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Grimm DR, Lee YJ, Hu K, Liu L, Garcia O, Balakrishnan K, Ayoub NF. The utility of ChatGPT as a generative medical translator. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08708-8. [PMID: 38705894 DOI: 10.1007/s00405-024-08708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Large language models continue to dramatically change the medical landscape. We aimed to explore the utility of ChatGPT in providing accurate, actionable, and understandable generative medical translations in English, Spanish, and Mandarin pertaining to Otolaryngology. METHODS Responses of GPT-4 to commonly asked patient questions listed on official otolaryngology clinical practice guidelines (CPG) were evaluated with the Patient Education materials Assessment Tool-printable (PEMAT-P.) Additional critical elements were identified a priori to evaluate ChatGPT's accuracy and thoroughness in its responses. Multiple fluent speakers of English, Mandarin, and Spanish evaluated each response generated by ChatGPT. RESULTS Total PEMAT-P scores differed between English, Mandarin, and Spanish GPT-4 generated responses depicting a moderate effect size of language, Eta-Square 0.07 with scores ranging from 73 to 77 (P-value = 0.03). Overall understandability scores did not differ between English, Mandarin, and Spanish depicting a small effect size of language, Eta-Square 0.02 scores ranging from 76 to 79 (P-value = 0.17), nor did overall actionability scores Eta-Square 0 score ranging 66-73 (P-value = 0.44). Overall a priori procedure-specific responses similarly did not differ between English, Spanish, and Mandarin Eta-Square 0.02 scores ranging 61-78 (P-value = 0.22). CONCLUSION GPT-4 produces accurate, understandable, and actionable outputs in English, Spanish, and Mandarin. Responses generated by GPT-4 in Spanish and Mandarin are comparable to English counterparts indicating a novel use for these models within Otolaryngology, and implications for bridging healthcare access and literacy gaps. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David R Grimm
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yu-Jin Lee
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Katherine Hu
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Longsha Liu
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Omar Garcia
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Karthik Balakrishnan
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Noel F Ayoub
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.
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Azimzadeh JB, Sidell DR, Balakrishnan K, Mathew R, Asija R, Rutter MJ, Meister KD. Use of temporary tracheostomy occlusion to reduce the risk of sternal wound infection after sternotomy in congenital cardiac surgery. Cardiol Young 2024:1-6. [PMID: 38410052 DOI: 10.1017/s1047951124000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To describe a method of reducing the risk of sternal wound infection after sternotomy in children with a pre-existing tracheostomy. To report our outcomes using this method from 1 January, 2013 to 31 August, 2023. METHODS We describe a method for temporarily occluding the tracheal stoma with a removable implant with the primary goal of reducing the risk of sternotomy wound infection by preventing soilage due to tracheostomal secretions. We then performed a retrospective review of all children who underwent temporary tracheostomal occlusion between 1 January, 2013 and 31 August, 2023 at our quaternary care children's hospital. Clinical variables were extracted from the hospital medical records. The rates of antibiotic use and minor and major complications during the period when the stoma plug was in place were recorded. RESULTS Totally, 19 patients underwent tracheal stoma plugging prior to sternotomy and were included in our analysis. There were two cases of sternal wound infection; one case occurred while the stoma plug was in place, and one developed four days following plug removal. There was one minor complication, with one patient requiring stoma revision via serial dilation at bedside at the time of recannulation. There were no deaths. CONCLUSION Temporary occlusion of the tracheal stoma with an impermeable plug is a viable option for reducing the risk of sternal wound infection in children with a pre-existing tracheostomy who are undergoing sternotomy.
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Affiliation(s)
- Julien B Azimzadeh
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Roshni Mathew
- Department of Pediatric Infectious Diseases, Stanford University, Palo Alto, CA, USA
| | - Ritu Asija
- Department of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
| | - Michael J Rutter
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
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Ayoub NF, Noel J, Orloff LA, Balakrishnan K. Redefining "Value" in Surgery: Development of a Comprehensive Value Score for Outpatient Endocrine Surgery. Otolaryngol Head Neck Surg 2024; 170:151-158. [PMID: 37435656 DOI: 10.1002/ohn.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The value-based healthcare model aims to improve the quality of care and lower health care costs. The standard value equation (ie, Value = Quality/Cost), while conceptually useful, is grossly oversimplified and lacks clinical relevance. This study introduces a more detailed value equation that generates disease-specific value scores and incorporates real-world clinical and cost data to demonstrate its use. STUDY DESIGN Prospective observational study. SETTING Tertiary institution. METHODS A comprehensive new health care value equation was developed that includes 23 unique inputs. Sixteen inputs represent quality (numerator) and 7 inputs represent cost (denominator). Patients undergoing thyroid or parathyroid surgery were enrolled, and data were entered into the new equation to generate surgery-specific value scores for each patient. A subanalysis was performed for telehealth visits. RESULTS Ten patients were enrolled (60% female) with an average age of 62 years. The average total monetary cost per patient was $41,884 ($27,885 direct). Across all patients, the average total quality score was 0.99, and the cost score was 6.1, resulting in a final value score of 0.19. A subanalysis showed that changing a postoperative visit from in-person to telehealth would increase the value score by 0.66%. CONCLUSION This analysis creates a comprehensive value equation for surgical services that incorporates the complexity of modern surgical care. The new equation includes objective and subjective outcomes and health equity, quantitatively compares the value of different surgical interventions and health care services, illustrates how specific interventions can lead to the higher value of care, and can serve as the framework for future value equations.
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Affiliation(s)
- Noel F Ayoub
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Julia Noel
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
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Schiff E, Propst EJ, Balakrishnan K, Johnson K, Lounsbury DW, Brenner MJ, Tawfik MM, Yang CJ. Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations. Laryngoscope 2023; 133:3588-3601. [PMID: 37114735 PMCID: PMC10710770 DOI: 10.1002/lary.30674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To achieve consensus on critical steps and create an assessment tool for actual and simulated pediatric tracheostomy emergencies that incorporates human and systems factors along with tracheostomy-specific steps. METHODS A modified Delphi method was used. Using REDCap software, an instrument comprising 29 potential items was circulated to 171 tracheostomy and simulation experts. Consensus criteria were determined a priori with a goal of consolidating and ordering 15 to 25 final items. In the first round, items were rated as "keep" or "remove". In the second and third rounds, experts were asked to rate the importance of each item on a 9-point Likert scale. Items were refined in subsequent iterations based on analysis of results and respondents' comments. RESULTS The response rates were 125/171 (73.1%) for the first round, 111/125 (88.8%) for the second round, and 109/125 (87.2%) for the third round. 133 comments were incorporated. Consensus (>60% participants scoring ≥8, or mean score >7.5) was reached on 22 items distributed across three domains. There were 12, 4, and 6 items in the domains of tracheostomy-specific steps, team and personnel factors, and equipment respectively. CONCLUSIONS The resultant assessment tool can be used to assess both tracheostomy-specific steps as well as systems factors affecting hospital team response to simulated and clinical pediatric tracheostomy emergencies. The tool can also be used to guide debriefing discussions of both simulated and clinical emergencies, and to spur quality improvement initiatives. LEVEL OF EVIDENCE 5 Laryngoscope, 133:3588-3601, 2023.
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Affiliation(s)
- Elliot Schiff
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Evan J Propst
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karthik Balakrishnan
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kaalan Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Washington/ Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - David W Lounsbury
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
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Wei EX, Meister KD, Balakrishnan K, Cheng AG, Qian ZJ. Ankyloglossia: Clinical and Sociodemographic Predictors of Diagnosis and Management in the United States, 2004 to 2019. Otolaryngol Head Neck Surg 2023; 169:1020-1027. [PMID: 36994937 DOI: 10.1002/ohn.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE The past 2 decades have seen a rapid increase in the diagnosis of ankyloglossia. Patients are often managed by lingual frenotomy. The objective is to define the clinical and socioeconomic factors that determine which patients receive frenotomy. STUDY DESIGN A retrospective analysis of commercially insured children. SETTING Optum Data Mart database. METHODS Trends in frenotomy including provider and setting were described. Multiple logistic regression was used to determine predictors of frenotomy. RESULTS Diagnosis of ankyloglossia increased from 2004 to 2019 (from 3377 in 2004 to 13,200 in 2019), while lingual frenotomy similarly increased from 1483 in 2004 to 6213 in 2019. The proportion of inpatient frenotomy procedures increased from 6.2% to 16.6% from 2004 to 2019, with pediatricians having the highest odds of performing inpatient frenotomies (odds ratio: 4.32, 95% confidence interval: 4.08, 4.57). Additionally, during the study period, the proportion of frenotomies performed by pediatricians increased from 13.01% in 2004 to 28.38% in 2019. In multivariate regression analyses, frenotomy was significantly associated with the male sex, white non-Hispanic ethnicity, higher parental income and education, and a greater number of siblings. CONCLUSION Ankyloglossia has been increasingly diagnosed in the past 2 decades, and among patients with ankyloglossia, frenotomy is increasingly performed. This trend was driven at least in part due to increasing rates of pediatricians as proceduralists. After accounting for maternal and patient-level clinical factors, socioeconomic differences in the management of ankyloglossia were observed.
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Affiliation(s)
- Eric X Wei
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
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Weigel N, Hintz S, Kaplinski M, Barth R, Balakrishnan K, Panelli D, Ma M, Chitkara R. Prenatal Diagnosis and Postnatal Management of a Fetal Pericardial Mass. Neoreviews 2023; 24:e683-e689. [PMID: 37777619 DOI: 10.1542/neo.24-10-e683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Nicole Weigel
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
| | - Susan Hintz
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Michelle Kaplinski
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Richard Barth
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
- Department of Radiology/Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Karthik Balakrishnan
- Division of Pediatrics, Department of Otolaryngology (Head and Neck Surgery), Stanford University School of Medicine, Palo Alto, CA
| | - Danielle Panelli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Ritu Chitkara
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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7
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Ayoub NF, Balakrishnan K, Orloff LA, Noel JE. Time-Driven Activity-Based Cost Comparison of Thyroid Lobectomy and Radiofrequency Ablation. Otolaryngol Head Neck Surg 2023; 169:830-836. [PMID: 37157972 DOI: 10.1002/ohn.360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) of benign thyroid nodules has gained traction for its therapeutic effectiveness, thyroid function preservation, and minimally invasive nature. While a growing body of evidence reports positive outcomes from thyroid RFA, financial comparisons between both procedures remain limited. This analysis aims to more accurately measure the direct cost of thyroid RFA in comparison to thyroid lobectomy. STUDY DESIGN Bottom-up financial cost analysis. SETTING Tertiary endocrine head and neck surgery center. METHODS Time-driven activity-based costing was utilized to obtain unit-based cost estimates. The care cycles for thyroid lobectomy and RFA were defined, and process maps were developed comprising all personnel and work in the care cycle. Time estimates were calculated for all personnel involved, and public government data were used to obtain capacity cost rates for each component of the care cycle. Consumable supply and overhead costs were obtained for both procedures, and overall costs were compared. RESULTS For thyroid lobectomy, total personnel costs were $1087.97, consumable supplies were $942.68, and overhead costs $17,199.10. For thyroid nodule RFA performed in an office setting, the total personnel cost calculated was $379.90, consumable supplies $1315.28, and overhead $7031.20. Overall, the total cost for thyroid lobectomy was $19,229.75 compared to $8726.38 for RFA. CONCLUSION In-office thyroid nodule RFA is associated with lower direct costs than thyroid lobectomy, and overhead is the greatest cost driver for both procedures. If clinical and patient-centered outcomes are comparable, then RFA may provide higher value for appropriately selected patients.
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Affiliation(s)
- Noel F Ayoub
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Karthik Balakrishnan
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Lisa A Orloff
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Julia E Noel
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Jacobs IN, Giordano T, Soaper A, Din TF, Faig W, de Alarcon A, Balakrishnan K, Prager JD, Michael R, Douglas S, Piccione J. A multicenter study analyzing the impact of pre-existing comorbidities on laryngotracheal reconstruction (LTR) outcomes. Int J Pediatr Otorhinolaryngol 2023; 172:111631. [PMID: 37567085 DOI: 10.1016/j.ijporl.2023.111631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/11/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Comorbidities such as chronic lung disease and gastroesophageal reflux (GERD), prematurity, and numerous other conditions may impact the success of LTR. Single-center studies are limited in terms of patient numbers and may be underpowered. OBJECTIVES To analyze the impact of specific comorbidities on the operation-specific and overall surgical success of LTR in a large multicenter cohort and validate a predictive model for surgical success. METHODS A large retrospective multicenter 10-year review was undertaken to validate the data of a previous single-center study (Wertz et al. Laryngoscope 2020) which identified specific predictive comorbidities which impacted LTR outcomes. A Monte Carlo simulation based on the previous data set suggested that 300-400 cases would be needed to optimize the statistical power of a Bayesian model developed from the single-center data to predict surgical success. An IRB-approved data-sharing agreement was executed for 4 large U.S. CENTERS A virtual REDCap® data entry form inquired about patient characteristics that best predicted surgical success in the single-center model. These included demographics, surgical approaches, cardiac, airway, genetic, endocrine, musculoskeletal, gastrointestinal, and pulmonary comorbidities; details of the surgical procedures, and results of esophagogastroduodenoscopy (EGD), esophageal pH/impedance and flexible bronchoscopy with bronchioalveolar lavage (BAL) were included. Surgical success defined as successful decannulation or resolution of airway symptoms was recorded as single surgery success and overall success following open surgical revision surgery. Multivariate Bayesian analysis, logistical regression, and Kaplan-Meier analysis were performed. RESULTS 542 patients were identified, including 165 from the single-center study and an additional 377 patients from the multicenter group. The median age was 36 months at the time of the most recent surgery. 70.9% of the LTRs were double-staged procedures. The overall success rate was 86.4% and operation-specific success rate was 69.2%. The specific comorbidities and aerodigestive test results that impacted success based on univariate analysis included staging, bronchiectasis, pulmonary hypertension, GERD, ASD, PDA, grade of stenosis, advanced levels of stenosis, Trisomy 21, MRSA, prior open surgery at another hospital, and gross appearance on EGD. Bayesian model averaging with backward selection was used to validate and refine a predictive model for surgical success with favorable receiver operating curve characteristics - AUC values of 0.827 for single surgery success and 0.797 for overall success. DISCUSSION With over 500 patients reviewed, this was the largest multicenter study of LTR to date, which elucidated the impact of comorbidities on success with LTR and was able to improve upon the predictive modeling based on single-center data. Patient factors are most critical in the outcome of LTR. Stage and levels of stenosis, as well as pulmonary and GI conditions most strongly impact the likelihood of success. Future prospective case-control studies will be performed to further optimize the current model for outcome prediction and patient management.
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Affiliation(s)
- Ian N Jacobs
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, 5th Floor, Philadelphia, PA, 19104, USA.
| | - Teresa Giordano
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, 5th Floor, Philadelphia, PA, 19104, USA.
| | - Ashley Soaper
- Division of Pediatric Otolaryngology-HNS, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Taseer Feroze Din
- Division of Pediatric Otolaryngology, Lucile Packard Children's Hospital of Stanford University, 730 Welch Rd, 1st Floor, Palo Alto, CA, 94304, USA.
| | - Walter Faig
- Wescott Department of Biostatistics, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA.
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-HNS, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Karthik Balakrishnan
- Division of Pediatric Otolaryngology, Lucile Packard Children's Hospital of Stanford University, 730 Welch Rd, 1st Floor, Palo Alto, CA, 94304, USA.
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, Children's Hospital of Colorado, 13123 E. 16th Avenue, Aurora, CO, 80045, USA.
| | - Rutter Michael
- Division of Pediatric Otolaryngology-HNS, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Sidell Douglas
- Division of Pediatric Otolaryngology, Lucile Packard Children's Hospital of Stanford University, 730 Welch Rd, 1st Floor, Palo Alto, CA, 94304, USA.
| | - Joseph Piccione
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, 14th Floor, Philadelphia, PA, 19104, USA.
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Balakrishnan K, Faucett EA, Villwock J, Boss EF, Esianor BI, Jefferson GD, Graboyes EM, Thompson DM, Flanary VA, Brenner MJ. Allyship to Advance Diversity, Equity, and Inclusion in Otolaryngology: What We Can All Do. Curr Otorhinolaryngol Rep 2023; 11:201-214. [PMID: 38073717 PMCID: PMC10707492 DOI: 10.1007/s40136-023-00467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 01/31/2024]
Abstract
Purpose of review To summarize the current literature on allyship, providing a historical perspective, concept analysis, and practical steps to advance equity, diversity, and inclusion. This review also provides evidence-based tools to foster allyship and identifies potential pitfalls. Recent findings Allies in healthcare advocate for inclusive and equitable practices that benefit patients, coworkers, and learners. Allyship requires working in solidarity with individuals from underrepresented or historically marginalized groups to promote a sense of belonging and opportunity. New technologies present possibilities and perils in paving the pathway to diversity. Summary Unlocking the power of allyship requires that allies confront unconscious biases, engage in self-reflection, and act as effective partners. Using an allyship toolbox, allies can foster psychological safety in personal and professional spaces while avoiding missteps. Allyship incorporates goals, metrics, and transparent data reporting to promote accountability and to sustain improvements. Implementing these allyship strategies in solidarity holds promise for increasing diversity and inclusion in the specialty.
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Affiliation(s)
- Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Erynne A. Faucett
- Department of Otolaryngology-Head and Neck Surgery, University of CA-Davis , Sacramento, USA
| | - Jennifer Villwock
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Emily F. Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Brandon I. Esianor
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gina D. Jefferson
- Department of Otolaryngology-Head and Neck Surgery, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Dana M. Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Valerie A. Flanary
- Division of Pediatric Otolaryngology, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael J. Brenner
- Department of Otolaryngology–Head & Neck Surgery, University of Michigan medical School, 1500 East Medical Center Drive, 48108 Ann Arbor, MI, USA
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Kiessling P, Balakrishnan K, Fauer A, Sanan A, McDonald D, Thomas J, Erickson-Direnzo E, Sung CK, Nuyen B. Social Perception of External Laryngeal Anatomy Related to Gender Expression in a Web-based Survey. Laryngoscope 2023; 133:2292-2300. [PMID: 36453533 DOI: 10.1002/lary.30498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE(S) To quantify the effect of laryngeal prominence size on socially perceived attributes relating to gender expression. Chondrolaryngoplasty ("tracheal shave") is a common procedure performed for transgender women to feminize neck appearance. The extent of thyroid cartilage resection needed to convey socially-perceived feminine gender expression without destabilizing the voice is incompletely understood. METHODS Cross-sectional evaluation of a randomized allocation of images of varying laryngeal prominence to a non-repeated, random sample from November 2021 to December 2021. Photos of laryngeal prominence were isolated against a constant neck baseline with lateral, oblique, and frontal views. The images were embedded into a web-based survey with visual analog scales to capture perceived scaled gender expression (masculinity, femininity) and social traits (e.g., attractiveness, friendliness, leadership). We performed bivariate and multivariate analyses relating the laryngeal prominence to perceived gender expression and social traits. RESULTS The analytic sample included 1,026 respondents. Laryngeal grades similar to the demonstrated "grade M" in this study and smaller demonstrated similar perceptions of increased femininity and decreased masculinity. Grades larger than M demonstrate significantly increased perceived masculinity and significantly decreased perceived femininity. The lateral and oblique views of the neck appear to be the most gender-informative. CONCLUSION This crowd-sourced analysis of external laryngeal anatomy by a large population of observers provides clear, reproducible insights into social perceptions of gender identity and specifically femininity. These data will meaningfully inform patient counseling and surgical planning for gender-affirming interventions by establishing normative data representing the general public's perceptions. LEVEL OF EVIDENCE NA Laryngoscope, 133:2292-2300, 2023.
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Affiliation(s)
- Patrick Kiessling
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alex Fauer
- National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, School of Medicine, University of California, Los Angeles, California, USA
| | - Akshay Sanan
- Facial Plastic and Reconstructive Surgery, Private Practice, Los Angeles, California, USA
| | - Daniella McDonald
- University of California San Diego School of Medicine, San Diego, California, USA
| | | | - Elizabeth Erickson-Direnzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - C Kwang Sung
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Voice Doctor Clinic, Portland, Oregon, USA
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11
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Ayoub NF, Lee YJ, Grimm D, Balakrishnan K. Comparison Between ChatGPT and Google Search as Sources of Postoperative Patient Instructions. JAMA Otolaryngol Head Neck Surg 2023; 149:556-558. [PMID: 37103921 PMCID: PMC10141286 DOI: 10.1001/jamaoto.2023.0704] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/08/2023] [Indexed: 04/28/2023]
Abstract
This qualitative study rates the level of understandability, actionability, and procedure-specific content in postoperative instructions generated from ChatGPT, Google Search, and Stanford University.
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Affiliation(s)
- Noel F Ayoub
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - David Grimm
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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12
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Balakrishnan K, Sureshrao K, Krishnakumar R, Rajgopalan G, Ratnagiri R. Hemodynamic Consequences of Right Ventricular (RV) Dysfunction in Left Heart Failure : Insights from a Mathematical Model with Clinical Correlation from Patients Awaiting a Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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13
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Ayoub N, Balakrishnan K, Meister K, Grimm D, Johnson A, Maida K, Sidell DR. Safety and effectiveness of vocal fold injection laryngoplasty in infants less than one year of age. Int J Pediatr Otorhinolaryngol 2023; 168:111542. [PMID: 37058865 DOI: 10.1016/j.ijporl.2023.111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Injection laryngoplasty (IL) is commonly performed for unilateral vocal fold immobility (UVFI). However, the safety and efficacy in patients <1 year of age are not widely recognized. This study analyzes the safety and swallow outcomes in a cohort of patients <1 year who underwent IL. METHODS This retrospective analysis evaluated patients at a tertiary children's institution between 2015 and 2022. Patients were eligible if they underwent IL for UVFI and were <1 year at time of injection. Baseline characteristics, perioperative data, oral diet tolerance, and preoperative and postoperative swallow data were collected. RESULTS 49 patients were included, 12 (24%) of whom were premature. The average age at injection was 3.9 months (SD 3.8), time from UVFI onset to injection 1.3 months (2.0), and weight at injection 4.8 kg (2.1). The baseline American Association of Anesthesiologists physical status classification scores were 2 (14%), 3 (61%), and 4 (24%). 89% of patients had improvements in objective swallow function postoperatively. Of the 35 patients who were preoperatively enterally-dependent and did not have medical circumstances precluding advancement to oral feeds, 32 (n = 91%) tolerated an oral diet postoperatively. There were no long-term sequelae. Two patients had intraoperative laryngospasm, one intraoperative bronchospasm, and one with subglottic and posterior glottic stenosis was intubated for <12 h for increased work of breathing. CONCLUSIONS IL is a safe and effective intervention that can reduce aspiration and improve diet in patients <1 year old. This procedure can be considered at institutions with the appropriate personnel, resources, and infrastructure.
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Affiliation(s)
- Noel Ayoub
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA.
| | - Karthik Balakrishnan
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - Kara Meister
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - David Grimm
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA
| | - April Johnson
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA; Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Kelli Maida
- Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Douglas Ryan Sidell
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
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14
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Roy CF, Balakrishnan K, Boudewyns A, Cheng A, Chun RH, Daniel SJ, Fayoux P, Hart C, Hemansson A, Hewitt R, Hsu WC, Kuo M, Liu C, Maddalozzo J, Messner AH, Pransky S, Rahbar R, Rickert S, Roy S, Russell J, Rutter MJ, Sie KCY, Sidell D, Smith R, Soma M, Spratley J, Watters K, White DR, Wolter N, Zalzal G, Yeung JC. International Pediatric Otolaryngology Group: Consensus guidelines on the diagnosis and management of non-tuberculous mycobacterial cervicofacial lymphadenitis. Int J Pediatr Otorhinolaryngol 2023; 166:111469. [PMID: 36764081 DOI: 10.1016/j.ijporl.2023.111469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. OBJECTIVES This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges. METHODS A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. SETTING Multinational, multi-institutional, tertiary pediatric hospitals. RESULTS Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. CONCLUSION The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation.
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Affiliation(s)
- Catherine F Roy
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sam J Daniel
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Lille, F-59000, Lille, France
| | - Catherine Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ann Hemansson
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Richard Hewitt
- Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Wei-Chung Hsu
- Division of Pediatric Otolaryngology, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan
| | - Michael Kuo
- Department of Pediatric Otolaryngology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Christopher Liu
- Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Dallas, TX, USA
| | - John Maddalozzo
- Department of Otolaryngology/Head and Neck Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Anna H Messner
- Department of Otolaryngology/Head & Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Seth Pransky
- Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA
| | - Reza Rahbar
- Department of Pediatric Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott Rickert
- Division of Pediatric Otolaryngology, Hassenfeld Children's Hospital, New York University Langone Health, New York, NY, USA
| | - Soham Roy
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - John Russell
- Department of Pediatric Otorhinolaryngology, Children's Health Ireland (Crumlin), Dublin, Ireland
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, USA
| | - Douglas Sidell
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Richard Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Marlene Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jorge Spratley
- Pediatric Otorhinolaryngology, University of Porto Faculty of Medicine, S. Joao Hospital Center, CINTESIS, Porto, Portugal
| | - Karen Watters
- Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA
| | - David R White
- Division of Pediatric Otolaryngology, MUSC Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Nikolaus Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George Zalzal
- Division of Otolaryngology, Children's National Medical Center, George Washington University, Washington, DC, USA
| | - Jeffrey C Yeung
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada.
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15
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Balasubramanian N, Pounpandi P, Varatharaju G, Shanmugaiah V, Balakrishnan K, Thirunarayan MA. Distribution of virulence genes and biofilm characterization of human isolates of Streptococcus agalactiae: A pilot study. Colloids Surf B Biointerfaces 2023; 223:113151. [PMID: 36738701 DOI: 10.1016/j.colsurfb.2023.113151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
This study included 21 newly isolated clinical samples of Streptococcus agalactiae (Group B Streptococcus) screened in patients (six male, fifteen female) from various states of India with different infections (urinary tract infections, blood, pus and eye infections). All isolates were identified as Group B Streptococcus (GBS) using hemolytic properties, serogrouping and MALDI-TOF-MS analysis. Six virulence genes, cfb (100%), cylE (90.4%), lmp (85.7%), bca (71.4%), rib (38%) and bac (4.7%) were detected via polymerase chain reaction (PCR). Distribution studies of these six genes revealed five isolates containing five virulence genes (23.8%), followed by ten isolates containing four virulence genes (47.6%). The twenty GBS isolates selected on the glass surface included non-biofilm producers (n = 6, 30%), weak (n = 11, 55%) and moderate biofilm producers (n = 3, 15%). On the polystyrene surface, weak (n = 4, 20%), moderate (n = 2, 10%) and strong (n = 14, 70%) biofilm producers were detected. Live-dead cell staining revealed that more viable cells accumulated in the S. ag 7420 isolate than in the AH1 isolate. Scanning electron microscope (SEM) biofilm analysis showed S. ag AH1 cells appeared as chain-like structures, whereas the S. ag 7420 isolate biofilm cells appeared as fork-like structures on the glass surface. Biofilm elements were analyzed using Energy Dispersive X-Ray Analysis (EDAX) for both isolates and 13 elements with different orders of composition were found. Thus, virulence gene detection, distribution and biofilm formation by these new clinical isolates suggested the virulent nature of these pathogens, which might cause different levels of disease severity in humans.
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Affiliation(s)
- N Balasubramanian
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625021, India.
| | - P Pounpandi
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625021, India
| | - G Varatharaju
- Department of Microbial Technology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625021, India
| | - V Shanmugaiah
- Department of Microbial Technology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625021, India
| | - K Balakrishnan
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625021, India
| | - M A Thirunarayan
- Department of Microbiology, Apollo Hospitals, Greams Road, Chennai 600006, India
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16
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Chandrasekaran DK, Meera S, Sree R, Sathish N, Balakrishnan K. Squad Help – An Emotion based Music Player. 2023 International Conference on Computer Communication and Informatics (ICCCI) 2023. [DOI: 10.1109/iccci56745.2023.10128528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | - S. Meera
- Sri Sairam Engg College,CSE,Chennai,India
| | | | - N Sathish
- Sri Sairam Engg College,CSE,Chennai,India
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17
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Hleihil M, Balakrishnan K, Benke D. Protein phosphatase 2A regulation of GABAB receptors normalizes ischemia-induced aberrant receptor trafficking and provides neuroprotection. Front Mol Neurosci 2022; 15:1015906. [PMID: 36311027 PMCID: PMC9607930 DOI: 10.3389/fnmol.2022.1015906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
One major factor regulating the strength of GABAB receptor signaling and thereby neuronal excitability is the dynamic control of their cell surface expression. GABAB receptors are constitutively internalized and recycled back to the plasma membrane to maintain a stable number of receptors at cell surface for appropriate signaling. Protein phosphatase 2A (PP2A) dependent dephosphorylation of serine 783 (S783) in the GABAB2 subunit is a key event for downregulating GABAB receptor cell surface expression particularly under conditions associated with excitotoxicity. Here, we investigated the role of PP2A in regulating GABAB receptor cell surface expression under physiological and excitotoxic conditions. For this purpose, we developed an interfering peptide (PP2A-Pep) that inhibits the interaction of GABAB receptors with PP2A. Using cultured cortical neurons, we found that PP2A downregulates GABAB receptor cell surface expression by inhibiting recycling of the receptors and thereby promoting degradation of the receptors. Inhibition of the GABAB receptor/PP2A interaction by PP2A-Pep in cultured cortical neurons restored GABAB receptor cell surface expression after excitotoxic stress and inhibited progressing neuronal death even when added 48 h after the insult. To explore the therapeutic potential of PP2A-Pep, we further analyzed effect of PP2A-Pep in the middle cerebral artery occlusion (MCAO) mouse model of cerebral ischemia. Incubation of brain slices prepared from MCAO-treated mice with PP2A-Pep restored normal GABAB receptor expression and GABAB receptor-mediated inhibition, reduced ischemic-induced overexcitability of neurons, and prevented neuronal death in the ischemic penumbra. This data illustrates the crucial role of regulating GABAB receptor phosphorylation by PP2A for controlling neuronal inhibition and excitability. The results further suggest that interfering with the GABAB receptor/PP2A interaction is a promising strategy for the development of specific therapeutic interventions to treat neurological diseases associated with a disturbed excitation/inhibition balance and downregulation of GABAB receptors.
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Affiliation(s)
- Mohammad Hleihil
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zürich, Zurich, Switzerland
| | - Karthik Balakrishnan
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Dietmar Benke
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zürich, Zurich, Switzerland
- Drug Discovery Network Zurich, Zurich, Switzerland
- *Correspondence: Dietmar Benke,
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18
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Balakrishnan K. Hepatocellular carcinoma stage: an almost loss of fatty acid metabolism and gain of glucose metabolic pathways dysregulation. Med Oncol 2022; 39:247. [PMID: 36209296 DOI: 10.1007/s12032-022-01839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/01/2022] [Indexed: 10/10/2022]
Abstract
Cancer cells rewire the metabolic processes beneficial for cancer cell proliferation, survival, and their progression. In this study, metabolic processes related to glucose, glutamine, and fatty acid metabolism signatures were collected from the molecular signatures database and investigated in the context of energy metabolic pathways through available genome-wide expression profiles of liver cancer cohorts by gene sets-based pathway activation scoring analysis. The outcomes of this study portray that the fatty acid metabolism, transport, and its storage related signatures are highly expressed across early stages of liver tumors and on the contrary, the gene sets related to glucose transport and glucose metabolism are prominently activated in the hepatocellular carcinoma (HCC) stage. Based on the results, these metabolic pathways are clearly dysregulated across specific stages of carcinogenesis. The identified dimorphic metabolic pathway dysregulation patterns are further reconfirmed by examining corresponding metabolic pathway genes expression patterns across various stages encompassing profiles. Recurrence is the primary concern in the carcinogenesis of liver tumors due to liver tissues regeneration. Hence, to further explore these dysregulation effects on recurrent cirrhosis and recurrent HCC sample containing profile GSE20140 was examined and interestingly, this result also reiterated these differential metabolic pathways dysregulation. In addition, a recently established metabolome profile for the massive panel of cancer cell-lines, including liver cancer cell-lines, was used for further exploration. These findings also reassured those differential metabolites abundance of the fatty acid and glucose metabolic pathways enlighten those dimorphic metabolic pathways dysregulation. Moreover, ROC curves of fatty acid metabolic pathway genes such as acetyl-CoA carboxylase (ACACB), acyl-CoA dehydrogenase long chain (ACADL), and acyl-CoA dehydrogenase medium chain (ACADM) as well as glucose metabolic pathway genes such as phosphoglycerate kinase (PGK1), pyruvate dehydrogenase (PDHA1), pyruvate dehydrogenase kinase (PDK1) demonstrated greater sensitivity and specificity in the corresponding stage-specific tumors with significant p-values (p < 0.05). Furthermore, overall survival (OS) and recurrence-free survival (RFS) studies also reconfirmed that the rate-limiting genes expression of fatty acid and glucose metabolic pathways reveal better and poor survival in HCC patient cohorts, respectively. In conclusion, all these results clearly show that metabolic rewiring and the existence of two diverse metabolic pathways dysregulation involving fatty acid and glucose metabolism across the stages of liver tumors have been identified. These findings might be useful for developing therapeutic target treatments in stage-specific tumors.
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Affiliation(s)
- Karthik Balakrishnan
- Department of Biotechnology, Saroj Institute of Technology and Management (SITM), 12th KM Stone, Lucknow-Sultanpur Road, Lucknow, Uttar Pradesh, 226002, India.
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19
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Sidell DR, Meister KD, de Alarcon A, Boudewyns A, Brigger M, Chun R, Fayoux P, Goudy S, Hart CK, Hewitt R, Hsu WC, Javia LR, Johnson RF, Messner AH, Moreddu E, Nicollas R, Prager JD, Rahbar R, Rickert S, Rossi ME, Russell J, Rutter M, Sandu K, Smith RJH, Soma M, Thierry B, Trozzi M, White DR, Balakrishnan K. International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Evaluation and management of congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 2022; 161:111251. [PMID: 35988373 DOI: 10.1016/j.ijporl.2022.111251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To outline an expert-based consensus of recommendations for the diagnosis and management of pediatric patients with congenital tracheal stenosis. METHODS Expert opinions were sought from members of the International Pediatric Otolaryngology Group (IPOG) via completion of an 18-item survey utilizing an iterative Delphi method and review of the literature. RESULTS Forty-three members completed the survey providing recommendations regarding the initial history, clinical evaluation, diagnostic evaluation, temporizing measures, definitive repair, and post-repair care of children with congenital tracheal stenosis. CONCLUSION These recommendations are intended to be used to support clinical decision-making regarding the evaluation and management of children with congenital tracheal stenosis. Responses highlight the diverse management strategies and the importance of a multidisciplinary approach to care of these patients.
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Affiliation(s)
- Douglas R Sidell
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA
| | - Kara D Meister
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA
| | | | - An Boudewyns
- Antwerp University Hospital, University of Antwerp, Belgium
| | - Matthew Brigger
- Rady Children's Hospital and University of California San Diego, San DIego, CA, USA
| | - Robert Chun
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Steven Goudy
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Catherine K Hart
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Wei-Chung Hsu
- National Taiwan University Hospital and Children's Hospital, Taiwan
| | - Luv R Javia
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Eric Moreddu
- Dept of Pediatric Otolaryngology Head and Neck Surgery, Hôpital La Timone Enfants, Marseille, France
| | - Richard Nicollas
- Dept of Pediatric Otolaryngology Head and Neck Surgery, Hôpital La Timone Enfants, Marseille, France
| | - Jeremy D Prager
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | | | | | | | - John Russell
- Children's Health Ireland (Crumlin), Trinity College Dublin, Dublin, Ireland
| | - Michael Rutter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kishore Sandu
- Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | | | - Marlene Soma
- Sydney Children's Hospital, Edgecliff, NSW, Australia
| | - Briac Thierry
- Necker Enfants Malades Hospital - Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - David R White
- Medical University of South Carolina, Charleston, SC, USA
| | - Karthik Balakrishnan
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA.
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20
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Lui NS, Holsinger FC, Ma MR, Janus JR, Balakrishnan K. Single-port robotic transcervical long-segment thoracic tracheal reconstruction: Cadaveric proof-of-concept study. JTCVS Tech 2022; 16:231-236. [PMID: 36510525 PMCID: PMC9735391 DOI: 10.1016/j.xjtc.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/13/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Slide tracheoplasty is the standard technique to repair congenital long-segment tracheal stenosis. This operation most commonly requires median sternotomy, which has drawbacks in young children. We hypothesized that a transcervical approach without sternotomy would be feasible if done with a single-port robotic system. Methods This proof-of concept study was performed in 2 small adult cadavers using a single-port robotic surgical system via a small neck incision. Relevant information, including operative time and details of operative technique, were recorded. Results Long-segment slide tracheoplasty was completed successfully in 2 cadavers using a small neck incision and a single-port robotic surgical system. Strengths and pitfalls of the technique were identified, including technical refinements from the first attempt to the second. Operative time for robotic mobilization, incision, and anastomosis of the trachea was comparable to standard open approaches. Conclusions Small-incision transcervical slide tracheoplasty, assisted by a single-port surgical robotic system, is feasible in a human cadaver. More work is needed to determine safety and applicability in live patients, particularly in children.
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Affiliation(s)
- Natalie S. Lui
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - F. Christopher Holsinger
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Michael R. Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif,Aerodigestive and Airway Reconstruction Program, Lucile Packard Children's Hospital, Palo Alto, Calif
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Jacksonville, Fla
| | - Karthik Balakrishnan
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, Calif,Aerodigestive and Airway Reconstruction Program, Lucile Packard Children's Hospital, Palo Alto, Calif,Address for reprints: Karthik Balakrishnan, MD, MPH, FAAP, FACS, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, 2nd Floor, Palo Alto, CA 94305.
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21
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Balakrishnan K, Dhanalakshmi R, Akila M, Sinha BB. Improved equilibrium optimization based on Levy flight approach for feature selection. Evolving Systems 2022. [DOI: 10.1007/s12530-022-09461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Balakrishnan K, Ganesan K. Identification of oncogenic signaling pathways associated with the dimorphic metabolic dysregulations in gastric cancer subtypes. Med Oncol 2022; 39:132. [PMID: 35723749 DOI: 10.1007/s12032-022-01717-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
Metabolic dysregulations have been identified as intrinsic hallmarks of cancer cells. Investigations of altered metabolic processes, in the context of the associated oncogenic signaling pathways are expected to pave way for the development of targeted cancer therapeutics. We have recently identified the enrichment of glucose and glutamine metabolism in a subset of intestinal subtype gastric tumors at the level of expression of genes, gene sets and the occurrence of metabolites. On the other hand, glucose transport, glucan and fatty acid metabolism were enriched in a subset of diffuse subtype gastric tumors. In the current study, along with glucose metabolism, mTOR, HSP90, MYC, E2F, P53 and proteasome pathways were found enriched in a subset of intestinal subtype and a part of MSI subtype gastric tumors. On the other hand, along with fatty acid metabolism, the oncogenic pathway KRAS was found to be enriched in a subset of GS tumors among diffuse subtype gastric tumors. Thus, oncogenic signaling pathways associated with two distinct metabolic rewiring which differentially occurs between major gastric cancer subtypes were identified. These pathways seem the potential targets to differentially target these gastric cancer subtypes. Exploratory integrative genomic analyses reveal HSP90 inhibitors, AKT/mTOR inhibitors, and cell cycle inhibitors as potential agents to target the gastric tumors with the rewired glucose metabolism and MEK/MAPK inhibitors as suitable drug candidates to target the diffuse subtype tumors with the dysregulated fatty acid metabolism. This observation would pave way for the selective and targeted use of signaling pathway modulators for targeted and stratified gastric cancer therapeutics.
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Affiliation(s)
- Karthik Balakrishnan
- Unit of Excellence in Cancer Genetics, Department of Genetics, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, 625021, Tamil Nadu, India
| | - Kumaresan Ganesan
- Unit of Excellence in Cancer Genetics, Department of Genetics, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, 625021, Tamil Nadu, India.
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23
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Subramanian K, Balaraman D, Kaliyaperumal K, Devi Rajeswari V, Balakrishnan K, Ronald Ross P, Perumal E, Sampath Renuga P, Panangal M, Swarnalatha Y, Velmurugan S. Preparation of an Intelligent pH Film Based on Biodegradable Polymers for Monitoring the Food Quality and Reducing the Microbial Contaminants. Bioinorg Chem Appl 2022; 2022:7975873. [PMID: 35770237 PMCID: PMC9236817 DOI: 10.1155/2022/7975873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022] Open
Abstract
Hydrogel refers to a three-dimensional cross-linked polymeric network made of synthetic or natural polymers that can hold water in its porous structure. The inclusion of hydrophilic groups in the polymer chains, such as amino, carboxyl, and hydroxyl groups, contributes to the hydrogel's water-holding ability. At physiological temperature and pH, these polymeric materials do not dissolve in water, but they do swell significantly in aqueous media. Hydrogel can be manufactured out of almost any water-soluble polymer, and it comes in a variety of chemical compositions and bulk physical properties. Hydrogel can also be made in a variety of ways. Hydrogel comes in a variety of physical shapes, including slabs, microparticles, nanoparticles, coatings, and films. Due to its ease of manufacture and self-application in clinical and fundamental applications, hydrogel has been widely exploited as a drug carrier. Contact lenses, artificial corneas, wound dressing, suture coating, catheters, and electrode sensors are some of the biomedical applications of hydrogels. The pigment color changes were observed from colorless to pale pink followed by dark reddish-pink. Anthocyanin was produced in large quantities and tested using a UV-visible spectrophotometer. At 450-550 nm, the largest peak (absorbance) was detected, indicating the presence of anthocyanin. The FTIR analysis of this study shows the different stretches of bonds at different peaks: 2918.309 (-C-H alkane stretch), 2812.12 (-C-H aldehyde weak intensity), 192320.37/cm (C-O bend), 21915.50, 2029.08/cm (-C=C arene group), 1906.94/cm (=C-H aromatics), 1797.78/cm (=C-H), 1707.94 (-C=O ketene), 1579.70, 1382.96 (C-H alkane strong bend), 889.18/cm (C-H aromatics plane bend), and 412.77/cm (-C-CI strong bond). The spectra of the PVA/chitosan film depict the peak's formation: 1571.88, 1529.55, 1500.62/cm (C-H alkene strong bend), 1492.90, 1483.26, 1467.83/cm (C-H alkene strong bond), 670.48, 443.63, 412.77/cm (-O-H carboxylic acids with great intensity), 1708.93 (-C=O ketone), and 1656.0/cm (alkenyl C=C stretch strong bond).
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Affiliation(s)
- Kumaran Subramanian
- Centre for Drug Discovery and Development, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu 600119, India
| | | | - Kumaravel Kaliyaperumal
- National Navel Orange Engineering Research Centre, School of Life Sciences, Gannan Normal University, Ganzhou, Jiangxi, China
| | - V. Devi Rajeswari
- Department of Biomedical Sciences, School of Biosciences and Technology VIT, Vellore, Tamil Nadu, India
| | - K. Balakrishnan
- Department of Zoology, Government Arts College (A), Karur, Tamil Nadu, India
| | - P. Ronald Ross
- Department of Zoology, Annamalai University, Annamalai Nagar, Cuddalore, Tamil Nadu, 608002, India
| | - Elumalai Perumal
- Departments of Pharmacology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
| | | | - Mani Panangal
- Department of Biotechnology, Annai College of Arts & Science, Kumbakonam, Tamil Nadu, India
| | - Y. Swarnalatha
- Department of Biotechnology, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu 600119, India
| | - S. Velmurugan
- Department of Biology, School of Natural Science, Madawalabu University, Oromiya Region, Ethiopia
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Balakrishnan K, Hleihil M, Bhat MA, Ganley RP, Vaas M, Klohs J, Zeilhofer HU, Benke D. Targeting the interaction of GABA B receptors with CaMKII with an interfering peptide restores receptor expression after cerebral ischemia and inhibits progressive neuronal death in mouse brain cells and slices. Brain Pathol 2022; 33:e13099. [PMID: 35698024 PMCID: PMC9836377 DOI: 10.1111/bpa.13099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/29/2022] [Indexed: 01/21/2023] Open
Abstract
Cerebral ischemia is the leading cause for long-term disability and mortality in adults due to massive neuronal death. Currently, there is no pharmacological treatment available to limit progressive neuronal death after stroke. A major mechanism causing ischemia-induced neuronal death is the excessive release of glutamate and the associated overexcitation of neurons (excitotoxicity). Normally, GABAB receptors control neuronal excitability in the brain via prolonged inhibition. However, excitotoxic conditions rapidly downregulate GABAB receptors via a CaMKII-mediated mechanism and thereby diminish adequate inhibition that could counteract neuronal overexcitation and neuronal death. To prevent the deleterious downregulation of GABAB receptors, we developed a cell-penetrating synthetic peptide (R1-Pep) that inhibits the interaction of GABAB receptors with CaMKII. Administration of this peptide to cultured cortical neurons exposed to excitotoxic conditions restored cell surface expression and function of GABAB receptors. R1-Pep did not affect CaMKII expression or activity but prevented its T286 autophosphorylation that renders it autonomously and persistently active. Moreover, R1-Pep counteracted the aberrant downregulation of G protein-coupled inwardly rectifying K+ channels and the upregulation of N-type voltage-gated Ca2+ channels, the main effectors of GABAB receptors. The restoration of GABAB receptors activated the Akt survival pathway and inhibited excitotoxic neuronal death with a wide time window in cultured neurons. Restoration of GABAB receptors and neuroprotective activity of R1-Pep was verified by using brain slices prepared from mice after middle cerebral artery occlusion (MCAO). Treatment with R1-Pep restored normal GABAB receptor expression and GABA receptor-mediated K+ channel currents. This reduced MCAO-induced neuronal excitability and inhibited neuronal death. These results support the hypothesis that restoration of GABAB receptor expression under excitatory conditions provides neuroprotection and might be the basis for the development of a selective intervention to inhibit progressive neuronal death after ischemic stroke.
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Affiliation(s)
- Karthik Balakrishnan
- Institute of Pharmacology and Toxicology, University of ZurichZurichSwitzerland,Neuroscience Center ZurichUniversity of Zurich and ETH ZurichZurichSwitzerland,Present address:
Dewpoint Therapeutics GMBHDresdenGermany
| | - Mohammad Hleihil
- Institute of Pharmacology and Toxicology, University of ZurichZurichSwitzerland,Neuroscience Center ZurichUniversity of Zurich and ETH ZurichZurichSwitzerland
| | - Musadiq A. Bhat
- Institute of Pharmacology and Toxicology, University of ZurichZurichSwitzerland
| | - Robert P. Ganley
- Institute of Pharmacology and Toxicology, University of ZurichZurichSwitzerland
| | - Markus Vaas
- Institute of Pharmacology and Toxicology, University of ZurichZurichSwitzerland,Present address:
Clinical Trial Center ZurichUniversity Hospital of ZurichZurichSwitzerland
| | - Jan Klohs
- Neuroscience Center ZurichUniversity of Zurich and ETH ZurichZurichSwitzerland,Institute for Biomedical Engineering, University of Zurich and ETH ZurichZurichSwitzerland
| | - Hanns Ulrich Zeilhofer
- Institute of Pharmacology and Toxicology, University of ZurichZurichSwitzerland,Neuroscience Center ZurichUniversity of Zurich and ETH ZurichZurichSwitzerland,Drug Discovery Network ZurichZurichSwitzerland,Institute of Pharmaceutical Sciences, ETH ZurichZurichSwitzerland
| | - Dietmar Benke
- Institute of Pharmacology and Toxicology, University of ZurichZurichSwitzerland,Neuroscience Center ZurichUniversity of Zurich and ETH ZurichZurichSwitzerland,Drug Discovery Network ZurichZurichSwitzerland
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25
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Allen DZ, Challapalli S, Lee KH, Bell CS, Roy S, Bowe S, Balakrishnan K, Chang CWD, Huang Z. Impact of COVID-19 on nationwide pediatric otolaryngology practice: Adenotonsillectomies (TA) and tonsil-related diagnoses trends. Am J Otolaryngol 2022; 43:103526. [PMID: 35717857 PMCID: PMC9386644 DOI: 10.1016/j.amjoto.2022.103526] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
Objectives/hypothesis To determine the effects of the COVID-19 pandemic on Adenotonsillectomies (TA), Tonsil Related Cases (TC), and Peritonsillar Abscess (PTA) Trends. Study design Retrospective Cohort Study. Methods This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 51 children's hospitals. Regions were defined according to PHIS rules with at least five children's hospitals per region. We compared monthly total TA, TC, TC as a proportion of all hospital visits, and PTA from all encounters at each hospital from January 1, 2019, through December 31, 2021. Results Compared to 2019, April 2020 saw mean TC drop significantly from 371.62 to 68.37 (p < 0.001). Interestingly, June, September, and December 2020 had significantly higher mean TC compared to 2019. TC as a proportion of all hospital visits decreased significantly throughout the majority of 2021. Similarly, TA significantly decreased during 2020 and 2021 across all regions in the US, starting in March 2020 and this reduction in TA extended through the end of 2021 without any signs of recovery. PTA rates did not change significantly over the three years. Conclusions The pandemic-plagued 2020 saw a noticeable decrease in overall TC and TA but then rebounded quickly to even higher than pre-pandemic levels. However, this rebound halted for the majority of 2021 and subsequently decreased to lower than pre-pandemic levels, which differs from other communicable pathologies such as otitis media which decreased initially then recovered to pre-pandemic levels by Summer of 2021.
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Affiliation(s)
- David Z Allen
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America
| | - Sai Challapalli
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America
| | - Kyung Hyun Lee
- Center for Clinical Research & Evidence-Based Medicine, Department of Pediatrics, University of Texas Health Science Center, Houston, TX, United States of America
| | | | - Soham Roy
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Colorado, Denver, CO, United States of America
| | - Sarah Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), JBSA-Ft Sam Houston, TX, United States of America
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medical Center, Palo Alto, CA, United States of America
| | - C W David Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Zhen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America.
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Balakrishnan K, Haregu T, Hill AO, Young JT, Armstrong G. Discrimination experienced by sexual minority males in Australia: Associations with suicidal ideation and depressive symptoms. J Affect Disord 2022; 305:173-178. [PMID: 35278485 DOI: 10.1016/j.jad.2022.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Discrimination has been under-examined as a social determinant of the higher rates of poor mental health experienced by sexual minorities. The objectives of our study were to: 1) assess whether discrimination was independently associated with poor mental health among sexual minority males, and 2) assess the potential mediation role of discrimination in the associations between sexual minority status and poor mental health. METHODS We used cross-sectional data on 13,230 males aged 18-55 years from the Australian Longitudinal Study on Male Health; bisexual and homosexual males comprised 1.5% and 1.6% of the sample, respectively. We fit Poisson regression and zero-inflated negative binomial regression models to examine suicidality, depressive symptoms and perceived discrimination in the past two years as correlates of suicidality and depressive symptoms. RESULTS Statistically significant differences were observed in the prevalence of perceived discrimination by sexual orientation (p < 0.001), with the highest prevalence among bisexual (29.3%) and homosexual (40.4%) males, and the lowest prevalence among heterosexual males (18.6%). After adjusting for confounding, bisexual/homosexual males had higher rates of perceived discrimination (IRR = 1.88, p < 0.001), recent suicidal ideation (IRR = 1.51, p = 0.008), lifetime suicide attempt (IRR = 2.09, p < 0.001) and recent depressive symptoms (IRR = 1.34, p < 0.001) than heterosexual males. Analysis of β-coefficients suggested that discrimination may mediate a small to moderate proportion of the association between sexual minority status and poor mental health. LIMITATIONS Use of cross-sectional data. CONCLUSION Poor mental health is more common among sexual minority males, and discrimination may be a contributor to these mental health disparities. Reducing discrimination should be considered as part of a strategy to improve the mental wellbeing of sexual minority males.
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Affiliation(s)
- K Balakrishnan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - T Haregu
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - J T Young
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - G Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Bowe SN, Megwalu UC, Bergmark RW, Balakrishnan K. Moving Beyond Detection: Charting a Path to Eliminate Health Care Disparities in Otolaryngology. Otolaryngol Head Neck Surg 2022; 166:1013-1021. [PMID: 35439090 DOI: 10.1177/01945998221094460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The coronavirus pandemic has illuminated long-standing inequities in America's health care system and societal structure. While numerous studies have identified health care disparities within our specialty, few have progressed beyond detection. Otolaryngologists have the opportunity and the responsibility to act. Within this article, leaders from otolaryngology share their experience and perspective on health care disparities, including (1) a discussion of disparities in otolaryngology, (2) a summary of health care system design and incentives, (3) an overview of implicit bias, and (4) practical recommendations for providers to advance their awareness of health care disparities and the actions to mitigate them. While the path forward can be daunting, it should not be a deterrent. Throughout the course of this article, numerous resources are provided to support these efforts. To move ahead, our specialty needs to advance our level of understanding and develop, implement, and disseminate successful interventions toward the goal of eliminating health care disparities.
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft Sam Houston, Texas, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Regan W Bergmark
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
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Bhat MA, Esmaeili A, Neumann E, Balakrishnan K, Benke D. Targeting the Interaction of GABA B Receptors With CHOP After an Ischemic Insult Restores Receptor Expression and Inhibits Progressive Neuronal Death. Front Pharmacol 2022; 13:870861. [PMID: 35422706 PMCID: PMC9002115 DOI: 10.3389/fphar.2022.870861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 01/01/2023] Open
Abstract
GABAB receptors control neuronal excitability via slow and prolonged inhibition in the central nervous system. One important function of GABAB receptors under physiological condition is to prevent neurons from shifting into an overexcitation state which can lead to excitotoxic death. However, under ischemic conditions, GABAB receptors are downregulated, fostering over-excitation and excitotoxicity. One mechanism downregulating GABAB receptors is mediated via the interaction with the endoplasmic reticulum (ER) stress-induced transcription factor CHOP. In this study, we investigated the hypothesis that preventing the interaction of CHOP with GABAB receptors after an ischemic insult restores normal expression of GABAB receptors and reduces neuronal death. For this, we designed an interfering peptide (R2-Pep) that restored the CHOP-induced downregulation of cell surface GABAB receptors in cultured cortical neurons subjected to oxygen and glucose deprivation (OGD). Administration of R2-Pep after OGD restored normal cell surface expression of GABAB receptors as well as GABAB receptor-mediated inhibition. As a result, R2-Pep reduced enhanced neuronal activity and inhibited progressive neuronal death in OGD stressed cultures. Thus, targeting diseases relevant protein-protein interactions might be a promising strategy for developing highly specific novel therapeutics.
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Affiliation(s)
- Musadiq A Bhat
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Abolghasem Esmaeili
- Department of Cell and Molecular Biology & Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Elena Neumann
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Karthik Balakrishnan
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Dietmar Benke
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland.,Drug Discovery Network Zurich (DDNZ), Zurich, Switzerland
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Ratnagiri R, Balakrishnan K, Rao KG S. Survival After Heart Transplant is Poor with High Venous Pressures and Low Arterial Elastance. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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30
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Zoghbi V, Okonski F, Pan S, Lin C, Balakrishnan K, Tsui BCH. Suprazygomatic infratemporal pterygopalatine fossa block with adjuvant low-dose dexmedetomidine for adenotonsillectomy. Can J Anaesth 2022; 69:555-557. [DOI: 10.1007/s12630-022-02190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022] Open
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31
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Mortimer K, Montes de Oca M, Salvi S, Balakrishnan K, Hadfield RM, Ramirez-Venegas A, Halpin DMG, Ozoh Obianuju B, Han MeiLan K, Perez Padilla R, Kirenga B, Balmes JR. Household air pollution and COPD: cause and effect or confounding by other aspects of poverty? Int J Tuberc Lung Dis 2022; 26:206-216. [PMID: 35197160 PMCID: PMC8886958 DOI: 10.5588/ijtld.21.0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
SETTING : Household air pollution (HAP) and chronic obstructive pulmonary disease (COPD) are both major public health problems, reported to cause around 4 million and 3 million deaths every year, respectively. The great majority of these deaths, as well as the burden of disease during life is felt by people in low- and middle-income countries (LMICs). OBJECTIVE AND DESIGN : The extent to which HAP causes COPD is controversial; we therefore undertook this review to offer a viewpoint on this from the Global Initiative for COPD (GOLD). RESULTS : We find that while COPD is well-defined in many studies on COPD and HAP, there are major limitations to the definition and measurement of HAP. It is thus difficult to disentangle HAP from other features of poverty that are themselves associated with COPD. We identify other limitations to primary research studies, including the use of cross-sectional designs that limit causal inference. CONCLUSION : There is substantial preventable morbidity and mortality associated with HAP, COPD and poverty, separately and together. Although it may not be possible to define clear causal links between HAP and COPD, there is a clear urgency to reduce the avoidable burden of disease these inflict on the world’s poor.
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Affiliation(s)
- K Mortimer
- University of Cambridge, Cambridge, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela and Centro Médico de Caracas, Caracas, Venezuela
| | - S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | | | - R M Hadfield
- Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - A Ramirez-Venegas
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - D M G Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - B Ozoh Obianuju
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - R Perez Padilla
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - J R Balmes
- Department of Medicine, University of California, San Francisco and Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
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Allen DZ, Challapalli S, McKee S, Lee KH, Bell CS, Roy S, Bowe S, Balakrishnan K, Chang CD, Huang Z. Impact of COVID-19 on nationwide pediatric otolaryngology: Otitis media and myringotomy tube trends. Am J Otolaryngol 2022; 43:103369. [PMID: 35033925 PMCID: PMC8748207 DOI: 10.1016/j.amjoto.2021.103369] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The pandemic related to the novel coronavirus (COVID-19) has led to a decrease in communicable diseases due to social distancing and mask-wearing. How have the prevalence of otitis media (OM) and its associated procedures changed during the pandemic? STUDY DESIGN Retrospective Cohort Study. METHODS This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 48 children's hospitals. Regions were defined according to PHIS rules. We compared proportion of OM to total diagnoses codes, and collected mastoiditis, and MT placements from all encounters through January 1, 2019-June 31, 2021. RESULTS In April 2020, there was a decrease in mean proportion of OM cases per 100 hospital visits (7 v. 2, p < 0.0001) and this was sustained through 2020 and until June 2021 (6-7 v. 2-4, p < 0.05; p < 0.05). Compared to 2020, the months of April and June 2021 showed an increase in mean proportion of OM cases (6-7 v. 3-4, p < 0.05) while May did not. This relative increase in OM cases through April-June were primarily driven by the South, the Midwest, and the Northeast in April and the South and the Midwest in June. MT procedures followed similar trends. In 2020, there was no difference in mastoiditis as a proportion of OM cases compared to 2019 however there was a statistically higher rate of mastoiditis in 2020 compared to 2021. CONCLUSIONS The COVID-19 pandemic led to declines in OM and MT case volumes that have started to increase. A geographic relationship may exist, and this connection could be influenced by mask mandates and social distancing.
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Choo H, Galera RI, Balakrishnan K, Lin HFC, Ahn H, Lorenz P, Khosla RK, Profit J, Poets CF, Lee JS. Disruptive Therapy Using a Nonsurgical Orthodontic Airway Plate for the Management of Neonatal Robin Sequence: 1-Year Follow-up. Cleft Palate Craniofac J 2022; 60:758-767. [PMID: 35167404 DOI: 10.1177/10556656221076980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We recently published the 3-month follow-up of 2 neonates with Robin sequence whose mandibular hypoplasia and restricted airway were successfully treated with an orthodontic airway plate (OAP) without surgical intervention. Both infants were successfully weaned off the OAP after several months of continuous use. We present the course of OAP treatment in these patients with a focus on breathing, feeding, and facial growth during their first year of life. Both infants demonstrated stable mandibular projection, resolution of obstructive sleep apnea, and normal development.
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Affiliation(s)
- HyeRan Choo
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rhona I. Galera
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Karthik Balakrishnan
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hung-Fu C. Lin
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - HyoWon Ahn
- KyungHee University Dental Hospital, Seoul, Korea
| | - Peter Lorenz
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rohit K. Khosla
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jochen Profit
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Janice S. Lee
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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Boesch RP, de Alarcon A, Piccione J, Prager J, Rosen R, Sidell DR, Wootten C, Balakrishnan K. Consensus on Triple Endoscopy Data Elements Preparatory to Development of an Aerodigestive Registry. Laryngoscope 2022; 132:2251-2258. [PMID: 35122443 DOI: 10.1002/lary.30038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study defines essential data elements to be recorded during an aerodigestive "triple endoscopy" to form the foundation of a standardized multicenter registry and to clearly define measurement of each consensus item. STUDY DESIGN Modified Delphi process. METHODS Modified Delphi consensus with six survey rounds. Twenty-four expert pediatric otolaryngology, pulmonology, and gastroenterology aerodigestive clinicians from eight large academic pediatric aerodigestive programs formed the Delphi panel. After achieving consensus through the Delphi process, outside validation was performed at 2019 national Aerodigestive Society conference. Consensus, near-consensus, or exclusion was obtained for each proposed data element. Concordance was then measured between expert panel conclusions and validation group conclusions. RESULTS Overall response rate was 94.4%. 73/167 proposed items reached consensus in six domains (flexible bronchoscopy, bronchoalveolar lavage, microdirect laryngoscopy and bronchoscopy, esophagogastroduodenoscopy with biopsies, and esophageal impedance and pH probe). Measurement of all items was defined; classification/grading systems were selected for 11 items. Validation group endorsed importance of 82/167 data items; compared to expert consensus, overall, inclusion, and exclusion concordance rates were 94.5%, 98.7%, and 90.9%. CONCLUSION Triple endoscopy is a central component of aerodigestive care. This study identifies and defines data elements to be recorded for all triple endoscopy procedures. The list is of usable length, and clear definitions were created for all items, with explicit classification/grading systems selected for 11 items. Face validity was confirmed with an independent multispecialty sample of aerodigestive providers. This consensus provides the foundation for a triple endoscopy registry but also is immediately applicable to standardize clinical documentation in aerodigestive care. LEVEL OF EVIDENCE 5 Laryngoscope, 2022.
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Affiliation(s)
- Richard Paul Boesch
- Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, U.S.A
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Joseph Piccione
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Jeremy Prager
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A.,Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Rachel Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts, U.S.A
| | - Douglas R Sidell
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Christopher Wootten
- Division of Pediatric Otolaryngology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, U.S.A
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
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Banerjee A, Imig C, Balakrishnan K, Kershberg L, Lipstein N, Uronen RL, Wang J, Cai X, Benseler F, Rhee JS, Cooper BH, Liu C, Wojcik SM, Brose N, Kaeser PS. Molecular and functional architecture of striatal dopamine release sites. Neuron 2022; 110:248-265.e9. [PMID: 34767769 PMCID: PMC8859508 DOI: 10.1016/j.neuron.2021.10.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023]
Abstract
Despite the importance of dopamine for striatal circuit function, mechanistic understanding of dopamine transmission remains incomplete. We recently showed that dopamine secretion relies on the presynaptic scaffolding protein RIM, indicating that it occurs at active zone-like sites similar to classical synaptic vesicle exocytosis. Here, we establish using a systematic gene knockout approach that Munc13 and Liprin-α, active zone proteins for vesicle priming and release site organization, are important for dopamine secretion. Furthermore, RIM zinc finger and C2B domains, which bind to Munc13 and Liprin-α, respectively, are needed to restore dopamine release after RIM ablation. In contrast, and different from typical synapses, the active zone scaffolds RIM-BP and ELKS, and RIM domains that bind to them, are expendable. Hence, dopamine release necessitates priming and release site scaffolding by RIM, Munc13, and Liprin-α, but other active zone proteins are dispensable. Our work establishes that efficient release site architecture mediates fast dopamine exocytosis.
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Affiliation(s)
- Aditi Banerjee
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Cordelia Imig
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | | | - Lauren Kershberg
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Noa Lipstein
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | - Riikka-Liisa Uronen
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | - Jiexin Wang
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Xintong Cai
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Fritz Benseler
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | - Jeong Seop Rhee
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | - Benjamin H Cooper
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | - Changliang Liu
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Sonja M Wojcik
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | - Nils Brose
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, 37075 Göttingen, Germany
| | - Pascal S Kaeser
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA.
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Lam DJ, Balakrishnan K, Brenner MJ. Overcoming Vaccine Hesitancy Around Bell Palsy in Otolaryngology-Head and Neck Surgery: Lessons for COVID-19 Pandemic and Beyond. JAMA Otolaryngol Head Neck Surg 2021; 148:198. [PMID: 34882191 DOI: 10.1001/jamaoto.2021.3564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Derek J Lam
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Doernbecher Children's Hospital, Portland
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, California.,Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor
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Qian ZJ, Megwalu UC, Cheng AG, Balakrishnan K. Outpatient healthcare use and outcomes after pediatric tracheostomy. Int J Pediatr Otorhinolaryngol 2021; 151:110963. [PMID: 34736006 DOI: 10.1016/j.ijporl.2021.110963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To 1) describe health outcomes and outpatient healthcare use after pediatric tracheostomy, and 2) identify populations with higher morbidity that may benefit from improved post-operative monitoring. METHODS Optum's commercial insurance database was queried from 2003 to 2019. Children aged 0-18 who received tracheostomy identified. Mortality, decannulation, tracheostomy complications, and home ventilator dependence were determined, as well as physician office visits and specialty type. The effect that patient characteristics (age, sex, ethnicity, prematurity, and presence versus absence of chronic lung disease [CLD], congenital heart disease [CHD], neurologic impairment [NI], and upper airway obstruction [UAO]) had on outcomes were compared. RESULTS 1231 children were identified. Infants accounted for 33% of patients and 40% of the cohort was premature. The most common comorbid conditions were NI (76%), UAO (69%), CLD (48%), and CHD (35%). Within 5 years postoperatively, 25% died, 45% had home ventilator dependence, 53% had a complication, and 10% were decannulated. CHD was associated with higher risk of death (HR,1.98; 95% CI 1.22, 3.21), while UAO was associated with lower risk of death (HR,0.51; 95% CI 0.32, 0.83) and higher probability of decannulation (HR,3.56, 95% CI 1.08, 11.74). The median number of physician office visits was 6 per year (IQR 3,10). The most common specialty types were pediatrics (32%), pulmonary medicine (10%), and otolaryngology (8%). NI was associated with greater number of office visits (mean difference/year, 4.10; 95% CI 2.00, 6.19) while Hispanic ethnicity was associated with fewer visits (mean difference/year, -2.94; 95%CI -5.42, -0.45). CONCLUSIONS UAO was associated with lower risk of mortality and higher probability of decannulation, while NI was associated with greater outpatient healthcare utilization. Social disparities in outpatient tracheostomy care were observed.
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Affiliation(s)
- Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA.
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39
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Abstract
OBJECTIVE To improve hospital price transparency, the Centers for Medicare & Medicaid Services (CMS) requires, as of January 2021, that all hospitals reveal charges for specific items and services. This analysis investigates whether otolaryngology residency-affiliated hospitals have complied with this new regulation, and it evaluates the variability in hospital-reported charges for pediatric tonsillectomy. STUDY DESIGN Cross-sectional analysis. SETTINGS Subset of hospitals affiliated with otolaryngology residency programs. METHODS Hospital websites were searched to determine compliance rates with CMS guidelines by posting a price transparency tool and specific charges for Current Procedural Terminology code 42820 (tonsillectomy and adenoidectomy, <12 years old). Various charges were collected: gross charge, discounted cash price, deidentified minimum and maximum negotiated charges, hospital fees, and physician fees. RESULTS Overall 104 unique hospitals were analyzed: 81 (78%) provided pricing data, but only 28 (27%) complied with CMS guidelines. The median reported total gross charge was $13,239 (range, $600-$41,957); deidentified minimum negotiated charge, $9222 (range, $337-$25,164); and deidentified maximum negotiated charge, $17,355 (range, $1002-$54,987). Hospital fees (median, $11,900; range, $2304-$38,831) were consistently higher than physician fees (median, $1827; range, $420-$5063). All estimates included a disclaimer stating that values likely underrepresent true prices. CONCLUSION Hospital compliance with the new regulation remains low, which limits efforts toward improved price transparency. There is wide variability in reported charges for pediatric tonsillectomy and adenoidectomy.
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Affiliation(s)
- Noel Fahed Ayoub
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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Hleihil M, Vaas M, Bhat MA, Balakrishnan K, Benke D. Sustained Baclofen-Induced Activation of GABA B Receptors After Cerebral Ischemia Restores Receptor Expression and Function and Limits Progressing Loss of Neurons. Front Mol Neurosci 2021; 14:726133. [PMID: 34539344 PMCID: PMC8440977 DOI: 10.3389/fnmol.2021.726133] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
One important function of GABAB receptors is the control of neuronal activity to prevent overexcitation and thereby excitotoxic death, which is a hallmark of cerebral ischemia. Consequently, sustained activation of GABAB receptors with the selective agonist baclofen provides neuroprotection in in vitro and in vivo models of cerebral ischemia. However, excitotoxic conditions severely downregulate the receptors, which would compromise the neuroprotective effectiveness of baclofen. On the other hand, recent work suggests that sustained activation of GABAB receptors stabilizes receptor expression. Therefore, we addressed the question whether sustained activation of GABAB receptors reduces downregulation of the receptor under excitotoxic conditions and thereby preserves GABAB receptor-mediated inhibition. In cultured neurons subjected to oxygen and glucose deprivation (OGD), to mimic cerebral ischemia, GABAB receptors were severely downregulated. Treatment of the cultures with baclofen after OGD restored GABAB receptor expression and reduced loss of neurons. Restoration of GABAB receptors was due to enhanced fast recycling of the receptors, which reduced OGD-induced sorting of the receptors to lysosomal degradation. Utilizing the middle cerebral artery occlusion (MCAO) mouse model of cerebral ischemia, we verified the severe downregulation of GABAB receptors in the affected cortex and a partial restoration of the receptors after systemic injection of baclofen. Restored receptor expression recovered GABAB receptor-mediated currents, normalized the enhanced neuronal excitability observed after MCAO and limited progressive loss of neurons. These results suggest that baclofen-induced restoration of GABAB receptors provides the basis for the neuroprotective activity of baclofen after an ischemic insult. Since GABAB receptors regulate multiple beneficial pathways, they are promising targets for a neuroprotective strategy in acute cerebral ischemia.
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Affiliation(s)
- Mohammad Hleihil
- Institute of Pharmacology and Toxicology, University Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Vaas
- Institute of Pharmacology and Toxicology, University Zurich, Zurich, Switzerland
| | - Musadiq A Bhat
- Institute of Pharmacology and Toxicology, University Zurich, Zurich, Switzerland
| | - Karthik Balakrishnan
- Institute of Pharmacology and Toxicology, University Zurich, Zurich, Switzerland
| | - Dietmar Benke
- Institute of Pharmacology and Toxicology, University Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
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Gruszczynski NR, Low CM, Choby G, Meister KD, Smith BH, Balakrishnan K. Effects of Social Determinants of Health Care on Pediatric Thyroid Cancer Outcomes in the United States. Otolaryngol Head Neck Surg 2021; 166:1045-1054. [PMID: 34311618 DOI: 10.1177/01945998211032901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify social determinants of health care that are associated with poorer pediatric well-differentiated thyroid cancer (WDTC) outcomes and increased stage at presentation. STUDY DESIGN Using the SEER database (Surveillance, Epidemiology, and End Results), we retrospectively gathered data on pediatric WDTC across the United States between 1973 and 2015. SETTING All patients between 0 and 19 years old with a diagnosis of WDTC were included. METHODS Patient variables were analyzed for relationships to AJCC stage at presentation (American Joint Committee on Cancer), overall survival, and disease-specific survival. RESULTS Among 3913 patients with pediatric thyroid cancer, 3185 were female (81.4%), 3366 had papillary thyroid cancer (85.3%), and 367 had follicular thyroid cancer (9.4%). Two- and 5-year overall and disease-specific survival approached 100%. However, when outcomes were analyzed by specific populations, male sex, non-Caucasian race, poverty, and language isolation were linked to worse overall survival. Male sex and poverty were associated with poorer disease-specific survival. Regarding overall AJCC stage at presentation, male sex and Black race were related to higher overall presenting AJCC stage. Later AJCC T stage at presentation was seen in male, Hispanic, Asian, and Black patients. There were no variables significantly related to following through with recommended surgery. CONCLUSION Pediatric WDTC continues to carry an excellent prognosis in the United States. However, when we consider specific populations, the social determinants of health care affect survival and disease burden at presentation: male sex, poverty, language isolation, and race affected survival and/or AJCC stage at presentation in pediatric WDTC.
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Affiliation(s)
- Nelson R Gruszczynski
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Byron H Smith
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Palo Alto, California, USA
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Tsui BCH, Pan S, Smith L, Lin C, Balakrishnan K. Opioid-Free Tonsillectomy With and Without Adenoidectomy: The Role of Regional Anesthesia in the "New Era". Anesth Analg 2021; 133:e7-e9. [PMID: 34127598 DOI: 10.1213/ane.0000000000005567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California,
| | - Stephanie Pan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California,
| | - Lauren Smith
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California,
| | - Carole Lin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California,
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck, Lucile Packard Children's Hospital at Stanford, Stanford, California
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Low CM, Balakrishnan K, Smith BM, Stokken JK, O'Brien EK, Van Gompel JJ, Rowan NR, Choby G. Sinonasal adenocarcinoma: Population-based analysis of demographic and socioeconomic disparities. Head Neck 2021; 43:2946-2953. [PMID: 34117674 DOI: 10.1002/hed.26783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/22/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sinonasal adenocarcinoma (SNAC) is a rare tumor. The impact of health disparities on survival, stage at presentation, and utilization of surgery is not well understood in patients with SNAC. METHODS The Surveillance, Epidemiology, and End Results database was queried for cases of SNAC from 1973 to 2015. Cases were analyzed to assess for disparities in presentation, treatment, and survival. RESULTS SNAC was identified in 630 patients. In a multivariate model of overall survival, an age increase of 10 years (Hazard Ratio (HR) = 1.37, p < 0.001), male sex (HR = 1.26, p = 0.045), and more recent decade of diagnosis (HR = 0.74, p < 0.001) were significantly related to time-to-death. There is a higher rate of SNAC-related death in counties with more rural populations (p = 0.027). CONCLUSION Future interventions targeting rural and less well-educated populations may improve care with the goal of increasing the span of healthy life and reducing survival disparities related to SNAC.
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Affiliation(s)
- Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Byron M Smith
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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44
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Kohn J, Balakrishnan K, Sidell D. Pediatric Bilateral Vocal Fold Paralysis. Curr Otorhinolaryngol Rep 2021. [DOI: 10.1007/s40136-021-00334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Affiliation(s)
- Karthik Balakrishnan
- Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, Palo Alto, California.,Center for Pediatric Voice and Swallowing Disorders, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford Children's Health, Stanford, Palo Alto, California
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor.,Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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46
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Ravikumar R, Balakrishnan K, Sureshrao K, Srinath V, Veena R, Ajay A. Low Organ Perfusion Pressure Indexed to Body Surface Area is a Powerful Predictor of Poor Outcomes Even after Heart Transplantation in the Presence of High Right Atrial Pressure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kiessling P, Smith A, Puccinelli C, Balakrishnan K. Postoperative dysphagia immediately following pediatric endoscopic laryngeal cleft repair. Int J Pediatr Otorhinolaryngol 2021; 142:110625. [PMID: 33454453 DOI: 10.1016/j.ijporl.2021.110625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES In pediatric patients undergoing endoscopic laryngeal cleft repair, immediate postoperative dysphagia is not well-characterized. This study examined whether worsened dysphagia is present in the immediate postoperative period as detected by clinical swallow evaluation, and evaluated how this relates to postoperative change in presenting symptoms and findings on swallow studies. METHODS A retrospective cohort was conducted at a tertiary academic medical center, evaluating all pediatric patients who underwent endoscopic laryngeal cleft repair by a single surgeon from October 2014 through December 2018. All patients underwent instrumental swallow evaluation preoperatively and clinical swallow evaluation within 24 h following surgery. RESULTS Thirty-nine patients met inclusion criteria. Based on clinical swallow evaluation performed within 24 h after surgery, 4 patients (10%) were recommended to thicken their diet from preoperative baseline; all others were unchanged. All patients were admitted to the PICU for observation; 34 (87%) discharged on postoperative day 1. Thirty-seven patients attended 6-week follow-up, with 2 (5%) requiring thicker diet since discharge; all others were stable or improved. Prevalence of recurrent respiratory infections, subjective dysphagia, chronic cough, and wheezing significantly decreased after surgery. No statistically significant change occurred in prevalence of aspiration or penetration on instrumental swallow studies postoperatively. CONCLUSION Endoscopic laryngeal cleft repair is well-tolerated in pediatric patients, and most do not have obviously worsened dysphagia at immediate postoperative evaluation. Improvement in symptoms postoperatively may be a more useful indicator of surgical outcomes beyond instrumental swallow studies alone. The relative stability of these patients provides further evidence that they can likely be managed on the floor or as outpatients rather than in the ICU postoperatively.
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Affiliation(s)
| | - Alyssa Smith
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cassandra Puccinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology,Head and Neck Surgery, Stanford University, Palo Alto, CA, USA; Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
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48
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Kennedy A, Hart CK, de Alarcon A, Balakrishnan K, Boudewyns A, Chun R, Fayoux P, Goudy SL, Hartnick C, Hsu WC, Johnson RF, Kuo M, Peer S, Pransky SM, Rahbar R, Rickert S, Roy S, Russell J, Sandu K, Sidell DR, Smith RJ, Soma M, Spratley J, Thierry B, Thompson DM, Trozzi M, Watters K, White DR, Wyatt M, Zalzal GH, Zdanksi CJ, Zur KB, Rutter MJ. International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 2021; 141:110565. [PMID: 33341719 DOI: 10.1016/j.ijporl.2020.110565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/12/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To provide recommendations to otolaryngologists, pulmonologists, and allied clinicians for tracheostomy decannulation in pediatric patients. METHODS An iterative questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group. RESULTS Twenty-six members completed the survey. Recommendations address patient criteria for decannulation readiness, airway evaluation prior to decannulation, decannulation protocol, and follow-up after both successful and failed decannulation. CONCLUSION Tracheostomy decannulation recommendations are aimed at improving patient-centered care, quality and safety in children with tracheostomies.
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Affiliation(s)
- Aimee Kennedy
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - Robert Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head and Neck Surgery, University Hospital of Lille, Lille, France
| | - Steven L Goudy
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Christopher Hartnick
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Wei-Chung Hsu
- Division of Pediatric Otolaryngology, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan
| | - Romaine F Johnson
- Children's Health Airway Management Program, UT Southwestern Medical Center, Dallas, TX, USA
| | - Michael Kuo
- Otolaryngology, Birmingham Children's Hospital, UK
| | - Shazia Peer
- Division of Otolaryngology, University of Cape Town & Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Seth M Pransky
- Pediatric Otolaryngology Head and Neck Surgery, Pediatric Specialty Partners, San Diego, CA, USA
| | - Reza Rahbar
- Division of Pediatric Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott Rickert
- Division of Pediatric Otolaryngology, Hassenfeld Children's Hospital, New York University Langone Health, New York, NY, USA
| | - Soham Roy
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Memorial Hermann Hospital, University of Texas Medical School, Houston, TX, USA
| | - John Russell
- Department of Paediatric Otolaryngology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Kishore Sandu
- Airway Unit, Department of Otolaryngology, Lausanne University Hospital, CHUV, Switzerland
| | - Douglas R Sidell
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Richard J Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Marlene Soma
- Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jorge Spratley
- Pediatric Otorhinolaryngology, University of Porto Medical School, S. Joao Hospital Center, Porto, Portugal
| | - Briac Thierry
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, Paris, France
| | - Dana M Thompson
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marilena Trozzi
- Pediatric Surgery Department, Bambino Gesu Children's Hospital, Rome, Italy
| | - Karen Watters
- Division of Pediatric Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David R White
- Division of Pediatric Otolaryngology, MUSC Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Michelle Wyatt
- Paediatric Otolaryngology, Great Ormond Street Hospital, London, England, UK
| | - George H Zalzal
- Division of Otolaryngology, Children's National Medical Center, George Washington University, Washington DC, USA
| | - Carlton J Zdanksi
- Department of Otolaryngology/Head and Neck Surgery and Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Karen B Zur
- Department of Otolaryngology: Head & Neck Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadephia, PA, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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49
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Caloway C, Balakrishnan K, Boudewyns A, Chan KH, Cheng A, Daniel SJ, Fayoux P, Garabedian N, Hart C, Moreddu E, Muntz H, Nicollas R, Nuss R, Pransky S, Rahbar R, Russell J, Rutter M, Sidell D, Smith RJ, Soma M, Spratley J, Thompson D, Ward RF, Watters K, Wyatt M, Zalzal G, Hartnick C. International Pediatric Otolaryngology Group (IPOG) survey: Efforts to avoid complications in home tracheostomy care. Int J Pediatr Otorhinolaryngol 2021; 141:110563. [PMID: 33360407 DOI: 10.1016/j.ijporl.2020.110563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To provide guidance for home care tracheostomy management in the pediatric population. The mission of the IPOG is to develop expertise-based recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. METHODS Survey of expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). RESULTS Survey results provide guidance for caregiver teaching, the reuse of tracheostomies and suction catheters while inpatient and following discharge, acceptable sterilization practices for tracheostomies, tracheitis workup and management, and outpatient follow-up practices. CONCLUSION This presentation of common home tracheostomy care practices are aimed at improving patient-centered care in the pediatric population.
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Affiliation(s)
- Christen Caloway
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | | | - Alan Cheng
- The Children's Hospital at Westmead, Sydney, Australia
| | - Sam J Daniel
- Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Hospital, CHU Lille, Université de Lille, Lille, France
| | - Noel Garabedian
- Pediatric ENT Department, Ho^pital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - Catherine Hart
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric Moreddu
- Department of Pediatric Otorhinolaryngology - Head and Neck Surgery - La Timone Children's Hospital, Aix-Marseille Universite, Marseille, France
| | - Harlan Muntz
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, UT, USA
| | - Richard Nicollas
- Department of Pediatric Otorhinolaryngology - Head and Neck Surgery - La Timone Children's Hospital, Aix-Marseille Universite, Marseille, France
| | - Roger Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Seth Pransky
- Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - John Russell
- Children's Health Ireland (Crumlin), Dublin, Ireland
| | - Mike Rutter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Richard J Smith
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Jorge Spratley
- Hospital S. João Center, Univ. of Porto Faculty of Medicine, Cintesis, Porto, Portugal
| | - Dana Thompson
- Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Karen Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | | | - George Zalzal
- Children's National Medical Center, Washington, DC, USA
| | - Christopher Hartnick
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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50
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Sidell DR, Balakrishnan K, Best SR, Zur K, Buckingham J, De Alarcon A, Baroody FM, Bock JM, Boss EF, Bower CM, Campisi P, Chen SF, Clarke JM, Clarke KD, Cocciaglia A, Cotton RT, Cuestas G, Davis KL, DeFago VH, Dikkers FG, Dossans I, Florez W, Fox E, Friedman AD, Grant N, Hamdi O, Hogikyan ND, Johnson K, Johnson LB, Johnson RF, Kelly P, Klein AM, Lawlor CM, Leboulanger N, Levy AG, Lam D, Licameli GR, Long S, Lott DG, Manrique D, McMurray JS, Meister KD, Messner AH, Mohr M, Mudd P, Mortelliti AJ, Novakovic D, Ongkasuwan J, Peer S, Piersiala K, Prager JD, Pransky SM, Preciado D, Raynor T, Rinkel RNPM, Rodriguez H, Rodríguez VP, Russell J, Scatolini ML, Scheffler P, Smith DF, Smith LP, Smith ME, Smith RJH, Sorom A, Steinberg A, Stith JA, Thompson D, Thompson JW, Varela P, White DR, Wineland AM, Yang CJ, Zdanski CJ, Derkay CS. Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement. Laryngoscope 2021; 131:E1941-E1949. [PMID: 33405268 DOI: 10.1002/lary.29343] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality. STUDY DESIGN Delphi method-based survey series. METHODS A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up. RESULTS The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics (22), and Prior Workup Characteristics (18). CONCLUSION This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes. LEVEL OF EVIDENCE 5 Laryngoscope, 131:E1941-E1949, 2021.
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Affiliation(s)
- Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, and, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Karen Zur
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Julia Buckingham
- Maternal and Child Health Research Institute, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Alessandro De Alarcon
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery and Department of Pediatrics, University of Chicago Medicine and The Comer Children's Hospital, Chicago, Illinois, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Division of Laryngology and Professional Voice, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Charles M Bower
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences (UAMS), Arkansas Children's Hospital, Little Rock, Alaska, U.S.A
| | - Paolo Campisi
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sharon F Chen
- Department of Pediatrics, Division of Infectious Diseases, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Jeffrey M Clarke
- Department of Medicine, Division of Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Kevin D Clarke
- Pediatric Otolaryngology, Division of Otolaryngology Head and Neck Surgery, University of British Columbia (UBC, UVIc), Victoria General Hospital, Victoria, British Columbia, Canada
| | - Alejandro Cocciaglia
- ENT-Respiratory Endoscopy Department, Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Robin T Cotton
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Giselle Cuestas
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - Kara L Davis
- Department of Pediatrics, Division of Pediatric Oncology, Bass Center for Childhood Cancer and Blood Disorders, Stanford University, Stanford, California, U.S.A
| | - Victor H DeFago
- Pediatric Surgery, Sanatorio del Salvador Privado SA, Cordoba, Argentina
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ines Dossans
- Otolaryngology-Head and Neck Surgery, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Walter Florez
- Department of Otolaryngology, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | - Elizabeth Fox
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, Tennessee, U.S.A
| | - Aaron D Friedman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, U.S.A
| | - Nazaneen Grant
- Department of Otolaryngology, Division of Laryngology, Medstar Georgetown University Hospital, Georgetown, Washington, District of Columbia, U.S.A
| | - Osama Hamdi
- Howard University College of Medicine, Washington, District of Columbia, U.S.A
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Kaalan Johnson
- University of Washington School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, Seattle, Washington, District of Columbia, U.S.A
| | - Liane B Johnson
- Department of Surgery, Dalhousie University, Division of Paediatric Otolaryngology-Head and Neck Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Peggy Kelly
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | - Adam M Klein
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Claire M Lawlor
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Nicolas Leboulanger
- Head and Neck Surgery, Pediatric Otolaryngology, Necker Enfants Malades Hospital, Paris University, Paris, France
| | - Alejandro G Levy
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Arnold Palmer Hospital Center for Children's Cancer and Blood Disorders, Orlando Health, Orlando, Florida, U.S.A
| | - Derek Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Greg R Licameli
- Department of Otolaryngology, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Steve Long
- Department of Head and Neck Surgery, Kaiser Permanente, Hillsboro, Oregon, U.S.A
| | - David G Lott
- Department of Otorhinolaryngology, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Dayse Manrique
- Department of Otorhinolaryngology, Universidad Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - James Scott McMurray
- Pediatric Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Anna H Messner
- Department of Otolaryngology/Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Michael Mohr
- Department of Hematology, Oncology and Respiratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Pamela Mudd
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Anthony J Mortelliti
- Department of Otolaryngology-Head and Neck Surgery, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, U.S.A
| | - Daniel Novakovic
- Department of Otolaryngology, Head and Neck Surgery, Central Clinical School, Faculty of Medicine and Health, University of Sydney, The Canterbury Hospital, Sydney, New South Wales, Australia
| | - Julian Ongkasuwan
- Department of Otolaryngology, Division of Adult and Pediatric Laryngology, Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Shazia Peer
- Division of Otorhinolaryngology, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Krysztof Piersiala
- Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinksa University Hospital, Stockholm, Sweden
| | - Jeremy D Prager
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | | | - Diego Preciado
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Tiffany Raynor
- Department of Otolaryngology, Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Rico N P M Rinkel
- Department of Otolaryngology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hugo Rodriguez
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Verónica P Rodríguez
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - John Russell
- Department of Paediatric Otolaryngology, Children's Health Ireland, Dublin, Ireland
| | - María Laura Scatolini
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Patrick Scheffler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - David F Smith
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Lee P Smith
- Division of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York, U.S.A
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Abraham Sorom
- Otolaryngology, Head and Neck Surgery, Confluence Health, Wenatchee, Washington, District of Columbia, U.S.A
| | - Amalia Steinberg
- Otolaryngology, Head and Neck Surgery, Alaska Native Medical center, Anchorage, Alaska, U.S.A
| | - John A Stith
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, SSM Cardinal Glennon Children's Hospital Medical Center, St. Louis, Missouri, U.S.A
| | - Dana Thompson
- Division of Pediatric Otolaryngology Head and Neck Surgery Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jerome W Thompson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric ENT, LeBonheur Children's Hospital, College of Medicine, University of Tennnessee, Memphis, Tennessee, U.S.A
| | - Patricio Varela
- Pediatric Surgery Department, Universidad de Chile, Mackenna Children Hospital, Clinica Las Condes Medical center, Santiago, Chile
| | - David R White
- Division of Pediatric Otolaryngology, Medical University of South Carolina (MUSC) Shawn Jenkins Children's Hospital, Charleston, South Carolina, U.S.A
| | - Andre M Wineland
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Christina J Yang
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, New York, New York, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, Division of Pediatric Otolaryngology/Head and Neck Surgery, North Carolina Children's Hospital, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, U.S.A
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