasta Costanza , Buti Sebastiano , Gasparro Donatello , Zanoni Daniele , Majori Maria , De Filippo Massimo , Mazzoni Francesca , Maddau Cristina , Naldi Nadia , Sammarelli Gabriella , Frati Caterina , Pinto Carmine , Ardizzoni Andrea
Published: July 2015

Background

The identification of ALK and ROS1 rearrangements and the availability of an effective target therapy, such as crizotinib, represent a new option in the treatment of advanced non‐small cell lung cancer (NSCLC) patients. In light of recent advances in non‐invasive diagnostic procedures, we aimed to demonstrate that direct cytological smears are suitable for assessing ALK and ROS1 rearrangements in patients with NSCLC.

Methods

Fifty‐five patients with a cytological diagnosis of lung adenocarcinoma (ADC) were evaluated for ALK rearrangements by fluorescence in situ hybridization (FISH) and 12 patients for ROS1 FISH rearrangements. Seventeen of the 55 cytological samples tested for ALK were obtained from the primary tumor and 38 from metastatic lesions. Ten of 12 samples evaluated for ROS1 were obtained from metastatic sites and two from the primary tumor.

Results

ALK FISH was successful in 49/55 (89%) cytological ADC samples and ROS1 FISH in all 12 cytological samples. ALK rearrangements were found in 3/13 (23%) primary tumors and 7/36 (19%) metastatic sites. ROS1 rearrangements were found in one of the two primary tumors and in two of the 10 metastases. Two of the three rearranged cases were tested on cytology after knowing that they were rearranged on histology in order to increase representativeness of ROS1 rearranged cases in this study.

Conclusion

Whenever cytology represents the only available material for diagnosis and biological characterization of NSCLC, minimally invasive procedures may provide an additional important source of cellular material for FISH assessment of ALK and ROS1 rearrangements.//// Diagn. Cytopathol. 2015;43:941–946. © 2015 Wiley Periodicals, Inc.
High quality lard with low cholesterol content produced by aqueous enzymatic extraction and β‐cyclodextrin treatment
Authors: Wang Qing‐Ling , Jiang Jiang , Li Jin‐Wei , Qiu Mei‐Bin , Lin Chuan‐Zhou , Shi Xu‐Hao , Cao Pei‐Rang , Liu Yuan‐Fa
Published: July 2015

New food processing technology is required for food production with high quality and healthfulness. In this study, a novel application was developed to extract lard from pig fatback, a by‐product of the slaughter plant, by an aqueous enzymatic extraction method (AEE). Various proteases with different properties including Alcalase 2.4 L, Neutrase 1.5 MG, Flavourzyme 1000 L, and Protamex were evaluated for their efficiency in oil release and lard qualities. Alcalase 2.4 L was more effective for oil extraction with a yield of 95.19%. A high quality of lard was produced by AEE in comparison with lards produced by conventional extraction methods in aspects of color, acid value, peroxide value, phospholipids, cholesterol, and oxidation stability. A further refinement to reduce cholesterol from lard by β‐cyclodextrin (β‐CD) was developed and the optimal conditions were established. The optimal conditions were 7% β‐CD addition (w/w) to a mixture of equal amount of lard and distilled water at reaction temperature 50°C for about 60 min. The cholesterol content of lard from this refinement process was about 3.2 mg/100 g which was about 93.7% reduction from 51.2 mg/100 g. This simple process by AEE and cholesterol reduction did not affect the composition of fatty acids and construction of triglyceride. Factors that were components of lard or produced during the lard extraction processes were evaluated for their influence on the cholesterol removal. Phospholipids could slightly enhance cholesterol removal, while free fatty acids with saturated or unsaturated aliphatic chains would have inhibitory effects because of their competition with cholesterol for β‐CD.

Practical applications: An excellent quality of lard was produced by a novel application of an aqueous enzymatic extraction method (AEE). This lard could be further refined by β‐cyclodextrin for cholesterol reduction. This procedure would be a promising technology to obtain healthy lard and explore animal by‐products for the food industry. This lard with high nutrients could have very broad applications such as in baking, cooking, deep fat frying in food industry.

Lard obtained by combination of aqueous enzymatic extraction and β‐cyclodextrin treatment presented high quality and very low cholesterol.
Fate of contaminants during the refining process of vegetable oils and fats: A calculation model
Authors: van Duijn Gerrit
Published: July 2015

Crude vegetable oils and fats after oil extraction may contain contaminants introduced in the supply chain. Many of these contaminants are largely removed from the oil by the refining process. However, these contaminants will concentrate in the refinery by‐products; acid oil from soapsplitting and filter blowing, spent bleaching earth, and deodorizer distillate. The contaminant levels in these by‐products are calculated by determining the lipids balance of the refinery and the fate of the contaminants in the refining process. Calculations of some example oils with characteristic contaminant levels show that deodorizer distillate from chemical refining has a high‐contamination risk, deodorizer distillate from physical refining and spent bleaching earth has a medium risk, whereas acid oil from soapsplitting and filter blowing have a low‐contamination risk.

Extracted oils and fats contain impurities like free fatty acids, phospholipids, etc., and may contain contaminants like polycyclic aromatic hydrocarbons and pesticides. The impurities and some entrained oil form the refinery by‐products; acid oil, spent earth, and deodorizer distillate. The contaminants will concentrate in these by‐products. For application in animal feed, acid oil is relatively safe (green), oil from spent bleaching earth requires contaminant analysis (orange), whereas contaminant levels in deodorizer distillate are often too high for use in feed (red).
Effect of pretreatment using ultrasound and hydrogen peroxide on digestion of waste activated sludge in an anaerobic membrane bioreactor
Authors: Joshi Priyanka , Parker Wayne
Published: July 2015

This study investigated combining pretreatment of waste activated sludge with anaerobic digestion in a submerged anaerobic membrane bioreactor. Preliminary tests revealed that a hydrogen peroxide and ultrasound pretreatment resulted in a chemical oxygen demand solubilization of 40% when a dose of 50 gH2O2/kgTS and sonication for 60 min were employed. Raw and pretreated waste activated sludge were fed to an anaerobic membrane bioreactor to determine if this increase in solubilization affected the biodegradability of the sludge. It was observed that pretreatment increased the extent to which the sludge was digested and hence it was concluded that the combined action of ultrasound and peroxide increased the biodegradable fraction of the sludge, while reducing the bioreactor and waste stream solids concentration. At a constant flux of 2.75 L/m2/hour, the transmembrane pressure and the fouling rate remained low and relatively constant over the course of operation, despite reduced mass flow of solids. The performance of the membrane was attributed to the fouling minimizing protocol that consisted of regular maintenance cleaning, a relaxed mode of operation, and continuous gas sparging. © 2015 American Institute of Chemical Engineers Environ Prog, 34: 1724–1730, 2015
Simulation of masonry out‐of‐plane failure modes by multi‐body dynamics
Authors: Costa Alexandre A. , Penna Andrea , Arêde António , Costa Aníbal
Published: July 2015

The seismic assessment of the local failure modes in existing masonry buildings is currently based on the identification of the so‐called local mechanisms, often associated with the out‐of‐plane wall behavior, whose stability is evaluated by static force‐based approaches and, more recently, by some displacement‐based proposals. Local mechanisms consist of kinematic chains of masonry portions, often regarded as rigid bodies, with geometric nonlinearity and concentrated nonlinearity in predefined contact regions (unilateral no‐tension behavior, possible sliding with friction). In this work, the dynamic behavior of local mechanisms is simulated through multi‐body dynamics, to obtain the nonlinear response with efficient time history analyses that directly take into account the characteristics of the ground motion. The amplification/filtering effects of the structure are considered within the input motion.

The proposed approach is validated with experimental results of two full‐scale shaking‐table tests on stone masonry buildings: a sacco‐stone masonry façade tested at Laboratório Nacional de Engenharia Civil and a two‐storey double‐leaf masonry building tested at European Centre for Training and Research in Earthquake Engineering (EUCENTRE). Copyright © 2015 John Wiley & Sons, Ltd.
Planning for Disaster
Authors: Banerjee Mohini P.
Published: July 2015

Some of my friends and relatives wonder why I want to spend my time thinking about social inequities in the context of natural disasters. I have tried to explain the importance of understanding how humanity's responses mitigate or worsen the human toll of “acts of God.” Disaster ethics presents a unique set of challenges.
Rationing Is Still Rationing
Authors: Wells Robert J.
Published: July 2015

A commentary on “Why It's Not Time for Health Care Rationing,” by Peter A. Ubel, in the March‐April 2015 issue.
the author replies
Authors: Hardwig John
Published: July 2015

A response to “Can Voice Be Given If No One Is Listening?,” by Chelsea A. Jack.
Candor about Adverse Events: Physicians versus the Data Bank
Authors: Morreim Haavi
Published: July 2015

Many major medical institutions have now embraced the idea that it is best to be honest with patients and families when an error causes harm that could have been avoided. This kind of disclosure improves patient safety and quality of care; enhances satisfaction for patients, families, and providers; and reduces malpractice litigation costs. The University of Michigan has perhaps the best‐known program. Since 2001, that institution has seen more than a 55 percent drop in the number of new malpractice claims filed, a comparable reduction in lawsuits, and a dramatic drop in both defense costs and malpractice payouts—money then redirected toward quality improvement. A few states have also embraced this approach, sometimes known as “Candor” (for “communication and optimal resolution”). Yet all of these efforts face a major challenge. Although many physicians would like very much to achieve insight, reconciliation, and quality improvement in just this way, many fear that money paid to resolve an incident in which they were involved can result in a lifelong black mark in the National Practitioner Data Bank.
The Bitter Pill of Name‐Brand Drugs
Authors: Gorin Moti
Published: July 2015

Imagine a drug—let's call it Curebitt—that is safe, cheap, and very effective: take a pill once a day and you will be healthier. Curebitt's taste is so unpleasant, so bitter, however, that a significant proportion of patients cannot bring themselves to ingest the pill regularly. Now suppose that after some time, another drug, Curesweet, hits the market. This drug is clinically equivalent to Curebitt and costs the same, but it is much more palatable, so adherence rates for it are significantly higher than for Curebitt. Should physicians continue prescribing Curebitt, now that Curesweet is available? No, prescribing the bitter pill puts patients at a greater risk of nonadherence and ultimately results in reduced clinical benefit for a significant proportion of patients, whereas prescribing Curesweet benefits more patients and increases the probability that any given patient's health will improve. The Curebitt versus Curesweet scenario draws our attention to how a physician can fail her patients by prescribing drugs with lower adherence rates when equivalent drugs with higher adherence rates are available. What does this fictional case tell us about the real world? A lot. We know that adherence rates vary with out‐of‐pocket costs. Name‐brand drugs carry higher out‐of‐pocket costs than their generic counterparts; as a result, when name‐brand drugs are prescribed rather than their generic counterparts, fewer patients receive health benefits. If prescribing Curebitt is unethical, then so is prescribing the name‐brand drug.
Training in Research Ethics and Standards for Community Health Workers and Promotores Engaged in Latino Health Research
Authors: Nebeker Camille , Kalichman Michael , Talavera Ana , Elder John
Published: July 2015

A model frequently used to implement community‐based research involves engaging local community health workers who are trusted members of the community and familiar with local customs, language, and culture. In Spanish‐speaking communities, the CHWs are also known as promotores de salud (“health promoters”). Depending on the study design and nature of the research, promotores facilitate research through community outreach, instrument design, participant recruitment, intervention delivery, data collection, and other research‐related tasks. In 2000, the National Institutes of Health published a regulation requiring training of “key personnel” named on NIH‐supported research involving human subjects. Regardless of whether promotores are technically designated as key personnel on a particular study, they may benefit from training in research ethics. Unfortunately, the educational programs designed for academic researchers in response to the NIH mandate were poorly aligned with the needs of promotores and not suited for learning about human research ethics applied to the community health setting. For example, many promotores in our California‐Mexico border region are monolingual Spanish speakers who have no formal academic research training. Therefore, we set out to develop a training alternative appropriate to our local CHWs. In this essay, we provide overviews of the relevant instructional design principles and our formative research process, including examples of key findings.
Beyond Harms and Benefits: Rethinking Duties to Disclose Misattributed Parentage
Authors: Garrett Jeremy R.
Published: July 2015

In this issue of the Hastings Center Report, Amulya Mandava, Joseph Millum, and Benjamin E. Berkman revisit an old conundrum—whether to disclose incidental findings of misattributed parentage—in light of new developments in genomic sequencing that will make that conundrum both more complex and more common. While the authors’ defense of nondisclosure as the appropriate default action in genomic research aligns with prior thinking and practice, their exploration of philosophical foundations is refreshingly rigorous and developed. The final product of their analysis—an applied taxonomy of the types of harms and benefits that can result from disclosure of misattributed parentage—is an important contribution to the literature on this subject and worthy of serious consideration by genomic researchers and bioethicists alike. Despite these virtues, I am struck by the authors’ deference to the traditional assumption that disclosure ethics can be adequately understood and appreciated within a purely consequentialist framework.
Tissue performance of bladder following stretched electrospun silk fibroin matrix and bladder acellular matrix implantation in a rabbit model
Authors: Huang Jian‐Wen , Xu Yue‐Min , Li Zhao‐Bo , Murphy Sean V. , Zhao Weixin , Liu Qiang‐Qiang , Zhu Wei‐Dong , Fu Qiang , Zhang Yao‐Peng , Song Lu‐Jie
Published: July 2015

The goal of this study was to investigate the tissue performance of bladder following stretched electrospun silk fibroin matrix (SESFM) implantation compared with bladder acellular matrix (BAM). We compared SESFM with BAM based on porosity and pore size. Scaffolds were separately transplanted into opposite walls of the bladder of 30 rabbits after stripping the bladder mucosa and smooth muscle (1.5 × 2.0 cm2). Gross anatomical observation, histological analysis and muscle contractility studies were performed at 2, 4, and 8 weeks post‐op. SESFM has higher porosity and larger pore size compared with BAM (p < 0.05). At 2 weeks, the presence of vesical calculus was evident in 7/10 rabbits. Histological analysis showed that SESFM and BAM promoted similar degree of urothelium regeneration (p > 0.05). However, SESFM promoted a higher degree of smooth muscle and vessel regeneration compared to BAM (p < 0.05). In addition, muscle strips supported by SESFM displayed higher contractile responses to carbachol, KCl, and phenylephrine compared with BAM. At 8 weeks, both matrices elicited similar mild acute and chronic inflammatory reactions. Our results demonstrated that SESFM has greater ability to promote bladder tissue regeneration with structural and functional properties compared to BAM, and with similar biocompatibility. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 9–16, 2016.
MRI assessment of excess cardiac iron in thalassemia major: When to initiate?
Authors: Chen Xiaodong , Zhang Zuoquan , Zhong Jinglian , Yang Qihua , Yu Taihui , Cheng Ziliang , Chan Queenie , Guo Hua , Liang Biling
Published: July 2015

Background

To determine optimal initial age of cardiac iron screening with magnetic resonance imaging (MRI) T2* in patients with thalassemia major (TM).

Methods

We retrospectively reviewed black blood cardiac T2* assessments from 102 TM patients from the ages of 3 to 32 years. Cases of patients under and above 7 years old with detectable cardiac iron overload were analyzed separately. Associations between cardiac T2* and various factors, such as serum ferritin (SF), patient age and hepatic T2*, were assessed using either scatterplots or regression. Images were evaluated by two independent radiologists.

Results

With a T2* cut‐off value of 20 ms, no patient under 5 years old showed cardiac iron overload. Three of 19 (15.8%) patients under 7 years of age had a cardiac T2* ≤ 20 ms (5.5 to 7 years) but none had ≤10 ms, while 35 of 83 (42.2%) patients above 7 years old had a cardiac T2* ≤ 20 ms (8 to 32 years) and 18 of them ≤10 ms. Cardiac T2* correlated weakly with serum ferritin and liver T2* (r = −0.39 and 0.41, respectively, both P < 0.001), but not with patient age (P > 0.05).

Conclusion

Cardiac iron overload can occur in young TM patients, even as young as 5.5 years old. Assessment of cardiac iron with T2* might need to begin as early as 5 years old if suboptimal chelation therapy is administered. J. Magn. Reson. Imaging 2015;42:737–745.
Robotic inguinal hernia repair
Authors: Escobar Dominguez Jose E. , Gonzalez Anthony , Donkor Charan
Published: July 2015

Inguinal hernias have been described throughout the history of medicine with many efforts to achieve the cure. Currently, with the advantages of minimally invasive surgery, new questions arise: what is going to be the best approach for inguinal hernia repair? Is there a real benefit with the robotic approach? Should minimally invasive hernia surgery be the standard of care? In this report we address these questions by describing our experience with robotic inguinal hernia repair. J. Surg. Oncol. 2015; 112:310–314. © 2015 Wiley Periodicals, Inc.
An improved cell membrane chromatography method for the simultaneous screening of two epidermal growth factor receptor antagonists from radix scutellariae
Authors: Sun Meng , Hou Xiaofang , Lin Yuanyuan , Zhang Jie , Wang Sicen
Published: July 2015

A high‐expression epidermal growth factor receptor cell membrane chromatography using the silica gel with the average particle size of 3 μm as the stationary phase carrier coupled with high‐performance liquid chromatography and mass spectrometry was established for the online screening of epidermal growth factor receptor antagonists from Radix Scutellariae (Huang Qin in Chinese), a traditional Chinese medicine. In this study, the growth factor receptor cell membrane chromatography model using the smaller particle size carrier showed a higher efficiency for simultaneous screening baicalein, another one of the potential epidermal growth factor receptor antagonists from Radix Scutellariae extract besides wogonin, which was found in our previous work. The molecular docking result showed the occupancy site and binding mode of baicalein and wogonin with epidermal growth factor receptor tyrosine kinase were similar to gefitinib. The result of the assay for the in vitro inhibitory activity showed that baicalein and wogonin inhibited the growth of the high‐expression epidermal growth factor receptor cell in a dose‐dependent manner and even achieved a better inhibition effect than gifitinib in the low‐dosage range.
Systematic characterization and simultaneous quantification of the multiple components of Rhododendron dauricum based on high‐performance liquid chromatography with quadrupole time‐of‐flight tandem mass spectrometry
Authors: Wang Lijuan , Zhu Xiaoyu , Lou Xinwei , Zheng Feng , Feng Yichen , Liu Wenyuan , Feng Feng , Xie Ning
Published: July 2015

Rhododendron dauricum L. has been used as a traditional Chinese medicine to treat cough and asthma and relieve phlegm and bronchitis. In this study, a reliable method based on high‐performance liquid chromatography with diode array detection and quadrupole time‐of‐flight tandem mass spectrometry was established to systematically identify and quantify the components in this herb for the first time. A total of 33 compounds were identified, including 24 flavonoids, six phenolic acids, two coumarins and one terpene. Among them, poriolin (17), farrerol‐7‐O‐β‐d‐glucopyranoside (20), and syzalterin (30) were isolated from this plant for the first time, and quercetin‐3‐β‐d‐(6‐p‐hydroxy benzoyl) galactoside (19), quercetin‐3‐β‐d‐(6‐p‐coumaroyl) galactoside (21), and myrciacetin (23) were identified from this genus for the first time. Fragmentation pathways of flavonoids also have been investigated by electrospray ionization mass spectrometry. Moreover, seven bioactive constituents, namely, gallic acid (1), scopoletin (6), dihydroquercetin (7), quercetin (22), kaempferol (25), 8‐desmethyl farrerol (27), and farrerol (28), were simultaneously quantified. The developed method has been validated and applied to analyze ten samples of R. dauricum from Hebei Province successfully. The contents of the seven compounds have been detected and compared.
Stakeholder Influence on the Implementation of Environmental Management Practices in the Hotel Industry
Authors: Sánchez‐Medina Patricia S. , Díaz‐Pichardo René , Cruz‐Bautista Maricela
Published: July 2015

Based on the stakeholder theory, this research aims to analyze the relationship between hoteliers' perceptions of stakeholders' interests and the implementation of environmental management practices in Oaxaca, Mexico, incorporating the effect of three hotel characteristics: size, age and economic capacity. Empirical evidence, obtained from hotel owners and/or managers, reveals a direct and positive relationship between the hoteliers' perceptions of stakeholders' interests and the implementation of environmental management practices, with hotel age and size having a moderating effect. Economic capacity, as an independent variable, is also an important factor in the implementation of environmental management practices. Copyright © 2015 John Wiley & Sons, Ltd.
Clinical factor for successful nonsurgical treatment of pediatric peritonsillar abscess
Authors: Kim Dong‐Kyu , Lee Jung Woo , Na Yoon Sung , Kim Myung Jin , Lee Jun Ho , Park Chan Hum
Published: July 2015

Objectives/Hypothesis

Current management for peritonsillar abscess in pediatric patients includes intensive medical therapy using antibiotics with or without surgical drainage. However, attaining proper surgical drainage is difficult in young children because they have narrow oral cavities and are less cooperative than adults. The aim of this study was to investigate which factors are associated with a good response to nonsurgical treatment of a pediatric peritonsillar abscess.

Study Design

A retrospective analysis.

Methods

This study included consecutive children who visited our pediatric clinic for the treatment of peritonsillar abscess. All patients initially received medical treatment, and additional surgical treatment was provided if the patient appeared unlikely to recover. Multivariate logistic regression models were constructed to identify factors associated with a good response to nonsurgical treatment. In addition, a receiver operating characteristic curve was used to identify the age cutoff for predicting good treatment response.

Results

A total of 88 children were included the study. Patient age, recurrent tonsillitis, and abscess size were significantly associated with response to nonsurgical treatment (adjusted odds ratios = 1.485, 2.403, and 1.325, respectively) after adjusting for sex, body mass index, season, serum C‐reactive protein levels, and tonsil grade. The age cutoff associated with good response to nonsurgical treatment was 7.5 years (80.0% sensitivity, 51.5% specificity).

Conclusion

Our findings suggest that a younger age, fewer episodes of acute tonsillitis, and smaller abscess size predict a successful response to nonsurgical treatment in children with peritonsillar abscess.

Level of Evidence

4. Laryngoscope, 125:2608–2611, 2015
Comparison of intraoral and extraoral approaches to mandibular angle fracture repair with cost implications
Authors: Hsueh Wayne D. , Schechter Clyde B. , Tien Shaw I , Stupak Howard D.
Published: July 2015

Objectives/Hypothesis

The objective of this study was to analyze outcomes of intraoral and extraoral approaches to mandibular angle fractures and provide cost estimates for comparison.

Study Design

A retrospective review from January 2005 to June 2013 was performed of patients who underwent open reduction internal fixation of mandibular angle fractures at a level I trauma center.

Methods

Patients were treated by three surgical specialties: otolaryngology–head and neck surgery, oral and maxillofacial surgery, and plastic and reconstructive surgery. Inpatient and outpatient medical records were reviewed for pertinent data including age, gender, duration of follow‐up, presence of other mandible fractures, surgical approach, surgical team, operative time, and postoperative complications.

Results

Of the 155 patients with mandibular angle fractures, 74% underwent open reduction internal fixation through an intraoral approach, whereas 26% of patients were treated with an extraoral approach. The occurrence of any complication was 69.6% in the extraoral group and 39% in the intraoral group (P = 0.009). In propensity‐weighted analysis, however, the occurrence of any complication was less frequent in intraoral cases but no longer statistically significant (odd ratio 0.28; 95% confidence interval, 0.08 to 1.02; P = 0.053). Operating room time was significantly shorter with the intraoral approach. We estimate that the intraoral approach directly saves at least $2,900 per case.

Conclusion

We recommend the use of an intraoral approach for the repair of mandibular angle fractures when clinically appropriate. This can result in a comparable rate of success, however, with significant cost savings to the health care system.

Level of Evidence

4. Laryngoscope, 126:591–595, 2016
Evaluation of the prevalence of and factors associated with laryngeal diseases among the general population
Authors: Hah J. Hun , Sim Songyong , An Soo‐Youn , Sung Myung‐Whun , Choi Hyo Geun
Published: July 2015

Objectives/Hypothesis

Despite the high prevalence of voice disorders, the prevalence of laryngeal disease in the general population has not been determined using laryngoscopy. Factors considered associated with laryngeal disease have mostly been assessed using patient data or highly specific populations. We evaluated the prevalence of and associated factors with laryngeal diseases in the general Korean population.

Study Design

Cross‐sectional study.

Methods

We analyzed data from the Korea National Health and Nutrition Examination Survey for 19,039 participants assessed between 2008 and 2011. The prevalence, subjective discomforts rates of, and odd ratios (demographics, life‐style factors, and diseases factors) for laryngeal disease were analyzed using simple and multiple logistic regression analyses, taking into account the complex sampling structure of the data.

Results

The top five laryngeal diseases in prevalence were laryngitis (3,513/100,000), vocal nodules (1,487/100,000), vocal polyp (404/100,000), Reinke's edema (347/100,000), and epiglottic cyst (296/100,000). Prevalence of laryngeal disease was higher in males, whereas the rate of subjective voice complaints was higher in females. In the logistic regression analysis, gender was not associated with laryngeal diseases after adjusting for other factors. We observed a positive association between low body mass index (BMI) and vocal nodules, and between high BMI and laryngitis, smoking and epiglottic cyst/hyperkeratosis/laryngeal cancer, higher education level and vocal nodules, and allergic rhinitis and vocal nodules/laryngitis/epiglottic cyst.

Conclusions

The rate of subjective voice complaints and laryngeal disease co‐occurrence was low. This study provides more reliable information of laryngeal disease because it includes participants without subjective complaints.

Level of Evidence

2b. Laryngoscope, 125:2536–2542, 2015
Recurrent laryngeal nerve alterations in developing spontaneously hypertensive rats
Authors: da Silva Greice Anne Rodrigues , de Aguiar Mendes Vania Alice , Genari Adriana Borges , Castania Jaci Ayrton , Salgado Hélio Cesar , Fazan Valéria Paula Sassoli
Published: July 2015

Objectives/Hypothesis

It is well known that the recurrent laryngeal nerve not only innervates the larynx but also contains baroreceptor fibers, as demonstrated by physiological studies. Because hypertension has a negative impact on both peripheral nerve morphology and the baroreflex, we investigated the recurrent laryngeal nerve morphological alterations related to the development of hypertension.

Methods

We compared morphological and morphometric aspects of different segments of the recurrent laryngeal nerve in male and female spontaneously hypertensive rats in different ages: 5, 8, and 20 weeks (n = 6 per group). Blood pressure and heart rate were recorded in anesthetized animals, followed by removal of the right and left recurrent laryngeal nerves for epoxy resin embedding and light microscopy analysis. Computer software was used for morphometric analysis.

Results

The blood pressure was significantly higher in 20‐week‐old animals compared to those at 5 weeks. Body weight increased significantly with age, as did the nerve fascicles. For the myelinated fibers and respective axons, there was a reduction of fiber size, more evident on the axon, associated with a reduction of the small myelinated fibers percentage in animals with high blood pressure. Also, 20‐week‐old animals showed a significant reduction of the blood vessel percentage of occupancy compared to younger ages. No differences were observed between genders.

Conclusion

Hypertension development impaired axon growth, affecting mainly the small myelinated fibers. Males and females were affected equally. The alterations of the endoneural blood vessels probably played an important role on the small fibers alterations.

Level of Evidence

N/A. Laryngoscope, 126:E40–E47, 2016
Laryngeal adenoid cystic carcinoma: A population‐based perspective
Authors: Dubal Pariket M. , Svider Peter F. , Folbe Adam J. , Lin Ho‐Sheng , Park Richard C. , Baredes Soly , Eloy Jean Anderson
Published: July 2015

Objectives/Hypothesis

Adenoid cystic carcinoma (ACC) occurs infrequently in the larynx. Consequently, no large samples describing its clinical behavior are available in the literature. Our objective was to use a nationally representative population‐based resource to evaluate clinical behavior, patient demographics, and outcomes among patients diagnosed with laryngeal ACC (LACC).

Study Design

Retrospective database analysis.

Methods

The National Cancer Institute's Surveillance, Epidemiology, and End Results database was analyzed for patients diagnosed with LACC between 1973 and 2011. Patient demographics, incidence, treatment, and survival between LACC and other laryngeal malignancies were compared.

Results

Of 69 LACC patients, 63.8% were female, 78.2% Caucasian, and the median age was 54 years. LACC patients were much more likely to have subglottic lesions (44.9%) than individuals with other malignancies (1.6%). The incidence of LACC was 0.005/100,000 individuals. The majority of patients with LACC harbored T4 lesions at initial diagnosis, although 87.9% had N0 disease, and only 6.1% had distant metastasis at diagnosis. Disease‐specific survival (DSS) was greater at 1 year for LACC compared to other laryngeal malignancies, but not at 5 or 10 years. Five‐year DSS was greater for LACC patients who underwent surgery versus those who did not undergo surgery.

Conclusions

This analysis notes that LACC has a low incidence with no significant change in incidence over the study period. Compared to other laryngeal malignancies, LACC has a female preponderance, is much more common in the subglottis, presents at a younger age, and more often presents with T4 disease. Surgery was noted to confer a survival advantage in LACC.

Level of Evidence

4. Laryngoscope, 125:2485–2490, 2015
A systematic review and meta‐analysis on acoustic voice parameters after uncomplicated thyroidectomy
Authors: Lang Brian H. H. , Wong Carlos K. H. , Ma Estella P. M.
Published: July 2015

Background

Postthyroidectomy voice changes are common even without apparent laryngeal nerve injury. Our study evaluated the impact of open cervical thyroidectomy on five acoustic voice parameters in the early (< 3 months) and late (≥ 3 months) postoperative periods.

Methods

A systematic review was performed to identify studies that quantitatively assessed voice quality by acoustic voice analysis before and after thyroidectomy. Parameters included average fundamental frequency (F0, Hz), jitter (%), shimmer (%), noise‐to‐harmonic ratio (NHR), and maximum phonation time (MPT) (in secs). Meta‐analysis was performed using both fixed‐ and random‐effects models.

Results

A total of 896 patients were analyzed. Relative to baseline, F0 significantly worsened in the early period (from 194.9 ± 34.9 Hz to 188.0 ± 34.0 Hz, P = 0.001). This was equivalent to a quarter‐tone loss (P = 0.004). Shimmer (from 3.15 ± 1.59% to 3.19 ± 1.70%, P = 0.040) and MPT (from 17.9 secs to 16.7 secs, P = 0.046) also worsened in the early period, whereas jitter and NHR remained unchanged in the early and late periods. Males suffered greater deterioration in F0 (from 120.6 ± 18.8 Hz to 111.0 ± 18.5 Hz, P = 0.048) and in NHR (from 0.12 ± 0.02 to 0.16 ± 0.03, P = 0.019) than females in the early period. Four of the five acoustic parameters (F0, jitter, shimmer, and NHR) significantly worsened after total thyroidectomy (TT) and not after lesser resection.

Conclusion

F0, shimmer, and MPT significantly worsened in the early and not in the late postoperative period. F0 impairment was perceptually significant. Males and those undergoing TT suffered greater voice impairment than their counterparts during the early period. Laryngoscope, 126:528–537, 2016
Faculty diversity and inclusion program outcomes at an academic otolaryngology department
Authors: Lin Sandra Y. , Francis Howard W. , Minor Lloyd B. , Eisele David W.
Published: July 2015

Objectives/Hypothesis

To describe a 10‐year diversity initiative to increase the number of women and underrepresented minorities in an academic department of otolaryngology–head and neck surgery.

Study Design

Retrospective review.

Methods

A multifaceted approach was undertaken to recruit and retain women and underrepresented minority (URM) faculty: creation of a climate of diversity, aggressive recruitment, achievement of parity of salary at rank regardless of gender or minority status, provision of mentorship to women and URM faculty, and increasing the pipeline of qualified candidates. Primary outcomes measures included number of women and URM faculty, academic rank, and salary.

Results

From 2004 to 2014, the percentage of women clinical faculty increased from 5.8% to 23.7%; women basic science faculty increased from 11.1% to 37.5%. The number of women at associate professor rank increased from 0 to eight. During this period, underrepresented minority faculty increased in number from two to four; URM full professors increased in number from 0 to 1. In 2004, women earned 4% to 12% less than their male counterparts; there were no salary differences for URM. In 2014, salary was equal by rank and subspecialty training independent of gender or minority status.

Conclusion

A comprehensive diversity and inclusion initiative has increased representation of women and URM faculty in an academic department of otolaryngology–head and neck surgery. However, there continue to be opportunities to further increase diversity.

Level of Evidence

N/A. Laryngoscope, 126:352–356, 2016
Post‐sinus surgery insertion of steroid‐eluting bioabsorbable intranasal devices: A systematic review
Authors: Rizan Chantelle , Elhassan Hassan A.
Published: July 2015

Objectives/Hypothesis

Postendoscopic sinus surgery corticosteroid administration reduces polyp formation, inflammation, and adhesions. Steroid‐eluting bioabsorbable intranasal devices (SEBID) are novel interventions thought to improve local drug delivery while minimizing systemic side effects. The primary aim of this systematic review is to evaluate the efficacy and safety of bioabsorbable SEBIDs. The secondary aim is to inform clinical recommendations and to introduce clinicians to this novel technology.

Study Design

MEDLINE, PubMed, Embase, and Cochrane Database were searched according to Preferred Reporting Items for Systematic Review and Meta‐Analyses guidelines.

Methods

Original articles assessing the efficacy of SEBIDs inserted after endoscopic sinus surgery. For each study, we recorded the efficacy endpoints and safety outcomes.

Results

Seven studies met the inclusion criteria from 737 initial articles identified, including five prospective randomized controlled trials and two prospective single‐cohort studies involving 394 sinuses within treatment arms. Patients were followed up for 2 to 6 months. Six studies demonstrated SEBID efficacy with statistical significance (P < 0.05). Steroid‐eluting bioabsorbable intranasal devices were effective in reducing adhesion formation, polyp formation, inflammation, Lund‐Kennedy scores, and perioperative sinus endoscopy scores. The devices improved patient‐reported outcomes and olfaction while reducing postoperative interventions. They were not associated with adverse events and pose no ocular safety risk. Complications in three SEBID applications were reported.

Conclusion

There is limited data available on SEBIDS; further studies are required to determine whether they are safe and effective adjuncts postendoscopic sinus surgery. Future studies are needed to optimize the dosing regimen, compare devices, and provide long‐term outcomes. Steroid‐eluting bioabsorbable intranasal devices may tentatively be incorporated into future evidence‐based practice. Laryngoscope, 126:86–92, 2016
Shape of the Osseous External Auditory Canal and Its Relationship to Troublesome Cavities
Authors: van Spronsen Erik , van Waegeningh Huibert F. , Geerse Simon , Fokkens Wytske J. , Ebbens Fenna A.
Published: July 2015

Objectives/Hypothesis

On the basis of clinical observations, the shape of the osseous external auditory canal (OEAC) has often been seen as an etiological factor in troublesome cavities after modified radical mastoidectomy.

Study Design

Retrospective analysis of CT scans.

Methods

To assess the role of the shape of the OEAC in troublesome modified radical cavities using computed tomographic scans of three groups of patients (without pathology and with or without draining cavities), we determined the depth of the pretympanic recess (DPTR) and its anterior curvature (ACPTR). In addition to looking at the shape of the OEAC, we also studied the role of any remaining mastoid air cells in relation to troublesome radical cavities, as well as the consultation frequency.

Results

The DPTR was significantly deeper in draining cavities than in ears without pathology and dry cavities. No difference in the ACPTR was observed. The presence of remaining mastoid air cells is significantly associated with the presence of a troublesome radical cavity.

Conclusions

The shape of the OEAC (i.e., the DPTR) is a contributory factor to the drainage of modified radical cavities.

Level of Evidence

4. Laryngoscope, 126:693–698, 2016
MicroRNA‐34c‐5p is related to recurrence in laryngeal squamous cell carcinoma
Authors: Re Massimo , Çeka Artan , Rubini Corrado , Ferrante Luigi , Zizzi Antonio , Gioacchini Federico M. , Tulli Michele , Spazzafumo Liana , Sellari‐Franceschini Stefano , Procopio Antonio D. , Olivieri Fabiola
Published: July 2015

Objectives/Hypothesis

Altered microRNA expression has been found in many cancer types, including laryngeal squamous cell carcinoma (LSCC). We investigated the association of LSCC‐related miR‐34c‐5p with disease‐free survival and overall survival.

Study Design

Retrospective cohort study.

Methods

Expression levels of miR‐34c‐5p were detected in 90 LSCC formalin‐fixed paraffin‐embedded tissues by reverse‐transcription quantitative polymerase chain reaction. Overall survival and disease‐free survival were evaluated using the Kaplan‐Meier method, and multivariate analysis was performed using Cox proportional hazard analysis.

Results

A downregulation of miR‐34c‐5p expression significantly correlated with worse disease‐free and overall survival. In the multivariate analysis, low miR‐34c‐5p expression was associated with an increased risk of recurrence.

Conclusions

A downregulation of miR‐34c‐5p in LSCC is independently associated with unfavorable disease‐free survival, suggesting that miR‐34c‐5p might be a promising marker for evaluating the risk of recurrences.

Level of Evidence

NA Laryngoscope, 125:E306–E312, 2015
Rapidly fluctuating anosmia: A clinical sign for unilateral smell impairment
Authors: Negoias Simona , Friedrich Hergen , Caversaccio Marco D. , Landis Basile N.
Published: July 2015

Reports about fluctuating olfactory deficits are rare, as are reports of unilateral olfactory loss. We present a case of unilateral anosmia with contralateral normosmia, presenting as rapidly fluctuating anosmia. The olfactory fluctuation occurred in sync with the average nasal cycle duration. Examination after nasal decongestion, formal smell testing, and imaging revealed unilateral, left‐sided anosmia of sinonasal cause, with right‐sided normosmia. We hypothesize that the nasal cycle induced transient anosmia when blocking the normosmic side. Fluctuating olfactory deficits might hide a unilateral olfactory loss and require additional unilateral testing and thorough workup. Laryngoscope, 126:E57–E59, 2016