bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical use of the STOP‐BANG questionnaire to determine postoperative risk in veterans
Authors: Chang Katherine W. , Steward David L. , Tabangin Meredith E. , Altaye Mekibib , Malhotra Vidhata , Patil Reena Dhanda 
Published: September 2018

ObjectivesTo determine whether STOP‐BANG (snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, gender) scores are associated with immediate postoperative adverse events in veterans undergoing surgery.MethodsIn this prospective cohort study, veterans presenting to the presurgical clinic at a Veterans Affairs hospital answered the STOP‐BANG questionnaire, which was scored as high risk (5–8), intermediate risk (3–4), and low risk (0–2) for obstructive sleep apnea (OSA), during a 6‐month study period. Immediate postoperative respiratory and cardiovascular adverse events were recorded.ResultsThe patient population included 1,080 veterans. Ninety‐five patients (8.8%) experienced adverse events, of which 74 (6.9%) were respiratory and 21 (1.9%) were cardiovascular in nature. Patients with high‐risk STOP‐BANG scores (5–8) had significantly greater odds of having an adverse event odds ratio (OR) 2.1 (95% confidence interval [CI]: 1.4, 3.3) and hypoxia OR 2.8 (95% CI: 1.7, 4.6) compared to those with low‐ to intermediate‐risk scores (0–4). Among patients with OSA, those with high‐risk scores (5–8) had greater odds of an adverse event OR 3.9 (95% CI: 1.1, 13.9) and hypoxia OR 3.7 (95% CI: 1.1, 13.0) compared to those with low‐ to intermediate‐risk scores (0–4). Patients without a history of OSA with high‐risk scores (5–8) did not have significantly greater odds of an adverse event OR 1.5 (95% CI: 0.82, 2.6) or a hypoxic event OR 1.7 (95% CI: 0.87, 3.4) compared to those with low‐ to intermediate‐risk scores (0–4).ConclusionThe STOP‐BANG questionnaire was useful in the veteran population because high‐risk scores were predictive of adverse events, in particular, hypoxia for patients with a previous diagnosis of OSA. In the future, this may direct studies and clinical activities aimed at optimizing safe and effective perioperative practices.Level of Evidence2b Laryngoscope, 129:259–264, 2019
Initial presentation of human papillomavirus‐related head and neck cancer: A retrospective review
Authors: Khalid Mian B. , Ting Peter , Pai Akila , Russo Jack L. , Bakst Richard , Chai Raymond L. , Teng Marita S. , Genden Eric M. , Miles Brett A. 
Published: September 2018

ObjectiveHuman papillomavirus (HPV) has been identified as a risk factor for oropharyngeal squamous cell carcinoma (OPSCC) and a cause of the recent dramatic rise in the incidence of this disease. HPV‐positive OPSCC typically affects a younger population and has no validated screening test. This study aims to outline the common presenting signs of HPV‐positive OPSCC.MethodsWe conducted a retrospective single‐institution review on 370 patients who were treated at the Icahn School of Medicine at Mount Sinai, New York City, between April 2007 and November 2015 for OPSCC. We included patients with newly diagnosed OPSCC and sufficient history and physical data in the final analysis. Univariate analysis was used to compare HPV‐positive and HPV‐negative cohorts for demographics, tumor location, tumor staging, initial presentation and symptoms, and physical exam findings.ResultsTwo hundred and seven patients met the inclusion criteria. The most common initial symptoms for OPSCC were neck mass (51.7%) and sore throat (13.0%). The HPV‐positive cohort was more likely to present with a chief complaint of neck mass compared to the HPV‐negative cohort (56.1% vs. 22.2%; P = 0.0015). A positive neck exam was associated with HPV‐positive status (73.9% vs. 40.7%; P = 0.0012).ConclusionHPV‐positive OPSCC is an incipient epidemic, poised to surpass cervical cancer as the most common HPV‐related cancer by 2020. Initial presenting signs may often be mistaken for benign processes. This study provides physicians with a better understanding of initial presentation of patients with HPV‐positive OPSCC, leading to earlier diagnosis and improved outcomes.Level of Evidence4 Laryngoscope, 129:877–882, 2019
Association Between Age and Patient‐Reported Changes in Voice and Swallowing After Thyroidectomy
Authors: Sahli Zeyad , Canner Joseph K. , Najjar Omar , Schneider Eric B. , Prescott Jason D. , Russell Jonathon O. , Tufano Ralph P. , Zeiger Martha A. , Mathur Aarti 
Published: September 2018

ObjectivesDespite intact recurrent laryngeal nerves, patient‐reported voice and swallowing changes are common after thyroidectomy. The association between patient age or frailty status and these changes is unknown. The aim of this study was to evaluate the impact of age and frailty on the incidence of voice and swallowing alterations after thyroidectomy.MethodsWe performed an institutional review board (IRB)‐approved retrospective review of consecutive patients who underwent total thyroidectomy with intraoperative recurrent laryngeal nerve (RLN) monitoring at a single institution between January 2014 and September 2016. Patients with RLN injury were excluded. After data extraction, a modified frailty index (mFI) was calculated for each patient. The association among risk factors, including age, mFI, prior history of neck surgery, frequent voice use, presence of malignancy or gastroesophageal reflux disease, and smoking status and reported voice and/or swallowing changes was examined.ResultsOf 924 patients undergoing thyroidectomy, 148 (16.0%) reported only changes in voice; 52 (5.6%) reported only difficulty in swallowing; and 26 (2.8%) reported changes with both voice and swallowing. On multivariate analysis, we found a significant increase in voice or swallowing alterations up to the age of 50 years (5% increased odds per year), after which these changes plateaued. We found that mFI was not associated with voice or swallowing changes.ConclusionAge ≥ 50 years is independently associated with the development of voice or swallowing changes after thyroidectomy, despite intact RLN. Additional prospective studies are needed to validate these findings, further define this association, and identify risk factors for developing these changes.Level of Evidence2b Laryngoscope, 129:519–524, 2019
Extended high‐frequency hearing loss following the first episode of otitis media
Authors: Cordeiro Francisco Polanski , da Costa Monsanto Rafael , Kasemodel Ana Luiza Papi , de Almeida Gondra Luiza , de Oliveira Penido Norma 
Published: September 2018

Objectives/HypothesisOtitis media has been associated with several auditory and developmental sequelae. Here, the results of auditory tests were evaluated in patients who had a first episode of unilateral otitis media and compared with the contralateral healthy ear.Study DesignCohort study.MethodsThis study was undertaken from 2015 to 2016, with a follow‐up period of 6 months.ResultsA total of 41 patients who had been diagnosed with unilateral acute otitis media were selected. Standard (250 Hz–8 kHz) and extended high‐frequency (8 kHz–16 kHz) audiometry was performed within 5 days of the beginning of the clinical symptoms, and then in defined time frames for a period of 6 months. The results of the contralateral healthy ears were used as individual controls. After closure of the initial air‐bone gap, the results of the standard audiometry did not demonstrate significant differences in the thresholds of diseased ears compared with controls. A significant elevation of the mean extended high‐frequency thresholds in the ears affected by otitis media was observed at the first and subsequent appointments within the 6‐month follow‐up period. Diseased ears from patients who experienced tinnitus during the 6‐month follow‐up period had significantly higher thresholds in the extended high frequencies than diseased ears from patients without residual tinnitus.ConclusionsThese results suggest that the first episode of otitis media may lead to persistent elevation of the mean thresholds of extended high‐frequencies, whereas persistent tinnitus after 6 months of the acute infection is associated with more severe hearing loss.Level of Evidence2b Laryngoscope, 128:2879–2884, 2018
Changing prognosis of oral cancer: An analysis of survival and treatment between 1973 and 2014
Authors: Cheraghlou Shayan , Schettino Amy , Zogg Cheryl K. , Judson Benjamin L. 
Published: September 2018

Objectives/HypothesisOral cavity cancer is the most commonly occurring malignancy of the head and neck. There are limited data suggesting a change in prognosis of oral cavity cancers. We aimed to evaluate temporal trends in demographics, treatment, and prognosis of oral cavity cancer diagnosed between 1973 and 2014 inclusive.Study DesignRetrospective database analysis.MethodsA retrospective study of 16,030 adult patients diagnosed with oral cavity cancer between 1973 and 2014 inclusive and treated surgically in the Surveillance, Epidemiology, and End Results (SEER) 9 registry was conducted. A supplemental analysis was conducted using data from the National Cancer Database. Multivariate Cox survival regressions and univariate Kaplan‐Meier analyses were conducted.ResultsThe prognosis of both early‐ and late‐stage disease has significantly improved between 1973 and 2014. Among patients with early‐stage disease, 3‐year survival increased from 78.0% (standard error [SE] = 1.3) for those diagnosed from 1973 to 1980 to 92.2% (SE = 1.1) for those diagnosed from 2011 to 2014. Among patients with late‐stage disease, 3‐year survival ranged from 51.9% (SE = 1.5) for those diagnosed from 1973 to 1980 to 70.3% (SE = 1.9) for those diagnosed from 2011 to 2014. For patients with late‐stage disease, this improved prognosis occurred in tandem with increasing usage of chemoradiotherapy as adjuvant therapy. There has also been increasing utilization of neck dissection for early‐ and late‐stage disease, along with higher nodal yields from performed dissections.ConclusionsThe prognosis of oral cavity cancer has improved significantly from the early 1970s to recent years. In late‐stage oral cancer, this change has been associated with an increased use of adjuvant therapy and adjuvant chemoradiotherapy in particular.Level of Evidence4 Laryngoscope, 128:2762–2769, 2018
Lacrimal Sac Rhinosporidiosis and Surgical Management by Transnasal Endoscopic Excision: A Case Series
Authors: Rajesh Raju George , Sandeep Suresh 
Published: September 2018

ObjectivesTo study the clinical profile and the route of spread of lacrimal sac rhinosporidiosis. To device a standard transnasal endoscopic surgical procedure in the treatment of lacrimal sac rhinosporidiosis.MethodsThis is a retrospective analysis of a case series on lacrimal sac rhinosporidiosis. Thirteen cases of lacrimal sac rhinosporidiosis reported in our institution from July 2003 to July 2016 were included. Workup included diagnostic nasal endoscopy and lacrimal syringing. All patients underwent transnasal endoscopic excision of rhinosporidiosis.ResultsLacrimal sac rhinosporidiosis was more prevalent among males and in the 31 to 40 years age group. All patients had a history of bathing in stagnant water bodies. The most common clinical presentation was a doughy swelling medial to the medial canthus. Lacrimal sac rhinosporidiosis invariably presented with involvement of the nasolacrimal duct. Following the endoscopic excision of lacrimal sac rhinosporidiosis, all patients were followed up for a mean period of 16 months, and only one patient had recurrence.ConclusionA unique aspect of our case series is that patients presented with features pertaining to isolated lacrimal system involvement rather than sinonasal involvement. Involvement of the nasolacrimal duct and nasal cavity without involvement of the eyes in all cases confirms the retrograde spread of rhinosporidiosis from the nasal cavity into the lacrimal sac via the nasolacrimal duct as the most common route of spread of infection. We recommend that endoscopic dacryocystorhinostomy, along with nasolacrimal duct excision used for surgical management in our case series with superior results, must become the standard of care in treatment of this condition.Level of Evidence4 Laryngoscope, 128:2693–2696, 2018
Development and evaluation of rhinoplasty spreader graft suture simulator for novice surgeons
Authors: Oh Connie J. , Tripathi Prem B. , Gu Jeffrey T. , Borden Pamela , Wong Brian J‐F. 
Published: September 2018

ObjectiveSurgical simulators aimed at mimicking elements of rhinoplasty surgery, specifically those aimed at improving cartilage suturing, are not available. Here, we present a surgical simulator for spreader graft placement that uses cartilage rather than synthetic materials and gauge improvement using objective measures for suture placement accuracy, speed, and efficiency of hand motion.MethodsTwenty‐two otolaryngologists in two groups (residents [10] and experts [12]) were instructed to secure the two spreader graft specimen into position with three mattress sutures on a nose model that used porcine septal cartilage as a proxy for the human counterpart. Hand motion was tracked using an electromagnetic position sensing device. The time required to complete the suture task, total hand displacement, cumulative number of hand motion direction changes, and accuracy of suture insertion were measured. These measurements were compared between the two cohort groups for construct validity. The subjects completed a survey to evaluate realism and value of the model.ResultsThe expert group had a lower mean time required to complete the task (P < 0.05), total hand displacement (P < 0.01), and number of hand motion direction changes (P < 0.001). No significant difference was observed between the two groups in suture precision measurement. The subjects agreed on the face validity and usefulness of the trainer.ConclusionsOur study suggests that the simulator may be a useful tool to objectively gauge suturing efficiency. Devices such as this may be useful for developing skill with suturing cartilage tissue and potentially be used to assess resident acquisition of surgical skill.Level of EvidenceNA Laryngoscope, 129:344–350, 2019
Pathophysiology of sensorineural hearing loss in jugular foramen paraganglioma
Authors: Isaacson Brandon , Wick Cameron C. , Perez Carlos , Cantrell Sarah C. , Killeen Daniel E. 
Published: September 2018

Objectives/HypothesisPathologic involvement of the inferior cochlear vein is a mechanism of sensorineural hearing loss in patients with jugular foramen paraganglioma.Study DesignRetrospective case‐control study.MethodsThe presenting audiograms, magnetic resonance imaging, and computed tomography were reviewed in 46 subjects with jugular foramen paragangliomas. Four‐frequency bone conduction average was compared between the tumor and nontumor ears in each subject to establish the presence of sensorineural hearing loss. Imaging findings for each subject were recorded. Univariate and multivariate statistical analyses were performed to determine which radiographic features were associated with sensorineural hearing loss. Hearing data were analyzed as a continuous variable and as a categorical variable.ResultsTwenty subjects (43.4%) had a bone‐conduction pure‐tone asymmetry of greater than 15 dB. Inferior cochlear vein involvement was identified in 19 of the 20 (95%) subjects with sensorineural hearing loss. Inferior cochlear vein involvement was found to be a statistically significant predictor of sensorineural hearing loss using univariate and multivariate analyses. Other imaging findings that were statistically significant predictors of sensorineural hearing loss include Glasscock‐Jackson stage, Fisch‐Mattox stage, hypoglossal canal involvement, jugulo‐carotid spin erosion, and petrous carotid canal erosion.ConclusionsInvolvement of the inferior cochlear vein appears to be a plausible mechanism for sensorineural hearing loss in patients with jugular foramen paraganglioma.Level of Evidence4 Laryngoscope, 129:67–75, 2019
Decreased intramuscular calcium hydroxyapatite implant resorption in a murine model of osteoporosis
Authors: Randall Derrick R. , Nativ‐Zeltzer Nogah , Cates Daniel J. , Tinling Steve P. , Belafsky Peter C. 
Published: September 2018

ObjectiveCalcium hydroxyapatite (CaHA) is a common material for vocal fold injection augmentation. Durability is variable, and factors involved in implant longevity are not understood. Animal models of osteoporosis show decreased bone density and increased mineral liberation, suggesting CaHA retention may be altered in these conditions.Study DesignProspective murine investigation.MethodsFourteen skeletally mature, 10‐month‐old female Sprague‐Dewley rats were treated by one of three interventions: oophorectomy, laparotomy without oophorectomy (sham), or monthly risedronate injection (90 μg/kg, subcutaneous). CaHA was implanted into the right lateral thigh muscle in all animals at the time of procedure or first risedronate injection. After 17 weeks, all rats were sacrificed, and the residual CaHA isolated from excised lateral thigh muscle through incubation in a 900 °C calcinator for 9 hours.ResultsMean CaHA mass remaining in the oophorectomy group was 65.9 (standard deviation ± 16.1) mg, compared to 44.4 ± 10.0 mg CaHA in the risedronate group and 48.6 ± 7.5 mg in the sham group. One‐way analysis of variance found a statistically significant difference between the oophorectomy and risedronate groups but not between the sham and other groups, F(2,11) = 4.404, P = 0.039.ConclusionPersistent estrogen deficiency in a murine model of osteoporosis demonstrated decreased rate of CaHA resorption. This suggests that hormone alterations associated with osteoporosis may alter the longevity of CaHA implant resorption through an uncertain mechanism.Level of EvidenceNA. Laryngoscope, 2576–2580, 2018
Diagnostic Accuracy of Dysphonia Classification of DSI and AVQI
Authors: Barsties v. Latoszek Ben , Ulozaitė‐Stanienė Nora , Petrauskas Tadas , Uloza Virgilijus , Maryn Youri 
Published: September 2018

ObjectiveThe Dysphonia Severity Index (DSI) and the Acoustic Voice Quality Index (AVQI) have been successfully investigated to quantify voice quality. The aim of the present study was to evaluate the diagnostic accuracy of both measurements in comparison with the dysphonia classification.MethodsIn total, 264 subjects with vocally healthy voices (n = 105) and with various voice disorders (n = 159) were included in the study. To determine the dysphonia classification, all subjects underwent a videolaryngostroboscopy and, if necessary, a direct microlaryngoscopy plus a clinical examination to diagnose a voice disorder. Patients with a vocally healthy voice had no actual voice complaints, no history of chronic laryngeal diseases or voice disorders, no hearing problems and were determined as healthy voices by clinical voice specialists. To evaluate the diagnostic accuracy, receiver operating characteristic statistics and correct classification rate (CCR) were used.ResultsThe diagnostic accuracy of DSI and AVQI showed strong sensitivity and specificity in the determination of dysphonia classification. A DSI threshold of 3.05 obtained a high sensitivity of 94.3% and specificity of 84.3%. An CCR of 88% was determined for DSI. Also, an AVQI threshold of 3.31 showed reasonable sensitivity of 71.7% and specificity of 88%. The CCR for AVQI was 79%.ConclusionAlthough DSI and AVQI were developed to quantify voice quality, the present results showed that both measurements can evaluate the dysphonia classification as well. Particularly, the DSI might have higher potential in the evaluation of dysphonia classification.Level of Evidence2C Laryngoscope, 129:692–698, 2019
Short‐term carbon emissions: Effect of various tree harvesting, transport, and tillage methods under a eucalyptus plantation
Authors: Fialho Ricardo Cardoso , da Silva Teixeira Rafael , Teixeira Ana Paula Mendes , da Silva Ivo Ribeiro 
Published: September 2018

AbstractEucalyptus forests stand out for their potential to sequestrate atmospheric CO2 in soil organic matter throughout their growth. Our study evaluated the harvesting and tillage effect in eucalyptus plantations to the soil CO2, 13C–CO2, and CH4 fluxes. This study was carried out in a eucalyptus plantation, on Typic Haplustox soil. The study used stands cultivated with eucalyptus at the end of the first rotation (7 years), established over degraded pastures. The effect of harvesting was assessed through comparisons of samples taken before and after harvesting with Feller + Skidder (F + S) and Harvester + Forwarder (H + F) methods and separate samples of plant rows (R) and plant interrows (IR). The effect of tillage was assessed through comparisons of R and IR samples taken before and after subsoiling tillage in areas harvested with F + S and H + F methods. A nested experimental design was used with eight replicates. The harvest operation (F + S and H + F methods) in eucalyptus plantations increased soil CO2 fluxes, which were primarily derived from eucalyptus materials (‘new C’). The F + S harvesting method resulted in the highest soil density and soil moisture reduction in the IR. The tillage operation (subsoiling) resulted in higher soil CO2 fluxes in eucalyptus plantations harvest with F + S and H + F methods. However, the H + F method preserved the older soil organic carbon (40.8% in R and 50.4% IR of C4–CO2). The soil in the eucalyptus plantations showed soil CH4 influxes, and the harvest and tillage (subsoiling) operations did not negatively affect the net soil CH4 influx in the studied eucalyptus plantations.
Roles of microRNAs in T cell immunity: Implications for strategy development against infectious diseases
Authors: Giri Bikash R. , Mahato Ram I. , Cheng Guofeng 
Published: September 2018

AbstractT cell immunity plays a vital role in pathogen infections. MicroRNA (miRNAs) are small, single‐stranded noncoding RNAs that regulate T cell immunity by targeting key transcriptional factors, signaling proteins, and cytokines associated with T cell activation, differentiation, and function. The dysregulation of miRNA expression in T cells may lead to specific immune responses and can provide new therapeutic opportunities against various infectious diseases. Here, we summarize recent studies that focus on the roles of miRNAs in T cell immunity and highlight miRNA functions in prevalent infectious diseases. Additionally, we also provide insights into the functions of extracellular vesicle miRNAs and attempt to delineate the mechanism of miRNA sorting into extracellular vesicles and their immunomodulatory functions. Moreover, methodologies and strategies for miRNA delivery against infectious diseases are summarized. Finally, potential strategies for miRNA‐based therapies are proposed.