Multilevel Sleep Surgery Including the Palate in Nonsyndromic, Neurologically Intact Children with Obstructive Sleep Apnea

OBJECTIVE: To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population. STUDY DESIGN: A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017. SETTING: A tertiary care, university children\u27s hospital. SUBJECTS AND METHODS: Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN within the same patient for the effects of adenotonsillectomy (T&A) vs multilevel sleep surgery. RESULTS: In patients who underwent T&A previously, multilevel sleep surgery, including palate procedures, resulted in improved OSA severity in 6 (86%) patients and worsened OSA in 1 (14%) patient. Multilevel sleep surgery, including palate procedures, significantly decreased mean AHI from 37.98 events/h preoperatively to 8.91 events/h postoperatively (P = .005). However, it did not significantly decrease OSN. CONCLUSION: This study includes one of the largest populations of children in whom palate procedures as a part of multilevel sleep surgery have been performed safely with no major complications and a low rate of velopharyngeal insufficiency. Therefore, palatal surgery as a part of multilevel sleep surgery is not necessarily the pariah that we have traditional thought it is in pediatric otolaryngology

Solid variant of aneurysmal bone cyst of the thoracic spine: a case report

<p>Abstract</p> <p>Introduction</p> <p>The solid variant of aneurysmal bone cyst is rare, and only 13 cases involving the spine have been reported to date, including seven in the thoracic vertebrae. The diagnosis is difficult to secure radiographically before biopsy or surgery.</p> <p>Case report</p> <p>An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits. An MRI scan demonstrated a 6 cm diameter enhancing multi-cystic mass centered at the T6 vertebral body with involvement of the left proximal sixth rib and extension into the pleural cavity; the spinal cord was severely compressed with evidence of abnormal T2 signal changes. Our patient was taken to the operating room for a total spondylectomy of T6 with resection of the left sixth rib from a single-stage posterior-only approach. The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation. Histologically, the resected specimen showed predominant solid fibroblastic proliferation, with minor foci of reactive osteoid formation, an area of osteoclastic-like giant cells, and cyst-like areas filled with erythrocytes and focal hemorrhage, consistent with a predominantly solid variant of aneurysmal bone cyst. At 16 months after surgery, our patient remains neurologically intact with resolution of his chest and back pain.</p> <p>Conclusions</p> <p>Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting. The solid variant of aneurysmal bone cyst is difficult to diagnose radiologically before biopsy or surgery, and we hope to remind other physicians that it should be included in the differential diagnosis of any lytic expansile destructive lesion of the spine.</p

Mono- versus polydrug abuse patterns among publicly funded clients

To examine patterns of mono- versus polydrug abuse, data were obtained from intake records of 69,891 admissions to publicly funded treatment programs in Tennessee between 1998 and 2004. While descriptive statistics were employed to report frequency and patterns of mono- and polydrug abuse by demographic variables and by study years, bivariate logistic regression was applied to assess the probability of being a mono- or polydrug abuser for a number of demographic variables. The researchers found that during the study period 51.3% of admissions reported monodrug abuse and 48.7% reported polydrug abuse. Alcohol, cocaine, and marijuana were the most commonly abused substances, both alone and in combination. Odds ratio favored polydrug abuse for all but one drug category–other drugs. Gender did not affect drug abuse patterns; however, admissions for African Americans and those living in urban areas exhibited higher probabilities of polydrug abuse. Age group also appeared to affect drug abuse patterns, with higher odds of monodrug abuse among minors and adults over 45 years old. The discernable prevalence of polydrug abuse suggests a need for developing effective prevention strategies and treatment plans specific to polydrug abuse

Velocity-spectrum testing using a closed kinetic chain

Two force and two power variables were monitored during standardized multiple-joint, closed-chain, velocity-spectrum tests to ascertain if contiguous velocities produced discrete or redundant output. Measurements were obtained from 52 men and 50 women during squats performed at six velocities ranging from 0.51 to 2.04 m·s-1. Main effects as well as the sex-by-main-effects interaction were significant (P \u3c 0.001) for all four variables. Therefore, post hoc tests were performed separately for men and women. Maximal squatting forces over the velocity spectrum produced force-velocity curves resembling classical single-joint ones. The highest force output occurred at the slowest test velocity as expected and signifcantly decreased (P \u3c 0.05) for each increment in velocity for both men and women. Concurrently, maximal squatting power over the velocity spectrum produced power-velocity curves resembling classical single-joint ones. The highest power output (x- = 1.26 m·s-1) occurred as part of a plateau at intermediate velocities as expected and was signifcantly less at faster and slower velocities. However, maximal power output generally materialized at faster velocities for men (x- = 1.54 m·s-1) than for women (x- = 0.97 m·s-1). It appears the six squatting velocities used in this investigation elicit discrete force data for both men and women, and results for force and power resemble what would be expected for isolated single-joint testing protocols. However, it remains unclear why an apparent gender difference exists in the velocity at which the highest peak power is produced

Variance components of indoor and outdoor VOC concentrations

Concentrations of airborne volatile organic compounds (VOCs) can vary tremendously in both indoor and outdoor environments, yet few studies have quantitatively partitioned the variability. Using VOC concentrations measured inside and outside of 162 residences in three industrial, urban and suburban communities in southeast Michigan, U.S.A., the variance of concentrations is apportioned across cities, between homes, between seasons, and between replicate measurements using mixed-models. In indoor environments, measurement uncertainty contributed less than 20% of the indoor variances, thus measurements were highly reproducible. Between-home and seasonal variances contributed 34 and 54%, respectively, of the total variance. Across-city variation was small, suggesting that neighborhood effects were insignificant. For outdoor concentrations, different patterns emerged: variance components were generally ranked as seasonal \u3e between-replicate \u3e across city \u3e across-site. Thus, ambient VOCs displayed strong seasonal and neighbourhood effects. Measurement uncertainties occurring at low concentrations may confound the other factors

The Relationship Between Body Weight Concerns and Adolescent Smoking

Although a number of factors have been found to predict smoking status among adolescents, few researchers have examined how belief in smoking as a weight-control strategy may be related to smoking in this high-risk population. With the goal of discovering whether belief in smoking as a weight-control strategy predicted smoking status, the present investigation surveyed 659 Black and White high school students. Analyses showed that among regular smokers, 39% of White female and 12% of White male smokers reported using smoking to control their appetite and weight. In contrast, not a single Black male or female reported using smoking to control appetite and weight. Although belief in smoking as a weight-control strategy did not predict regular smokers versus never smokers, the weight-belief item reliably separated experimental smokers from regular smokers. The survey also revealed that White female restrained eaters were the most likely to actually use smoking as a weight-control strategy

The Relationships Among Students\u27 Future-Oriented Goals and Subgoals, Perceived Task Instrumentality, and Task-Oriented Self-Regulation Strategies in an Academic Environment

The authors performed path analysis, followed by a bootstrap procedure, to test the predictions of a model explaining the relationships among students\u27 distal future goals (both extrinsic and intrinsic), their adoption of a middle-range subgoal, their perceptions of task instrumentality, and their proximal task-oriented self-regulation strategies. The model was based on R. B. Miller and S. J. Brickman\u27s (2004) conceptualization of future-oriented motivation and self-regulation, which draws primarily from social-cognitive and self-determination theories. Participants were 421 college students who completed a questionnaire that included scales measuring the 5 variables of interest. Data supported the model, suggesting that students\u27 distal future goals (intrinsic future goals in particular) may be related to their middle-range college graduation subgoal, to their perceptions of task instrumentality, and to their adoption of proximal task-oriented self-regulation strategies. © 2008 American Psychological Association

Effects of childhood exposure to PM2.5 in a Memphis pediatric asthma cohort

The effects of childhood exposure to ambient air pollution and their influences on healthcare utilization and respiratory outcomes in Memphis pediatric asthma cohort are still unknown. This study seeks to (1) investigate individual-level associations between asthma and exposure measures in high asthma rate and low asthma rate areas and (2) determine factors that influence asthma at first year of a child’s life, first 2 years, first 5 years, and during their childhood. Datasets include physician-diagnosed asthma patients, on-road and individual PM2.5 emissions, and high-resolution spatiotemporal PM2.5 estimates. Spatial analytical and logistic regression models were used to analyze the effects of childhood exposure on outcomes. Increased risk was associated with African American (AA) (odds ratio (OR) = 3.09, 95% confidence interval (CI) 2.80–3.41), aged \u3c 5 years old (OR = 1.31, 95% 1.17–1.47), public insurance (OR = 2.80, 95% CI 2.60–3.01), a 2.5-km radius from on-road emission sources (OR = 3.06, 95% CI 2.84–3.30), and a 400-m radius from individual PM2.5 sources (OR = 1.33, 95% CI 1.25–1.41) among the cohort with residence in high asthma rate areas compared to low asthma rates areas. A significant interaction was observed between race and insurance with the odds of AA being approximately five times (OR = 4.68, 95% CI 2.23–9.85), public insurance being about three times (OR = 2.65, 95% CI 1.68–4.17), and children in their first 5 years of life have more hospital visits than other age groups. Findings from this study can guide efforts to minimize emissions, manage risk, and design interventions to reduce disease burden

Variability of indoor and outdoor VOC measurements: An analysis using variance components

This study examines concentrations of volatile organic compounds (VOCs) measured inside and outside of 162 residences in southeast Michigan, U.S.A. Nested analyses apportioned four sources of variation: city, residence, season, and measurement uncertainty. Indoor measurements were dominated by seasonal and residence effects, accounting for 50 and 31%, respectively, of the total variance. Contributions from measurement uncertainty (\u3c20%) and city effects (\u3c10%) were small. For outdoor measurements, season, city and measurement variation accounted for 43, 29 and 27% of variance, respectively, while residence location had negligible impact (\u3c2%). These results show that, to obtain representative estimates of indoor concentrations, measurements in multiple seasons are required. In contrast, outdoor VOC concentrations can use multi-seasonal measurements at centralized locations. Error models showed that uncertainties at low concentrations might obscure effects of other factors. Variance component analyses can be used to interpret existing measurements, design effective exposure studies, and determine whether the instrumentation and protocols are satisfactory

Computation of noncentral ƒ probabilities. A computer program

Methods of computing the noncentral F probabilities for integer degrees of freedom are proposed. A computer program is developed which calculates the noncentral F probability for a desired accuracy. This program is written in FORTRAN and can be easily converted to any computer supporting ANSI 77 Standard. Some comparisons are made. © 1992