SCULLING TECHNIQUES IN SYNCHRONIZED SWIMMING

The purpose of this study was to investigate sculling techniques in synchronized swimming based on three-dimensional motion analysis. Movements during sculling for ten elite synchronized swimmers were analyzed using a three-dimensional direct linear transformation method. Sculling! techniques for more advanced synchronized swimmers included holding the elbows and upper arms stationary and changing the attack angles of the hands smoothly and evenly. When swimmers were given a 1.5-kg load, scull tempo increased and range of motion of the forearms was reduced

Functionally confirmed compound heterozygous ADAM17 missense loss-of-function variants cause neonatal inflammatory skin and bowel disease 1

A disintegrin and metalloprotease 17 (ADAM17) is the major sheddase that processes more than 80 substrates, including tumour necrosis factor-α (TNFα). The homozygous genetic deficiency of ADAM17 causing a complete loss of ADAM17 expression was reported to be linked to neonatal inflammatory skin and bowel disease 1 (NISBD1). Here we report for the first time, a family with NISBD1 caused by functionally confirmed compound heterozygous missense variants of ADAM17, namely c.1699T>C (p.Cys567Arg) and c.1799G>A (p.Cys600Tyr). Both variants were detected in two siblings with clinical features of NISBD1, such as erythroderma with exudate in whole body, recurrent skin infection and sepsis and prolonged diarrhoea. In a cell-based assay using Adam10/17 double-knockout mouse embryonic fibroblasts (Adam10/17−/− mEFs) exogenously expressing each of these mutants, phorbol 12-myristate 13-acetate-stimulated shedding was strongly reduced compared with wild-type ADAM17. Thus, in vitro functional assays demonstrated that both missense variants cause the loss-of-function of ADAM17, resulting in the development of NISBD1. Our study further expands the spectrum of genetic pathology underlying ADAM17 in NISBD1 and establishes functional assay systems for its missense variants

Mental workload during endoscopic sinus surgery is associated with surgeons’ skill levels

IntroductionSurgeons’ mental workload during endoscopic sinus surgery (ESS) has not been fully evaluated. The assessment was challenging due to the great diversity of each patient’s anatomy and the consequence variety of surgical difficulties. In this study, we examined the mental workload of surgeons with various surgical skill levels during ESS under the standardized condition provided by novel-designed 3D sinus models.Materials and methodsForty-seven participants performed a high-fidelity ESS simulation with 3D-printed sinus models. Surgeons’ mental workload was assessed with the national aeronautics and space administration-task load index (NASA-TLX). Associations between the total and subscales score of NASA-TLX and surgical skill index, including the board certification status, the number of experienced ESS cases, and the objective structured assessment of technical skills (OSATS), were analyzed. In addition, 10 registrars repeated the simulation surgery, and their NASA-TLX score was compared before and after the repetitive training.ResultsThe total NASA-TLX score was significantly associated with OSATS score (p = 0.0001). Primary component analysis classified the surgeons’ mental burden into three different categories: (1) the skill-level-dependent factors (temporal demand, effort, and performance), (2) the skill-level-independent factors (mental and physical demand), and (3) frustration. After the repetitive training, the skill-level-dependent factors were alleviated (temporal demand; z = −2.3664, p = 0.0091, effort; z = −2.1704, p = 0.0346, and performance; z = −2.5992, p = 0.0017), the independent factors were increased (mental demand; z = −2.5992, p = 0.0023 and physical demand; z = −2.2509, p = 0.0213), and frustration did not change (p = 0.3625).ConclusionSome of the mental workload during ESS is associated with surgical skill level and alleviated with repetitive training. However, other aspects remain a burden or could worsen even when surgeons have gained surgical experience. Routine assessment of registrars’ mental burdens would be necessary during surgical training to sustain their mental health

Otologic and rhinologic manifestations of EGPA

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic autoimmune disease that manifests as asthma, recurrent sinusitis and peripheral eosinophilia. In this study, we investigated the clinical features of the ear and nasal manifestations of EGPA in comparison with those of granulomatosis with polyangiitis (GPA). Materials and Methods: Twenty-one patients diagnosed with EGPA were studied. The frequency of otologic manifestations, the degree of hearing loss and the frequency of nasal symptoms were assessed. The onset of ear symptoms, sinusitis and asthma in patients with EGPA were also examined. Results: Eleven patients (52.4%) with EGPA demonstrated otologic symptoms. The EGPA patients commonly presented mild-to-moderate mixed or sensorineural hearing loss. The pattern of hearing loss was mainly flat, and all but 1 patient achieved complete remission from their hearing impairments. Eighteen patients (85.7%) with EGPA demonstrated nasal symptoms. Patients with EGPA showed a significantly higher incidence of nasal polyps than did those with GPA. The median Lund and Mackey scoring system score was 13.7 for patients with EGPA, and ethmoid sinus shadows were more severe than those of the maxillary sinus. Most ear symptoms associated with EGPA were observed after definitive diagnosis, although sinusitis and asthma tended to manifest themselves before diagnosis. There were significant differences between the onset of ear symptoms and those of asthma and sinusitis. Conclusion: As over 80% of patients with EGPA had nasal symptoms and over half had ear symptoms, otolaryngologists should be aware of this disease. Recognition of the characteristic ear and nasal symptoms are thought to be particularly important to obtain an early diagnosis of EGPA

The Quantification of Extracellular Trap Cell Death-Derived Products as Diagnostic Biomarkers for Otitis Media With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and Eosinophilic Otitis Media

Objective: This study aimed to quantify the cell-free deoxyribonucleic acid (DNA), citrullinated-histone H3 (cit-H3)-DNA complex, and myeloperoxidase (MPO)-DNA complex as extracellular trap cell death (ETosis)-derived products in the middle ear fluid, and to identify diagnostic biomarkers for the discrimination of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) from eosinophilic otitis media (EOM). Study Design: Prospective study. Setting: Tertiary referral center. Patients: OMAAV patients were eligible for inclusion in this analysis. Patients with EOM were examined as controls. Intervention: All samples were obtained from the middle ear fluid in patients with OMAAV or EOM. The fluid samples were aspirated from the middle ear through the anterior-inferior portion of the tympanic membrane using a 1-ml tuberculin syringe with a 24- or 26-gauge needle under a microscope. Main Outcome Measures: The levels of cell-free DNA, cit-H3-DNA complex and MPO-DNA complex in the fluid samples were quantified using an enzyme-linked immunosorbent assay. Results: Patients with OMAAV showed significantly higher levels of MPO-DNA complex compared to patients with EOM, regardless of the serum ANCA status at the time of sampling (p p < 0.001, respectively). Meanwhile, there were no significant differences in the values of cell-free DNA or cit-H3-DNA complex between the OMAAV and EOM patients. Conclusion: The findings of this study suggest that the detection and quantification of MPO-DNA complex in the otitis media fluid can be utilized to discriminate OMAAV, especially in cases of eosinophilic granulomatosis with polyangiitis, from EOM regardless of the serum ANCA status. It should be noted that it is possible for cell-free DNA and cit-H3-DNA complex in fluid samples to be derived from dead cells other than neutrophils that undergo ETosis

Estimates of GHG emission reduction potential by country, sector, and cost

In this study, emission reduction potentials in greenhouse gases (GHG) are assessed by country, sector, and cost using a GHG emission reduction assessment model with high resolutions with respect to region and technology and high consistency in terms of assumptions, interrelationships, and solution principles. Model analyses show that large potential reductions can be achieved at low cost in developing countries and power sectors. In addition, cost-efficient emission reductions were evaluated for some international emission reduction targets that have been derived on the basis of the principle of common but differentiated responsibilities among developed and developing countries. If (1) emission reduction measures at negative costs and below 50 $/tCO2 for developed countries, (2) intensity improvement measures for selected sectors at negative costs and below 20Â$/tCO2 for major developing countries, and (3) all emission reduction measures with negative costs for other developing countries in 2020 are adopted, then emission reductions of 8.9, 14.8, and 27.7 GtCO2 eq./yr compared to the technology-frozen case can be expected in developed countries, major developing countries, and globally, corresponding to a 11% decrease, 40% increase, and 17% increase from 2005 levels, respectively. Large-scale emission reductions can be achieved even if CO2-intensity targets for major sectors are assumed for major developing countries.Climate change Emission reduction cost Sectoral approach

Objective evaluation of caudal deviation of the nasal septum and selection of the appropriate septoplasty technique

Objective: Several methods have been reported to correct caudal deviation of the nasal septum, including open septorhinoplasty (OSR) and septoplasty with Killian incision (KI). In general, OSR is applied instead of KI for caudal deviation. However, there is little objective evidence own on the effects of OSR and KI for caudal deviation. In this study, we compared surgical outcomes between OSR and KI by quantifying nasal septum deviation using two simple and objective parameters on routine paranasal sinus CT scans. Methods: We retrospectively analyzed 18 patients who underwent OSR and 11 patients who underwent septoplasty with KI between April 2006 and October 2019. Caudal deviation was defined on the basis of the "Anterior-posterior Position of the most deviated point of the nasal septum (AP)," which was measured on computerized tomography. The deformation rate (DR) of the nasal septum was also calculated. Nasal airway resistance and visual analogue scale (VAS) score for nasal obstruction were examined. Results: The AP was significantly correlated with the VAS score (r =-0.58, p = 0.017). The DR in patients with caudal septal deviation was significantly decreased by OSR (0.14 +/- 0.06 to 0.03 +/- 0.03, p = 0.004), but not by KI (0.09 +/- 0.08 to 0.04 +/- 0.03, p = 0.25). OSR also improved nasal airway resistance (1.10 +/- 0.44 to 0.42 +/- 0.15, p = 0.02), and the VAS score (79.11 +/- 14.74 to 5.78 +/- 7.89, p = 0.004). Conclusion: Nasal obstruction is more severe in patients with the caudal deviation. OSR corrects caudal deviation of the nasal septum more effectively than does KI. The AP could be useful for the evaluation of the deviation of the nasal septum and help in selecting the appropriate septoplastic technique . (C) 2021 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved