bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheostomy Timing and Outcomes in the Critically Ill
Authors: Tong Charles C. L. , Kubinski Jacqueline , Kleinberger Andrew J. , Altman Kenneth W. 
Published: September 2011

ObjectiveAlthough data supports the use of tracheostomy in trauma patients admitted to intensive care units (ICUs), optimal timing of tracheostomy in nontrauma patients remains controversial. The purpose of this study is to examine the impact of early tracheostomy on duration of ICU and overall hospital stay in unselected ICU patients.MethodThe following data were collected from records of adult patients (n = 1097) who underwent tracheostomy from 2005 to 2010: demographics, survival, duration of oral intubation, mechanical ventilation (MV), ICU stay, overall hospital stay, and incidence of ventilator‐associated pneumonia (VAP). Tracheostomy was considered early if it was performed by day 7 of MV.ResultsOf the 114 unselected ICU patients who underwent tracheostomies with preliminary data available, 26 were early and 88 were late. Differences between age, sex, and survival were not statistically significant. Duration of MV, ICU stay, and overall hospital stay were significantly shorter in the early tracheostomy group (mean ± standard error: 16.54 ± 2.54 days vs 31.18 ± 1.83 days).ConclusionEarly tracheostomy in unselected ICU patients is associated with early movement from the ICU, shorter duration of mechanical ventilation, and shorter length of overall hospital stay without affecting mortality. Development of clinical guidelines that describe the criteria for early tracheostomy of non‐trauma patients is warranted.
Unverifiable Ghost Publications in Otolaryngology Residency Applications
Authors: Ishman Stacey L. , Benke James , Donahue Rachel , Carvey Roxann , Mettel Tiffany L. , Ishii Lisa M. 
Published: September 2011

ObjectiveDetermine the incidence of unverifiable (or “ghost”) publications in applications to an otolaryngology residency program through the Electronic Residency Application Services and determine if this incidence changed after the addition of pubmed (PMID) numbers to the application.MethodERAS applications submitted in 2007 and 2008 to an academic otolaryngology residency program were reviewed. Publications were verified against Medline, PubMed, ISI Web of Science, and Google. Ghost publications were defined as journals, books, abstracts, or posters that could not be verified as presented, published or including the applicant author.ResultsA total of 546 applications were reviewed: 256 before PMID numbers were requested and 248 after. Of 1967 publications, 41% (821 of 1967) could not be verified: 706 out of 1156 (61%) abstracts/posters, 92 out of 774 (12%) journal articles, and 23 out of 37 (62%) chapters. An additional 281 (14%) listings were not actual publications. Overall, abstracts/posters and book chapters were hardest to verify. The overall proportion of publications that could be verified was unchanged after the addition of the PMID to the ERAS application (P =. 67), and the proportion of verified journal articles decreased from 96% to 84% (P =. 005). Positive predictors of ghost publications were age and foreign medical school.ConclusionA substantial number of publications, especially book chapters and posters/abstracts, listed on otolaryngology residency ERAS applications cannot be verified. The addition of the PMID to ERAS applications has not significantly reduced the number of ghost journal publications.
Using the iPhone for Voice Recordings in Laryngology
Authors: Hornibrook Jeremy , Lin Emily , Ormond Tika 
Published: September 2011

Objective1) Evaluate the adequacy of an iPhone for voice recording enabling acoustic measurement of voice quality, and 2) demonstrate the usefulness of an iPhone‐based acoustic analysis for identifying voice aberration and monitoring voice changes after phonosurgery.MethodTwenty‐two voice patients, aged from 25 to 92 years (mean, 54.8 years; SD, 18.5 years), read sentences taken from a standard passage. An iPhone (Model 1303) with an internal microphone was used for voice recording. Vowels segmented from the sentences were submitted to an acoustic analysisprocedure to yield measures.ResultsCompared with the simultaneous voice recordings via another direct digitization method, the iPhone voice recordings showed relatively high measure‐remeasure and acceptable between‐system reliabilities for aselection of acoustic measures. In patients with pre‐ and posttreatment recordings, perturbation measures, including percent jitter, percentage shimmer, and signal‐to‐noise ratios, and the vowel space area consistently demonstrated positive changes after treatment. Measures of the amplitude difference between the first 2 harmonics, which has been related to breathiness, reflected subtle voice changes due to treatment. Changes in singing power ratio were found to be vowel‐dependent, while those in spectral tilt might be gender or pathology‐dependent.ConclusionVoice recordings using the iPhone model with a high sampling rate are adequate for acoustic measurement of speech and voice quality. However, due to large inter‐subject variations, most of these measures are more useful for intra‐subject than for norm‐referenced comparisons inmonitoring the progression of the disorder or treatment effect.
A Report on Outpatient Thyroid Surgery from the University Health System Consortium
Authors: Stack Brendan C. , Spencer Horace , Bodenner Donald 
Published: September 2011

ObjectiveDetermine demographics and cost analysis for outpatients undergoing thyroid surgery at hospitals belonging to the University Health System Consortium (UHC).MethodThe University Health System Consortium (UHC), Oak Brook, Illinois, was formed in 1984 and consists of 107 academic medical centers and 232 of their affiliated hospitals. This represents 90% of non‐profit academic medical centers in the United States (www.uhc.edu). Data were compiled from discharge summaries into a secure data base.ResultsThere were 28,648 patients who had outpatient thyroid surgery. A total of 19,487 patients had thyroid surgery for benign disease. A total of 8,909 patients had surgery for thyroid cancer. A total of 36.2% of surgeries were hemithyroidectomy and 44.5% were totals. A total of 1,333 of the thyroid cancer patients had a simultaneous neck dissection (5%). A total of 252 patients had neck dissection for thyroid cancer as a separate procedure. The average age was 48.7 (14.7) years and 71.8% of patients were female.ConclusionThyroid surgery is increasingly being done outpatient. Improved surgical technique, anesthesia technique, hemostatic methods, and calcium management make this possible. This becomes a cost‐effective way to manage both benign and malignant thyroid diseases. This is the largest series reporting outpatient thyroid surgery.
The Cost and Challenges of Facial Trauma: AAO‐HNS Survey
Authors: McCusker Scott B. , Schmalbach Cecelia E. 
Published: September 2011

Objective1) Define practice patterns and perceptions of young otolaryngologists treating maxillofacial trauma. 2) Identify manners in which the AAO‐HNS can meet future maxillofacial trauma needs.MethodA 26‐question survey was designed to identify demographic factors, practice patterns, perceptions of facial trauma, and areas for improvement in trauma care. It was distributed anonymously to AAO‐HNS members who completed residency from 2005 to 2009 and analyzed using descriptive statistics.ResultsA total of 444 of 1378 (32%) otolaryngologists responded. A total of 85% treat maxillofacial trauma (<1 case/month). A total of 64% identify trauma as part of their ideal practice. Sense of duty (54%) and institutional requirement (33%) are the most common reasons for trauma participation. Major deterrents: patient noncompliance (60%) and lifestyle limitations (47%). While insufficient reimbursement is a major deterrent (52%), only 35% would increase their volume if reimbursement improved. Sixteen (3.7%) have had a trauma‐related lawsuit. Increased education represents the most common request to the AAO‐HNS (59%), followed by focus on improved reimbursement/tort reform (28%). Topics proposed: practice guidelines, pediatric, laryngeal, and midface trauma.ConclusionMost otolaryngologists treat facial trauma, but do so infrequently. A total of 64% of young otolaryngologists identify trauma as a component of their ideal practice. However, universal concerns include inadequate reimbursement, limited pool of treating physicians, and lack of practice guidelines.
Adenoviral Therapy in Radioresistant Squamous Cell Cancer
Authors: Lee Sei‐Young , Kim Se‐Heon 
Published: September 2011

ObjectiveResistance to radiation is one of the main determinants of treatment outcome in the oral squamous cell carcinoma. We aim to identify that genetically modified adenovirus expressing RLX (Relaxin), which affects collagen metabolism, can effectively inhibit growth of the radioresistant oral SCC cell line.MethodRadioresistant oral SCC cell line was established. LDH assay was used to confirm the acquisition of radioresistance and cytotoxic effect of adenovirus. Tumor bearing nude mice were treated with expressing RLX adenovirus, dose dependently. Spread of adenovirus throughout the tumor mass was verified by immunohistochemistry.ResultsRadioresistant oral SCC cell line was more resistant to radiation therapy than mother oral SCC cell lines (p3 vs 45mm3 vs 0mm3 at Day 21). Also, the data shown that the minimum dose of adenovirus has the ability to kill the tumor cells (MOI = 5). In IHC data, the RLX expressing adenovirus eliminated collagens more effectively than non‐RLX expressing adenovirus.ConclusionOncolytic adenovirus can effectively inhibit growth of the radioresistance oral cancer cell line.
Analysis of Normative Vagal and Recurrent Laryngeal Nerve Electrophysiological Data
Authors: Eimear Phelan , Slough Chris , Randolph Gregory W. 
Published: September 2011

Objective1) Provide normative electrophysiological vagal and recurrent laryngeal nerve reference range values for intraoperative nerve monitoring in humans. 2) Highlight potential documentation implications of intraoperative nerve monitoring.MethodConsecutive monitored adult patients undergoing thyroid, parathyroid, and related neck surgery were included in this IRB approved study performed over an 8 month period. All patients had a preoperative and postoperative laryngeal examination to assess vocal cord function. Patients with an abnormal preoperative laryngeal examination were excluded.ResultsIn 64 patients the mean amplitude of the RLN (704mV, SD ± 512.7mV) was greater than the vagus nerve (524.5mV, SD± 388.0mV). The mean latency of the left and right RLN were 3.36ms (SD ± 0.92) and 3.45ms (SD ± 0.62) respectively. The mean latency of the left vagus was 7.48ms (SD ± 1.32), and the right vagus was 6.65ms (SD ± 1.28). The mean threshold intensity of stimulation of the right (0.41 mV, SD 0.20 mV) and left vagus (0.40 mV, SD 0.23 mV) were similar. The mean threshold of stimulation was higher in the right RLN (0.51 mV, SD 0.44). Amplitudes tended to be higher in females.ConclusionNormative vagal and RLN data is presented. The mean amplitude of the RLN was greater than the vagus nerve. The mean latency of the left vagus is longer than the right side. The threshold of stimulation is well below the standard stimulation current of 1 to 2 milliamps.
AntiBiofilm Molecules on Tracheo‐esophageal Speaking Valves
Authors: Shakir Adam , Burgess Grant , Jakubovics Nick , Shields Robert , El‐Badawey Mohamed Reda 
Published: September 2011

ObjectiveThe collection of biofilms on tracheo‐esophageal speaking valves (TESV) detrimentally shortens their lifespan. A novel nontoxic enzyme (NucB) was discovered in the University of Newcastle and proved effective for dispersing marine biofilms. We propose to ascertain the effect of NucB on disrupting and removing mixed organism biofilms on TESVs.MethodWe designed a case control study of ex‐vivo TESVs, with build up of biofilms. Each TESV was divided into 2 equal parts. One half was treated with NucB and the other half with a nonactive control solution. Outcomes are measured by microscopy and culture of biofilm organisms.ResultsTen TESVs were collected for our analysis in the microbiology laboratory. The more efficient our agent is in dispersing biofilms, the more organisms are released that can be cultured. With aerobic growth mediums, more organisms were cultured in 9 samples (90%, 95% CI 57‐99%). With the use of growth mediums favouring fungal organisms, more organisms were cultured in 6 samples (60%, 95% CI 31‐83%). The macroscopic appearances of TESVs were noticeably improved after treatment with NucB, with less visible contamination compared to control treated valves.ConclusionNucB, which is a nontoxic nuclease, was effective in the dispersion of the biofilms matrix collecting on TESVs. The treatment effect was greater for aerobic bacteria than fungal organisms. Our aim would be to use this agent to prolong the lifespan of TESVs and thus reduce costs.
Association of DNA Copy Number and miRNA Expression in OSCC
Authors: Serrano Nicholas Anthony , Xu Chang , Houck John , Wang Pei , Fan Wenhong , Liu Yan , Lohavanichbutr Pawadee 
Published: September 2011

ObjectiveBetter understand possible mechanisms involved in the dysregulation unique to OSCC metastasis, we examined whether DNA copy number aberrations (CNAs) are associated with differential expression of miRNA that are found in OSCC metastasis.MethodTumor cells were laser capture microdissected from 17 nonmetastatic primary tumors and 20 metastatic lymph nodes. CNAs and gene expression profiles were previously determined using Affymetrix 250K Nsp I SNP Arrays and HU133 plus 2.0 expression profiles. MiRNAs were interrogated with Exiqon’s Ready‐to‐use PCR Panels.ResultsWe found 155 miRNAs expressed in >80% of metastatic or nonmetastatic samples with 31 of them differentially expressed in metastatic tumor cells (FDR<0.4; 27 over‐expressed, 4 under‐expressed). We found the expression of 11 miRNAs to be significantly associated with their DNA copy numbers (p < 0.5) and 7 of these were among the differentially expressed miRNAs. Among these, miR‐140‐3p, miR‐29c, and miR‐29a showed a correlation between their expression and corresponding DNA copy number. These miRNAs were also associated with the down‐regulation of their target genes in the MAP/ERK oncogenic pathway.ConclusionOur results suggest that DNA copy number aberration may play a role in the dysregulation of miRNA in OSCC metastasis and that copy number driven miRNAs warrant further investigation.
Bilateral IJV Sampling for Parathyroid Adenoma Localization
Authors: Kalyoussef Evelyne , Henick David H. , Rosen Arie , Patel Chirag 
Published: September 2011

Objective1) Study the accuracy and utility of direct intraoperative internal jugular vein (IJV) sampling of parathyroid hormone (PTH) for localization of parathyroid adenoma. 2) Compare the accuracy of intraoperative IJV PTH sampling to that of preoperative Sestamibi scanning for lateralization.MethodA retrospective chart review of 51 consecutive neck explorations for primary hyperparathyroidism between 2007 and 2011. Direct bilateral IJV PTH sampling was performed prior to excision in all cases. Laterality based on IJV samples was compared with preoperative Sestamibi scans and operative findings.ResultsThere were no complications associated with sampling. 50 patients had single parathyroid adenomas, and 1 patient had ipsilateral double adenomas. All IJV sampling value difference was considered lateralizing. In 39 cases, IJV sampling successfully predicted laterality of adenoma, yielding a positive predictive value (PPV) of 76.5%. Sestamibi scans correctly lateralized in 37 cases (72.5%), 12 (23.5%) were nonlocalizing, and 2 (3.9%) were incorrect. PPV of Sestamibi scanning was 95%. IJV sampling successfully predicted the laterality of adenoma in 9 (75%) of the nonlocalizing Sestamibi scans and in 1 of the 2 incorrect scans.ConclusionIn patients with unilateral parathyroid adenomas, intraoperative bilateral IJV PTH sampling is a safe means of determining laterality of adenomas with a positive predictive value of 76.5%. This can be a valuable adjunct in cases where preoperative localization studies were unsuccessful or inaccurate in localizing the adenoma.
Calcium Management after Thyroidectomy: A Simple and Cost‐Effective Method
Authors: Singer Michael C. , Bhakta Dimpal , Terris David J. , Seybt Melanie Wilson 
Published: September 2011

ObjectiveHypocalcemia is one of the principal complications of total or completion thyroidectomy. A number of different protocols for managing this potential complication have been published. Our simple postoperative regimen is described and the safety and cost‐effectiveness assessed.MethodProspective analysis of a consecutive series of patients undergoing thyroid surgery from January 2008 through June 2010 was performed. Data collected included age, gender, procedure performed, levels of ionized calcium, parathyroid hormone, vitamin D, complications, and need for readmission. Standard descriptive statistics were used to summarize this data.ResultsA total of 526 patients had thyroid surgery during the 30‐month study period. Of these, 307 patients underwent completion or total thyroidectomy and were prescribed a 3‐week, tapering course of calcium carbonate postoperatively. Twenty‐four patients (7.8%) experienced symptoms of hypocalcemia which were managed easily with additional doses of oral calcium. A single patient (0.3%) required readmission. The cost of a 3‐week regimen of calcium carbonate is approximately $15. This is considerably less expensive than the cost of overnight admission or published laboratory protocols that are designed to predict the risk of hypocalcemia.ConclusionProphylactic calcium supplementation without routine laboratory assessment proved to be a safe and cost‐effective method of preventing and managing postoperative hypocalcemia following total or completion thyroidectomy.
Can Pathology of a Thyroid Nodule Be Determined by Positron Emission Tomography?
Authors: Stack Brendan C. , Boeckmann Jacob O. , Bodenner Donald , Siegel Eric R. 
Published: September 2011

ObjectivePositron emission tomography (PET) uptake in the thyroid gland is common. It occurs incidentally in diagnosis or surveillance of many cancers. Focal uptake indicates thyroid mass lesions. The goal was to determine if standardized uptake values (SUV) on PET can predict pathology in masses of the thyroid gland.MethodA total of 23,982 PET scans were retrospectively reviewed from the University of Arkansas for Medical Sciences in Little Rock, AR. These scans were performed from 2002 to 2010. 1,290 (5.4%) of scans had uptake in the thyroid gland, 614 were considered to be diffuse and 676 were considered focal.ResultsA total of 112 patients had PET scan with accompanying thyroid cytology or pathology. The mean SUV for benign (N = 78) was 3.75 ± 2.99 and for malignant (N = 35) was 8.22 ± 7.91, × 2 0.0011. Age, lesion size, and gender were not significant. Receiver operating curves (ROC) were constructed with empirical or binormal distribution assumptions. The area under the curve (AUC) was 0.693 and 0.702 respectively. A SUV of 3.6 maximized empirical sensitivity and sensitivity while minimizing (FP) and negatives (FN). A SUV threshold of 3.6 minimized binormal FP and FN whereas a SUV of 7.9 maximized sensitivity and specificity.ConclusionUptake on the thyroid on PET scan is a common incidental finding. The above data can help inform providers as to when these incidental lesions need to be aggressively evaluated through ultrasound guided needle biopsy or excision or when they can be observed.
Cartilaginous Reinforcing Sutures in Tracheal Anastomosis
Authors: Schilt Peter Nielsen , McRae Bryan R. , Kokoska Mimi S. , Halum Stacey L. , Musunuru Swapna 
Published: September 2011

Objective1) Determine what additional stability, if any, the addition of cartilaginous reinforcing sutures adds to tracheal stability. 2) Further clarify mechanisms of tracheal rupture.MethodProspective cadaver study. Eleven cadaver tracheas were harvested and divided in half. Each half trachea was cut and anastomosed using circumferential sutures. The other half underwent the exact same procedure with the addition of cartilaginous reinforcing sutures. The force necessary for anastomosis rupture was measured for each half trachea.ResultsEleven tracheas were used for a total of 22 trials. Analysis demonstrated a mean anastomotic rupture point for tracheas with reinforcing sutures was 297 N ± 94.6, while the mean for trials without reinforcing sutures was 173 N ± 51.4 (P <. 05). The point of rupture occurred at the anastomosis in 1 out of 11 cases with reinforcing sutures and in 8 out of 11 cases without reinforcing sutures. In all trials, the reinforcing sutures remained intact.ConclusionCartilaginous reinforcing sutures were found to provide a higher force requirement for rupturing tracheal anastomoses when compared to anastomoses without these sutures. This improved stability in tracheal anastomoses may result in a decreased risk of tracheal rupture after anastomosis.
Cervical Root Branches Preservation in Head and Neck Surgery
Authors: Garzaro Massimiliano , Raimondo Luca , Giordano Carlo , Pecorari Giancarlo , Riva Giuseppe , Aghemo Laura 
Published: September 2011

Objective1) Evaluate the hypothesis that the preservation of cervical root branches will be associated with better quality of life (QoL), greater shoulder motility, and lower loss of sensation in the neck after functional neck dissection sparing spinal accessory nerve. 2) Investigate the impact of physiotherapy.MethodThis retrospective study evaluated 41 patients surgically treated for head and neck cancer between 2006 and 2009 at our department. Patients were divided in 2 groups, according to the preservation or removal of cervical root branches during functional neck dissection. QoL, shoulder motility, and neck sensation were evaluated.ResultsThe analysis of the University of Washington‐Quality of Life questionnaire, fourth version, demonstrated lower pain, less shoulder complaints, and less limitations to activities and recreation in patients who hadn’t undergone removal of cervical root branches (P 0.05).ConclusionThis study demonstrated that the preservation of cervical root branches improved QoL and shoulder motility in patients who underwent functional neck dissection. Physiotherapy had a positive impact on the analyzed outcomes.
Thyroidectomy Related Malpractice Claims Are Rare
Authors: Singer Michael C. , Terris David J. , Iverson Kenneth 
Published: September 2011

ObjectiveLittle information is available regarding the frequency of thyroidectomy related malpractice claims. Previous studies have not assessed claims that were settled or dropped before trial, providing only a limited view of the medical‐legal environment. We sought to determine the frequency of thyroid surgery related malpractice claims, their causes and outcomes.MethodThe database of the Physician Insurers Association of America (PIAA) was reviewed. This data is estimated to represent 25% of medical malpractice claims in the United States. Claims from 1985 to 2008 with thyroid‐related procedure codes were evaluated for claimant information, insured’s specialty, loss description and causation, and claim outcomes.ResultsDuring the 23‐year period reviewed, 381 claims related to thyroid surgery were reported. 128 claims (33.6% of total claims) resulted in an indemnity payment either due to settlement or a finding against the defendant. The average indemnity payment was $185,366 (range $363 to $2,000,000). Among cases in which a specific outcome was reported, 55 were related to laryngeal nerve injury or voice disturbance. No marked change occurred in the incidence of claims across the study period. During this time, approximately 2,585,000 thyroidectomies were performed. Extrapolating from PIAA data, this works out to an estimated 1.5 claims per 10,000 cases.ConclusionMalpractice claims related to thyroid surgery are surprisingly infrequent. While the rates of thyroid surgery have risen steadily, there has not been a corresponding increase in related malpractice claims.