Endoscopic Posterior Cricoid Split with Costal Cartilage Graft: A Fifteen‐Year Experience

Objective To evaluate outcomes of the endoscopic posterior cricoid split with rib graft (EPCS/RG) procedure in the treatment of subglottic stenosis (SGS), posterior glottic stenosis (PGS), and bilateral vocal fold immobility (BVFI). Study Design Retrospective chart review. Methods Chart review of all patients who underwent EPCS/RG at a single tertiary-care facility between 1999 and 2014. Patients were grouped based on the primary indication for the procedure. Decannulation was the primary endpoint. Secondary endpoints were the number of subsequent airway procedures and length of hospitalization. Results Thirty-three patients were identified; 32 had tracheotomy. Overall decannulation rate was 65.6%. Subgroup analysis demonstrated the following decannulation rates: 53.8% for SGS, 100% for PGS, and 28.6% for BVFI. Fisher exact test found a significant difference in overall decannulation rates between groups (P = 0.002). Operation-specific decannulation rates for patients who never required an open procedure were 23% for SGS, 91.6% for PGS, and 28.6% for BVFI. This difference was also statistically significant (P = 0.001). Multivariate logistic regression analysis found prematurity had a positive correlation with decannulation that approached statistical significance (P < 0.051; odds ratio 6.1; 95% confidence interval 0.99, 37.6). The percentage of patients who underwent repeat airway procedures for the groups was 61.5% for SGS, 16.6 % for PGS, and 14.3% for BVFI. The median length of hospitalization after EPCS/RG was 3 days. Conclusion This represents the largest series of patients who have undergone EPCS/RG and demonstrates that the majority of patients can be decannulated after this procedure. Patients with PGS had the highest operation-specific decannulation rates

Clinically small tonsils are typically not obstructive in children during drug-induced sleep endoscopy

OBJECTIVE: To determine whether the degree of lateral pharyngeal wall (LPW) obstruction on pediatric drug-induced sleep endoscopy (DISE) correlates with preprocedure tonsillar hypertrophy score on physical examination, and to determine if clinically small tonsils are obstructive. METHODS: Retrospective review of 154 patients who underwent DISE at a single pediatric tertiary care center over a 4-year period. Inclusion criteria were documentation of Brodsky tonsil score on preoperative physical examination. Exclusion criteria were previous tonsillectomy, adenoidectomy, or adenotonsillectomy. Lateral pharyngeal wall obstruction was graded for each patient from 0 (no obstruction) to 3 (severe obstruction) using a validated pediatric DISE scoring system known as the Chan-Parikh scoring system (C-P). Data were analyzed using multivariate linear regression controlling for age at time of DISE and presence of comorbid conditions. RESULTS: One hundred fifteen patients met criteria for analysis. Median age at DISE was 5.1 years. A moderate positive correlation was calculated between Brodsky score and DISE score, Spearman correlation coefficient 0.55, P = 50% obstruction); and six (9%) had a score of 3 (100% obstruction). CONCLUSION: There is a positive correlation between Brodsky Score and DISE LPW score. The majority of children with sleep-disordered breathing with a Brodsky score of 1 did not demonstrate LPW obstruction. These children may benefit from DISE for identification of alternative sites of upper airway obstructio

Phyto-assisted synthesis of Silver nanoparticles using Tinospora cordifolia leaf extract and their antibacterial activity: An ecofriendly approach

To meet the increasing demands for commercial nanoparticles new eco-friendly methods of synthesis are being discovered. Plant mediated synthesis of nanoparticles offers single step, easy extracellular synthesis of nanoparticles. We report the synthesis of antibacterial Silver nanoparticles using leaf extract of the medicinal plant, Tinospora cordifolia. The leaf extract was prepared by boiling chopped leaves of Tinospora cordifolia in deionized water for 10 min and filtering the mixture with Whatman filter paper No.1. The filtrate was used as a reducing agent and stabilising agent for AgNO3. On adding 1 mM solution of Silver nitrate to the leaf extract and stirring at 75 °C for 25 min, a change in colour from yellow-brown to brown-black specified the production of Silver nanoparticles. The formation of Silver nanoparticles was monitored by UV-visible spectroscopy and further characterization of the synthesized Silver nanoparticles was done by XRD studies. The antibacterial studies were performed on Gram negative and Gram positive pathogens, Salmonella typhi, Pseudomonas aeruginosa, Enterobacter aerogenes and Staphylococcus aureus, by agar well diffusion method, on Mueller Hinton agar medium. The Silver nanoparticles synthesized from Tinospora cordifolia leaf extract were found to have antimicrobial activity against these Gram negative and Gram positive pathogenic bacteria

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Pediatric Nasal Lobular Capillary Hemangioma

Background. LCH is a benign vascular growth of the skin and mucous membranes commonly affecting the head and neck. Since it was first described in the nineteenth century, this entity has been variously known as “human botryomycosis” and “pyogenic granuloma.” The shifting nomenclature reflects an evolving understanding of the underlying pathogenesis. We review the histopathology of and current epidemiological data pertaining to LCH which suggests that the development of these lesions may involve a hyperactive inflammatory response influenced by endocrine factors. We report two new cases of pediatric lobular capillary hemangioma (LCH) of the nasal cavity and review current theories regarding the etiology, diagnosis, and treatment of nasal LCH. Methods. Retrospective case series. Case Series. Two adolescent females presented with symptoms of recurrent epistaxis, nasal obstruction, and epiphora. Both patients underwent computed tomography imaging and biopsy of their intranasal mass. The tumors were excised using image-guided transnasal endoscopic technique. Seven other cases of nasal LCH have been reported to date in the pediatric population. Conclusion. Nasal LCH is a rare cause of an intranasal mass and is associated with unilateral epistaxis, nasal obstruction, and epiphora. We advocate for image-guided endoscopic excision of LCH in the adolescent population

The Role of Language Concordant Care on Increasing Parental Engagement in Shared Decision Making

BACKGROUND: Shared decision making (SDM) allows patients and physicians to make decisions together by incorporating clinical expertise and patient preference. While SDM can improve patient satisfaction, preferences on the extent of involvement in SDM vary, particularly among different cultures and languages. We sought to describe preferences in decision making and degree of SDM among Spanish-speaking caregivers receiving pediatric Otolaryngology care. We hypothesized that language-concordant encounters would have higher SDM scores. METHODS: A cross-sectional study of Spanish-speaking caregivers undergoing consultation with pediatric otolaryngology was performed (May-August 2022). Care was provided in a language-concordant (LC) setting in which the physician and caregiver communicate in Spanish, or a language–discordant (LD) setting in which the physician communicates with interpreter support. Following their appointment, caregivers were invited to complete the Spanish Control Preferences Scale (CPS, select 2 of 5 options) to determine their two most preferred roles in medical decision making, and the Shared Decision-Making Questionnaire (SDM-Q-9; scored 0-100) to assess perceived SDM. Descriptive statistics, Fisher’s exact and the Mann-Whitney U test were used for analysis. RESULTS: Sixty-one caregivers were enrolled. CPS scores revealed the passive-collaborative medical decision making role was the most favored (59%), followed by an active-collaborative role (26%), and passive role (13%). Median SDM-Q-9 score for all caregivers was 100.00 (mean=93.70). The median SDMQ-9 score was 100 in LC visits, and 97.78 in LD visits (p = 0.428). No differences in SDM-Q-9 scores were detected for CPS categories between LC and LD visits. CONCLUSION: High levels of SDM were observed among Spanish-speaking caregivers using both LC and LD care. Most caregivers preferred a passive-collaborative role in medical decision making. Results may be influenced by positive response bias given the high scores observed. Further studies with larger sample sizes can further our understanding of the impact of LC care in SDM

A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws

Objectives Postoperative calcium management is challenging following pediatric thyroidectomy given potential limitations in self-reporting symptoms and compliance with phlebotomy. A protocol was created at our tertiary children's institution utilizing intraoperative parathyroid hormone (PTH) levels to guide electrolyte management during hospitalization. The objective of this study was to determine the effect of a new thyroidectomy postoperative management protocol on two primary outcomes: (1) the number of postoperative calcium blood draws and (2) the length of hospital stay. Study design Institutional review board approved retrospective study (2010–2016). Methods Consecutive pediatric total thyroidectomy and completion thyroidectomy ± neck dissection cases from 1/1/2010 through 8/5/2016 at a single tertiary children's institution were retrospectively reviewed before and after initiation of a new management protocol. All cases after 2/1/2014 comprised the experimental group (post-protocol implementation). The pre-protocol control group consisted of cases prior to 2/1/2014. Multivariable linear and Poisson regression models were used to compare the control and experimental groups for outcome measure of number of calcium lab draws and hospital length of stay. Results 53 patients were included (n = 23, control group; n = 30 experimental group). The median age was 15 years. 41 patients (77.4%) were female. Postoperative calcium draws decreased from a mean of 5.2 to 3.6 per day post-protocol implementation (Rate Ratio = 0.70, p < .001), adjusting for covariates. The mean number of total inpatient calcium draws before protocol initiation was 13.3 (±13.20) compared to 7.2 (±4.25) in the post-protocol implementation group. Length of stay was 2.1 days in the control group and 1.8 days post-protocol implementation (p = .29). Patients who underwent concurrent neck dissection had a longer mean length of stay of 2.32 days compared to 1.66 days in those patients who did not undergo a neck dissection (p = .02). Hypocalcemia was also associated with a longer mean length of stay of 2.41 days compared to 1.60 days in patients who did not develop hypocalcemia (p < .01). Conclusions The number of calcium blood draws was significantly reduced after introduction of a standardized protocol based on intraoperative PTH levels. The hospital length of stay did not change. Adoption of a standardized postoperative protocol based on intraoperative PTH levels may reduce the number of blood draws in children undergoing thyroidectomy

Clean Coal Power Initiative

This report is the fifth quarterly Technical Progress Report submitted by NeuCo, Incorporated, under Award Identification Number, DE-FC26-04NT41768. This award is part of the Clean Coal Power Initiative (''CCPI''), the ten-year, $2B initiative to demonstrate new clean coal technologies in the field. This report is one of the required reports listed in Attachment B Federal Assistance Reporting Checklist, part of the Cooperative Agreement. The report covers the award period January 1, 2006 - March 31, 2006 and NeuCo's efforts within design, development, and deployment of on-line optimization systems during that period

Synthesis and characterization of a novel inulin hydrogel crosslinked with pyromellitic dianhydride

This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 24 month embargo from date of publication (November 2018) in accordance with the publisher’s archiving policy.Smart hydrogels with pH and enzyme triggered release suitable for colon specific drug delivery were prepared by crosslinking inulin with pyromellitic dianhydride (PMDA) in a simple one pot synthesis. Back titration, Fourier transform infrared spectroscopy (FTIR) and ultraviolet spectrophotometry (UV) demonstrated that the hydrogel crosslinking reaction resulted in ester linkages and carboxylic acid groups and that the amount of the crosslinker in the hydrogel increased with increasing PMDA concentration in the crosslinking reaction. Thermal analysis and scanning electron microscopy (SEM) confirmed the chemical change by illustrating the hydrogels changed thermal properties and appearance compared to inulin. This hydrogel showed excellent swelling in water and the degree of swelling was inversely proportional to the cross-linking density, as determined using Flory-Rehner theory. Due to the presence of the carboxylic acid groups in the structure, the swelling was pH dependent, with significantly reduced swelling as acidity decreased from pH 7.4 to pH 1.2.This research work was also supported by a grant from the Australian Research Council's Linkage Projects funding scheme (Project number LP140100142)

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio