Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale

The nasal obstruction symptom evaluation (NOSE) scale is a validated disease-specific, self-completed questionnaire for the assessment of quality of life related to nasal obstruction. The aim of this study was to validate the Dutch (NL-NOSE) questionnaire. A prospective instrument validation study was performed in a tertiary academic referral center. Guidelines for the cross-cultural adaptation process from the original English language scale into a Dutch language version were followed. Patients undergoing functional septoplasty or septorhinoplasty and asymptomatic controls completed the questionnaire both before and 3 months after surgery to test reliability and validity. Additionally, we explored the possibility to reduce the NOSE scale even further using graded response models. 129 patients and 50 controls were included. Internal consistency (Cronbach’s alpha 0.82) and test–retest reliability (intraclass correlation coefficient 0.89) were good. The instrument showed excellent between-group discrimination (Mann–Whitney U = 85, p < 0.001) and high response sensitivity to change (Wilcoxon rank p < 0.001). The NL-NOSE correlated well with the score on a visual analog scale measuring the subjective sensation of nasal obstruction, with exception of item 4 (trouble sleeping). Item 4 provided the least information to the total sc

A critical appraisal of perioperative sleep apnoea management after nasal surgery:A review of up-to-date literature supplemented by findings of a retrospective observational study

Objective: To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery. Design: Retrospective cohort study. Setting: Department of Otorhinolaryngology and Anesthesiology/Intensive Care, University Teaching Hospital, Rotterdam, the Netherlands. Participants: The medical charts of 61 patients with sleep apnoea who were admitted to the post-anaesthesia care unit between 2016 and 2020, following nasal surgery were reviewed. Main outcome measures: Number of respiratory events during post-anaesthesia care unit admission that required medical intervention. Results: In all 61 patients, continuous positive airway pressure could not be used. In 13 patients (8%), decreased oxygen saturation levels were registered during the first postoperative night, and in five of these patients, supplemental oxygen was needed. No other respiratory incidents of medical interventions were registered. Conclusions: The number of clinically relevant respiratory events of obstructive sleep apnoea patients with bilateral nasal packing following nasal surgery is low. We suggest that the safety of less expensive and less scarce alternatives of postoperative observation should be explored.</p

A critical appraisal of perioperative sleep apnoea management after nasal surgery:A review of up-to-date literature supplemented by findings of a retrospective observational study

Objective: To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery. Design: Retrospective cohort study. Setting: Department of Otorhinolaryngology and Anesthesiology/Intensive Care, University Teaching Hospital, Rotterdam, the Netherlands. Participants: The medical charts of 61 patients with sleep apnoea who were admitted to the post-anaesthesia care unit between 2016 and 2020, following nasal surgery were reviewed. Main outcome measures: Number of respiratory events during post-anaesthesia care unit admission that required medical intervention. Results: In all 61 patients, continuous positive airway pressure could not be used. In 13 patients (8%), decreased oxygen saturation levels were registered during the first postoperative night, and in five of these patients, supplemental oxygen was needed. No other respiratory incidents of medical interventions were registered. Conclusions: The number of clinically relevant respiratory events of obstructive sleep apnoea patients with bilateral nasal packing following nasal surgery is low. We suggest that the safety of less expensive and less scarce alternatives of postoperative observation should be explored.</p

Validation of the SCID-hu Thy/Liv mouse model with four classes of licensed antiretrovirals.

BackgroundThe SCID-hu Thy/Liv mouse model of HIV-1 infection is a useful platform for the preclinical evaluation of antiviral efficacy in vivo. We performed this study to validate the model with representatives of all four classes of licensed antiretrovirals.Methodology/principal findingsEndpoint analyses for quantification of Thy/Liv implant viral load included ELISA for cell-associated p24, branched DNA assay for HIV-1 RNA, and detection of infected thymocytes by intracellular staining for Gag-p24. Antiviral protection from HIV-1-mediated thymocyte depletion was assessed by multicolor flow cytometric analysis of thymocyte subpopulations based on surface expression of CD3, CD4, and CD8. These mice can be productively infected with molecular clones of HIV-1 (e.g., the X4 clone NL4-3) as well as with primary R5 and R5X4 isolates. To determine whether results in this model are concordant with those found in humans, we performed direct comparisons of two drugs in the same class, each of which has known potency and dosing levels in humans. Here we show that second-generation antiretrovirals were, as expected, more potent than their first-generation predecessors: emtricitabine was more potent than lamivudine, efavirenz was more potent than nevirapine, and atazanavir was more potent than indinavir. After interspecies pharmacodynamic scaling, the dose ranges found to inhibit viral replication in the SCID-hu Thy/Liv mouse were similar to those used in humans. Moreover, HIV-1 replication in these mice was genetically stable; treatment of the mice with lamivudine did not result in the M184V substitution in reverse transcriptase, and the multidrug-resistant NY index case HIV-1 retained its drug-resistance substitutions.ConclusionGiven the fidelity of such comparisons, we conclude that this highly reproducible mouse model is likely to predict clinical antiviral efficacy in humans

A relapsing swelling of the nasal tip

The dermatologist referred a 59-year-old male to the otorhinolaryngology department for further analysis of a progressive, intermittent tingling and swelling of the left nasal tip. His symptoms started one year before without any preceding trauma. Local skin biopsy had revealed signs of rosacea telangiectatica, insufficiently explaining these symptoms. Physical examination showed a solid, subcutaneous swelling with a diameter of 1.5 cm in the area of the left lower lateral cartilage. A more prominent columellar show on the ipsilateral side was suggestive of skin retraction, either secondary to the biopsy or to the lesion (figure 1). Inflammatory parameters and autoimmune markers were normal (WBC, CRP, ESR, p- and cANCA, rheumatoid factor, anti-CCP, ANA and subtypes). To rule out a malignancy causing skin retraction an external rhinoplasty was performed, exposing amorphous irregular cartilage on the vestibular side of the lower lateral cartilage, which was resected (figure 2). Histologically, the cartilage was irregular, covered by fibrous connective tissue and perivascular inflammatory cells

The Rhinoplasty Rosetta Stone:Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale

BACKGROUND: The Nasal Obstruction Symptom Evaluation (NOSE) and the Functional subscale of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS-O) are widely used patient-reported outcome measures to measure functional outcomes of rhinoplasty. However, as different instruments produce scores on different metrics, results of these instruments cannot be linked directly, thus hindering comparison and aggregating of rhinoplasty outcome data from practices using either instrument. The aim of this study was to develop and validate crosswalks between the NOSE and the SCHNOS-O.METHODS:In a sample of 552 rhinoplasty patients who completed both instruments, the NOSE and SCHNOS-O scales were co-calibrated onto a common interval-scaled metric using Rasch analysis. Separate Rasch models were run per instrument, and the latent constructs were estimated using the calibrated item parameters. By anchoring original patient-reported outcome measure scores of both instruments to this Rasch computed measurement scale, the scores of both instruments were linked. A second independent sample was used to validate the created crosswalks. RESULTS: Total scores on the NOSE and SCHNOS-O were strongly correlated. The Rasch-based co-calibration of the NOSE and SCHNOS-O items resulted in a model that adequately fitted the data. Back-and-forth crosswalk tables were created from the NOSE to the SCHNOS-O. For patients with moderate nasal obstruction, predicted SCHNOS-O scores were slightly higher for a given level of the NOSE. Intraclass correlation coefficients between predicted and actual scores were 0.93 for both directions, indicating adequate agreement for group-level comparisons. CONCLUSIONS: This study developed and validated Rasch-based crosswalks from the NOSE to the SCHNOS-O and vice versa. The provided crosswalks enhance comparison and harmonization of functional rhinoplasty outcomes.</p

Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity

Background: Walnut allergy is common across the globe, but data on the involvement of individual walnut components are scarce. Objectives: To identify geographical differences in walnut component sensitization across Europe, explore cosensitization and cross-reactivity, and assess associations of clinical and serological determinants with severity of walnut allergy. Methods: As part of the EuroPrevall outpatient surveys in 12 European cities, standardized clinical evaluation was conducted in 531 individuals reporting symptoms to walnut, with sensitization to all known walnut components assessed in 202 subjects. Multivariable Lasso regression was applied to investigate predictors for walnut allergy severity. Results: Birch-pollen-related walnut sensitization (Jug r 5) dominated in Northern and Central Europe and lipid transfer protein sensitization (Jug r 3) in Southern Europe. Profilin sensitization (Jug r 7) was prominent throughout Europe. Sensitization to storage proteins (Jug r 1, 2, 4, and 6) was detected in up to 10% of subjects. The walnut components that showed strong correlations with pollen and other foods differed between centers. The combination of determinants best predicting walnut allergy severity were symptoms upon skin contact with walnut, atopic dermatitis (ever), family history of atopic disease, mugwort pollen allergy, sensitization to cat or dog, positive skin prick test result to walnut, and IgE to Jug r 1, 5, 7, or carbohydrate determinants (area under the curve = 0.81; 95% CI, 0.73-0.89). Conclusions: Walnut-allergic subjects across Europe show clear geographical differences in walnut component sensitization and cosensitization patterns. A predictive model combining results from component-based serology testing with results from extract-based testing and information on clinical background allows for good discrimination between mild to moderate and severe walnut allerg

Triple Therapy Protocol for Primary and Secondary Auricular Keloids:A Prospective Outcome Evaluation

BACKGROUND:Ear keloid lesions present a significant challenge to the aesthetic surgeon. Keloids are known to recur and can cause severe cosmetic, functional, and psychological impairments. Several adjuvants to surgical removal have been promoted, with varying recurrence rates. OBJECTIVE: To evaluate the effectiveness of triple therapy to treat secondary (and large primary) auricular keloids. MATERIALS AND METHODS: Patients with secondary or large primary auricular keloids undergoing triple therapy were prospectively studied. Keloids were excised intramarginally under magnification and repeated triamcinolone acetonide 40 mg/mL injections were administered, followed by the application of a custom-made acrylate pressure device. Recurrent keloid formation and adverse events were monitored during a minimum of 6 months of follow-up. RESULTS: Sixteen auricular keloid lesions (3 large primary and 13 secondary) were subjected to the proposed technique with a mean follow-up of 28 months. All cases that adhered to the protocol were free of keloid after triple therapy. Side effects were limited to 1 case of lobular atrophy and slight hypopigmentation. All patients were satisfied with the results. CONCLUSION: The triple therapy protocol is highly effective in primary and secondary auricular keloid as long as patients remain compliant.</p

Acquiescence and Extremity in Cross-National Surveys: Domain Dependence and Country-Level Correlates

Likert-type rating scales are susceptible to response styles, such as acquiescence and extremity scoring. Although it is widely acknowledged that response styles can seriously invalidate findings of cross-cultural research, their theoretical underpinnings are hardly explored. The current study analyzed domain-dependency and country differences in acquiescence and extremity scoring in a large dataset of the International Social Survey Program. The hypothesis that response styles are more likely in domains with a high personal relevance compared to domains with a low personal relevance was tentatively confirmed. Correlations with various cultural, psychological, and economic variables were investigated. We found that acquiescence was negatively related to affluence, individualism, and well-being, while extremity was only negatively related to well-being. Positive associations were found between uncertainty avoidance and both acquiescence and extremity