bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of a Lateral Nasal Wall Block Technique for Endoscopic Sinus Surgery Under Local Anesthesia
Authors: Scott Grace M. , Diamond Chris , Micomonaco Damian C. 
Published: June 2018

Introduction With increasingly limited operative resources and patient desires for minimally invasive procedures, there is a trend toward local endoscopic procedures being performed in the outpatient clinic setting. However, there remain limited data supporting a technique to adequately anesthetize the lateral nasal wall and provide patient comfort during these procedures. The objective of this study is to assess the efficacy of a novel lateral nasal wall block for use in office-based endoscopic sinus surgery. Methods A prospective cohort study assessing consecutive patients undergoing office-based endoscopic sinus surgery using our described lateral nasal wall block anesthesia technique. Procedural patient comfort was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS), completed by participants immediately following an office-based endoscopic procedure and prior to discharge from clinic. Postoperative analgesic use was assessed at the first postoperative visit. Results Thirty-five consecutive patients undergoing office-based outpatient endoscopic sinus surgery for chronic rhinosinusitis (with and without polyps) were assessed. The mean ISAS score was 2.83 (95% confidence interval: [2.69, 2.97]). All participants (100%) agree or strongly agree that they were satisfied with their anesthesia care and would want the same anesthetic again. No participant required narcotic analgesia, and 80% used no oral analgesia following the procedure. Conclusions Recent advances in office-based endonasal surgical procedures must be accompanied by the assessment and validation of local anesthetic techniques. The described novel lateral nasal wall block is well tolerated, provides patient satisfaction, and allows for limited use of postprocedure oral analgesics.
Effect of MeCP2 on TGF-β1-induced Extracellular Matrix Production in Nasal Polyp-derived Fibroblasts
Authors: Shin Jae-Min , Um Ji-Young , Lee Seoung-Ae , Park Il-Ho , Lee Soo-Hyung , Lee Heung-Man 
Published: June 2018

Purpose Methyl-CpG-binding protein 2 (MeCP2), known as a transcriptional regulator, has been suggested to play an important role in myofibroblast differentiation in the lung. The purpose of this study was to investigate the role of MeCP2 in transforming growth factor (TGF)- β1-induced myofibroblast differentiation and extracellular matrix (ECM) production in nasal polyp-derived fibroblasts (NPDFs). Methods To identify the expression of MeCP2 in nasal polyp tissues, immunohistochemistry staining and Western blot were performed. TGF- β1-induced NPDFs were treated with 5-azacytidine, a DNA methylation inhibitor, and the expression levels of α-SMA and fibronectin were determined by semiquantitative reverse transcription polymerase chain reaction, immunoﬂuorescent staining, and Western blotting. The total soluble collagen was analyzed by the Sircol collagen assay. MeCP2 silenced by MeCP2-specific small interference ( si) RNA was verified by Western blot. Results The expression levels of MeCP2 increased in nasal polyp tissues compared to normal inferior turbinate tissues. 5-Azacytidine significantly inhibited the expression of α-SMA and fibronectin mRNA in a dose-dependent manner. In addition, 5-azacytidine suppressed collagen production and the expression of MeCP2 in the same manner. The expression levels of a-SMA and collagen production were significantly blocked by MeCP2 silencing in TGF- β1-induced NPDFs. Conclusions Our data suggest that MeCP2 plays an essential role in TGF- β1-induced myofibroblast differentiation and ECM production in NPDFs.
Axonal Guidance Signaling Pathway Is Suppressed in Human Nasal Polyps
Authors: Wu Dawei , Mueller Sarina K. , Nocera Angela L. , Finn Kristen , Libermann Towia A. , Bleier Benjamin S. 
Published: June 2018

Background Dysfunctional innervation might contribute to the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), but the state of the axonal outgrowth signaling in CRSwNP is unknown. The purpose of this study was to explore the axonal outgrowth pathway-related protein expression in CRSwNP. Methods Institutional review board approved study in which tissue proteomes were compared between control and CRSwNP patients (n = 10/group) using an aptamer-based proteomic array and confirmed by whole transcriptomic analysis. Results Compared with controls, proteins associated with axonal guidance signaling pathway such as beta-nerve growth factor, semaphorin 3A, Ras-related C3 botulinum toxin substrate 1, Bcl-2, protein kinase C delta type, and Fyn were significantly decreased in patients with CRSwNP (fold change [FC] = −1.17, P = .002; FC = −1.09, P < .001; FC = −1.33, P < .001; FC = −1.31, P < .001; FC = −1.31, P = .004; and FC = −1.20, P = 0.012, respectively). In contrast, reticulon-4 receptor, an inhibitory factor, was significantly increased in patients with CRSwNP (FC = 1.25, P < .001). Furthermore, neuronal growth-associated proteins such as ciliary neurotrophic factor receptor subunit alpha, neuronal growth regulator 1, neuronal cell adhesion molecule, neural cell adhesion molecule L1, platelet-derived growth factor subunit A, and netrin-4 were all significantly decreased in patients with CRSwNP (FC = −1.25, P < .001; FC = −1.27, P = .002; FC = −1.65, P = .013; FC = −4.20, P < .001; FC = −1.28, P < .001; and FC = −2.31, P < .001, respectively). In contrast, tissue eosinophil count ( P < .001) and allergic inflammation factors such as IgE, periostin, and galectin-10 were all significantly increased in patients with CRSwNP (FC = 12.28, P < .001; FC = 3.95, P < .001; and FC = 2.44, P < .001, respectively). Furthermore, the log FC of the studied proteins expression significantly and positively correlated with log FC of their mRNA expression ( P < .001, r = .88). Conclusions Axonal guidance signaling and neural growth factors pathways proteins are significantly suppressed in eosinophilic CRSwNP.
Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis
Authors: Kanjanawasee Dichapong , Seresirikachorn Kachorn , Chitsuthipakorn Wirach , Snidvongs Kornkiat 
Published: June 2018

Background Saline nasal lavage is one of the treatments of sinonasal diseases. Evidence from basic research favors hypertonic saline (HS) over isotonic saline (IS) for mucociliary clearance, but evidence from clinical studies is controversial. Conversely, HS may carry greater side effects. Objective To compare the effects of HS and IS nasal irrigation in treating sinonasal diseases. Methods Systematic search with Ovid MEDLINE, Scopus, PubMed, Google Scholar, and Manual additional sources was conducted. Randomized controlled trials comparing HS with IS nasal irrigation in treating any sinonasal diseases, including rhinitis and rhinosinusitis, were included. Data were pooled for meta-analyses. Outcomes were symptom scores, sinonasal outcome test (SNOT), and adverse events. Heterogeneity was explored by subgroup analyses. Results Nine studies (740 patients) were included. HS nasal irrigation brought greater benefits over IS in symptom reduction (standardized mean difference (SMD) −0.58; 95% confidence interval [CI]: −0.76, −0.40); however, no difference was shown in SNOT-20 improvement (mean difference 1.81; 95% CI: −0.68, 4.30). In subgroup analyses, effects favoring HS on symptoms were larger in 4 subgroups. These were (1) patients with rhinitis (SMD −1.09; 95% CI: −1.42, −0.76) compared with rhinosinusitis (SMD −0.37; 95% CI: −0.58, −0.15), P < .01; (2) patients under the age of 18 years (SMD −1.22; 95% CI: −1.53, −0.91) compared with patients over the age of 18 years (SMD −0.26; 95% CI: −0.49, −0.04), P < .01; (3) saline irrigation using high volume (SMD −0.89; 95% CI: −1.18, −0.60) compared with low volume (SMD −0.39; 95% CI: −0.62, −0.16), P < .01; and (4) saline irrigation with hypertonicity of <3% (SMD −1.09; 95% CI: −1.42, −0.76) and hypertonicity of 3%–5% (SMD −1.20; 95% CI: −1.61, −0.78) compared with hypertonicity of >5% (SMD 0.20; 95% CI: −0.15, 0.55), P < .01. Buffered saline and operative status did not have impact. HS brought greater minor adverse effects. No major adverse effects were reported. Conclusion HS improves symptoms over IS nasal irrigation in treating sinonasal diseases. There is no difference in disease-specific quality of life. However, HS brings greater minor side effects than IS.
Nasal Endoscopy Billing Patterns: A Survey of the American Rhinologic Society
Authors: Tabaee Abtin , Riley Charles A. , Brown Seth M. , McCoul Edward D. 
Published: June 2018

Introduction Nasal endoscopy (NE) is an essential element of office-based clinical rhinology, including the evaluation of chronic rhinosinusitis. Despite the presence of guidelines, variability exists regarding coding and billing for NE especially with regard to inclusion of evaluation and management (E&M) codes and use of the 25 modifier. The goal of this survey was to assess the billing patterns for NE among American Rhinologic Society (ARS) members. Methods An invitation to participate in a web-based survey was electronically sent to all ARS members. Survey participants were queried regarding demographics and billing patterns for NE in several different clinical scenarios using a 5-point Likert-type scale, with a score of 5 representing “always” and a score of 1 representing “never” for billing E&M. Results A total of 93 respondents successfully completed the survey with a range of the number of years since completing training, practice type (50.5% private, 44.1% academic) and completion of a rhinology fellowship (40.9%). Variable responses for billing patterns for distinct clinical scenarios were noted. Higher scores for billing both E&M and NE for the queried clinical scenarios were noted for new patients (mean 4.50) compared to established patients (mean 3.81) and postoperative patients (mean 3.04). Inclusion of a septoplasty as part of the surgery impacted billing an E&M code 28% of the time. Practice type and history of performing a fellowship did not significantly influence billing patterns for NE. Conclusions Significant variability exists among ARS respondents with regard to billing patterns for NE, despite the presence of coding guidelines. Additional teaching of standard coding practices for NE may limit variability among otolaryngologists.
Medical Therapy Versus Balloon Sinus Dilation in Adults With Chronic Rhinosinusitis (MERLOT): 12-Month Follow-up
Authors: Stolovitzky J. Pablo , Mehendale Neelesh , Matheny Keith E. , Brown William J. , Rieder Anthony A. , Liepert Douglas R. , Tseng Ewen , Gould Andrew 
Published: June 2018

Background Chronic rhinosinusitis (CRS) is a devastating disease affecting nearly 30 million people in the United States. An interim analysis of data from the present study suggested that, in patients who had previously failed medical therapy, balloon sinus dilation (BSD) plus medical management (MM) provides a significant improvement in the quality of life (QOL) at 24 weeks postprocedure compared to MM alone. Objective The primary objective of this final analysis was to evaluate the durability of treatment effects through the 52-week follow-up. Methods Adults aged 19 and older with CRS who had failed MM elected either BSD plus MM or continued MM. Patients were evaluated at 2 (BSD arm only), 12, 24, and 52 weeks posttreatment. Balloon dilations were performed either as an office-based procedure under local anesthesia or in the operating room per physicians’ and patients’ discretion. The primary end point was change in patient-reported QOL as measured by Chronic Sinusitis Survey (CSS) total score from baseline to the 24-week follow-up. Secondary outcomes including changes in CSS, Rhinosinusitis Disability Index (RSDI), and Sino-Nasal Outcome Test (SNOT) total and subscores, sinus medication usage, missed days of work/school, number of medical care visits, and sinus infections from baseline to the 52-week follow-up are reported here within. Results BSD led to sustained greater improvements in self-reported QOL using the CSS and RSDI total scores with a trend toward improvement in the SNOT-20 total score from baseline to the 52-week follow-up compared to continued MM. There were no changes in medication usage apart from nasal steroid usage for which the MM cohort had an increase in usage. There were no device-related serious adverse events. Conclusion The current analysis highlights the safety, effectiveness, and durability of BSD in CRS patients aged 19 and older who had previously failed MM.
Use of Autologous Fat Grafts for the Endoscopic Reconstruction of Skull Base Defects: Indications, Outcomes, and Complications
Authors: Lam Kent , Luong Amber U. , Yao William C. , Citardi Martin J. 
Published: June 2018

Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods. Four representative clinical cases have additionally been selected to highlight the common indications for which the fat graft may be effective in skull base reconstruction. Results Of the 27 patients who were identified for inclusion in this review, 25 (92.6%) demonstrated successful repair of preoperative or intraoperative CSF leaks following primary skull base repair. Two patients developed recurrent CSF leaks occurring about 1 week after their primary closures, and a secondary closure rate of 96.3% was achieved with use of fat grafts. Other complications included seroma and hematoma formation at the abdominal donor sites, each occurring in 1 patient. Conclusions The use of autologous fat remains a viable option for grafting material during endoscopic skull base reconstruction. Despite the wide variety of closure techniques in skull base surgery, autologous fat provides safe and easily accessible material to repair CSF leaks.
Endoscopic-Powered Dacryocystorhinostomy Without Stenting: Long-term Outcomes of 120 Procedures
Authors: Ciğer Ejder , Balci Mustafa K. , Arslanoğlu Seçil , Eren Erdem 
Published: June 2018

Background The necessity of silicone stenting in endoscopic dacryocystorhinostomy (DCR) procedures is a controversial subject in the literature. Objective The purpose of the present study is to assess the long-term anatomical and functional outcomes of endoscopic-powered DCR (EP-DCR) without stenting or mucosal flaps. Methods One hundred twenty EP-DCR procedures were performed in 107 patients. Anatomical success was defined as a patent ostium on irrigation and functional success as free flow of dye from the ostium and resolution of epiphora. Results The mean follow-up was 46.5 months (range: 24–87). Of the 120 procedures, 13 were bilateral and 94 were unilateral. Anatomical and functional success rates of 92.5% were obtained. Conclusion EP-DCR without stenting is a safe and economic technique that provides satisfactory long-term results and could be considered as the treatment of choice for patients with postsaccal nasolacrimal duct obstruction.
Optimizing Protein Harvest From Nasal Brushings for Determining Local Allergy Responses
Authors: Saricilar Erin C. , Hamizan Aneeza , Alvarado Raquel , Rimmer Janet , Sewell William , Tatersall Jessica , Barham Henry P. , Harvey Richard 
Published: June 2018

Background Rhinitis is a highly prevalent yet often misdiagnosed condition. Patients who have local allergic rhinitis are regularly mislabeled as having a nonallergic etiology. Thus, a highly accurate, reproducible, and noninvasive assessment, which can be performed quickly and with minimal discomfort to the patient, is required. Objective The aim of this research was to identify the efficiency of various nasal brushes as tools for harvest and collection of epithelial proteins and its suitability for identification of rhinitis. Methods Nasal epithelial mucosa samples were taken from patients undergoing turbinate surgery using a cytology brush, a dental brush, and a nasal curette in random order. After washing in phosphate-buffered saline, the suspended cells were sonicated. Total protein content was assessed for all samples by bicinchoninic acid assay measured using a Nanodrop machine. Identification of nasal-specific immunoglobulin E (spIgE) was then assessed using immunoassay and compared to the patient’s allergic status from epicutaneous and serum testing. The lower threshold limit for the spIgE in nasal brushings was determined using the results of serum spIgE tests as the reference. The diagnostic accuracy of this new established cutoff value was determined. Results The cytology brush was found to be the optimal tool for maximal nasal mucosa protein collection followed by dental brush and nasal curette (0.75 ± 0.45 mg/mL vs 0.43 ± 0.24 mg/mL vs 0.071 ± 0.55 mg/mL, respectively; P < .01). The optimal cutoff value of nasal spIgE from the cytology nasal brushings was 0.14 kUA/L to predict allergic status from serum testing. This gave a sensitivity of 75%, specificity of 86%, positive predictive value of 74%, likelihood ration positive of 5.40, and diagnostic odds ratio of 18.62. Conclusion The cytology brush is the optimal tool for protein collection. This is an easy and direct method to sample the nasal mucosa for assessment of nasal allergy or future biomarkers.
Dural venous sinus thrombosis: The combination of noncontrast CT, MRI and PC-MR venography to enhance accuracy
Authors: Ozturk Kerem , Soylu Esra , Parlak Mufit 
Published: June 2018

Aim The aim of this article is to determine whether a combination of noncontrast CT (NCCT), three-dimensional-phase contrast magnetic resonance venography (3D PC-MRV), T1- and T2-weighted MRI sequences can help to identify acute and subacute dural venous sinus thrombosis (DVST) with greater accuracy. Methods A total of 147 patients with DVST ( n = 30) and a control group ( n = 117) underwent NCCT, T1- and T2-weighted MRI sequences, and 3D PC-MRV from 2012 to 2016. Two experienced observers interpreted the images retrospectively for the presence of DVST. Nonvisualization of the dural venous sinuses on 3D PC-MRV and signal changes supporting acute or subacute thrombus on T2- and T1-weighted images were considered a direct sign of DVST. Also, using circle region of interest (ROI) techniques, attenuation measurement from each sinus was obtained on NCCT. Sensitivity and specificity were computed for these modalities separately and in combination for diagnosis of DVST using digital subtraction angiography as the reference standard. Results Nonvisualization of venous sinuses on 3D PC-MRV (sensitivity 100%, specificity 71%) in combination with both applying Hounsfield unit (HU) threshold values of greater than 60 on NCCT (sensitivity 70%, specificity 94%) and acquiring signal changes supporting DVST on T2- and T1-weighted images (sensitivity 83%, specificity 96%), were found to have 100% sensitivity and 100% specificity in the identification of acute or subacute DVST. Conclusion The combination of NCCT, T1- and T2-weighted MRI and 3D PC-MRV may allow the diagnosis of acute or subacute DVST and may obviate the need for contrast usage in patients with renal impairment or contrast allergies.
Identification of clinical factors predicting warfarin sensitivity after cardiac surgery
Authors: Tyson Karen , Hutchinson Nevil , Williams Sian , Scutt Greg 
Published: June 2018

Background: Warfarin is commonly initiated post-cardiac surgery to reduce the risk of intracardiac thrombus formation. Studies have found that sensitivity is increased after cardiac surgery and anticoagulation is subsequently difficult to manage. This study set out to identify clinical markers of increased warfarin sensitivity in patients after cardiac surgery, and build a model that can predict warfarin sensitivity, and improve safety in this setting. Methods: The study was an observational, retrospective cohort design. Clinical parameters including left ventricular ejection fraction (LVEF), cross-clamp time, age, serum albumin and C-reactive protein concentrations were collected from consenting patients who had undergone cardiac surgery and were prescribed postoperative warfarin. The warfarin dose index (WDI) was calculated for each patient from their international normalized ratio (INR) and warfarin dose, as a measure of sensitivity. Results: A total of 41 patients were recruited to the study. Logarithmically transformed WDI (log WDI) significantly correlated with LVEF, cardiopulmonary bypass (CPB) time, cross-clamp time, baseline INR and co-administration of amiodarone ( p < 0.05). When added to a linear regression model, LVEF and cross-clamp time produced a model that accounted for 41% of the variance in log WDI (R2 = 0.41), p = 0.0002). Applying a log WDI cutoff value of −0.349 discriminated between patients who develop an INR > 4 and those who do not, with a sensitivity of 75% and a specificity of 70%. Conclusions: This single-centre study has highlighted two risk factors for increased warfarin sensitivity post-cardiac surgery. Further research is needed to confirm these findings in a wider, more diverse population, and to validate this model.
Safety and immunogenicity of conjugate quadrivalent meningococcal vaccination after hematopoietic cell transplantation
Authors: Cheng Matthew P. , Pandit Alisha , Antin Joseph H. , Walsh Stephen R. , Huynh Daisy , Ghobrial Irene M. , Baden Lindsey R. , Marty Francisco M. , Issa Nicolas C. 
Published: June 2018

Key Points
One dose of MCV4 was safe and immunogenic after HCT. Serogroup-specific responses varied between 52% and 77% after 1 vaccine dose, suggesting that a second dose may be beneficial after HCT.
Bluegill sunfish use high power outputs from axial muscles to generate powerful suction-feeding strikes
Authors: Camp Ariel L. , Roberts Thomas J. , Brainerd Elizabeth L. 
Published: June 2018

ABSTRACT
Suction-feeding fish rapidly expand the mouth cavity to generate high-velocity fluid flows that accelerate food into the mouth. Such fast and forceful suction expansion poses a challenge, as muscle power is limited by muscle mass and the muscles in fish heads are relatively small. The largemouth bass powers expansion with its large body muscles, with negligible power produced by the head muscles (including the sternohyoideus). However, bluegill sunfish – with powerful strikes but different morphology and feeding behavior – may use a different balance of cranial and axial musculature to power feeding and different power outputs from these muscles. We estimated the power required for suction expansion in sunfish from measurements of intraoral pressure and rate of volume change, and measured muscle length and velocity. Unlike largemouth bass, the sternohyoideus did shorten to generate power, but it and other head muscles were too small to contribute more than 5–10% of peak expansion power in sunfish. We found no evidence of catapult-style power amplification. Instead, sunfish powered suction feeding by generating high power outputs (up to 438 W kg−1) from their axial muscles. These muscles shortened across the cranial half of the body as in bass, but at faster speeds that may be nearer the optimum for power production. Sunfish were able to generate strikes of the same absolute power as bass, but with 30–40% of the axial muscle mass. Thus, species may use the body and head muscles differently to meet the requirements of suction feeding, depending on their morphology and behavior.