100
Eur Arch Otorhinolaryngol
. 2020 May 25. doi: 10.1007/s00405-020-06080-x. Online ahead of print.
Regional Variability of Hemorrhage Following Tonsil Surgery in 1,520,234 Cases
Jochen P Windfuhr 1, Paraskevi Alizoti 2, Christina Hendricks 3
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PMID: 32451670 DOI: 10.1007/s00405-020-06080-x
Abstract
Purpose: To evaluate, whether the regional variability of tonsil surgery in terms of the 16 Federal States of Germany was mirrored by a comparable variability of bleeding complications in male and female patients.

Methods: A longitudinal population-based inpatient cohort study was performed including all patients who had undergone tonsil surgery between 2005 and 2018. The database was provided by the Federal Statistical Office of Germany and included all inpatient cases after tonsillectomy (with or without adenoidectomy), tonsillotomy, abscess-tonsillectomy and secondary tonsillectomy. The population was stratified by region (16 Federal States) and gender. Operation rates were calculated in relation to the end-year population number of each region. Bleeding percentages were calculated for each calendar year and region as the number of procedures to achieve hemostasis divided by the total number of operations.

Results: The surgical rates varied significantly between the 16 Federal States in male, female and all patients (p = 0.001). Revision surgery to achieve hemostasis was predominantly performed in male patients (5.2-11.4% male vs. 3.7-7.6% female patients). Bleeding percentages did not differ significantly from national values in male and female patients in 5 Federal States, but were significantly higher than the national average in 3 Federal States and significantly lower in 7 Federal States for both genders (p < 0.05), while in 1 Federal State it was significantly lower only for the male patients. Pearson's correlation coefficient for surgical and bleeding rates was positive and statistically significant (p < 0.05) for all Federal States, except for two. This phenomenon was emphasized by female gender.

Conclusions: Gender had an impact not only on surgical rates but also on bleeding percentages and this was independent from the decrease in the total number of operations. Surprisingly, there was a clear correlation between the rates of both variables in the majority of the Federal States of Germany. It needs further studies to clarify, why a higher prevalence of surgical practice, thus surgical experience, was not followed by lower bleeding complications.

Keywords: Pharyngitis; Tonsillectomy; Tonsillitis; Tonsillotomy.

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101
Facial Plast Surg Aesthet Med
. 2020 May 26. doi: 10.1089/fpsam.2020.0073. Online ahead of print.
Long-Term Results of a Pedicled and Innervated Sternocleidomastoid Muscle Flap to Immediately Reconstruct Superficial Parotidectomy Defects
Julianna Zenke 1, Abdulrahman Alenazi 2, Connor Sommerfeld 2, Justin Pyne 2, Sherif Idris 3, Ahmed Darwish 2, Hadi Seikaly 2, Kal Ansari 2
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PMID: 32456521 DOI: 10.1089/fpsam.2020.0073
Abstract
Importance: Conventional reconstruction techniques for superficial parotidectomy have been criticized for their ability to provide long-term volumetric correction and to prevent Frey's syndrome. Objective: To demonstrate the long-term effectiveness of a pedicled and innervated sternocleidomastoid muscle flap (PISCMMF) to reconstruct superficial parotidectomy defects. Design, Setting, and Participants: This is a retrospective cohort study of patients treated by a single surgeon in a tertiary care center from July 2012 to March 2018. Seventeen of a possible 34 eligible adults having undergone reconstruction with a PISCMMF for benign parotid disease with at least 1 year of follow-up were included through convenience sampling. Patients with revision parotid surgery, malignant parotid tumors, neck dissections, or prior spinal accessory nerve dysfunction were excluded. Intervention: A PISCMMF was used to immediately reconstruct superficial parotidectomy defects. Main Outcomes and Measures: Participants underwent three-dimensional facial imaging, starch-iodine testing for Frey's syndrome, and completed a validated satisfaction questionnaire. The surface area of the positive starch-iodine tests was calculated. An average model was generated from participant images, allowing the calculation of surface millimeter differences comparing the operative with nonoperative sides. Results: Seventeen patients [7 male (41.2%), mean age 50.82 ± 12.37 years] underwent a PISCMMF to reconstruct excision (mean specimen weight = 21.45 ± 12.22 g) of benign lesions [9 pleomorphic adenomas (52.9%), 5 Warthin's tumors (29.4%), 2 cysts (11.8%), 1 chronic parotitis (5.9%)], with a mean follow-up time of 35.41 ± 12.30 months. Rates of objective and subjective Frey's syndrome were 29.4% and 11.8%, respectively. The average surface area affected was 2.32 cm2 [standard deviation (SD) = 1.95 cm2] compared with the average surface area of 16.35 cm2 (SD = 9.20 cm2) of the excised specimens. Facial symmetry analysis revealed an average millimeter difference of -1.57 ± 2.55 mm that was not significant at a threshold of 2 mm [t(16) = 0.69, p = 0.50]. No participants had postoperative shoulder or neck dysfunction. Overall satisfaction was 95.4%. Age (β = -0.51, p = 0.02) and case number (β = 0.44, p = 0.04) were significant predictors of smaller millimeter difference (R2 = 0.48, F(2,14) = 6.41, p = 0.01). The specimen mass (β = -0.05, p = 0.35) did not predict millimeter difference (R2 = 0.11, F(1,8) = 0.10, p = 0.35). Conclusions and Relevance: A PISCMMF immediately reconstructing parotidectomy defects successfully restores facial symmetry, prevents clinically significant Frey's syndrome, and results in high patient satisfaction in the long term without significant morbidity.

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102
Med Sci Monit
. 2020 May 27;26:e924934. doi: 10.12659/MSM.924934.
Bioinformatics Analysis and Identification of Underlying Biomarkers Potentially Linking Allergic Rhinitis and Asthma
Zhanfeng Yan 1 2, Lili Liu 2, Lulu Jiao 2, Xiaohui Wen 1, Jianhua Liu 2, Ningyu Wang 1
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PMID: 32460303 DOI: 10.12659/MSM.924934
Abstract
BACKGROUND Rhinitis is the most common clinical manifestation of allergy, affecting more than 400 million people around the world. Rhinitis increases the risk of developing bronchial hyper-responsiveness and asthma. Previous studies have shown that rhinitis is closely related with the physiology, pathology, and pathogenesis of asthma. We analyzed co-expressed genes to explore the relationships between rhinitis and asthma and to find biomarkers of comorbid rhinitis and asthma. MATERIAL AND METHODS Asthma- and rhinitis-related differentially-expressed genes (DEGs) were identified by bioinformatic analysis of GSE104468 and GSE46171 datasets from the Gene Expression Omnibus (GEO) database. After assessment of Gene Ontology (GO) terms and pathway enrichment for DEGs, a protein-protein interaction (PPI) network was conducted via comprehensive target prediction and network analyses. We also evaluated co-expressed DEGs and corresponding predicted miRNAs involved in the developing process of rhinitis and asthma. RESULTS We identified 687 and 1001 DEGs in bronchial and nasal epithelia samples of asthma patients, respectively. For patients with rhinitis, we found 245 DEGs. The hub-genes of PAX6, NMU, NTS, NMUR1, PMCH, and KRT6A may be associated with rhinitis, while CPA3, CTSG, POSTN, CLCA1, HDC, and MUC5B may be involved in asthma. The co-expressed DEGs of BPIFA1, CCL26, CPA3, and CST1, together with corresponding predicted miRNAs (e.g., miR-195-5p and miR-125a-3p) were found to be significantly correlated with rhinitis and asthma. CONCLUSIONS Rhinitis and asthma are related, and there are significant correlations of BPIFA1, CCL26, CPA3, and CST1 genes with novel biomarkers involved in the comorbidity of rhinitis and asthma.

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103
Review Ann Allergy Asthma Immunol
. 2020 May 23;S1081-1206(20)30355-0. doi: 10.1016/j.anai.2020.05.016. Online ahead of print.
Outside-in Hypothesis Revisited: The Role of Microbial, Epithelial and Immune Interactions
Kazunari Sugita 1, Michael B Soyka 2, Paulina Wawrzyniak 3, Arturo Rinaldi 4, Yasuaka Mitamura 4, Mübeccel Akdis 5, Cezmi A Akdis 4
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PMID: 32454094 DOI: 10.1016/j.anai.2020.05.016
Abstract
Objective: Our understanding of the origin of allergic diseases has increased in recent years, highlighting the importance of microbial dysbiosis and epithelial barrier dysfunction in affected tissues. Exploring the microbial-epithelial-immune crosstalk underlying the mechanisms of allergic diseases will allow the development of novel prevention and treatment strategies of allergic diseases.

Data sources: This review summarizes recent advances in microbial, epithelial, and immune interactions in atopic dermatitis, allergic rhinitis, chronic rhinosinusitis and asthma.

Study selections: We performed a literature search, identifying relevant recent primary articles and review articles.

Results: Dynamic crosstalk between the environmental factors and microbial, epithelial, and immune cells in the development of atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, and asthma underlies the pathogenesis of these disease. There is substantial evidence in the literature suggesting that environmental factors directly affect barrier function of epithelium. In addition, T helper 2 cells, type 2 innate lymphoid cells and their cytokine IL-13 damage skin and lung barriers. The effects of environmental factors may at least in part be mediated by epigenetic mechanisms.Histondeacetylase activation by type 2 immune response has a major effect on leaky barriers and blocking of histone deacetylase activity corrects the defective barrier in human air-liquid interface cultures and mouse models of allergic asthma with rhinitis. We also present and discuss a novel device to detect and monitor skin barrier dysfunction, which provides an opportunity to rapidly and robustly assess disease severity.

Conclusion: A complex interplay between environmental factors, epithelium, and the immune system is involved in the development of systemic allergic diseases.

Keywords: asthma; atopic dermatitis; chronic rhinosinusitis; electrical impedance spectroscopy; environmental factors; epithelial barrier; tight junction.

Copyright © 2020. Published by Elsevier Inc.

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104
Otolaryngol Head Neck Surg
. 2020 May 26;194599820931836. doi: 10.1177/0194599820931836. Online ahead of print.
Endoscopic Skull Base Surgery Protocol From the Frontlines: Transnasal Surgery During the COVID-19 Pandemic
Todd Spock 1, Remi Kessler 2, David Lerner 1, Peter Filip 1, Anthony Del Signore 1, Patrick Colley 1, Peter Morgenstern 2, Madeleine Schaberg 1, Joshua Bederson 2, Satish Govindaraj 1, Alfred Marc Iloreta 1, Raj Shrivastava 2
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PMID: 32452722 DOI: 10.1177/0194599820931836
Abstract
Objective: The coronavirus disease 2019 (COVID-19) pandemic disrupted the standard management paradigms for care of patients with sinus and skull base presentations due to concern for patient and health care provider safety, given the high aerosol-generating potential of endonasal procedures.

Data sources: We reviewed the relevant literature complied from available sources, including PubMed, Google Scholar, and otolaryngology journals providing electronic manuscripts ahead of indexing or publication.

Review methods: Incorporating available evidence and the projected infection control and resource limitations at our institution, we collectively authored a dynamic set of protocols guiding (1) case stratification, (2) preoperative assessment, (3) operative setup, and (4) postoperative care of patients with sinus or skull base presentations. Due to the rapidly evolving nature of COVID-19 publications, lack of rigorous data, and urgent necessity of standardized protocols, strict inclusion and exclusion criteria were not employed.

Conclusions: As scarce hospital resources are diverted to COVID-19 care and staff are redeployed to forward-facing roles, endonasal procedures have largely ceased, leaving patients with ongoing sinonasal and skull base complaints untreated. Skull base teams now weigh the urgency of surgery in this population with the regional availability of resources.

Implications for practice: The COVID-19 pandemic will have an enduring and unpredictable impact on hospital operations and surgical skull base practices and will require a dynamic set of management protocols responsive to new evidence and changing resources. In the current resource-limited environment, clinicians may utilize these protocols to assist with stratifying patients by acuity, performing preoperative assessment, and guiding peri- and postoperative care.

Keywords: COVID-19; SARS-CoV-2; coronavirus; endoscopy; pandemic; sinus; skull base.

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105
Int J Pediatr Otorhinolaryngol
. 2020 Feb;129:109761. doi: 10.1016/j.ijporl.2019.109761. Epub 2019 Oct 31.
Publishing Trends in Velopharyngeal Insufficiency
Charles Poff 1, Joshua Horton 2, Ryan Boerner 2, Alexander P Marston 2, Shaun A Nguyen 2, David R White 2
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PMID: 31760335 DOI: 10.1016/j.ijporl.2019.109761
Abstract
Objective: This study seeks to describe publishing trends for VPI over a 33-year span with regard to treating specialty, methods of assessment, related diagnoses, and methods of treatment for each specialty.

Methods: A PubMed search was performed on "velopharyngeal insufficiency" using medical subject headings terms from 1985 to 2017. Publisher specialty, method(s) of VPI assessment, associated diagnosis/diagnoses, and method(s) of VPI treatment per specialty and combined across specialties were analyzed. Respective publications were totaled in 11-year intervals and two-way analysis of variance was used to compare change over time within specialties and across specialties.

Results: 763 publications were included for analysis. The total number of publications on VPI increased from a total of 6 in 1985 to a peak of 67 in 2015. The specialties that showed the largest increase in relative frequency of publication were Otolaryngology (p < 0.001), Plastic Surgery (p < 0.001), and Multidisciplinary (p < 0.001). Publications on endoscopic (p < 0.001) evaluation of VPI have significantly increased over time relative to magnetic resonance imaging and lateral cephalometry. Across all specialties, publications that feature pharyngoplasty (p < 0.001), palatoplasty (p < 0.001), and pharyngeal flap (p < 0.001) as methods of VPI treatment have significantly increased over time.

Conclusion: There is a trend towards endoscopy for diagnostics and a multidisciplinary approach when managing patients with VPI. The specialty that showed the largest increase in the relative frequency of publication was Otolaryngology. Surgical methods of treatment continue to be described at increasing frequency relative to more conservative treatments.

Keywords: Bibliometrics; Publication trends; VPI.

Copyright © 2019 Elsevier B.V. All rights reserved.

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106
Review Ann Otol Rhinol Laryngol
. 2020 Jun;129(6):628-632. doi: 10.1177/0003489419901140. Epub 2020 Jan 22.
Thyroglossal Duct Cyst Occupying Posterior Hyoid Space With Endolaryngeal Extension Presenting After Neck Trauma
Samuel Bosco 1, Jason E Cohn 2, Marissa Evarts 2, Paul Papajohn 2, Raymond Lesser 3
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PMID: 31965811 DOI: 10.1177/0003489419901140
Abstract
Objective: Thyroglossal duct cysts are the most common congenital neck mass. They typically present as a painless midline neck mass in a child or young adult, but may also present later in adulthood when the cyst becomes symptomatic. Thyroglossal duct cysts are most commonly located inferior to the hyoid bone in close relation with the thyrohyoid membrane. Very rarely, they may extend intralaryngeal, occupy the posterior hyoid space, and present with dysphonia and/or dysphagia. To our knowledge, this is the 24th reported case in the literature.

Methods: Case report with a comprehensive review of the literature.

Results: The patient was a 43-year-old male experiencing dysphonia and dysphagia following a motor vehicle accident. He was subsequently found to have a large thyroglossal duct cyst with endolaryngeal extension that was previously asymptomatic and undiagnosed. He underwent successful surgical excision which resulted in resolution of symptoms.

Conclusion: This is the first reported case of a thyroglossal duct cyst in the posterior hyoid space with endolaryngeal extension being diagnosed following a traumatic event. This case illustrates the need to consider thyroglossal duct cyst in the differential diagnosis when working up a post-traumatic intralaryngeal neck mass. A secondary educational objective in this case is to be diligent to consider and rule out laryngeal fracture in the case of a neck mass presenting after trauma as they can easily be missed and present with many overlapping symptoms.

Keywords: congenital; laryngeal cyst; miscellaneous; neck mass; otolaryngology; thyroglossal duct cyst; trauma.

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107
Ann Lab Med
. 2020 May;40(3):224-231. doi: 10.3343/alm.2020.40.3.224.
A Novel Heterozygous Missense Variant (c.667G>T;p.Gly223Cys) in USH1C That Interferes With Cadherin-Related 23 and Harmonin Interaction Causes Autosomal Dominant Nonsyndromic Hearing Loss
Ju Sun Song # 1, Amel Bahloul # 2 3 4 5, Christine Petit 2 3 4 6, Sang Jin Kim 7, Il Joon Moon 8, Jinhyuk Lee 9 10, Change Seok Ki 11
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PMID: 31858762 PMCID: PMC6933062 DOI: 10.3343/alm.2020.40.3.224
Free PMC article
Abstract
Background: Pathogenic variants of USH1C, encoding a PDZ-domain-containing protein called harmonin, have been known to cause autosomal recessive syndromic or nonsyndromic hearing loss (NSHL). We identified a causative gene in a large Korean family with NSHL showing a typical pattern of autosomal dominant (AD) inheritance.

Methods: Exome sequencing was performed for five affected and three unaffected individuals in this family. Following identification of a candidate gene variant, segregation analysis and functional studies, including circular dichroism and biolayer interferometry experiments, were performed.

Results: A novel USH1C heterozygous missense variant (c.667G>T;p.Gly223Cys) was shown to segregate with the NSHL phenotype in this family. This variant affects an amino acid residue located in the highly conserved carboxylate-binding loop of the harmonin PDZ2 domain and is predicted to disturb the interaction with cadherin-related 23 (cdh23). The affinity of the variant PDZ2 domain for a biotinylated synthetic peptide containing the PDZ-binding motif of cdh23 was approximately 16-fold lower than that of the wild-type PDZ2 domain and that this inaccessibility of the binding site was caused by a conformational change in the variant PDZ2 domain.

Conclusions: A heterozygous variant of USH1C that interferes with the interaction between cdh23 and harmonin causes novel AD-NSHL.

Keywords: Harmonin; Heterozygous variant; Nonsyndromic hearing loss; USH1C.

© The Korean Society for Laboratory Medicine.

Conflict of interest statement
No potential conflicts of interest relevant to this paper were reported.

17 references2 figures
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108
Otolaryngol Head Neck Surg
. 2020 May 26;194599820920833. doi: 10.1177/0194599820920833. Online ahead of print.
SimTube: A National Simulation Training and Research Project
Gregory J Wiet 1 2, Ellen S Deutsch 3 4, Sonya Malekzadeh 5, Amanda J Onwuka 6, Nathan W Callender 7, Michael D Seidman 8 9 10, Marvin P Fried 11
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PMID: 32450737 DOI: 10.1177/0194599820920833
Abstract
Objective: To test the feasibility and impact of a simulation training program for myringotomy and tube (M&T) placement.

Study design: Prospective randomized controlled.

Setting: Multi-institutional.

Subjects and methods: An M&T simulator was used to assess the impact of simulation training vs no simulation training on the rate of achieving competency. Novice trainees were assessed using posttest simulator Objective Structured Assessment of Technical Skills (OSATS) scores, OSATS score for initial intraoperative tube insertion, and number of procedures to obtain competency. The effect of simulation training was analyzed using χ2 tests, Wilcoxon-Mann-Whitney tests, and Cox proportional hazards regression.

Results: A total of 101 residents and 105 raters from 65 institutions were enrolled; however, just 63 residents had sufficient data to be analyzed due to substantial breaches in protocol. There was no difference in simulator pretest scores between intervention and control groups; however, the intervention group had better OSATS global scores on the simulator (17.4 vs 13.7, P = .0003) and OSATS task scores on the simulator (4.5 vs 3.6, P = .02). No difference in OSATS scores was observed during initial live surgery rating (P = .73 and P = .41). OSATS scores were predictive of the rate at which residents achieved competence in performing myringotomy; however, the intervention was not associated with subsequent OSATS scores during live surgeries (P = .44 and P = .91) or the rate of achieving competence (P = .16).

Conclusions: A multi-institutional simulation study is feasible. Novices trained using the M&T simulator achieved higher scores on simulator but not initial intraoperative OSATS, and they did not reach competency sooner than those not trained on the simulator.

Keywords: simulation; simulation training; surgical training.

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109
Health Qual Life Outcomes
. 2020 May 25;18(1):151. doi: 10.1186/s12955-020-01399-9.
Development of Two Psychological Experience Questionnaires for Screening Violence-Related Mental Health Disorders of Non-Psychiatric Inpatients
Yanjun Meng 1 2, Yuling Li 1, Hongbao Cao 3, Yong Xu 4, Binquan Wang 5 6
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PMID: 32450852 DOI: 10.1186/s12955-020-01399-9
Free article
Abstract
Background: Increased violent events happen in the general hospitals in China and yet non-psychiatric departments do not have tools for violence-tendency screening.

Methods: The current study developed and evaluated two Inpatient Psychological Experience Questionnaires (IPEQs) for the screening of violence-related six mental health disorders: (Inpatient Psychological Experience Questionnaire-1 (IPEQ-1): anxiety, depression and suicidality; Inpatient Psychological Experience Questionnaire-2 (IPEQ-2): paranoid personality disorder, emotionally unstable personality disorder and histrionic personality disorder). Two initial IPEQs (IPEQ-1: 37 items and IPEQ-2: 30 items) were developed and assessed by domain experts. Then 1210 inpatients were recruited and divided into three groups (160, 450 and 600 samples, respectively) for IPEQs item selection and evaluation. During the two-stage item selection, three statistical methods including Pearson's correlation coefficient, exploratory factor analysis and item response theory were applied. For the item evaluation, Cronbach's alpha coefficient, test-retest reliability, criterion-related validity and construct validity of the final questionnaires were measured.

Results: Twelve items were selected for each IPEQs. Cronbach's alpha coefficients were 0.91 and 0.78 for IPEQ-1 and IPEQ-2, respectively. Test-retest replication ratios were 0.95 and 0.87 for IPEQ-1 and IPEQ-2, respectively. Correlation coefficients between different disorders and their related-tools scores were [0.51, 0.44] and [0.40, 0.44] for IPEQ-1 and IPEQ-2, respectively and were significant (P < 0.01). Confirmatory factor analysis supported the validity of the final IPEQs (P < 0.05), and the model fit index met the criterion generally.

Conclusion: The IPEQs developed in this study could be effective and easy-to-use tools for screening inpatients with violence-intendancy in non-psychosomatic departments.

Keywords: Anxiety; Depression; Emotionally unstable personality disorder; Histrionic personality disorder; Paranoid personality disorder; Psychological questionnaire; Suicidality; Violence.

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110
Eur J Neurosci
. 2019 May;49(10):1220-1232. doi: 10.1111/ejn.14299. Epub 2018 Dec 27.
Neural Coding of the Sound Envelope Is Changed in the Inferior Colliculus Immediately Following Acoustic Trauma
Amarins N Heeringa 1 2, Pim van Dijk 1 2
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PMID: 30549334 DOI: 10.1111/ejn.14299
Abstract
Sensorineural hearing loss is often accompanied by difficulties with understanding speech in fluctuating backgrounds, suggesting that neural coding of complex sound features, such as the sound envelope, is impaired. Here, we studied how temporal and rate coding of the envelope is affected in the inferior colliculus immediately after acoustic trauma. Neural activity in response to amplitude-modulated noise was recorded from the inferior colliculus of the guinea pig, before and immediately after a 1-hr 11-kHz acoustic trauma. Units with a characteristic frequency (CF) below the trauma frequency (<11 kHz) showed increased response gains, a measure for temporal coding of the sound envelope, especially at low modulation frequencies (≤128 Hz). Units with a CF > 11 kHz, which had large acoustic trauma-induced threshold shifts, had decreased response gains to amplitude-modulated noise. Shapes of temporal modulation transfer functions shifted toward a higher proportion of low-pass shapes in low-CF units, and to less band-pass shapes in high-CF units. Furthermore, driven firing rates decreased, especially at high modulation frequencies for high-CF units. The observed changes occurred immediately following trauma and were thus a result of the immediate trauma-induced damage to the auditory system. If also present in human subjects, reduced response gains in high-frequency units could disrupt coding of consonants and consequently impair speech understanding in noisy environments. Moreover, the enhanced temporal coding by low-CF units of the low modulation frequencies could overly amplify responses to low-frequency noise, further deteriorating listening in noise.

Keywords: amplitude modulation; guinea pig; noise-induced hearing loss; rate coding; temporal coding.

© 2018 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Cited by 2 articles
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111
Medicina (Kaunas)
. 2020 May 22;56(5):E254. doi: 10.3390/medicina56050254.
Sclerotherapy of Vascular Malformations in the Oral Cavity-Minimizing Postoperative Morbidity
Itai Zeevi 1, Gavriel Chaushu 2 3, Michael Alterman 1, Liat Chaushu 4
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PMID: 32456057 DOI: 10.3390/medicina56050254
Free article
Abstract
Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. Special attention was given to factors that may contribute to minimizing postoperative morbidity. Data from 25 patients (32 lesions) with oral VMs submitted to sclerotherapy with monoethanolamine oleate (EAO) were included. A structured form was used to collect data. An arbitrary score was determined to evaluate postoperative morbidity. Each of the following signs or symptoms received one point: pain, swelling, hematoma, ulceration, erythema, transient numbness, and transient itching. Pain and swelling were further divided into mild to moderate (1 point) and severe (2 points). Theoretically, the score was in the range of 0-9. Calculated scores ranged 0-4. The patients were further divided into two groups with scores of 0-1 denoting minimal morbidity (MIN) and 2-4 denoting significant morbidity (SIG). The number of lesions in each morbidity-score group were comparable (MIN 17and SIG 15). There were no statistically significant differences between the groups regarding age, number of applications, or average injection volume per mm lesion. Statistically significant differences were noted regarding gender (p = 0.05), lesion diameter (p = 0.030), total volume of first (p = 0.007) and second application (p = 0.05), and total injected volume (p = 0.03). Factors contributing to the risk for significant morbidity included being male, lesion diameter > 5 mm, volume > 0.3 mL per application, and total injected volume > 0.3 mL. A waiting time of 12 weeks prior to additional EAO application was required in 12 out of 29 lesions for clinical observation of complete regression. It was concluded that sclerotherapy with EAO as monotherapy is easy to apply, safe, and effective within a small number of sessions. Application of <0.3 mL EAO per session, and a waiting time of 12 weeks prior to the second application, would significantly minimize morbidity.

Keywords: ethanolamine oleate; morbidity; sclerotherapy; vascular malformation.

Conflict of interest statement
The authors declare no conflict of interest.

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112
Comment Ann Surg Oncol
. 2019 Dec;26(Suppl 3):698-699. doi: 10.1245/s10434-019-07730-z. Epub 2019 Aug 19.
ASO Author Reflections: Treatment of the Paratracheal Nodes in the Clinically Negative Neck in Salvage Laryngectomy
Janice L Farlow 1, Andrew J Rosko 1, Matthew E Spector 2
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PMID: 31429020 DOI: 10.1245/s10434-019-07730-z
Comment on
Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy.
Farlow JL, Birkeland AC, Rosko AJ, VanKoevering K, Haring CT, Smith JD, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, McLean SA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME.
Ann Surg Oncol. 2019 Aug;26(8):2542-2548. doi: 10.1245/s10434-019-07270-6. Epub 2019 Mar 4.
PMID: 30830535 Clinical Trial.
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113
Ann Otol Rhinol Laryngol
. 2020 Jun;129(6):611-617. doi: 10.1177/0003489420903336. Epub 2020 Jan 29.
Are Children Scheduled for Ventilation Tubes Insertion Overweight? A Cohort of Israeli Children
Ayala Klein 1, Oded Kraus 1, Alisa Luria 1, Sharon Ovnat Tamir 1, Tal Marom 1
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PMID: 31994406 DOI: 10.1177/0003489420903336
Abstract
Objective: To study the hypothesis that children scheduled for ventilation tube insertion (VTI), a surrogate procedure reflecting otitis media (OM) presence, are overweight or obese.

Patients and methods: Charts of Israeli children aged 0 to 9 years undergoing VTI with or without adenoidectomy between 9/1/17 and 3/31/19 in a secondary level hospital were retrospectively identified. We compared their mean body mass index (BMI, kg/m2) to the mean BMI of a control group comprised of children who underwent surgeries unrelated to OM (fracture fixation/reduction, inguinal/umbilical hernia repair, meatotomy, appendectomy). BMI measurements were plotted on gender- and age-matched curves to determine BMI percentile, and were also compared to the national pediatric overweight/obesity data. Normal weight was defined as BMI percentile <85%, overweight was BMI percentile between 85% and 97%, and obesity was BMI percentile >97%.

Results: The VTI group included 83 children (mean age: 3.5 ± 1.8 years). The control group included 77 children (mean age: 6.3 ± 1.9 years). No statistically significant difference was found in the mean BMI values between both groups (P = .22). When compared to age- and gender-adjusted 50th BMI percentile of the general pediatric population, the mean BMI of the VTI group was significantly higher: for boys, 16.9 versus 15.2 (P < .01), and for girls, 16.6 versus 15.3 (P = .03), but not in the control group: P = .16 (boys) and P = .11 (girls).

Conclusion: Children undergoing VTI were overweight when compared to their age- and gender-matched peers. This observation was more noticeable in boys.

Keywords: body mass index; otitis media; overweight; pediatric obesity; ventilating tube insertion.

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114
Review Int J Mol Sci
. 2020 May 24;21(10):E3693. doi: 10.3390/ijms21103693.
Insight Toward the MicroRNA Profiling of Laryngeal Cancers: Biological Role and Clinical Impact
Takashi Takeuchi 1 2, Hiromichi Kawasaki 1 3, Amalia Luce 1, Alessia Maria Cossu 1 4, Gabriella Misso 1, Marianna Scrima 4, Marco Bocchetti 1 4, Filippo Ricciardiello 5, Michele Caraglia 1 4, Silvia Zappavigna 1
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PMID: 32456271 DOI: 10.3390/ijms21103693
Free article
Abstract
Head and neck squamous cell carcinoma (HNSCC), a heterogeneous disease arising from various anatomical locations including the larynx, is a leading cause of death worldwide. Despite advances in multimodality treatment, the overall survival rate of the disease is still largely dismal. Early and accurate diagnosis of HNSCC is urgently demanded in order to prevent cancer progression and to improve the quality of the patient's life. Recently, microRNAs (miRNAs), a family of small non-coding RNAs, have been widely reported as new robust tools for prediction, diagnosis, prognosis, and therapeutic approaches of human diseases. Abnormally expressed miRNAs are strongly associated with cancer development, resistance to chemo-/radiotherapy, and metastatic potential through targeting a large variety of genes. In this review, we summarize on the recent reports that emphasize the pivotal biological roles of miRNAs in regulating carcinogenesis of HNSCC, particularly laryngeal cancer. In more detail, we report the characterized miRNAs with an evident either oncogenic or tumor suppressive role in the cancers. In addition, we also focus on the correlation between miRNA deregulation and clinical relevance in cancer patients. On the basis of intriguing findings, the study of miRNAs will provide a new great opportunity to access better clinical management of the malignancies.

Keywords: biomarkers; chemo-/radio resistance; head and neck cancer; laryngeal cancer; lifestyle habit; metastasis; microRNA; prediction; prognosis; therapeutic target.

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115
Otolaryngol Head Neck Surg
. 2020 May 26;194599820924621. doi: 10.1177/0194599820924621. Online ahead of print.
Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals
Rodrigo Martinez-Monedero 1, Arman Danielian 2, Varun Angajala 3, Jennifer E Dinalo 4, Eric J Kezirian 1
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PMID: 32450783 DOI: 10.1177/0194599820924621
Abstract
Objective: To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals.

Data sources: Ovid Medline, Embase, and Cochrane Library.

Review methods: A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions.

Results: Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews.

Conclusion: Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.

Keywords: meta-analysis; systematic review.

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116
Lancet Infect Dis
. 2019 Feb;19(2):131-132. doi: 10.1016/S1473-3099(18)30802-8. Epub 2019 Jan 30.
Gender-neutral HPV Vaccination in the UK, Rising Male Oropharyngeal Cancer Rates, and Lack of HPV Awareness
Matt Lechner 1, Oliver S Jones 2, Charles E Breeze 3, Richard Gilson 4
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PMID: 30722999 DOI: 10.1016/S1473-3099(18)30802-8
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117
JAMA Dermatol
. 2020 May 27. doi: 10.1001/jamadermatol.2020.1450. Online ahead of print.
Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma
Cristian Navarrete-Dechent 1 2, Konstantinos Liopyris 2, Ayelet Rishpon 2 3, Nadeem G Marghoob 4, Miguel Cordova 2, Stephen W Dusza 2, Aditi Sahu 2, Kivanc Kose 2, Margaret Oliviero 5, Harold Rabinovitz 5, Klaus J Busam 6, Michael A Marchetti 2, Chih-Chan J Chen 2, Ashfaq A Marghoob 2
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PMID: 32459294 DOI: 10.1001/jamadermatol.2020.1450
Abstract
Importance: Basal cell carcinoma (BCC) is the most common skin cancer. Dermoscopic imaging has improved diagnostic accuracy; however, diagnosis of nonpigmented BCC remains limited to arborizing vessels, ulceration, and shiny white structures.

Objective: To assess multiple aggregated yellow-white (MAY) globules as a diagnostic feature for BCC.

Design, setting, and participants: In this retrospective, single-center, case-control study, nonpigmented skin tumors, determined clinically, were identified from a database of lesions consecutively biopsied during a 7-year period (January 1, 2009, to December 31, 2015). A subset of tumors was prospectively diagnosed, and reflectance confocal microscopy, optical coherence tomography, and histopathologic correlation were performed. Data analysis was conducted from July 1 to September 31, 2019.

Exposures: Investigators evaluated for the presence or absence of known dermoscopic criteria. MAY globules were defined as aggregated, white-yellow structures visualized in polarized and nonpolarized light.

Main outcomes and measures: The primary outcome was the diagnostic accuracy of MAY globules for the diagnosis of BCC. Secondary objectives included the association with BCC location and subtype. Interrater agreement was estimated.

Results: A total of 656 nonpigmented lesions from 643 patients (mean [SD] age, 63.1 [14.9] years; 381 [58.1%] male) were included. In all, 194 lesions (29.6%) were located on the head and neck. A total of 291 (44.4%) were BCCs. MAY globules were seen in 61 of 291 BCC cases (21.0%) and in 3 of 365 other diagnoses (0.8%) (P < .001). The odds ratio for diagnosis of BCC was 32.0 (96% CI, 9.9-103.2). The presence of MAY globules was associated with a diagnosis of histologic high-risk BCC (odds ratio, 6.5; 95% CI, 3.1-14.3). The structure was never seen in cases of superficial BCCs.

Conclusions and relevance: The findings suggest that MAY globules may have utility as a new BCC dermoscopic criterion with a high specificity. MAY globules were negatively associated with superficial BCC and positively associated with deeper-seated, histologic, higher-grade tumor subtypes.

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118
Aesthetic Plast Surg
. 2020 May 26. doi: 10.1007/s00266-020-01786-z. Online ahead of print.
An Overlooked Landmark for the Crooked Nose: Eyebrow Position
Goknil Gultekin 1, Alper Koycu 2, Fuat Buyuklu 2, Melike Bahcecitapar 3
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PMID: 32458043 DOI: 10.1007/s00266-020-01786-z
Abstract
Background: Rhinoplasty is one of the most unforgiving operations in facial plastic surgery. The correction of nasal deviation in an asymmetrical face can be challenging because known facial landmarks may mislead the surgeon. Eyebrows trimmed asymmetrically in an effort to create a more symmetrical facial appearance may be overlooked by surgeons.

Objective: To define the relationship between the eyebrow position and external nasal deviation in patients with a crooked nose.

Design, setting, and participants: Analysis was made of the preoperative and 6-month postoperative life-size photographs of female rhinoplasty patients who had been referred to the senior author's clinic between May 2014 and June 2019. The anthropometric landmarks on the life-size photographs were identifed. The most medial points of the eyebrows and most deviated part of the nose were marked and the distance from the mid-canthal point was measured.

Main outcomes and measure: The direction and amount of eyebrow shift were compared with the direction and amount of nasal deviation.

Results: Of the total 94 female rhinoplasty patients with at least one level external nasal deviation, 67 (71.2%) had ipsilateral eyebrow shift with external nasal deviation. The preoperative external nasal deviation amount was 1.81 ± 1.21 mm and preoperative eyebrow shift was 1.18 ± 1.06 mm (rS = 0.429, p < 0.001). The postoperative nasal deviation was 0.79 ± 0.92 mm, and the eyebrow shift was 0.54 ± 0.62 mm (rS = 0.570, p < 0.001).

Conclusion and relevance: Patients may tend to trim their eyebrows towards the side of the external nasal deviation. After centralization of the crooked nose with rhinoplasty, asymmetric eyebrow shaping tendencies of the patients were also seen to be improved.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords: Deviated nose; Eyebrows; Facial asymmetry.

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119
J Gastroenterol Hepatol
. 2020 May 26. doi: 10.1111/jgh.15118. Online ahead of print.
Associations Between lncRNA-related Polymorphisms and Hepatocellular Carcinoma Risk: A Two-Stage Case-Control Study
Yue Li 1, Hui-Chan He 2, Da-Lei Zhou 1, Qing Liu 1, Xiao Zhang 1, Xin-Hua Yang 1, Zu-Lu Ye 1, Jun-Ling Peng 1, Tao Tang 1, Xuan Su 3, Cai-Yun He 1
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PMID: 32453900 DOI: 10.1111/jgh.15118
Abstract
Background and aim: Single-nucleotide polymorphisms (SNPs) in long non-coding RNAs (lncRNAs) are potential biomarkers for cancer risk, but their association with hepatocellular carcinoma (HCC) is unclear. We examined the association of lncRNA-related SNPs with HCC susceptibility and explored the optimal genetic models for SNPs.

Methods: Five candidate SNPs linked with digestive tumors were first genotyped in a screening population of 700 HCC and 2800 control cases. The association between each SNP and HCC risk was estimated by multivariate logistic regression adjusted by sex and age and recorded as odds ratio (OR) with 95% confidence interval. Significant associations were further tested in a validation population with 1140 HCC and 5115 control cases. Finally, the most appropriate genetic models for HCC-associated SNPs were identified using pairwise allele differences; the overall gene effects of each SNP were further evaluated based on optimal genetic models.

Results: Three candidate SNPs, rs7315438, rs6983267, and rs10795668, showed statistical connections with HCC risk in the discovery stage. Among these, rs7315438 remained steadily significant in the validation stage; rs7315438 and rs10795668 both reached statistical threshold in the combined analysis of both stages. SNP rs7315438 (TC vs. TT/CC, OR = 1.410, P < 0.001) was associated with increased risk of HCC in a complete overdominant model, whereas rs10795668 (AG vs. AA/GG, OR = 0.892, P = 0.035) exerted a protective effect on HCC risk in a complete overdominant model.

Conclusions: LncRNA-related SNPs rs7315438 and rs10795668 are potential biomarkers for HCC susceptibility, especially when evaluated based on their optimal genetic models.

This article is protected by copyright. All rights reserved.

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120
Ann Otol Rhinol Laryngol
. 2020 Jun;129(6):618-624. doi: 10.1177/0003489420903332. Epub 2020 Jan 30.
Aging Effects on Esophageal Transit Time in the Upright Position During Videofluoroscopy
Kendrea L Focht Garand 1, Lindsey Culp 2, Bin Wang 2, Kate Davidson 3, Bonnie Martin-Harris 4
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PMID: 31997657 DOI: 10.1177/0003489420903332
Abstract
Objectives: The purpose of this study was to examine age-related effects on esophageal transit times (ETT) among healthy adult participants.

Methods: A total of 175 healthy, non-dysphagic participants underwent a modified barium swallow study (MBSS), and ETT was recorded for two standardized swallowing tasks. Differences across age groups were determined using Kruskal-Wallis test. Relationships between an Esophageal Clearance (Modified Barium Swallow Impairment Profile Component 17) score and ETT were also explored.

Results: No significant differences were observed in ETT across age groups for nectar-thickened liquid (P = .335) or pudding (P = .231) consistencies. No significant differences were observed between males and females in ETT for either the nectar (P = .112) or pudding trial (P = .817). For nectar, the mean ETT for patients with Component 17 scores of 2 or greater were significantly higher than that of participants with a score of 0 (P < .0001). For pudding, participants with a score >0 demonstrated significantly higher mean ETT compared to participants with a score of 0 (with P = .0008 and P < .0001, respectively).

Conclusion: Study findings failed to support age-related or sex-related differences in ETT for two standardized swallowing tasks administered during a MBSS in healthy individuals. The normative values following a standardized protocol in this study provide guidance in clinical interpretation of esophageal function.

Keywords: MBSImP; adults; esophageal transit time; healthy; presbyphagia.

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121
Otolaryngol Head Neck Surg
. 2020 May 26;194599820924635. doi: 10.1177/0194599820924635. Online ahead of print.
Initial Facial Feminization Surgery Experience in a Multicenter Integrated Health Care System
David W Chou 1, Nizar Tejani 1, Andrew Kleinberger 2, Charles Shih 1
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PMID: 32450751 DOI: 10.1177/0194599820924635
Abstract
Objective: There are few large studies on facial feminization surgery (FFS). We provide the largest comprehensive report to date of an FFS cohort regarding the safety of multilevel surgery, patient-specific considerations with FFS procedures, and complications of surgery.

Study design: Retrospective cohort study.

Setting: Multicenter integrated health care system.

Subjects and methods: We examined all patients undergoing FFS within our institution from April 2016 to October 2018. Patients over the age of 18 with a diagnosis of gender dysphoria underwent any combination of scalp advancement, cranioplasty, brow lift, rhinoplasty, upper lip lift, mandibuloplasty, chondrolaryngoplasty, and/or additional cosmetic procedures. Medical records were reviewed for preoperative characteristics, FFS procedures undergone, and postoperative complications.

Results: In total, 121 patients underwent a total of 594 FFS procedures. Seventy-five percent of patients had only 1 or no comorbidities, and 90% of patients underwent cranioplasty, scalp advancement, and brow lift. African American patients (n = 5) less commonly underwent cranioplasty compared to those of other ethnicities (white, P < .001; Asian, P = .022; Hispanic, P = .014; multiracial, P = .006). Asian patients less commonly underwent rhinoplasty than white patients (38% vs 73%, P = .023). Only 8 (6.6%) patients experienced a significant complication after surgery.

Conclusions: The population undergoing FFS is generally healthy, the upper third of the face is most commonly addressed, there are age and ethnic considerations in FFS, and major complications after multilevel surgery are uncommon.

Keywords: cranioplasty; facial feminization surgery; facial plastic surgery; genioplasty; integrated health care; mandibuloplasty; reconstruction; rhinoplasty; transgender.

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122
Int J Audiol
. 2019 Nov;58(11):769-773. doi: 10.1080/14992027.2019.1627009. Epub 2019 Jun 14.
Increased Incidence in Hospitalised Patients With Sudden Sensorineural Hearing Loss: A 14-year Nationwide Population-Based Study
Chao-Yin Kuo 1, Chi-Hsiang Chung 2 3, Chih-Hung Wang 1, Wu-Chien Chien 2 3, Hsin-Chien Chen 1
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PMID: 31195853 DOI: 10.1080/14992027.2019.1627009
Abstract
Objective: To conduct a 14-year nationwide study on the epidemiologic incidence in patients with sudden sensorineural hearing loss (SSNHL). Design: Retrospective cross-sectional design. Study sample: Data of patients hospitalised with the diagnosis of SSNHL from 2000 to 2013, extracted from the Taiwan National Health Insurance Research Database. Results: In total, 31,258 patients were included. The mean age was 50.30 ± 16.70 years. Males (53.5%) were more commonly diagnosed with SSNHL than females (46.5%). The patients most commonly presented with SSNHL were in the age group of 45-64 years. The crude incidence of SSNHL from 2000 to 2013 was 9.76 per 100,000 people per year. The annual incidence rate shows a steady increased from 5.15 in 2000 to 13.97 per 100,000 people in 2013 with a statistical significance (p < 0.001). Conclusion: This 14-year nationwide study indicated an increased incidence rate of SSNHL. This necessitates the development of additional treatment modalities to enhance the prognosis and the clarification of the underlying mechanism of this enigmatic disease.

Keywords: Epidemiology; incidence; medical insurance; sudden hearing loss.

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123
Mod Pathol
. 2020 May 26. doi: 10.1038/s41379-020-0576-2. Online ahead of print.
Molecular Patterns in Salivary Duct Carcinoma Identify Prognostic Subgroups
Simon A Mueller 1 2 3, Marie-Emilie A Gauthier 4 5 6, James Blackburn 7 8, John P Grady 5, Spiridoula Kraitsek 9, Elektra Hajdu 5, Matthias S Dettmer 10, Jane E Dahlstrom 11, C Soon Lee 12 13 14 15 16 17, Peter P Luk 4 16, Bing Yu 9 17, Roland Giger 18, Sarah Kummerfeld 5 8, Jonathan R Clark 4 17 19, Ruta Gupta 4 16 17, Mark J Cowley 5 6 8
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PMID: 32457410 DOI: 10.1038/s41379-020-0576-2
Abstract
Salivary duct carcinoma (SDCa) is a rare cancer with high rate of metastases and poor survival despite aggressive multimodality treatment. This study analyzes the genetic changes in SDCa, their impact on cancer pathways, and evaluates whether molecular patterns can identify subgroups with distinct clinical characteristics and outcome. Clinicopathologic details and tissue samples from 66 patients (48 males, 18 females) treated between 1995 and 2018 were obtained from multiple institutions. Androgen receptor (AR) was assessed by immunohistochemistry, and the Illumina TruSight 170 gene panel was used for DNA sequencing. Male gender, lympho-vascular invasion, lymph node metastasis, and smoking were significant predictors of disease-free survival. AR was present in 79%. Frequently encountered alterations were mutations in TP53 (51%), PIK3CA (32%) and HRAS (22%), as well as amplifications of CDK4/6 (22%), ERBB2 (21%), MYC (16%), and deletions of CDKN2A (13%). TP53 mutation and MYC amplifications were associated with decreased disease-free survival. Analysis of cancer pathways revealed that the PI3K pathway was most commonly affected. Alterations in the cell cycle pathway were associated with impaired disease-free survival (HR 2.6, P = 0.038). Three subgroups based on AR and ERBB2 status were identified, which featured distinct molecular patterns and outcome. Among AR positive SDCa, HRAS mutations were restricted to AR positive tumors without ERBB2 amplification and HRAS mutations featured high co-occurrence with PIK3CA alterations, which seems specific to SDCa. AR negative SDCa were associated with poor disease-free survival in multivariate analysis (HR 4.5, P = 0.010) and none of these tumors exhibited ERBB2 amplification or HRAS mutations. AR and ERBB2 status in SDCa thus classifies tumors with distinct molecular profiles relevant to future targeted therapy. Furthermore, clinical factors such as smoking and molecular features such as MYC amplification may serve as markers of poor prognosis of SDCa.

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124
Aging (Albany NY)
. 2020 May 26;12. doi: 10.18632/aging.103227. Online ahead of print.
MiR-1908/EXO1 and MiR-203a/FOS, Regulated by scd1, Are Associated With Fracture Risk and Bone Health in Postmenopausal Diabetic Women
Yi-Sheng Chen 1, Xue-Ran Kang 2, Zi-Hui Zhou 1, Jiang Yang 3, Qi Xin 1, Chen-Ting Ying 1, Yun-Peng Zhang 1, Jie Tao 1
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PMID: 32454462 DOI: 10.18632/aging.103227
Free article
Abstract
Background: Stearoyl-coenzyme A desaturase-1 (SCD1) can inhibit the development of diabetic bone disease by promoting osteogenesis. In this study, we examined whether this regulation by SCD1 is achieved by regulating the expression of related miRNAs.

Methods: SCD1 expression levels were observed in human bone-marrow mesenchymal stem cells (BM-MSCs) of patients with type 2 diabetes mellitus (T2DM), and the effect of SCD1 on osteogenesis was observed in human adipose-derived MSCs transfected with the SCD1 lentiviral system. We designed a bioinformatics prediction model to select important differentially expressed miRNAs, and established protein-protein interaction and miRNA-mRNA networks. miRNAs and mRNAs were extracted and their differential expression was detected. The SCD1-miRNA-mRNA network was validated.

Findings: SCD1 expression in bone marrow was downregulated in patients with T2DM and low-energy fracture, and SCD1 expression promotes BM-MSC osteogenic differentiation. The predictors in the nomogram were seven microRNAs, including hsa-miR-1908 and hsa-miR-203a. SCD1 inhibited the expression of CDKN1A and FOS, but promoted the expression of EXO1 and PLS1. miR-1908 was a regulator of EXO1 expression, and miR-203a was a regulator of FOS expression.

Interpretation: The regulation of BM-MSCs by SCD1 is a necessary condition for osteogenesis through the miR-203a/FOS and miR-1908/EXO1 regulatory pathways.

Keywords: bone mesenchymal stem cell (BMSC); diabetes; fracture risk; nomogram; stearoyl-coenzyme A desaturase (SCD1).

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125
Am J Otolaryngol
. 2020 May 4;102518. doi: 10.1016/j.amjoto.2020.102518. Online ahead of print.
MRI Surveillance Following Concurrent Cochlear Implantation in Cases of Vestibular Schwannoma Resection
Nofrat Schwartz 1, Meredith A Rooth 2, Margaret T Dillon 2, Brandan P O'Connell 2, Matthew M Dedmon 2, Benjamin Y Huang 3, Kevin D Brown 2
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PMID: 32451290 DOI: 10.1016/j.amjoto.2020.102518
Abstract
Objective: Cochlear nerve preserving translabyrinthine vestibular schwannoma (VS) resection enables concurrent cochlear implantation. Implantation in patients with VS raises important concerns including the ability to undergo postoperative magnetic resonance imaging (MRI) monitoring of residual tumor growth or tumor recurrence, specifically with a retained magnet. We aim to assess the feasibility of MRI monitoring and the impact on image quality with retained cochlear implant (CI) magnets.

Methods: Retrospective review of post-operative head MRI scans in CI recipients with a retained CI magnet, after cochlear nerve preserving translabyrinthine excision of VS. The ability to visualize the ipsilateral and contralateral internal auditory canal (IAC) and cerebellopontine angle (CPA) were assessed.

Results: A total of eight surveillance head MRI were performed in six patients. In one case, in which the receiver was positioned lower, the view of the ipsilateral IAC and CPA was distorted. In all other cases, the views of both the ipsilateral and contralateral IAC and CPA were overall unimpaired.

Discussion: Imaging artifact only very rarely impedes adequate visualization of the ipsilateral IAC or CPA in CI recipients. In anticipation of the need for further IAC and CPA imaging, it would be advisable to place the receiver in an exaggerated superior-posterior position to further decrease obscuring artifact. Thus, serial monitoring of VS tumors can be performed safely with preservation of image quality with a retained receiver magnet.

Conclusions: When placing the CI receiver-stimulator farther posterior-superiorly, excellent visualization of the IAC and CPA can be accomplished without significantly impairing the image quality.

Keywords: Cochlear implant; Cochlear nerve preserving translabyrinthine; MRI; Retained magnet; Vestibular schwannoma.

Published by Elsevier Inc.

Conflict of interest statement
Declaration of competing interest Dr. Kevin D. Brown is on the Surgical Advisory. Board of MED-EL. Meredith A. Rooth and Margaret T. Dillon receive a research grant support from MED-EL. For the remaining author, none were declared.

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126
Oral Oncol
. 2020 May 23;108:104766. doi: 10.1016/j.oraloncology.2020.104766. Online ahead of print.
Rare Thyroid Malignancies in Europe: Data From the Information Network on Rare Cancers in Europe (RARECAREnet)
Laura Locati 1, Stefano Cavalieri 2, Luigino Dal Maso 3, Susanna Busco 4, Lesley Ann Anderson 5, Laura Botta 6, Maria José Bento 7, Marià Carulla 8, Maria Dolores Chirlaque López 9, Mario Fusco 10, Marcela Guevara 11, Kaire Innos 12, Tom Børge Johannesen 13, Rita Micallef 14, Pamela Minicozzi 15, Chiara Panato 16, Dafina Petrova 17, Jordi Rubio-Casadevall 18, Giedre Smailyte 19, Maria Francesca Vitale 20, Annalisa Trama 21, RARECAREnet Working Group
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PMID: 32454415 DOI: 10.1016/j.oraloncology.2020.104766
Abstract
Objective: Limited information is available on the incidence of rare thyroid cancer (TC) subtypes: anaplastic (ATC) and medullary (MTC). The aim of this study was to describe incidence variations and trends across European countries of all TC subtypes.

Materials and methods: We used the RARECAREnet database including 80721 TC incident cases in the period 2000-2007 from 77 population-based cancer registries (CRs) in Europe. In the trend analyses, we included 68890 TC cases from 53 CRs with at least 6 years of incidence data in the years 2000-2007.

Results: In Europe age-standardised incidence rates (ASR) in women were <0.3/100,000 for MTC and ATC whereas ASR were 5.3/100,000 for papillary thyroid cancer (PTC) and 1.1/100,000 for follicular TC (FTC). Corresponding ASRs in men were <0.2/100,000 for MTC and ATC, 1.5 for PTC and 0.4 for FTC. Across countries and in both sexes the incidence of FTC and MTC was moderately correlated (r ~ 0.5) with that of PTC, while a less marked correlation (r < 0.4) emerged for ATC ASRs. The changes of the PTC ASRs across countries and time were weakly (r < 0.3) or moderately (r ~ 0.5) correlated to the changes of the other subtypes for both sexes.

Conclusion: The huge increase and heterogeneity between countries of PTC incidence has a small influence on the trends and variations of MTC and ATC in Europe. Large-scale epidemiological and clinical registry-based studies are warranted to increase knowledge about the rarest TC subtypes. This information would be fundamental for the design of new clinical trials and for inference.

Keywords: Anaplastic thyroid cancer; Cancer registries; Epidemiology; Incidence; Medullary thyroid cancer; Thyroid cancer.

Copyright © 2020 Elsevier Ltd. All rights reserved.

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127
Evid Based Complement Alternat Med
. 2020 May 11;2020:4689296. doi: 10.1155/2020/4689296. eCollection 2020.
Acupuncture for Poststroke Dysphagia: A Pilot, Nonrandomized, Self-Controlled Trial
Yu Tat Chan 1 2, Hong Wei Zhang 1, Wai Zhu Sun 1, Kevin Ka Hang Or 1, Yuan-Qi Guo 3, Min Chen 3, Guan-Yi Wu 4, Guang-Yao Xu 5, Connie Leung 5, Sylvia Tam 5, Francis Chun-Keung Mok 6, Yiu Keung Kwan 6, Eddie Chow 6, Joshua Kam Wo Mak 6, Angus Chun-Kwok Chu 6, Kathy Lee 7, Thomas Law 7, Rita Wai Ming Wong 7, Zhi-Xiu Lin 1
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PMID: 32454860 PMCID: PMC7240803 DOI: 10.1155/2020/4689296
Free PMC article
Abstract
Objective: To evaluate the effectiveness and safety of acupuncture treatment for dysphagia as a complication of stroke. Methods and Design. This is a multicenter, pragmatic, nonrandomized, self-controlled clinical trial. A total of 39 patients were recruited from several Chinese medicine outpatient clinics and hospital-affiliated speech therapy outpatient clinics in Hong Kong. 26 patients completed all the 24 sessions of acupuncture treatment within two months, and only 12 of them were used as self-control. For the self-control group, the retrospective clinical data was taken from the electronic patient records with patient consent. The descriptive swallowing function data were converted into the quantitative Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS) scores by two registered speech therapists through a validation process. And the data were validated by reaching consensus between the two speech therapists. All subjects underwent a baseline assessment before commencement of treatment, and outcome assessments were conducted upon the completion of treatment. The primary outcome measure is the RBHOMS score, which is a swallowing disability rating scale for monitoring difficulties in daily swallowing function. Secondary outcome measures include the Chinese version of the Swallow Quality-of-Life Questionnaire and adverse events. All the primary and secondary outcomes were assessed at baseline as well as at the end of acupuncture treatment (month 2).

Results: A total of 39 participants aged 46 to 89 years were enrolled in the study, and the male-to-female ratio was 15 : 11. The mean baseline RBHOMS score of all 39 participants was 5.92 ± 2.23. The mean retrospective RBHOMS score of the 12 subjects who were used as self-control was 5.67 ± 1.72 before enrollment, while the mean RBHOMS score of the 26 participants who completed all the 24 sessions of treatment was 6.92 ± 2.07. There were statistically significant differences between the RBHOMS score at the completion of treatment and baseline (p=0.006), and retrospective data (p=0.042). Moreover, a significant difference was also found in terms of swallow quality-of-life score before and after acupuncture treatment (p < 0.01).

Conclusions: This pilot study provides preliminary evidence for the effectiveness of acupuncture for poststroke dysphagia. The findings from this trial can be used as a foundation for future full-scale randomized controlled clinical trials to assess the efficacy and safety of acupuncture for poststroke dysphagia. Ethics and Dissemination. The ethical approval of the clinical research study was granted by the Research Ethics Committee of both New Territories East and West Cluster of Hong Kong. Written informed consent was obtained from all participants, and the study was undertaken according to the ICH-GCP Guidelines. Trial Registration. This trial is registered with ChiCTR-TRC-12002621 and the registration date is 2012-10-26.

Copyright © 2020 Yu Tat Chan et al.

Conflict of interest statement
The authors declare that they have no conflicts of interest.

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128
Otolaryngol Head Neck Surg
. 2020 May 26;194599820923659. doi: 10.1177/0194599820923659. Online ahead of print.
In Situ Simulation to Assess Pediatric Tracheostomy Care Safety: A Novel Multicenter Quality Improvement Program
Sharan J Shah 1, Cristen Cusumano 1, Sadia Ahmed 1, Anthony Ma 1, Farrukh N Jafri 2, Christina J Yang 1 3
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PMID: 32450759 DOI: 10.1177/0194599820923659
Abstract
Objectives: Our objectives were (1) to use in situ simulation to assess the clinical environment and identify latent safety threats (LSTs) related to the management of pediatric tracheostomy patients and (2) to analyze the effects of systems interventions and team factors on LSTs and simulation performance.

Methods: A multicenter, prospective study to assess LSTs related to pediatric tracheostomy care management was conducted in emergency departments (EDs) and intensive care units (ICUs). LSTs were identified through equipment checklists and in situ simulations via structured debriefs and blinded ratings of team performance. The research team and unit champions developed action plans with interventions to address each LST. Reassessment by equipment checklists and in situ simulations was repeated after 6 to 9 months.

Results: Forty-one LSTs were identified over 21 simulations, 24 in the preintervention group and 17 in the postintervention group. These included LSTs in access to equipment (ie, availability of suction catheters, lack of awareness of the location of tracheostomy tubes) and clinical knowledge gaps. Mean equipment checklist scores improved from 76% to 87%. Twenty-one unique teams (65 participants) participated in the simulations. The average simulation score was 6.19 out of 16 points.

Discussion: In situ simulation is feasible and effective as an assessment tool to identify latent safety threats and thus measure the system-level performance of a clinical care environment.

Implications for practice: In situ simulation can be used to identify and reassess latent safety threats related to pediatric tracheostomy management and thereby support quality improvement and educational initiatives.

Keywords: PS/QI; latent safety threats; patient simulation; quality improvement; tracheostomy.

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129
J Clin Endocrinol Metab
. 2020 May 27;dgaa309. doi: 10.1210/clinem/dgaa309. Online ahead of print.
EV PD-L1 Is Correlated With Clinical Features and Contributes to T Cell Suppression in Pediatric Thyroid Cancer
Guoliang Wang 1, Shengcai Wang 1 2, Meng Zhang 1 3, Yanzhen Li 1 2, Qiaoyin Liu 1 2, Nian Sun 1 2, Xuexi Zhang 1 2, Yuwei Liu 1 2, Jie Zhang 1 2, Lejian He 1 3, Jun Tai 1 2, Xin Ni 1 2
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PMID: 32459310 DOI: 10.1210/clinem/dgaa309
Abstract
Context: The contribution of blood extracellular vesicular (EV) programmed death-ligand 1 (PD-L1) and programmed death-1 (PD-1) in papillary thyroid cancer (PTC) is uncertain.

Objective: We sought to determine the relationship of EV PD-L1/PD-1 with the clinical features of pediatric PTC and the role of EV PD-L1 in immunosuppression.

Main outcome measures: Plasma levels of EV and soluble PD-L1 and PD-1 and levels of plasma cytokines in PTC children and controls were determined by ELISA. Levels of tumor PD-L1 and the tumor-infiltrating lymphocyte (TIL) score were determined by immunohistochemistry. Correlations of the plasma PD-L1/PD-1 level with clinicopathological characteristics, levels of plasma cytokines, tumor PD-L1 expression and TIL score were analyzed. T cell suppression by EVs from PTC patients was determined by incubation of PD-L1high or PD-L1low EVs with activated CD8+ T cells. Changes in CD69 and PD-1 expression and changes in TNFa and IFNγ secretion were measured by flow cytometry.

Results: The levels of plasma PD-L1/PD-1 were significantly higher in PTC children than in controls. The levels of plasma EV PD-L1 significantly correlated with tumor T stage, tumor PD-L1 expression, TIL score, and plasma cytokine content. Levels of plasma soluble PD-1 significantly correlated with patient age, plasma EV PD-L1 and IFNα concentration. PD-L1high EVs significantly inhibited the activation of CD8+ T cells.

Conclusions: Plasma levels of EV PD-L1, but not soluble PD-L1, were associated with tumor T stage in PTC children. Plasma EV PD-L1 emerges as a useful metric for assessing tumor T stage and T cell suppression in PTC.

Keywords: Extracellular vesicle; PD-1; PD-L1; papillary thyroid cancer; pediatric thyroid cancer; tumor-infiltrating lymphocyte (TIL).

© Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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130
Ann Otol Rhinol Laryngol
. 2020 Jun;129(6):542-547. doi: 10.1177/0003489419898717. Epub 2020 Jan 8.
Correlation of Nasal Fluid Biomarkers and Symptoms in Patients With Persistent Allergic Rhinitis
Su Il Kim 1, Oh Eun Kwon 1, Jung Min Park 1, Jeon Gang Doo 1, Seok Hyun Kim 1, Hae Rim Jung 1, Jin Young Min 1, Sung Wan Kim 1, Young Chan Lee 1, Young-Gyu Eun 1
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PMID: 31910639 DOI: 10.1177/0003489419898717
Abstract
Objectives: This study investigated whether the biomarkers present in nasal fluid reflect the severity of symptoms in patients with persistent allergic rhinitis (PAR).

Methods: We enrolled 29 PAR patients complaining of nasal symptoms and testing positive to skin prick test. Patients' total nasal symptom score (TNSS) was measured and their nasal lavage fluid (NALF) was collected. The levels of biomarkers including Clara cell protein 16 (CC16), tryptase, and interleukin 5 (IL-5) in NALF were determined via enzyme-linked immunosorbent assay (ELISA).

Results: PAR patients were classified into persistent mild and persistent moderate-to-severe groups according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The CC16 alone was significantly negatively correlated with TNSS (P < .05). Further, the CC16 level was significantly lower in persistent moderate-to-severe group than persistent mild group of patients (P < .05).

Conclusions: The levels of CC16 alone among several NALF biomarkers showed an inverse correlation with symptoms of PAR patients.

Keywords: Clara cell protein 16; biomarker; nasal lavage fluid; persistent allergic rhinitis; total nasal symptom score.

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131
Int J Mol Sci
. 2020 May 21;21(10):E3627. doi: 10.3390/ijms21103627.
Smoking-Mediated Upregulation of the Androgen Pathway Leads to Increased SARS-CoV-2 Susceptibility
Jaideep Chakladar 1 2, Neil Shende 1 2, Wei Tse Li 1 2, Mahadevan Rajasekaran 3 4, Eric Y Chang 5 6, Weg M Ongkeko 1 2
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PMID: 32455539 DOI: 10.3390/ijms21103627
Free article
Abstract
The COVID-19 pandemic is marked by a wide range of clinical disease courses, ranging from asymptomatic to deadly. There have been many studies seeking to explore the correlations between COVID-19 clinical outcomes and various clinical variables, including age, sex, race, underlying medical problems, and social habits. In particular, the relationship between smoking and COVID-19 outcome is controversial, with multiple conflicting reports in the current literature. In this study, we aim to analyze how smoking may affect the SARS-CoV-2 infection rate. We analyzed sequencing data from lung and oral epithelial samples obtained from The Cancer Genome Atlas (TCGA). We found that the receptor and transmembrane protease necessary for SARS-CoV-2 entry into host cells, ACE2 and TMPRSS2, respectively, were upregulated in smoking samples from both lung and oral epithelial tissue. We then explored the mechanistic hypothesis that smoking may upregulate ACE2 expression through the upregulation of the androgen pathway. ACE2 and TMPRSS2 upregulation were both correlated to androgen pathway enrichment and the specific upregulation of central pathway regulatory genes. These data provide a potential model for the increased susceptibility of smoking patients to COVID-19 and encourage further exploration into the androgen and tobacco upregulation of ACE2 to understand the potential clinical ramifications.

Keywords: ACE2; COVID-19; SARS-CoV-2; TMPRSS2; androgen; smoking.

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132
Facial Plast Surg Aesthet Med
. 2020 May 22. doi: 10.1089/fpsam.2020.0080. Online ahead of print.
Quantifying Eye Alignment in Orbital Fracture Patients: The Digital Hess Screen
Sarah R Akkina 1, Aliya Shabbir 2, Annamarie Lahti 2, Raghu C Mudumbai 3, Christopher B Chambers 3, Kris S Moe 1, James O Phillips 1
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PMID: 32456473 DOI: 10.1089/fpsam.2020.0080
Abstract
Background: Quantifying diplopia to determine management and track outcomes for orbital fracture patients is vital for standardization between visits, physicians, and coordination among the multiple specialties that manage these patients. However, standardization is challenging, as diplopia is often reported subjectively. This study sought to describe the utility of the digital Hess screen in patients with orbital fractures compared with a control group. Materials and Methods: A prospective pilot study was designed in which adult patients who presented with orbital fractures between November 2017 and January 2019 without prior history of orbital pathology were recruited. Subjects underwent digital Hess screen testing, in which they wore anaglyph glasses and aligned targets on a computer screen to quantify static eye alignment. The degree of any eye misalignment was analyzed and compared with controls. Results: Ninety-one patients and 35 controls were enrolled. All participants were able to complete the digital Hess screen. Average cumulative deviation score of orbital fracture patients within 1 month of injury was 0.65°, compared with 0.28° in controls. This was a statistically significant difference (p < 0.01, 95% confidence interval -0.18 to 0.18). Conclusion: The Hess screen has been used to quantify phoria as a correlate of eye alignment and diplopia, but older versions were cumbersome and difficult to analyze. This study is the first to report on using the digital Hess screen to quantify phoria in orbital fracture patients and provides a more concise and standardized means to track clinical and surgical outcomes of eye alignment.

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133
Otolaryngol Head Neck Surg
. 2020 May 26;194599820930244. doi: 10.1177/0194599820930244. Online ahead of print.
Evolving Management of COVID-19: A Multi-institutional Otolaryngology Perspective
Johanna L Wickemeyer 1, Kathleen R Billings 2 3, Taher S Valika 2 3
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PMID: 32450770 DOI: 10.1177/0194599820930244
Abstract
Objective: To provide evolving information on active protocols regarding inpatient, outpatient, procedural, and surgical case management taking place in otolaryngology practices in response to COVID-19.

Study type: Cross-sectional multi-institutional survey.

Methods: An online survey of 55 otolaryngology departments across North America.

Results: As of March 25, 2020, almost all (n = 53 of 55, 96.3%) otolaryngology departments had canceled elective cases and were performing only urgent consults. Most residents continued to participate in operative cases (n = 45 of 49, 91.8%) and take call (n = 48 of 50, 96.0%). Of the respondents, 27 of 29 (93.1%) stated that they were deferring nonemergent tracheostomy procedures for the time being. The use of personal protective equipment followed a general trend of an increasing level of protection with an increased risk of the procedure; most (n = 49 of 54, 90.7%) incorporated N95 mask usage for bedside/clinic examinations with flexible laryngoscopy. Powered air-purifying respirators and N95 masks were used mainly for procedures involving the mucosal surfaces.

Discussion: Due to the high viral density in the nasal cavity and nasopharynx of patients with COVID-19, basic examinations and common otolaryngology procedures place practitioners at high risk of exposure. Although there is variability in practice among otolaryngologists across North America in managing the COVID-19 outbreak, most are primarily seeing urgent ambulatory and inpatient consultations. Most are also incorporating personal protective equipment appropriate to the level of transmission across mucous membranes.

Implications for practice: In these rapidly evolving times, it is helpful to find solidarity and assurance among health care providers. Current data aimed to provide (1) perceived methods regarding the safe care of otolaryngology patients and (2) updated practice patterns at a national level.

Keywords: COVID-19; otolaryngology; quality improvement.

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134
Ann Otol Rhinol Laryngol
. 2020 May 26;3489420929717. doi: 10.1177/0003489420929717. Online ahead of print.
Intramuscular Corticosteroids for Acute Upper Respiratory Infections Affects Healthcare Utilization
Sean M Parsel 1, Alaa E Mohammed 2, Daniel Fort 2, Blair M Barton 3, Edward D McCoul 1 4 5
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PMID: 32456500 DOI: 10.1177/0003489420929717
Abstract
Objective: To examine the use of intramuscular corticosteroid (IMCS) injections for treatment of acute upper respiratory infections (URI) and the influence on healthcare utilization.

Methods: This retrospective cohort study used patient encounter data from a large multicenter regional health care system between 2013 and 2017. Adult patients diagnosed with acute URI (acute pharyngitis, acute sinusitis, acute otitis media, and URI not otherwise specified) during ambulatory encounters were included. Follow-up encounters for a diagnosis of acute URI within 60 days were identified and patient characteristics, encounter details, and procedure codes were retrieved. Frequency data was used to calculate IMCS injection administration prevalence, utilization trends, and associations with covariates. Follow-up data for return encounters within 60 days for the same diagnosis was examined.

Results: Of the 153 848 initial encounters, 34 600 (22.5%) patients received IMCS injection for acute URI. Injection rates varied from 0.85% to 49.1% depending on specialty and practitioner type. Internal medicine, family medicine, urgent care, and otorhinolaryngology clinics most commonly administered IMCS. 3788 patients returned for a second encounter of which 751 (19.8%) received an injection. IMCS injection during the first encounter was associated with increased odds of repeat visit within 60 days (OR: 1.74; 95% CI: 1.61-1.88).

Conclusion: IMCS use in the treatment of acute URI is highly prevalent despite lack of evidence for impact and safety. Prevalence is variable across multiple medical and surgical specialties including otorhinolaryngology. Administration of IMCS injection may contribute to the likelihood of a subsequent healthcare visit for the same indication.

Keywords: corticosteroid; healthcare utilization; practice patterns; respiratory tract infections; treatment outcomes.

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135
Otolaryngol Head Neck Surg
. 2020 May 26;194599820917427. doi: 10.1177/0194599820917427. Online ahead of print.
The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration
Rebecca L Cherney 1 2, Vinciya Pandian 3, Ashly Ninan 1 3, Debra Eastman 1, Brian Barnes 1, Elizabeth King 1, Brianne Miller 1, Samantha Judkins 1, Alfred E Smith 4th 4, Nan M Smith 4, Julie Hanley 1, Eileen Creutz 1, Megan Carlson 1, Kevin J Schneider 5, Leah L Shever 1 2, Keith A Casper 5, Patricia M Davidson 3, Michael J Brenner 4 5
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PMID: 32450771 DOI: 10.1177/0194599820917427
Abstract
Objective: To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes.

Methods: The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117).

Results: Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P < .05). The incidence of adverse events was unchanged.

Discussion: Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement.

Implications for practice: Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

Keywords: LOS; PS/QI; adverse events; airway; intensive care unit; interdisciplinary collaboration; length of stay; multidisciplinary team; nursing; patient safety; patient-centered care; quality improvement; respiratory therapy; simulation; speech-language pathology; tracheostomy.

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136
Ear Nose Throat J
. 2020 May 26;145561320927912. doi: 10.1177/0145561320927912. Online ahead of print.
Prediction of Malignancy in Salivary Gland Tumors by a New Cytology Reporting System
Doh Young Lee 1, Seulki Song 1, Seung Koo Yang 1, Min Hyung Lee 1, Ji Eun Kim 2, Young Ho Jung 3, Tack-Kyun Kwon 1
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PMID: 32453644 DOI: 10.1177/0145561320927912
Abstract
Objectives: The aim of this study was to analyze the risk of malignancy in salivary gland tumors on the basis of the Milan System for Reporting Salivary Gland Cytopathology.

Methods: A retrospective review was performed of the charts of patients with salivary gland tumors in whom the final diagnosis was confirmed by surgical excision. Preoperative fine needle aspiration results were categorized according to the Milan System for Reporting Salivary Gland Cytopathology: non-diagnostic (category I), nonneoplastic (category II), atypia of undetermined significance (category III), neoplasm (category IV), suspicious for malignancy (category V), and malignant (category VI). Fine needle aspiration and final diagnosis were compared, and the risk of malignancy and operative/oncological outcomes were analyzed.

Results: A total of 288 patients were enrolled in this study. Postoperative histopathologic salivary gland malignancies were found in 30 (10.4%) patients. Risk of malignancy was 7.1%, 0%, 48.0%, 4.8%, 88.7%, and 100% in categories I, II, III, IV, V, and VI, respectively. The most common malignant tumor in category III was salivary duct carcinoma (37.5%), followed by acinic cell carcinoma (25.0%), mucoepidermoid carcinoma (25.0%), and squamous cell carcinoma (12.5%). The 5-year survival rate of patients with malignant tumors showed no statistical difference between category III and category V/VI (P = .140). Risk of malignancy was 88.9% and 100% in category V and VI, respectively.

Conclusions: A half of atypia of undetermined significance (category III) cases were malignant. Once diagnosed, the prognosis of malignant tumor in category III was similar with that in category V/VI.

Keywords: atypia; fine needle aspiration; risk of malignancy; salivary gland.

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137
Am J Otolaryngol
. 2020 May 11;102539. doi: 10.1016/j.amjoto.2020.102539. Online ahead of print.
Opioid Prescribing Patterns and Usage After Rhinologic Surgery: A Systematic Review
Zhong Zheng 1, Charles A Riley 2, Matthew Kim 1, Anthony Sclafani 1, Abtin Tabaee 3
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PMID: 32451289 DOI: 10.1016/j.amjoto.2020.102539
Abstract
Objective: Judicious management of analgesics following rhinologic surgery is important for curtailing over-prescription of opioids. Limited data exists defining expected pain levels and appropriate opioid requirements after rhinologic surgery.

Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, Ovid MEDLINE, Cochrane Library databases were queried, and relevant articles were identified.

Results: A total of 405 articles were identified, of which 13 met final inclusion criteria. Significant heterogeneity existed regarding type and quantity of opioid medication prescribed. Eight studies utilized a subjective patient-reported pain score as an outcome measure and reported mild to moderate postoperative pain that diminished over the first 3-6 days. Eight studies reported over-prescription of opioid medications with inappropriate storage of excess pills at home. Several factors were associated with an increased opioid requirement, including concurrent septoplasty, younger age, and current smoking status.

Conclusion: Rhinologic surgery is well tolerated with mild to moderate, short-lived postoperative pain. A limited amount and duration of opioid medications is required for routine management. Patients are frequently prescribed more opioids than is necessary for expected pain level, resulting in the potential for opioid misuse, abuse, and diversion. Current evidence is limited by a predominance of level 4 studies. Larger, higher quality studies with standardized reporting of pain score and opioid prescription quantity are needed.

Keywords: Endoscopic sinus surgery; Evidence based medicine; Opioid; Postoperative pain; Rhinologic surgery.

Copyright © 2020 Elsevier Inc. All rights reserved.

Conflict of interest statement
Declaration of competing interest None. There are no commercial or financial grant/assistance/disclosures declarations associated with this publication. The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US government. Accepted for podium presentation at the American Rhinologic Society Annual Meeting in September 2019 in New Orleans, LA.

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138
Ann Surg Oncol
. 2020 May 26. doi: 10.1245/s10434-020-08408-7. Online ahead of print.
Regional Lymph Node Metastasis of Scalp Angiosarcoma: A Detailed Clinical Observation Study of 40 Cases
Yungjee Kang 1, Juyoung Bae 2, Sangjoon Choi 3, Kee-Taek Jang 3, Jeongil Yu 4, Jung Yong Hong 5, So Young Lim 6, Han-Sin Jeong 7
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PMID: 32458324 DOI: 10.1245/s10434-020-08408-7
Abstract
Background: The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas.

Methods: This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner.

Results: The overall survival rate for the patients was 35.8% at 2 years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6 months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes.

Conclusions: For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.

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139
Innate Immun
. 2020 May 26;1753425920918911. doi: 10.1177/1753425920918911. Online ahead of print.
IL-33/ST2 Axis Promotes the Inflammatory Response of Nasal Mucosal Epithelial Cells Through Inducing the ERK1/2 Pathway
Yun-Qiu Li 1, Yu Zhong 1, Xu-Ping Xiao 1, Dan-Dan Li 1, Zheng Zhou 1, Yan-Yan Tian 2
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PMID: 32456598 DOI: 10.1177/1753425920918911
Abstract
Allergic rhinitis (AR) is a nasal mucosal inflammatory disease mediated by environmental allergens. At present, the relationship between the IL-33/ST2 axis, ERK1/2 pathway and AR progression needs further exploration. In our study, an AR model was constructed in vitro by treating HNEpC cells with Der p1. qRT-PCR was applied to assess the mRNA levels of IL-33, ST2, TNF-α, IL-6, and IL-8. Western blotting was used to measure the protein levels of IL-33, ST2, and the downstream proteins p-ERK1/2, ERK1/2, p-RSK, and RSK. IL-6, IL-8, IL-33, and TNF-α protein levels in cell supernatants were evaluated by ELISA. Flow cytometry was performed to check cell apoptosis of HNEpC in the presence or absence of Der p1. Our results indicate that the relative levels of IL-33, ST2, TNF-α, IL-6, and IL-8 were increased significantly in the AR model group. The above effects were notably reversed after transfection with shIL-33 or shST2. IL-33 stimulation further resulted in the increase in both ST2 and inflammation-associated cytokines, and these effects were restored after shST2 treatment. Also, the levels of inflammatory factors induced by IL-33 stimulation or ST2 overexpression were reversed after applying an ERK1/2 pathway blocker. In conclusion, IL-33/ST2 mediated inflammation of nasal mucosal epithelial cells by inducing the ERK1/2 pathway.

Keywords: Allergic rhinitis; ERK1/2 pathway; IL-33; ST2; inflammation.

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140
J Funct Biomater
. 2020 May 22;11(2):E34. doi: 10.3390/jfb11020034.
Coating Medpor ® Implant With Tissue-Engineered Elastic Cartilage
Dong Joon Lee 1, Jane Kwon 1, Yong-Il Kim 1 2, Yong Hoon Kwon 1 3, Samuel Min 1, Hae Won Shin 4
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PMID: 32455861 DOI: 10.3390/jfb11020034
Free article
Abstract
Inert biomaterials used for auricular reconstruction, which is one of the most challenging and diverse tasks in craniofacial or head and neck surgery, often cause problems such as capsule formation, infection, and skin extrusion. To solve these problems, scaffold consisting of inert biomaterial, high-density polyethylene (Medpor®) encapsulated with neocartilage, biodegradable poly(DL-lactic-co-glycolic acid) (PLGA) was created using a tissue engineering strategy. PLGA scaffold without Medpor® was created to serve as the control. Scaffolds were vacuum-seeded with rabbit chondrocytes, freshly isolated from the ear by enzymatic digestion. Then, cell-seeded scaffolds were implanted subcutaneously in the dorsal pockets of nude mice. After 12 weeks, explants were analyzed by histological, biochemical, and mechanical evaluations. Although the PLGA group resulted in neocartilage formation, the PLGA-Medpor® group demonstrated improved outcome with the formation of well-surrounded cartilage around the implants with higher mechanical strength than the PLGA group, indicating that Medpor® has an influence on the structural strength of engineered cartilage. The presence of collagen and elastin fibers was evident in the histological section in both groups. These results demonstrated a novel method of coating implant material with engineered cartilage to overcome the limitations of using biodegradable scaffold in cartilage tissue regeneration. By utilizing the patient's own chondrocytes, our proposed method may broaden the choice of implant materials while minimizing side effects and immune reaction for the future medical application.

Keywords: chondrocytes; high-density porous polyethylene (Medpor®); neocartilage; poly(DL-lactic-co-glycolic acid); scaffolds.

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141
Otolaryngol Head Neck Surg
. 2020 May 26;194599820917394. doi: 10.1177/0194599820917394. Online ahead of print.
Surgical Team Exposure to Cautery Smoke and Its Mitigation During Tonsillectomy
Daniel C O'Brien 1, Eun Gyung Lee 2, Jhy-Charm Soo 2, Sherri Friend 3, Sarah Callaham 4, Michele M Carr 1
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PMID: 32450780 DOI: 10.1177/0194599820917394
Abstract
Objectives: To assess the exposure of surgical personnel to known carcinogens during pediatric tonsillectomy and adenoidectomy (T&A) and compare the efficacy of surgical smoke evacuation systems during T&A.

Study design: Prospective, case series.

Setting: Tertiary children's hospital.

Subjects and methods: The present study assessed operating room workers' exposure to chemical compounds and aerosolized particulates generated during T&A. We also investigated the effect of 3 different smoke-controlling methods: smoke-evacuator pencil cautery (SE), cautery with suction held by an assistant (SA), and cautery without suction (NS).

Results: Thirty cases were included: 12 in the SE group, 9 in SA, and 9 in NS. The chemical exposure levels were lower than or similar to baseline background concentrations, with the exception of methylene chloride and acetaldehyde. Within the surgical plume, none of the chemical compounds exceeded the corresponding occupational exposure limit (OEL). The mean particulate number concentration in the breathing zone during tonsillectomy was 508 particles/cm3 for SE compared to 1661 particles/cm3 for SA and 8208 particles/cm3 for NS cases. NS was significantly different compared to the other two methods (P = .0009).

Conclusions: Although the exposure levels to chemicals were considerably lower than the OELs, continuous exposures to these chemicals could cause adverse health effects to surgical personnel. These findings suggest that the use of a smoke-evacuator pencil cautery or an attentive assistant with handheld suction would reduce exposure levels to the aerosolized particles during routine T&A, compared to the use of cautery without suction.

Keywords: electrocautery; occupational safety; operating room; smoke evacuation; surgical plume; surgical smoke; tonsillectomy.

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142
Otolaryngol Head Neck Surg
. 2020 May 26;194599820924331. doi: 10.1177/0194599820924331. Online ahead of print.
Visual Speech Recognition: Improving Speech Perception in Noise Through Artificial Intelligence
Arun M Raghavan 1, Noga Lipschitz 2, Joseph T Breen 2, Ravi N Samy 2, Gavriel D Kohlberg 2 3
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PMID: 32453650 DOI: 10.1177/0194599820924331
Abstract
Objectives: To compare speech perception (SP) in noise for normal-hearing (NH) individuals and individuals with hearing loss (IWHL) and to demonstrate improvements in SP with use of a visual speech recognition program (VSRP).

Study design: Single-institution prospective study.

Setting: Tertiary referral center.

Subjects and methods: Eleven NH and 9 IWHL participants in a sound-isolated booth facing a speaker through a window. In non-VSRP conditions, SP was evaluated on 40 Bamford-Kowal-Bench speech-in-noise test (BKB-SIN) sentences presented by the speaker at 50 A-weighted decibels (dBA) with multiperson babble noise presented from 50 to 75 dBA. SP was defined as the percentage of words correctly identified. In VSRP conditions, an infrared camera was used to track 35 points around the speaker's lips during speech in real time. Lip movement data were translated into speech-text via an in-house developed neural network-based VSRP. SP was evaluated similarly in the non-VSRP condition on 42 BKB-SIN sentences, with the addition of the VSRP output presented on a screen to the listener.

Results: In high-noise conditions (70-75 dBA) without VSRP, NH listeners achieved significantly higher speech perception than IWHL listeners (38.7% vs 25.0%, P = .02). NH listeners were significantly more accurate with VSRP than without VSRP (75.5% vs 38.7%, P < .0001), as were IWHL listeners (70.4% vs 25.0% P < .0001). With VSRP, no significant difference in SP was observed between NH and IWHL listeners (75.5% vs 70.4%, P = .15).

Conclusions: The VSRP significantly increased speech perception in high-noise conditions for NH and IWHL participants and eliminated the difference in SP accuracy between NH and IWHL listeners.

Keywords: artificial intelligence; computer vision; hearing loss; lip reading; speech perception; speech-in-noise; visual speech recognition.

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143
Otolaryngol Head Neck Surg
. 2020 May 26;194599820921857. doi: 10.1177/0194599820921857. Online ahead of print.
Reliability of Measuring Insertion Depth in Cochlear Implanted Infants and Children Using Cochlear View Radiography
Anisha R Noble 1, Erin Christianson 2, Susan J Norton 1 2 3, Henry C Ou 1, Grace S Phillips 4, Hedieh Khalatbari 4, Seth D Friedman 4, David L Horn 1 3
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PMID: 32450736 DOI: 10.1177/0194599820921857
Abstract
Objectives: Cochlear implant depth of insertion affects audiologic outcomes and can be measured in adults using plain films obtained in the "cochlear view." The objective of this study was to assess interrater and intrarater reliability of measuring depth of insertion using cochlear view radiography.

Study design: Prospective, observational.

Setting: Tertiary referral pediatric hospital.

Subjects and methods: Patients aged 11 months to 20 years (median, 4 years; interquartile range [IQR], 1-8 years) undergoing cochlear implantation at our institution were studied over 1 year. Children underwent cochlear view imaging on postoperative day 1. Films were deidentified and 1 image per ear was selected. Two cochlear implant surgeons and 2 radiologists evaluated each image and determined angular depth of insertion. Images were re-reviewed 6 weeks later by all raters. Inter- and intrarater reliability were calculated with intraclass correlation coefficients (ICCs).

Results: Fifty-seven ears were imaged from 42 children. Forty-nine ears (86%) had successful cochlear view x-rays. Median angular depth of insertion was 381° (minimum, 272°; maximum, 450°; IQR, 360°-395°) during the first round of measurement. Measurements of the same images reviewed 6 weeks later showed median depth of insertion of 382° (minimum, 272°; maximum, 449°; IQR, 360°-397°). Interrater and intrarater reliability ICCs ranged between 0.81 and 0.96, indicating excellent reliability.

Conclusions: Postoperative cochlear view radiography is a reliable tool for measurement of cochlear implant depth of insertion in infants and children. Further studies are needed to determine reliability of intraoperatively obtained cochlear view radiographs in this population.

Keywords: cochlear implant; insertion depth; pediatric otology.

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144
Am J Otolaryngol
. 2019 Sep 10;102298. doi: 10.1016/j.amjoto.2019.102298. Online ahead of print.
Olfaction in Juvenile Nasopharyngeal Angiofibroma: The First Study
Anupam Mishra 1, Pankaj Pandey 2, Subhash Chandra Mishra 2
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PMID: 32451287 DOI: 10.1016/j.amjoto.2019.102298
Abstract
Background: To study the pattern of olfactory dysfunction/recovery in juvenile nasopharyngeal angiofibroma (JNA).

Methods: Olfactory assessment was undertaken in 30 patients (category1) both pre- & post-operatively and in another 18 (category 2) only postoperative. All patients underwent transpalatal excision and variables of interest included age, radiological stage/parameters & tumor size.

Results: Objective olfactory dysfunction was seen in 60% while involvement of olfactory strip was suggested in 50%. Despite some marginal trends only noted between size/age with change of olfaction, Pearson's correlation test did not reveal any significance amongst multiple variables. However a better recovery of olfaction following surgery was evident in Category-2 where Chi-Square test (p < 0.05) significantly revealed this to be a function of postoperative duration. This regenerative course in JNA suggests an optimum period of 4 years for full recovery after surgery.

Conclusion: In this first study of olfaction in JNA many new trends have been appreciated. In general, deteriorations of olfaction were seen due to 'vascular-concussion' effect in early postoperative phase where post-surgical clearance of airway showed minimal effect in terms of improvement. The hypervascularity of olfactory epithelium with possible hormonal effects may be responsible for the unique pattern of olfactory function and recovery in JNA.

Keywords: Angiofibroma; Nasopharynx; Olfaction.

Copyright © 2019 Elsevier Inc. All rights reserved.

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145
Ear Nose Throat J
. 2020 May 26;145561320927946. doi: 10.1177/0145561320927946. Online ahead of print.
Emergency Laryngectomy Feasibility and Indications Beyond Airway Obstruction in the Era of Concurrent Chemoradiotherapy
Azhar Jan Battoo 1, Zahoor Ahmad Sheikh 1, Krishnakumar Thankappan 2, Altaf Gowhar Haji 3
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PMID: 32453642 DOI: 10.1177/0145561320927946
Abstract
Background: It is believed that carrying out laryngectomy in tracheotomized patients leads to higher postoperative complications and stomal recurrence compared to carrying out the procedure upfront without prior tracheotomy. We believe that emergency laryngectomy is a feasible procedure in most cancer centers and can be carried out for indications beyond acute airway obstruction as well and complex reconstruction procedures can be also carried out simultaneously. We hereby describe our experience with emergency laryngectomy with or without pharyngectomy.

Methods: Retrospective analysis of prospectively maintained data base was carried out. Patients who had undergone emergency laryngectomy in our department, from 2014 to 2018, were analyzed, and their clinicodemographic and histopathological features were noted. The indications for surgery and postoperative complications were charted down. Survival data of patients were also noted.

Results: Seven patients have undergone emergency laryngectomy, 5 for acute airway obstruction and 2 for acute bleeding. Five patients were chemoradiotherapy failures, whereas 2 patients were operated upfront. Two out of 7 patients had pyriform fossa carcinoma, whereas rest of the patients had carcinoma of glottis. Reconstruction with pectoralis myocutaneous/pectoralis muscle only flap was carried out in 4 patients. Minor salivary leak was noted in 4 patients at varying time intervals from second week onward. Two patients had post radiotherapy chondroradionecrosis, without any residual/recurrent tumor. Three out of 7 patients developed recurrence which was salvageable in only 1 patient.

Conclusion: Emergency laryngectomy can be safely carried out in emergency setting in most cancer centers, more so over it can be carried out for indications beyond acute airway obstruction and combined with complex reconstruction procedures.

Keywords: emergency complex reconstruction; emergency laryngectomy; emergency tracheotomy; laryngeal bleed.

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146
Case Reports Int J Pediatr Otorhinolaryngol
. 2020 Feb;129:109762. doi: 10.1016/j.ijporl.2019.109762. Epub 2019 Oct 31.
Bevacizumab as Adjuvant Therapy for Recurrent Respiratory Papillomatosis in an Infant
Christopher Gates 1, Patrick Tomboc 2, Andrew Allison 3, Michele Carr 4
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PMID: 31707187 DOI: 10.1016/j.ijporl.2019.109762
Abstract
Recurrent Respiratory Papillomatosis (RRP) is a benign disease of the airway that can result in symptoms ranging from mild dysphonia to respiratory distress to respiratory failure related to colonization of the lung parenchyma. It is a disease that typically begins in childhood and can require treatment indefinitely, though may remit in adolescence. Although treatment includes surgical management, certain cases require adjuvant therapy. Many therapies have been tried over the years with varying levels of success. Our patient presented as a 7 month old male in respiratory distress, who was subsequently diagnosed with RRP. He has required a tracheostomy, ventilation, and frequent surgical debridement for the last 20 months. Due to the aggressiveness of his disease, he was started on systemic bevacizumab (Avastin) in an effort to stabilize his lesions. Though early effect seemed apparent based on Derkay scores, systemic bevacizumab has failed to elicit clinical improvement in our patient. He remains with a tracheostomy receiving bevacizumab 10 mg/kg as an intermittent infusion approximately every 4 weeks along with surgical debridement with little to no clinical improvement thus far. In light of the recent successes with bevacizumab therapy, this case highlights the difficulty in finding new treatment for this disease.

Keywords: Bevacizumab; Pediatric airway; Recurrent respiratory papillomatosis.

Copyright © 2019 Elsevier B.V. All rights reserved.

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147
Review Pathogens
. 2020 May 22;9(5):E403. doi: 10.3390/pathogens9050403.
The Relationship Between Estrogen-Related Signaling and Human Papillomavirus Positive Cancers
Claire D James 1, Iain M Morgan 1 2, Molly L Bristol 1
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PMID: 32455952 DOI: 10.3390/pathogens9050403
Free article
Abstract
High risk-human papillomaviruses (HPVs) are known carcinogens. Numerous reports have linked the steroid hormone estrogen, and the expression of estrogen receptors (ERs), to HPV-related cancers, although the exact nature of the interactions remains to be fully elucidated. Here we will focus on estrogen signaling and describe both pro and potentially anti-cancer effects of this hormone in HPV-positive cancers. This review will summarize: (1) cell culture-related evidence, (2) animal model evidence, and (3) clinical evidence demonstrating an interaction between estrogen and HPV-positive cancers. This comprehensive review provides insights into the potential relationship between estrogen and HPV. We suggest that estrogen may provide a potential therapeutic for HPV-related cancers, however additional studies are necessary.

Keywords: cervical cancer; estrogen; estrogen receptor; head and neck cancer; human papillomavirus; oropharyngeal cancer.

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148
Case Reports J Dermatol
. 2019 Nov;46(11):e432-e433. doi: 10.1111/1346-8138.14950. Epub 2019 Jun 10.
Intractable Disseminated Maculopapular Eruption in a Patient With Granulocyte Macrophage Colony-Stimulating Factor-Producing Anaplastic Thyroid Carcinoma
Akira Kasuya 1, Shinsuke Shinkai 2, Sayuri Sakamoto 2, Pawit Phadungsaksawasdi 1, Takatoshi Shimauchi 1, Seiji Hosokawa 3, Atsushi Imai 3, Shigekazu Sasaki 2, Yutaka Oki 4, Yoshiki Tokura 1
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PMID: 31680312 DOI: 10.1111/1346-8138.14950
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149
Eur Arch Otorhinolaryngol
. 2020 May 25. doi: 10.1007/s00405-020-06064-x. Online ahead of print.
A Retrospective European Multicenter Analysis of the Functional Outcomes After Active Middle Ear Implant Surgery Using the Third Generation Vibroplasty Couplers
Torsten Rahne 1, Piotr Henryk Skarzynski 2 3 4, Rudolf Hagen 5, Andreas Radeloff 6, Luis Lassaletta 7, Maurizio Barbara 8, Stefan K Plontke 9, Robert Mlynski 10
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PMID: 32451668 DOI: 10.1007/s00405-020-06064-x
Abstract
Purpose: To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus.

Methods: Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS).

Results: Bone conduction threshold changes of more than 10 dB in 4PTABC were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTASF of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types.

Conclusion: Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.

Keywords: Active middle ear implant; Couplers; Hearing loss; Vibrant Soundbridge; Vibroplasty.

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150
Otolaryngol Head Neck Surg
. 2020 May 26;194599820931803. doi: 10.1177/0194599820931803. Online ahead of print.
Impact of Smoking on Survival Outcomes in HPV-Related Oropharyngeal Carcinoma: A Meta-analysis
Ryan Ference 1, David Liao 1, Qi Gao 2, Vikas Mehta 3
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PMID: 32452741 DOI: 10.1177/0194599820931803
Abstract
Objective: Characterize the survival impact of smoking on HPV-related (human papillomavirus) oropharyngeal squamous cell carcinoma.

Data sources: Articles from 2000 to 2019 in the PubMed, Embase, and Cochrane Library databases were systematically reviewed for content and inclusion/exclusion criteria.

Review methods: Two reviewers independently analyzed the databases for eligibility and quality of the articles. Demographic data, smoking history, and survival outcomes were recorded. Hazard ratios and 95% CIs were collectively analyzed through a random effects meta-analysis model.

Results: Fifteen articles were included in the meta-analysis for overall survival, disease-specific survival, disease-free survival, progression-free survival, and locoregional recurrence outcomes. The overall survival hazard ratio was 2.4 for ever having smoked (95% CI, 1.4-4.0; P = .0006, I2 = .384) and 3.2 for current smoking (95% CI, 2.2-4.6; P < .0001, I2 = 0). The hazard ratio for disease-specific survival in current smokers was 6.3 (95% CI, 1.3-29.3; P = .0194, I2 = 0). Ever smoking had a larger impact on overall survival and disease-specific survival than the 10-pack year smoking threshold.

Conclusion: Smoking negatively affects survival in patients with HPV-related oropharyngeal carcinoma across all outcomes. Current smoking during treatment is associated with the greatest reduction in survival, possibly secondary to diminished radiation therapy efficacy.

Keywords: HPV; oropharyngeal carcinoma; smoking; survival outcomes.

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151
Otolaryngol Head Neck Surg
. 2020 May 26;194599820931041. doi: 10.1177/0194599820931041. Online ahead of print.
Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic
Matthew J Urban 1, Tirth R Patel 1, Richard Raad 1, Phillip LoSavio 1, Kerstin Stenson 1, Samer Al-Khudari 1, Thomas Nielsen 1, Inna Husain 1, Ryan Smith 1, Peter C Revenaugh 1, R Mark Wiet 1, Peter Papagiannopoulos 1, Pete S Batra 1, Bobby A Tajudeen 1
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PMID: 32452746 DOI: 10.1177/0194599820931041
Abstract
Objective: To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic.

Methods: This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a "high-risk case protocol" was utilized to maximize available resources. As information and technology evolved, a "universal point-of-care protocol" was implemented.

Results: Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure (P = .92).

Discussion: Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on "COVID-19 clinics" or other community testing facilities.

Implications for practice: Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.

Keywords: COVID-19; PS/QI; coronavirus; operating room; otolaryngology; preoperative; protocol; screening; surgery.

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152
Otolaryngol Head Neck Surg
. 2020 May 26;194599820926129. doi: 10.1177/0194599820926129. Online ahead of print.
Psychological Status as an Effect Modifier of the Association Between Sinonasal Instrument and Imaging Results
Allen S Zhou 1, Anthony A Prince 1, Alice Z Maxfield 1, Jennifer J Shin 1
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PMID: 32450735 DOI: 10.1177/0194599820926129
Abstract
Objective: To determine whether psychological status is an effect modifier of the previously observed low discriminatory capacity of Sinonasal Outcome Test-22 (SNOT-22) scores for Lund-Mackay computed tomography (CT) results.

Study design: Observational outcomes study.

Setting: Tertiary care center.

Subjects and methods: We assessed patients presenting with chronic sinonasal complaints who underwent CT of the sinuses within 1 month of completing the SNOT-22 instrument. SNOT-22 overall and domain scores were calculated, as were Lund-Mackay CT scores. The discriminatory capacity of SNOT-22 scores for CT results was determined using the receiver-operator characteristic area under the curve (ROC-AUC). Patient-Reported Outcome Measurement Information System (PROMIS) mental health T-scores were assessed, and stratified analyses were used to test for effect modification by psychological status.

Results: In stratified analyses, patients with better PROMIS mental health scores had SNOT-22 overall (ROC-AUC 0.96) and nasal domain scores (ROC-AUC 0.97-0.98) that were highly discriminatory for Lund-Mackay scores, while those with worse mental health scores did not (ROC-AUC 0.42-0.55, P < .007). Patients with better SNOT-22 psychological domain scores also had nasal scores that discriminated among CT results significantly better than those with worse psychological domain scores (ROC-AUC 0.65-0.69 and 0.34-0.35, respectively, P < .013).

Conclusions: Psychological status is an effect modifier of the relationship between SNOT-22 and Lund-Mackay scores. SNOT-22 scores were discriminatory for Lund-Mackay CT results in patients with better psychological status, while they were nondiscriminatory in those with worse psychological status. When assessing the relationship between subjective and objective measures of chronic rhinosinusitis, accounting for effect modification may have practical utility.

Keywords: computed tomography; diagnostic testing; effect measure modification; patient-reported outcome measure; predictive value; rhinosinusitis; validated instrument.

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153
Eur J Cancer
. 2020 May 24;134:52-59. doi: 10.1016/j.ejca.2020.04.027. Online ahead of print.
The Current Epidemic of HPV-associated Oropharyngeal Cancer: An 18-year Danish Population-Based Study With 2,169 Patients
Martin Zamani 1, Christian Grønhøj 1, David H Jensen 1, Amanda F Carlander 1, Tina Agander 2, Katalin Kiss 2, Caroline Olsen 3, Louise Baandrup 3, Finn C Nielsen 4, Elo Andersen 5, Jeppe Friborg 6, Christian von Buchwald 7
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PMID: 32460181 DOI: 10.1016/j.ejca.2020.04.027
Abstract
Background: The objectives of this study were to investigate the incidence of high-risk genotypes of human papillomavirus (HPV) in tumours of patients with oropharyngeal squamous cell carcinoma (OPSCC) during an 18-year period in Eastern Denmark.

Methods: In this population-based, consecutive, semi-national registry study, all patients diagnosed with OPSCC from 2000 to 2017 in Eastern Denmark were evaluated at head and neck oncological departments at public university hospitals. Analyses included tumour characteristics (HPV-positive [HPV+] versus HPV-negative [HPV-]), age-adjusted incidence rates (AAIRs), average annual percentage change (AAPC) of OPSCC, and patient demographics. All HPV+ cases from 2011 to 2017 were genotyped.

Results: In total, 55% of 2169 OPSCC cases were HPV+. HPV16, HPV33, HPV35 or other types were found in 86%, 7.4%, 3.4% and 3.2% of cases, respectively. The AAIR per 100,000 of all OPSCCs was 1.8 in 2000, which increased to 5.1 in 2017 (HPV+: threefold increase, HPV-: twofold increase). The AAPC from 2000 to 2017 increased by 7% (HPV+ increased by 10% and HPV- by 4%). The median age at diagnosis for all OPSCC cases increased during the 18-year study period (HPV+: 58-61 years, p < 0.001; HPV-: 60-65 years, p < 0.001).

Conclusion: We report a threefold increase in OPSCC incidence during the 18-year observation period and a significant increase in median age at diagnosis. Over 93% of HPV genotypes in HPV+ OPSCC are included in current HPV vaccines except for HPV35 (4%). HPV vaccination of both sexes is advised to halt this emerging cancer epidemic.

Keywords: Human papillomavirus; Oropharyngeal cancer; Squamous cell carcinoma; Tonsil cancer.

Copyright © 2020 Elsevier Ltd. All rights reserved.

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154
Review Arq Bras Oftalmol
. Mar-Apr 2020;83(2):160-167. doi: 10.5935/0004-2749.20200037.
Clinical Studies Using Stem Cells for Treatment of Retinal Diseases: State of the Art
Carina Costa Cotrim 1, Rodrigo Jorge 1, Maria Carolina de Oliveira 2, Fabiano Pieroni 3, André M Vieira Messias 1, Rubens Camargo Siqueira 1 4
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PMID: 32159599 DOI: 10.5935/0004-2749.20200037
Free article
Abstract
Degenerative retinal diseases such as retinitis pigmentosa, Stargardt's macular dystrophy, and age-related macular degeneration are characterized by irreversible loss of vision due to direct or indirect photoreceptor damage. No effective treatments exist, but stem cell studies have shown promising results. Our aim with this review was to describe the types of stem cells that are under study, their effects, and the main clinical trials involving them.

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155
Int J Mol Sci
. 2020 May 24;21(10):E3697. doi: 10.3390/ijms21103697.
Mouthwash-Based Highly Sensitive Pyro-Genotyping for Nine Sexually Transmitted Human Papilloma Virus Genotypes
Yoshiyuki Watanabe 1 2, Yukiko Seto 1 3, Ritsuko Oikawa 2, Takara Nakazawa 1 3, Hanae Furuya 1 3, Hidehito Matsui 1 3, Sachiko Hosono 1 3, Mika Noike 1 3, Akiko Inoue 1 3, Hiroyuki Yamamoto 2, Fumio Itoh 2, Kota Wada 3
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PMID: 32456291 DOI: 10.3390/ijms21103697
Free article
Abstract
Human papillomavirus (HPV) is a common sexually transmitted infection worldwide, which spreads via contact with infected genital, anal, and oral/pharyngeal areas (oral sex) owing to diverse manners of sexual intercourse. In this study, we devised an oral HPV detection method using mouthwash waste fluids that causes less psychological resistance to visiting the outpatient otolaryngology departments. We successfully detected only the specific unique reverse sequencing probe (using pyro-genotyping) and identified the nine genotypes of HPV targeted for vaccination by pyrosequencing the mouthwash waste fluids of non-head and neck cancer patient volunteers (n = 52). A relatively large number (11/52) of mouthwash waste fluids tested positive for HPV (21.2%; genotype 6, n = 1; 11, n = 1; 16, n = 1; and 18, n = 8). These results surpassed the sensitivity observed testing the same specimens using the conventional method (1/52, 1.9%). Our method (pyro-genotyping) was developed using nine HPV genotypes targeted for vaccination and the results were highly sensitive compared to those of the conventional method. This less expensive, high-throughput, and simple method can be used for detecting oral HPV infection with fewer socio-psychological barriers.

Keywords: HPV genotyping; mouthwash; pyrosequencing; sexually transmitted infections (STIs).

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156
Cell Rep
. 2020 May 26;31(8):107674. doi: 10.1016/j.celrep.2020.107674.
Lactobacilli Have a Niche in the Human Nose
Ilke De Boeck 1, Marianne F L van den Broek 1, Camille N Allonsius 1, Irina Spacova 1, Stijn Wittouck 1, Katleen Martens 2, Sander Wuyts 1, Eline Cauwenberghs 1, Katarina Jokicevic 3, Dieter Vandenheuvel 1, Tom Eilers 1, Michelle Lemarcq 4, Charlotte De Rudder 5, Sofie Thys 6, Jean-Pierre Timmermans 6, Anneclaire V Vroegop 7, Alex Verplaetse 4, Tom Van de Wiele 5, Filip Kiekens 3, Peter W Hellings 8, Olivier M Vanderveken 9, Sarah Lebeer 10
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PMID: 32460009 DOI: 10.1016/j.celrep.2020.107674
Abstract
Although an increasing number of beneficial microbiome members are characterized for the human gut and vagina, beneficial microbes are underexplored for the human upper respiratory tract (URT). In this study, we demonstrate that taxa from the beneficial Lactobacillus genus complex are more prevalent in the healthy URT than in patients with chronic rhinosinusitis (CRS). Several URT-specific isolates are cultured, characterized, and further explored for their genetic and functional properties related to adaptation to the URT. Catalase genes are found in the identified lactobacilli, which is a unique feature within this mostly facultative anaerobic genus. Moreover, one of our isolated strains, Lactobacillus casei AMBR2, contains fimbriae that enable strong adherence to URT epithelium, inhibit the growth and virulence of several URT pathogens, and successfully colonize nasal epithelium of healthy volunteers. This study thus demonstrates that specific lactobacilli are adapted to the URT and could have a beneficial keystone function in this habitat.

Keywords: lactobacillus; microbiome; niche-adaptation; probiotics; sinusitis; upper respiratory tract.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Conflict of interest statement
Declaration of Interests A patent application (PCT/EP2018/057497) was filed on March 23, 2018, related to this work.

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157
Otolaryngol Head Neck Surg
. 2020 May 26;194599820925757. doi: 10.1177/0194599820925757. Online ahead of print.
Quality Indicators of Central Compartment Neck Dissection in Thyroid Surgery
Alexandra E Quimby 1, Martin J Corsten 2, Elysia Grose 3, Michael Odell 1, Stephanie Johnson-Obaseki 1
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PMID: 32453652 DOI: 10.1177/0194599820925757
Abstract
Objectives: Quality metrics are an increasingly important means of improving patient care. Variability in the number of lymph nodes removed during central compartment lymph node dissection (CCLND) at the time of thyroidectomy has not been studied.

Study design: A retrospective cohort study was performed using American College of Surgeons National Quality Improvement Program (ACS-NSQIP) data.

Setting: Centers in North America and worldwide contributing data to ACS-NSQIP and performing thyroidectomy on adults in inpatient and outpatient settings were included.

Subjects and methods: Adult patients undergoing thyroidectomy with or without CCLND were included. Outcomes of interest were number of nodes removed during CCLND and risks of postoperative hypocalcemia.

Results: In total, 6108 patients met inclusion criteria (1565 with CCLND). The median number of lymph nodes removed during CCLND was 2. There was no statistically significant association between postoperative hypocalcemia and CCNLD, regardless of number of nodes removed. However, we were underpowered to detect this association based on the overall low nodal yield of many CCLNDs performed.

Conclusion: In many cases where CCLND is documented as part of thyroidectomy, very few lymph nodes are removed. Our ability to draw conclusions regarding the effect of CCLND on postoperative hypocalcemia is restricted due to the limited nature of many CCLNDs performed.

Keywords: CCLND; hypocalcemia; lymph node; quality indicators; thyroidectomy.

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158
Jpn J Clin Oncol
. 2020 May 27;hyaa079. doi: 10.1093/jjco/hyaa079. Online ahead of print.
Pull-through Resection Without Free-Flap Reconstruction for Lateral Wall Oropharyngeal Cancer
Fumihiko Matsumoto 1, Kenya Kobayashi 1, Go Omura 1, Satoko Matsumura 1, Yoshifumi Matsumoto 1, Masahiko Fukasawa 1, Seiichi Yoshimoto 1
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PMID: 32458994 DOI: 10.1093/jjco/hyaa079
Abstract
Background: While transoral robotic surgery (TORS) is widely used for the management of lateral wall oropharyngeal carcinomas (OPC), open surgical techniques are still used in some cases. A pull-through method for open surgical resections of OPC has recently been introduced. We improved on this method by eliminating the need for subsequent free-flap reconstruction.

Methods: 16 patients with lateral wall OPC underwent pull-through resections. After resection, we used the digastric muscle, stylohyoid muscles, submandibular gland and the surrounding tissues to block the neck and oral cavity and to avoid reconstruction.

Results: This novel technique was performed without major complications or morbidities. The average post-operative hospital stay was 14.6 ± 6.1 days, and the average duration until initiation of oral intake post-operation was 6.5 ± 2.9 days. Oncological outcomes, post-operative course and function were acceptable.

Conclusions: Our novel method provides an efficient and less invasive surgical technique than conventional open approaches.

Keywords: lip-splitting; mandibular swing; oropharyngeal cancer; pull-through; reconstruction.

© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.

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159
Asian Pac J Cancer Prev
. 2020 May 1;21(5):1481-1485. doi: 10.31557/APJCP.2020.21.5.1481.
Patterns of Care and Outcome Analysis of Nasopharyngeal Carcinoma: An Indonesian Single Institution Study
Hamida Hayati Faisal 1, Nobuteru Kubo 2, Endang Nuryadi 2 3, Joedo Prihartono 4, Tubagus Djumhana Atmakusuma 5, Lisnawati Rachmadi 6, Takahiro Oike 2, Takashi Nakano 2, Soehartati A Gondhowiardjo 3, Marlinda Adham 1
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PMID: 32458659 DOI: 10.31557/APJCP.2020.21.5.1481
Free article
Abstract
Background: Nasopharyngeal cancer is endemic to Southeast Asia. However, there is limited clinical evidence of nasopharyngeal cancer in Indonesia, which has the largest population in Southeast Asia.

Methods: Patterns of care and treatment outcomes in 428 patients with newly-diagnosed and pathologically-confirmed nasopharyngeal cancer were retrospectively analyzed.

Results: Concurrent chemo-radiotherapy (CCRT) was the first-line treatment for stages I-IVB diseases. The 2-year overall survival (OS) of all patients were 100.0%, 100.0%, 93.8%, 86.2%, 82.9%, and 62.4% for stages I, II, III, IVA, IVB, and IVC, respectively. The 2-year OS of CCRT-treated patients were 100.0%, 100.0%, 92.6%, 82.4%, and 78.3% for stages I, II, III, IVA, and IVB, respectively.

Conclusion: The patterns of care and treatment outcomes were potentially consistent with world standards, needing future validation. This is the largest study of newly diagnosed nasopharyngeal cancer in Indonesia, a huge disease burden, providing an important basis for the clinical management of this disease.

Keywords: Indonesia; Nasopharyngeal carcinoma; Radiation therapy; Treatment outcome; patterns of care.

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160
J Neurol
. 2020 May 26. doi: 10.1007/s00415-020-09891-4. Online ahead of print.
Upbeat Vertical Nystagmus After Brain Stem Cavernoma Resection: A Rare Case of Nucleus Intercalatus/Nucleus of Roller Injury
Torstein R Meling 1 2 3, Aria Nouri 4, Adrien May 4, Nils Guinand 5, Maria Isabel Vargas 6 7, Christophe Destrieux 8 9
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PMID: 32458196 DOI: 10.1007/s00415-020-09891-4
Abstract
Introduction: CNS cavernomas are a type of raspberry-shaped vascular malformations that are typically asymptomatic, but can result in haemorrhage, neurological injury, and seizures. Here, we present a rare case of a brainstem cavernoma that was surgically resected whereafter an upbeat nystagmus presented postoperatively.

Case report: A 42-year old man presented with sudden-onset nausea, vomiting, vertigo, blurred vision, marked imbalance and difficulty swallowing. Neurological evaluation showed bilateral ataxia, generalized hyperreflexia with left-sided predominance, predominantly horizontal gaze evoked nystagmus on right and left gaze, slight left labial asymmetry, uvula deviation to the right, and tongue deviation to the left. MRI demonstrated a 13-mm cavernoma with haemorrhage and oedema in the medulla oblongata. Surgery was performed via a minimal-invasive, midline approach. Complete excision was confirmed on postoperative MRI. The patient recovered well and became almost neurologically intact. However, he complained of mainly vertical oscillopsia. The videonystagmography revealed a new-onset spontaneous upbeat nystagmus in all gaze directions, not suppressed by fixation. An injury of the rarely described intercalatus nucleus/nucleus of Roller is thought to be the cause.

Conclusion: Upbeat nystagmus can be related to several lesions of the brainstem, including the medial longitudinal fasciculus, the pons, and the dorsal medulla. To our knowledge, this is the first case of an iatrogenic lesion of the nucleus intercalatus/nucleus of Roller resulting in an upbeat vertical nystagmus. For neurologists, it is important to be aware of the function of this nucleus for assessment of clinical manifestations due to lesions within this region.

Keywords: Cavernoma; Complication; Nucleus intercalatus; Nystagmus.

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161
Surgeon
. 2020 May 22;S1479-666X(20)30054-8. doi: 10.1016/j.surge.2020.04.008. Online ahead of print.
The Effect of Preservation of the Supraclavicular Nerve on Sensation Recovery in Endoscopic Thyroidectomy via a Gasless Anterior Chest Approach: A Prospective Study
Zhiwei Zhou 1, Faya Liang 2, Shitong Yu 2, Xiaoming Huang 3
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PMID: 32451283 DOI: 10.1016/j.surge.2020.04.008
Abstract
Background: Factors to sensory change on the neck and chest after endoscopic thyroidectomy were not well studied. The aim of this study was to assess whether preservation of the supraclavicular nerve (SCN) could make a difference.

Methods: 33 cases with the SCN preserved (Group A) and 32 cases with the SCN damaged (Group B) were recruited. Evaluation of tactile sensitivity and pain sensitivity as well as a questionnaire concerning subjective symptoms and quality of life was also administered preoperatively and postoperatively.

Results: Sensation in the anterior chest of Group A had milder loss and reached preoperative level within the 1-year follow-up while that of Group B still showed deficit beneath the clavicle. Group A also had smaller proportion of numbness, symptomatic extension, psychological impact in early postoperative time.

Conclusion: Protection of the SCN can improve sensation recovery in the anterior chest and enhance the quality of life after surgery.

Keywords: Endoscopic thyroidectomy; Sensation recovery; Supraclavicular nerve.

Copyright © 2020 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

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162
Dis Markers
. 2020 May 5;2020:7253531. doi: 10.1155/2020/7253531. eCollection 2020.
Septin 9 Methylation in Nasopharyngeal Swabs: A Potential Minimally Invasive Biomarker for the Early Detection of Nasopharyngeal Carcinoma
Jie-Yu Lyu 1 2, Jian-Yong Chen 3, Xiao-Jun Zhang 2, Meng-Wen Zhang 2, Geng-Sheng Yu 4, Liang Zhang 5, Zhong Wen 1
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PMID: 32454907 PMCID: PMC7232724 DOI: 10.1155/2020/7253531
Free PMC article
Abstract
Nasopharyngeal carcinoma (NPC) is highly prevalent in Southeast Asia, and an unfavorable outcome is usually attributed to advanced stage NPC. Current methods for the early diagnosis of NPC have limitations in clinical practice. The aim of this study was to investigate the diagnostic ability of Septin 9 methylation for NPC. A quantitative methylation-sensitive PCR (qMS-PCR) assay was developed to measure the methylation status and levels of Septin 9 in nasopharyngeal tissues and paired swabs from patients with NPC, chronic nasopharyngitis, and healthy donors. Methylated Septin 9 was detected in 92% (23/25) of NPC tissues and 25% (4/16) of nasopharyngitis controls (p < 0.05). High-frequency hypermethylation with decreased mRNA expression of Septin 9 in NPC was also identified. Further, Septin 9 methylation was identified in 90.5% (19/21) of NPC biopsies and 71.4% (15/21) of paired swabs, indicating a good concordance between the two sample types. In addition, methylated Septin 9 was found in 16 (72.7%) nasal swabs from 22 NPC patients, 2 of 19 (10.5%) nasopharyngitis, but not in any of the healthy controls (p < 0.01). The methylation score in nasal swabs of the NPC group was also significantly higher than that of non-NPC controls (p < 0.001). Moreover, receiver operating characteristic (ROC) curve analysis showed an area under the curve (AUC) of 0.882 of Septin 9 methylation tests to discriminate NPC from non-NPC subjects. Our study demonstrated that frequent methylation of Septin 9 was present in NPC. Its detection in nasopharyngeal swabs may provide a minimally invasive and informative method for identifying early NPC cases.

Copyright © 2020 Jie-Yu Lyu et al.

Conflict of interest statement
The authors declare no conflict of interest.

32 references4 figures
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163
Editorial Ear Nose Throat J
. 2020 May 26;145561320925208. doi: 10.1177/0145561320925208. Online ahead of print.
To Balloon or Not to Balloon, The Current State of Management of Eustachian Tube Dysfunction
David J Lafferty 1, Brian J McKinnon 2
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PMID: 32453641 DOI: 10.1177/0145561320925208
Abstract
No abstract available
Keywords: Eustachian tube dilation; Eustachian tube dysfunction; Eustachian tuboplasty; otitis media.

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164
Otolaryngol Head Neck Surg
. 2020 May 26;194599820925050. doi: 10.1177/0194599820925050. Online ahead of print.
Lessons Learned From a Single-Surgeon Experience of More Than 1700 Parathyroidectomies
David J Terris 1, Ahmad Eltelety 1, Zachary Zimmerman 1, Luke Edelmayer 1
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PMID: 32453628 DOI: 10.1177/0194599820925050
Abstract
Objective: To define critical elements that contribute to successful parathyroidectomy based on a high-volume single-surgeon experience and explore learning curve characteristics.

Study design: Systematic analysis of prospectively maintained quality assurance database.

Setting: Academic tertiary care endocrine surgery practice.

Subjects and methods: In total, 4737 consecutive patients who underwent thyroid or parathyroid surgery from 2004 to 2020 were identified. Demographic data acquisition was undertaken on a subset of these patients who had initial surgery for primary hyperparathyroidism during the academic years 2005 to 2018. Patients with renal or syndromic hyperparathyroidism and those undergoing reoperative surgery were excluded.

Results: From 1710 patients who underwent parathyroid surgery, 1082 met inclusion criteria in order to focus on a homogeneous data set. These patients had a mean age of 60.1 ± 12.5 years and 76.4% were female. The overall cure rate was 98.3%, reflecting a success rate that increased from 95.5% during the first 200 cases to 99.7% over the final 300 cases. The complication rate was 1.7%. Over 2 decades, the patient phenotype evolved toward milder disease and smaller adenomas. A learning curve of 200 cases was required to become a proficient parathyroid surgeon; to achieve exceptional results required several hundred additional cases. Parathyroid surgery represents a higher proportion of an endocrine surgery practice than previously (54.0% in 2019 compared with 25.5% in 2004).

Conclusion: A focused practice dedicated to endocrine surgery yields surgical volumes exceeding 500 cases annually. There has been a steady shift toward parathyroid surgery. A lengthy learning curve can be shortened by pursuit of several specific strategies that are outlined in detail.

Keywords: endocrine surgery; imaging; parathyroid hormone level; parathyroidectomy; surgical volumes.

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165
Randomized Controlled Trial Medicine (Baltimore)
. 2020 May;99(18):e20095. doi: 10.1097/MD.0000000000020095.
Application of Probiotics in Adjuvant Treatment of Infant Allergic Rhinitis: A Randomized Controlled Study
Xueqiu Cao 1 2, Ping Zhong 1, Gang Li 1, Jiao Zhu 1, Yun Zheng 1
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PMID: 32358397 DOI: 10.1097/MD.0000000000020095
Free article
Abstract
Background: Several studies have suggested that intestinal flora may play an important role in allergic diseases. The purpose of this study was to investigate the effect of probiotics of Bifidobacterium triplex on the symptoms of allergic rhinitis (AR). The effects of this probiotic on the immune system have been reported in some studies, but most previous studies have been in animals.

Methods/design: 60 infants and young children with AR were randomly divided into 2 groups: probiotics/placebo group. The main outcome was the use of a comprehensive symptom drug score to assess allergy symptoms. In addition, health-related quality of life was investigated (rhinitis quality of life questionnaire). Secondary outcomes included a visual analog scale of allergy burden and a second quality of life questionnaire. This report describes the study design of a randomized controlled trial.

Discussion: The study design described a double-center, randomized, location at the Minda Hospital of Hubei Minzu University and West China Hospital of Sichuan University, which will be focused on the study about probiotics treatment and its effect on AR symptoms.

Trial registration: It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000031175), Registered March 22, 2020.

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166
Front Neurosci
. 2020 May 7;14:410. doi: 10.3389/fnins.2020.00410. eCollection 2020.
Pre-treatment Ongoing Cortical Oscillatory Activity Predicts Improvement of Tinnitus After Partial Peripheral Reafferentation With Hearing Aids
Jae Joon Han 1, Dirk De Ridder 2, Sven Vanneste 3 4, Yu-Chen Chen 5, Ja-Won Koo 6, Jae-Jin Song 6
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PMID: 32457569 PMCID: PMC7221249 DOI: 10.3389/fnins.2020.00410
Free PMC article
Abstract
Although hearing aids (HAs) are sometimes efficacious in abating tinnitus, the precise mechanism underlying their effect is unclear and predictors of symptom improvement have not been determined. Here, we examined the correlation between the amount of tinnitus improvement and pre-HA quantitative electroencephalography (qEEG) findings to investigate cortical predictors of improvement after wearing HAs. QEEG data of thirty-three patients with debilitating tinnitus were retrospectively correlated with the percentage improvements in tinnitus handicap inventory and the numerical rating scale scores of tinnitus. Activation of brain areas involved in the default mode network (DMN; inferior parietal lobule, parahippocampus, and posterior cingulate cortex) were found to be a negative predictor of improvement in tinnitus-related distress after wearing HAs. In addition, higher pre-HA cortical power at the medial auditory processing system or higher functional connectivity of the lateral/medial auditory pathway to the DMN was found to serve as a positive prognostic indicator with regard to improvement of tinnitus-related distress. In addition, insufficient activity of the pre-treatment noise canceling system tended to be a negative predictor of tinnitus perception improvement after wearing HAs. The current study may serve as a milestone toward a pre-HAs prediction strategy for tinnitus improvements in subjects with hearing loss and severe tinnitus.

Keywords: electroencephalography; hearing aids; hearing loss; neural plasticity; tinnitus; treatment.

Copyright © 2020 Han, Ridder, Vanneste, Chen, Koo and Song.

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167
Otolaryngol Head Neck Surg
. 2020 May 26;194599820931801. doi: 10.1177/0194599820931801. Online ahead of print.
Safety and Prognosis in Percutaneous vs Surgical Tracheostomy in 27 Patients With COVID-19
Juan Riestra-Ayora 1, Joaquin Yanes-Diaz 1, Oscar Penuelas 2 3, Cristina Molina-Quiros 1, Ricardo Sanz-Fernández 1, Eduardo Martin-Sanz 1
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PMID: 32450761 DOI: 10.1177/0194599820931801
Abstract
During the SARS-CoV-2 pandemic, patients in intensive care units who are undergoing long-term intubation may require tracheostomy. There is controversy about indication and health care professionals' safety regarding the conventional or percutaneous technique. We performed a prospective analysis of a series of 27 consecutive patients with COVID-19 comparing both tracheostomy techniques, safety, and prognosis clinical markers. The results show that the techniques are equally safe, without cases of infection in surgeons. The Sequential Organ Failure Assessment score before surgery and the progression in ventilation support during the first 72 hours after tracheostomy are optimal prognostic markers for these patients.

Keywords: COVID-19; SARS-CoV-2; airway management; infectious disease; quality improvement; tracheostomy.

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168
Case Reports Ann Otol Rhinol Laryngol
. 2020 Jun;129(6):633-636. doi: 10.1177/0003489420902491. Epub 2020 Jan 24.
Nasal Septal Abscess Caused by Protrusion of a Dental Implant Into the Nasopalatine Duct: A Case Report
Emiel A Kop 1, Wouter L Lodder 1, Jan Gam de Visscher 2, Herbert van den Berge 1
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PMID: 31975610 DOI: 10.1177/0003489420902491
Abstract
Objective: A nasal septal abscess after placement of a dental implant is seldom seen and is usually caused by an infection around the implant. A septal haematoma following dental implantation leading to septal abscess formation has never been reported.

Methods and results: We present a case of a patient who developed a septal abscess after dental implantation without accompanying signs of infection around the implant. On the computed tomography scan we found the implant protruding the nasopalatine duct which led to bilateral septal hemorrhage, resulting in abscess formation. The patient underwent reconstructive nasal septum surgery, using an autologous auricular cartilage graft. This resulted in a good nasal function and cosmetic outcome.

Conclusions: Medical health care professionals should be aware of a septal abscess in case of an acute blocked nose even without prior nasal or facial trauma or nasal surgery. Reconstruction of the septal nasal cartilage using autologous conchal cartilage is a good solution to preserve nasal function as well as tip support.

Keywords: abscess; complex nasal reconstruction; nasal obstruction; reconstructive techniques; rhinoplasty.

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169
PLoS Genet
. 2020 May 26;16(5):e1008826. doi: 10.1371/journal.pgen.1008826. Online ahead of print.
Congenital Hearing Impairment Associated With Peripheral Cochlear Nerve Dysmyelination in Glycosylation-Deficient Muscular Dystrophy
Shigefumi Morioka 1 2, Hirofumi Sakaguchi 2, Hiroaki Mohri 1, Mariko Taniguchi-Ikeda 3 4, Motoi Kanagawa 3, Toshiaki Suzuki 1, Yuko Miyagoe-Suzuki 5, Tatsushi Toda 3 6, Naoaki Saito 1, Takehiko Ueyama 1
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PMID: 32453729 DOI: 10.1371/journal.pgen.1008826
Free article
Abstract
Hearing loss (HL) is one of the most common sensory impairments and etiologically and genetically heterogeneous disorders in humans. Muscular dystrophies (MDs) are neuromuscular disorders characterized by progressive degeneration of skeletal muscle accompanied by non-muscular symptoms. Aberrant glycosylation of α-dystroglycan causes at least eighteen subtypes of MD, now categorized as MD-dystroglycanopathy (MD-DG), with a wide spectrum of non-muscular symptoms. Despite a growing number of MD-DG subtypes and increasing evidence regarding their molecular pathogeneses, no comprehensive study has investigated sensorineural HL (SNHL) in MD-DG. Here, we found that two mouse models of MD-DG, Largemyd/myd and POMGnT1-KO mice, exhibited congenital, non-progressive, and mild-to-moderate SNHL in auditory brainstem response (ABR) accompanied by extended latency of wave I. Profoundly abnormal myelination was found at the peripheral segment of the cochlear nerve, which is rich in the glycosylated α-dystroglycan-laminin complex and demarcated by "the glial dome." In addition, patients with Fukuyama congenital MD, a type of MD-DG, also had latent SNHL with extended latency of wave I in ABR. Collectively, these findings indicate that hearing impairment associated with impaired Schwann cell-mediated myelination at the peripheral segment of the cochlear nerve is a notable symptom of MD-DG.

Conflict of interest statement
The authors have declared that no competing interests exist.

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170
Clin Nucl Med
. 2020 May 20. doi: 10.1097/RLU.0000000000003106. Online ahead of print.
Intraoperative Detection of Hyperplastic Parathyroid Gland With Positron Emitter 18F-Fluorocholine and Handheld Probe
Anja Tea Golubić 1, Frano Poljak 1, Boris Bumber 2, Dražen Huić 1 3
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PMID: 32453078 DOI: 10.1097/RLU.0000000000003106
Abstract
We present the first intraoperative detection of a hyperplastic parathyroid gland with a positron emitter F-fluorocholine and handheld probe, with the estimation of the absorbed dose to the surgeon and surgical staff. Intraoperative positron emitter detection enabled the resection of a small parathyroid gland, resulting in normal postoperative values of PTH and serum calcium in a 69-year-old woman. Calculated whole-body dose to the surgical staff and surgeons' fingers is well below the annual limits for exposed workers and the general public. Intraoperative F-FCH detection with handheld probe is a safe and feasible method for localizing small parathyroid glands.

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171
J Speech Lang Hear Res
. 2020 May 27;1-7. doi: 10.1044/2020_JSLHR-19-00302. Online ahead of print.
Effects of Self-Generated Noise on Quiet Threshold by Transducer Type in School-Age Children and Adults
Heather L Porter 1, Lori J Leibold 2, Emily Buss 2
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PMID: 32459139 DOI: 10.1044/2020_JSLHR-19-00302
Abstract
Purpose Low-frequency detection thresholds in quiet vary across transducers. This experiment tested the hypothesis that transducer effects are larger in young children than adults, due to higher levels of self-generated noise in children. Method Listeners were normal-hearing 4.6- to 11.7-year-olds and adults. Warble-tone detection was measured at 125, 250, 500, and 1000 Hz with a sound-field speaker, insert earphones, and supra-aural headphones. Probe microphone recordings measured self-generated noise levels. Results Thresholds were similar across ages for speaker measurements. Transducer effects were larger for children than adults, with mean child-adult threshold differences at 125 Hz of 3.4 dB (insert earphones) and 6.6 dB (supra-aural headphones). Age effects on threshold were broadly consistent with noise levels measured in the ear canal. Conclusions Self-generated noise appears to elevate children's low-frequency thresholds measured with occluding transducers. These effects could be particularly relevant to the diagnosis of minimal and mild hearing loss in children.

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172
J Mater Chem B
. 2020 May 27. doi: 10.1039/d0tb00595a. Online ahead of print.
The Circadian Clock Gene PER2 Enhances Chemotherapeutic Efficacy in Nasopharyngeal Carcinoma When Combined With a Targeted Nanosystem
Li Hou 1, Hailiang Li 2, Haiyan Wang 3, Dede Ma 4, Jing Liu 5, Liqiong Ma 6, Zhihua Wang 7, Zhihua Yang 8, Faxuan Wang 9, Hechun Xia 10
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PMID: 32458942 DOI: 10.1039/d0tb00595a
Abstract
Treatment failure occurs in more than 40% of advanced nasopharyngeal carcinoma (NPC) patients including local recurrence and distant metastasis due to chemoradioresistance. Circadian clock genes were identified as regulating cancer progression and chemoradiosensitivity in a time-dependent manner. A novel nanosystem can ensure the accumulation and controllable release of chemotherapeutic agents at the tumour site at a set time. In this study, we investigated the expression of circadian clock genes and identified that period circadian regulator 2 (PER2) as a tumour suppressor plays a key role in NPC progression. A label-free proteomic approach showed that PER2 overexpression can inhibit the ERK/MAPK pathway. The chemotherapeutic effect of PER2 overexpression was assessed in NPC together with the nanosystem comprising folic acid (FA), upconverting nanoparticles covalently coupled with Rose Bengal (UCNPs-RB), 10-hydroxycamptothecin (HCPT) and lipid-perfluorohexane (PFH) (FURH-PFH-NPs). PER2 overexpression combined with the targeted and controlled release of nanoagents elevated chemotherapeutic efficacy in NPC, which has potential application value for the chronotherapy of tumours.

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173
Acta Cytol
. 2020 May 26;1-2. doi: 10.1159/000508768. Online ahead of print.
COVID-19 and Nasal Cytobrush Cytology
Matteo Gelardi 1, Mario Notargiacomo 2, Eleonora M C Trecca 3, Michele Cassano 1, Giorgio Ciprandi 4
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PMID: 32454497 DOI: 10.1159/000508768
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174
Laryngoscope
. 2020 May 27. doi: 10.1002/lary.28725. Online ahead of print.
Surgical Resection Is Justifiable for Oral T4b Squamous Cell Cancers With Masticator Space Invasion
H Michael Baddour 1 2, Matthew C Ochsner 1, Mihir R Patel 1 2, Jeffrey M Switchenko 2 3, Jonathan J Beitler 1 2 4 5, Kelly Magliocca 2 6, Kristen L Baugnon 2 7, Clementino A Solares 1 2, Conor E Steuer 2 5, Mark W El-Deiry 1 2
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PMID: 32460370 DOI: 10.1002/lary.28725
Abstract
Objectives: To examine survival endpoints in patients with tumor (T)4b oral cavity squamous cell carcinoma (OCSCC) with pathologically proven masticator space invasion treated with primary surgery followed by adjuvant therapy.

Study design: Retrospective review at an academic cancer center.

Methods: Twenty-five patients with T4b OCSCC with pathologic masticator space invasion were treated with primary surgery from May 2012 to December 2016. Only patients with ≥ 2 years follow-up from date of surgery were included. Sixteen patients received adjuvant chemoradiation.

Results: Median follow-up time was 39 months from date of surgery. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival at 24 months were 44.0%, 63.2%, and 52.6%, respectively. On univariate analyses, adjuvant chemoradiation was associated with improved OS. Advanced age and prolonged length of hospital stay was associated with worse OS.

Conclusion: For pT4b OCSCCA involving the masticator space, primary surgical resection followed by adjuvant chemoradiation demonstrates 24-month DSS of > 50% and OS of 44%.

Level of evidence: 4 Laryngoscope, 2020.

Keywords: Oral cavity squamous cell carcinoma; T4b tumor; masticator space; oral cancer.

© 2020 The American Laryngological, Rhinological and Otological Society, Inc.

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175
Neural Netw
. 2020 May 11;128:305-312. doi: 10.1016/j.neunet.2020.05.007. Online ahead of print.
Sparsity Through Evolutionary Pruning Prevents Neuronal Networks From Overfitting
Richard C Gerum 1, André Erpenbeck 2, Patrick Krauss 3, Achim Schilling 4
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PMID: 32454374 DOI: 10.1016/j.neunet.2020.05.007
Abstract
Modern Machine learning techniques take advantage of the exponentially rising calculation power in new generation processor units. Thus, the number of parameters which are trained to solve complex tasks was highly increased over the last decades. However, still the networks fail - in contrast to our brain - to develop general intelligence in the sense of being able to solve several complex tasks with only one network architecture. This could be the case because the brain is not a randomly initialized neural network, which has to be trained from scratch by simply investing a lot of calculation power, but has from birth some fixed hierarchical structure. To make progress in decoding the structural basis of biological neural networks we here chose a bottom-up approach, where we evolutionarily trained small neural networks in performing a maze task. This simple maze task requires dynamic decision making with delayed rewards. We were able to show that during the evolutionary optimization random severance of connections leads to better generalization performance of the networks compared to fully connected networks. We conclude that sparsity is a central property of neural networks and should be considered for modern Machine learning approaches.

Keywords: Artificial neural networks; Biological plausibility; Evolution; Evolutionary algorithm; Maze task; Overfitting.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Conflict of interest statement
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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176
Case Reports Ann Lab Med
. 2020 May;40(3):270-273. doi: 10.3343/alm.2020.40.3.270.
First Two Cases of Infected Aortic Aneurysm Caused by Non-Vaccine Streptococcus pneumoniae Serotype 23A
Risako Kakuta 1, Ryuichi Nakano 2, Hisakazu Yano 2, Daiki Ozawa 3, Nobuo Ohta 4, Takayuki Matsuoka 5, Naotaka Motoyoshi 6, Shunsuke Kawamoto 5, Yoshikatsu Saiki 6, Yukio Katori 3, Mitsuo Kaku 7 8
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PMID: 31858770 PMCID: PMC6933064 DOI: 10.3343/alm.2020.40.3.270
Free PMC article
Conflict of interest statement
No potential conflicts of interest relevant to this article were reported.

10 references
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177
Otolaryngol Head Neck Surg
. 2020 May 26;194599820931827. doi: 10.1177/0194599820931827. Online ahead of print.
Telemedicine During the COVID-19 Pandemic: A Pediatric Otolaryngology Perspective
Sarah E Maurrasse 1, Jeff C Rastatter 1 2, Stephen R Hoff 1 2, Kathleen R Billings 1 2, Taher S Valika 1 2
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PMID: 32450755 DOI: 10.1177/0194599820931827
Abstract
The COVID-19 pandemic has created a situation unparalleled in our lifetime. As the medical community has attempted to navigate a sea of ever-changing information and policies, this uncertainty has instead bred creativity, community, and evolution. Necessity is the mother of invention, and one of the by-products of our rapidly changing environment is the increased reliance on telemedicine. Here, we discuss our experience with incorporating telemedicine into an urban academic pediatric otolaryngology practice, the challenges that we have encountered, and the principles unique to this population.

Keywords: COVID 19; otolaryngology; pediatrics; quality improvement; telemedicine.

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178
Case Reports Korean J Fam Med
. 2020 May;41(3):202-204. doi: 10.4082/kjfm.18.0202. Epub 2020 May 20.
Olfactory Function Test for Early Diagnosis of Vascular Dementia
Kang Duk Suh 1, Sun Mi Kim 2, Doug Hyun Han 2, Hyun Jin Min 1, Kyung Soo Kim 1
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PMID: 32456388 DOI: 10.4082/kjfm.18.0202
Free article
Abstract
Olfactory impairment occurs in patients with Alzheimer's disease, and olfactory function tests are performed for the diagnosis of Alzheimer's disease. However, the diagnosis and patient status are not currently outlined for vascular dementia, and many physicians do not consider concurrent vascular dementia in patients complaining of olfactory dysfunction. Here, we report a case of vascular dementia with no symptoms of dementia other than olfactory dysfunction. This case suggested that the olfactory function test is helpful not only for the diagnosis of Alzheimer's disease but also for the early diagnosis of vascular dementia.

Keywords: Diagnosis; Olfactory Dysfunction; Olfactory Function Test; Vascular Dementia.

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179
Biotechnol Lett
. 2020 May 25. doi: 10.1007/s10529-020-02910-4. Online ahead of print.
Mechanical Loading Induces HIF-1α Expression in Chondrocytes via YAP
Xingzhi Jing 1, Xiaoxia Yang 1, Weimin Zhang 1, Shengjie Wang 2, Xingang Cui 1, Ting Du 3, Tao Li 4
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PMID: 32451801 DOI: 10.1007/s10529-020-02910-4
Abstract
Objectives: To investigate the role of YAP in cyclic mechanical stress induced up-regulation of HIF-1α in rat cartilage chondrocytes.

Results: Our in vitro and in vivo experiments demonstrated that cyclic mechanical stress promoted HIF-1α and YAP proteins expression in a magnitude dependent manner. Cyclic mechanical stress at 4000μ strain exhibited most significant effect in promoting HIF-1α and YAP up-regulation. Activation of YAP using LPA significantly promoted HIF-1α stabilization and expression, while YAP siRNA treatment suppressed the up-regulation of HIF-1α induced by cyclic mechanical stress.

Conclusion: Our results indicated that cyclic mechanical stress promoted HIF-1α stabilization and YAP is involved in mechanical stress induced HIF-1α up-regulation.

Keywords: Chondrocytes; Cyclic mechanical stress; HIF-1α; YAP.

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180
Korean J Fam Med
. 2020 May 27. doi: 10.4082/kjfm.20.0071. Online ahead of print.
Synchronous Occurrence of Bilateral Malignant Otitis Externa: Report of a Rare Case
Nur Adillah Lamry 1, Khairunnisak Misron 2, Tengku Mohamed Izam Tengku Kamalden 2, Azliana Aziz 1, Rosdan Salim 1
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PMID: 32456405 DOI: 10.4082/kjfm.20.0071
Free article
Abstract
Malignant otitis externa (MOE) is a rare and potentially life-threatening disease of the ear and temporal bone. Bilateral simultaneous MOE is extremely rare. Due to bilaterally symmetrical facial nerve palsy, it can easily be missed at the initial presentation, causing delay in management. Here, we report a case of bilateral MOE managed aggressively with regular ear toileting, ear packing with a ribbon gauze soaked with topical antimicrobials, and long-term intravenous and oral antibiotics. The patient showed good improvement in pain control, facial nerve status, and ear findings.

Keywords: Ear; Facial Paralysis; Otitis Externa; Temporal Bone.

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181
Otolaryngol Head Neck Surg
. 2020 May 26;194599820930246. doi: 10.1177/0194599820930246. Online ahead of print.
How Strong Is the Duty to Treat in a Pandemic? Ethics in Practice: Point-Counterpoint
Andrew J Redmann 1 2, Amy Manning 1 2, Aimee Kennedy 1 2, John H Greinwald 1 2, Alessandro deAlarcon 1 2
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PMID: 32450750 DOI: 10.1177/0194599820930246
Abstract
No abstract available
Keywords: COVID-19; duty to treat; ethics.

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182
J Eur Acad Dermatol Venereol
. 2020 May 26. doi: 10.1111/jdv.16672. Online ahead of print.
The COVID-19 Outbreak in Dermatologic Surgery: Resetting Clinical Priorities
Elena Rossi 1, Myrto Trakatelli 2, Luca Giacomelli 3 4, Barbara Ferrari 1, Mariangela Francomano 1, Giovanni Pellacani 1, Cristina Magnoni 1
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PMID: 32455485 DOI: 10.1111/jdv.16672
Abstract
Emilia-Romagna was one of the Italian regions mostly affected by the COVID-19 pandemic and lockdown measures were taken to slow the COVID-19 outbreak. All routine activities in Modena hospitals were suspended; however, urgent procedures were still to be performed. Setting the priority of procedures in oncological dermatology in the COVID-19 era is challenging.

Keywords: COVID-19; SARS-CoV-2; dermatologic surgery; melanoma; non-melanoma skin cancer.

This article is protected by copyright. All rights reserved.

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183
Clin Exp Dermatol
. 2020 May 27. doi: 10.1111/ced.14311. Online ahead of print.
Reduced Induction of Human β-Defensins Is Involved in the Pathological Mechanism of Cutaneous Adverse Effects Caused by EGFR Monoclonal Antibodies
R Ommori 1, Y Nakamura 1, F Miyagawa 1, C Shobatake 1, K Ogawa 1, F Koyama 2, M Sho 2, I Ota 3, T Kitahara 3, S Hontsu 4, S Muro 4, H Asada 1
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PMID: 32460367 DOI: 10.1111/ced.14311
Abstract
Epidermal growth factor receptor inhibitors (EGFRIs) frequently cause cutaneous adverse effects such as papulo-pustular eruptions. However, the mechanism of the reactions remains unclear. We investigated whether EGFRIs have an influence on innate immune response in patients' skin to reveal the pathological mechanism of cutaneous adverse reactions caused by EGFRIs. The levels of human β-defensins (hBDs), which serve as the first line of defense against infection by pathogenic microorganisms, in the stratum corneum samples of patients treated with EGFR monoclonal antibodies (mAbs) were measured before and after starting therapy. In contrast to the findings in patients without eruptions who showed no obvious trends in hBD production, a significant decrease in hBD1 and hBD3 production was observed in patients who developed papulo-pustular eruptions. Similar changes were observed in hBD2 production. Our results may suggest that a reduction in hBD contributes to the increased incidence of papulo-pustular eruptions.

This article is protected by copyright. All rights reserved.

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184
Otolaryngol Head Neck Surg
. 2020 May 26;194599820931082. doi: 10.1177/0194599820931082. Online ahead of print.
The Impact of the Pandemic on Otolaryngology Patients With Negative COVID-19 Status: Commentary and Insights From Orbital Emergencies
Judd H Fastenberg 1 2, Danielle Bottalico 1 3, William A Kennedy 1, Ahmed Sheikh 4, Michael Setzen 5, Rand Rodgers 4
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PMID: 32450752 DOI: 10.1177/0194599820931082
Abstract
Efforts aimed at minimizing the spread of COVID-19 and "flattening the curve" may be affecting clinical care delivery for non-COVID-19 cases that include otolaryngologic and orbital conditions. We are witnessing changes in the manner that patients present, as well as modifications in clinical management strategies. An improved understanding of these phenomena and the contributing factors is essential for otolaryngologists to provide sound clinical care during this unprecedented pandemic.

Keywords: COVID-19; acute sinusitis; graves eye disease; orbital abscess; otolaryngologic emergency; subperiosteal abscess.

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185
Thyroid
. 2020 May 27. doi: 10.1089/thy.2020.0321. Online ahead of print.
Reversal in Thyroid Cancer Incidence Trends in the United States, 2000-2017
Mark Lee 1, Ann E Powers 2, Luc G T Morris 3, Jennifer L Marti 4
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PMID: 32458757 DOI: 10.1089/thy.2020.0321
Abstract
Not applicable.

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186
Ear Nose Throat J
. 2020 May 26;145561320927553. doi: 10.1177/0145561320927553. Online ahead of print.
Fibrous Salivary Ductal Stricture: A Novel Histopathologic Correlate
Kathryn S Marcus 1, Vivian L Zhu 2, Renee L Eigsti 3, Henry T Hoffman 2
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PMID: 32453645 DOI: 10.1177/0145561320927553
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187
Nat Med
. 2020 May 26. doi: 10.1038/s41591-020-0927-z. Online ahead of print.
Mass-surveillance Technologies to Fight Coronavirus Spread: The Case of Israel
Moran Amit 1, Heli Kimhi 1, Tarif Bader 2 3, Jacob Chen 4, Elon Glassberg 2 5 6, Avi Benov 7 8
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PMID: 32457444 DOI: 10.1038/s41591-020-0927-z
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188
Otolaryngol Head Neck Surg
. 2020 May 26;194599820931819. doi: 10.1177/0194599820931819. Online ahead of print.
An Otolaryngologist Redeployed to a COVID-19 Intensive Care Unit: Lessons Learned
Shumon Ian Dhar 1
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PMID: 32450756 DOI: 10.1177/0194599820931819
Abstract
The COVID-19 pandemic has placed a significant personnel burden on intensive care units across the globe. Physicians from various specialties, including otolaryngology, have heeded the call and been redeployed to provide support, serving in a capacity outside their usual scope of practice. The author shares personal experience from redeployment and provides a framework for otolaryngologists to maximize their impact while providing high-quality patient care and preserving their personal safety.

Keywords: COVID-19; coronavirus; otolaryngology; redeployment.

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189
Plast Reconstr Surg
. 2020 Jun;145(6):1418-1419. doi: 10.1097/PRS.0000000000006866.
Discussion: Practical Classification of Upper Lateral Cartilage in Middle Vault Asymmetry
Dean M Toriumi 1
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PMID: 32459771 DOI: 10.1097/PRS.0000000000006866
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190
Oral Surg Oral Med Oral Pathol Oral Radiol
. 2020 Apr 18;S2212-4403(20)30163-2. doi: 10.1016/j.oooo.2020.04.009. Online ahead of print.
Virtual Assistance in Oral Medicine for Prioritizing Oral Cancer Diagnosis During the COVID-19 Pandemic
Marcio Ajudarte Lopes 1, Alan Roger Santos-Silva 1, Pablo Agustin Vargas 1, Luiz Paulo Kowalski 2
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PMID: 32451230 PMCID: PMC7165284 DOI: 10.1016/j.oooo.2020.04.009
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11 references
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191
J Biol Regul Homeost Agents
. Mar-Apr 2020;34(2):679-682. doi: 10.23812/20-70-L-3.
Prophylaxis With rFVIIa Before Third Molar Extraction in a Patient With Factor VII Deficiency
P C Passarelli 1, V Desantis 1, P De Angelis 1, G B Piccirillo 1, V Giovannini 1, P Papi 2, G Pompa 2, A D'Addona 1
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PMID: 32458671 DOI: 10.23812/20-70-L-3
Abstract
No abstract available
Keywords: bleeding disorder; extraction; oral surgery; third molar.

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