Morpho-electric diversity of human hippocampal CA1 pyramidal neurons

Hippocampal pyramidal neuron activity underlies episodic memory and spatial navigation. Although extensively studied in rodents, extremely little is known about human hippocampal pyramidal neurons, even though the human hippocampus underwent strong evolutionary reorganization and shows lower theta rhythm frequencies. To test whether biophysical properties of human Cornu Amonis subfield 1 (CA1) pyramidal neurons can explain observed rhythms, we map the morpho-electric properties of individual CA1 pyramidal neurons in human, non-pathological hippocampal slices from neurosurgery. Human CA1 pyramidal neurons have much larger dendritic trees than mouse CA1 pyramidal neurons, have a large number of oblique dendrites, and resonate at 2.9 Hz, optimally tuned to human theta frequencies. Morphological and biophysical properties suggest cellular diversity along a multidimensional gradient rather than discrete clustering. Across the population, dendritic architecture and a large number of oblique dendrites consistently boost memory capacity in human CA1 pyramidal neurons by an order of magnitude compared to mouse CA1 pyramidal neurons.

Buccal Fat Advancement-Transposition Flap for Reconstruction of Midface Volume Defects

Background: The buccal fat pad (BFP) has previously been utilized for repair of various defects of the head and neck. Objectives: We explore the utility of a pedicled buccal fat advancement-transposition (BFAT) flap in various forms of midface reconstruction through a variety of surgical approaches and characterize its volume and axial reach in human anatomic specimens. Methods: Ten adult full-head human anatomic specimens were dissected, and a single surgical case demonstrating the use of a BFAT flap is described. Results: Nasolabial, subciliary, and deep plane facelift incisions all provided access to the BFP for use as a BFAT flap. The mean volume of mobilizable fat contained within a BFAT flap accessible through external incision was 7.1 cm3. Once fully mobilized, the externalized BFAT flap had a mean axial reach of 6.9 cm without tension. We also present a case illustrating the successful use of a BFAT flap for volumization of a large midface defect secondary to Mohs micrographic surgical resection of a cutaneous malignancy. Discussion: The BFAT flap, which exhibited substantial volume and reach in this study, can be harvested through multiple dissection windows or pre-existing defects and be used to reconstruct a variety of midface defects.

Conserved and divergent gene regulatory programs of the mammalian neocortex

Divergence of cis-regulatory elements drives species-specific traits1, but how this manifests in the evolution of the neocortex at the molecular and cellular level remains unclear. Here we investigated the gene regulatory programs in the primary motor cortex of human, macaque, marmoset and mouse using single-cell multiomics assays, generating gene expression, chromatin accessibility, DNA methylome and chromosomal conformation profiles from a total of over 200,000 cells. From these data, we show evidence that divergence of transcription factor expression corresponds to species-specific epigenome landscapes. We find that conserved and divergent gene regulatory features are reflected in the evolution of the three-dimensional genome. Transposable elements contribute to nearly 80% of the human-specific candidate cis-regulatory elements in cortical cells. Through machine learning, we develop sequence-based predictors of candidate cis-regulatory elements in different species and demonstrate that the genomic regulatory syntax is highly preserved from rodents to primates. Finally, we show that epigenetic conservation combined with sequence similarity helps to uncover functional cis-regulatory elements and enhances our ability to interpret genetic variants contributing to neurological disease and traits.

Connecting single-cell transcriptomes to projectomes in mouse visual cortex

The mammalian brain is composed of diverse neuron types that play different functional roles. Recent single-cell RNA sequencing approaches have led to a whole brain taxonomy of transcriptomically-defined cell types, yet cell type definitions that include multiple cellular properties can offer additional insights into a neuron's role in brain circuits. While the Patch-seq method can investigate how transcriptomic properties relate to the local morphological and electrophysiological properties of cell types, linking transcriptomic identities to long-range projections is a major unresolved challenge. To address this, we collected coordinated Patch-seq and whole brain morphology data sets of excitatory neurons in mouse visual cortex. From the Patch-seq data, we defined 16 integrated morpho-electric-transcriptomic (MET)-types; in parallel, we reconstructed the complete morphologies of 300 neurons. We unified the two data sets with a multi-step classifier, to integrate cell type assignments and interrogate cross-modality relationships. We find that transcriptomic variations within and across MET-types correspond with morphological and electrophysiological phenotypes. In addition, this variation, along with the anatomical location of the cell, can be used to predict the projection targets of individual neurons. We also shed new light on infragranular cell types and circuits, including cell-type-specific, interhemispheric projections. With this approach, we establish a comprehensive, integrated taxonomy of excitatory neuron types in mouse visual cortex and create a system for integrated, high-dimensional cell type classification that can be extended to the whole brain and potentially across species.

Microscale visualization of cellular features in adult macaque visual cortex

Expansion microscopy and light sheet imaging enable fine-scale resolution of intracellular features that comprise neural circuits. Most current techniques visualize sparsely distributed features across whole brains or densely distributed features within individual brain regions. Here, we visualize dense distributions of immunolabeled proteins across early visual cortical areas in adult macaque monkeys. This process may be combined with multiphoton or magnetic resonance imaging to produce multimodal atlases in large, gyrencephalic brains.

Expansion-assisted selective plane illumination microscopy for nanoscale imaging of centimeter-scale tissues

Recent advances in tissue processing, labeling, and fluorescence microscopy are providing unprecedented views of the structure of cells and tissues at sub-diffraction resolutions and near single molecule sensitivity, driving discoveries in diverse fields of biology, including neuroscience. Biological tissue is organized over scales of nanometers to centimeters. Harnessing molecular imaging across three-dimensional samples on this scale requires new types of microscopes with larger fields of view and working distance, as well as higher imaging throughput. We present a new expansion-assisted selective plane illumination microscope (ExA-SPIM) with diffraction-limited and aberration-free performance over a large field of view (85 mm 2 ) and working distance (35 mm). Combined with new tissue clearing and expansion methods, the microscope allows nanoscale imaging of centimeter-scale samples, including entire mouse brains, with diffraction-limited resolutions and high contrast without sectioning. We illustrate ExA-SPIM by reconstructing individual neurons across the mouse brain, imaging cortico-spinal neurons in the macaque motor cortex, and tracing axons in human white matter.

Integrated multimodal cell atlas of Alzheimer's disease

Alzheimer's disease (AD) is the most common cause of dementia in older adults. Neuropathological and imaging studies have demonstrated a progressive and stereotyped accumulation of protein aggregates, but the underlying molecular and cellular mechanisms driving AD progression and vulnerable cell populations affected by disease remain coarsely understood. The current study harnesses single cell and spatial genomics tools and knowledge from the BRAIN Initiative Cell Census Network to understand the impact of disease progression on middle temporal gyrus cell types. We used image-based quantitative neuropathology to place 84 donors spanning the spectrum of AD pathology along a continuous disease pseudoprogression score and multiomic technologies to profile single nuclei from each donor, mapping their transcriptomes, epigenomes, and spatial coordinates to a common cell type reference with unprecedented resolution. Temporal analysis of cell-type proportions indicated an early reduction of Somatostatin-expressing neuronal subtypes and a late decrease of supragranular intratelencephalic-projecting excitatory and Parvalbumin-expressing neurons, with increases in disease-associated microglial and astrocytic states. We found complex gene expression differences, ranging from global to cell type-specific effects. These effects showed different temporal patterns indicating diverse cellular perturbations as a function of disease progression. A subset of donors showed a particularly severe cellular and molecular phenotype, which correlated with steeper cognitive decline. We have created a freely available public resource to explore these data and to accelerate progress in AD research at SEA-AD.org.

Comparative single cell epigenomic analysis of gene regulatory programs in the rodent and primate neocortex

Sequence divergence of cis- regulatory elements drives species-specific traits, but how this manifests in the evolution of the neocortex at the molecular and cellular level remains to be elucidated. We investigated the gene regulatory programs in the primary motor cortex of human, macaque, marmoset, and mouse with single-cell multiomics assays, generating gene expression, chromatin accessibility, DNA methylome, and chromosomal conformation profiles from a total of over 180,000 cells. For each modality, we determined species-specific, divergent, and conserved gene expression and epigenetic features at multiple levels. We find that cell type-specific gene expression evolves more rapidly than broadly expressed genes and that epigenetic status at distal candidate cis -regulatory elements (cCREs) evolves faster than promoters. Strikingly, transposable elements (TEs) contribute to nearly 80% of the human-specific cCREs in cortical cells. Through machine learning, we develop sequence-based predictors of cCREs in different species and demonstrate that the genomic regulatory syntax is highly preserved from rodents to primates. Lastly, we show that epigenetic conservation combined with sequence similarity helps uncover functional cis -regulatory elements and enhances our ability to interpret genetic variants contributing to neurological disease and traits.

Telemedicine in Otolaryngology During COVID-19: An Exploratory Assessment of Provider and Patient Attitudes

OBJECTIVE

To determine provider and patient attitudes toward telemedicine in Otolaryngology-Head and Neck Surgery (OHNS).

METHODS

Otolaryngology practitioners conducting outpatient clinics at an academic tertiary referral center were provided with a pre-Study Provider Perception Questionnaire (pre-PPQ) designed to evaluate pre-study perception of telemedicine in otolaryngology. A post-study Provider Perception Questionnaire (post-PPQ) designed to evaluate elements similar to those constituting the PrePPQ was completed at 6 weeks. Additionally, following each visit, providers and patients completed Individual Encounter Survey Questionnaires (IESQ) to evaluate the virtual clinical encounter experience.

RESULTS

The pre-PPQ was completed by 29 providers, while the post-PPQ was completed by 12 providers. A total of 236 post-visit provider IESQs were completed, of which 208 were deemed successful. Audio/visual (AV) difficulties and limited server connectivity for the patient were most common causes for unsuccessful encounters. Providers reported that the most appropriate use of telemedicine, on both pre-PPQ and post-PPQ, was triaging patients to determine the need for in-person visits. The inability to perform a physical exam was rated as the primary barrier to telemedicine in OHNS on both pre-PPQ and post-PPQ. Patients strongly agreed with the statements, "My healthcare provider was able to understand my healthcare condition" and, "I felt comfortable communicating with my healthcare provider" 92.0% and 95.4% of the time, respectively.

CONCLUSION

Both providers and patients demonstrated an overall positive attitude toward the use of telemedicine in the provision of otolaryngologic care.

Intravenous functional gene transfer throughout the brain of non-human primates using AAV

Adeno-associated viruses (AAVs) promise robust gene delivery to the brain through non-invasive, intravenous delivery. However, unlike in rodents, few neurotropic AAVs efficiently cross the blood-brain barrier in non-human primates (NHPs). Here we describe AAV.CAP-Mac, an engineered variant identified by screening in adult marmosets and newborn macaques with improved efficiency in the brain of multiple NHP species: marmoset, rhesus macaque, and green monkey. CAP-Mac is neuron-biased in infant Old World primates, exhibits broad tropism in adult rhesus macaques, and is vasculature-biased in adult marmosets. We demonstrate applications of a single, intravenous dose of CAP-Mac to deliver (1) functional GCaMP for ex vivo calcium imaging across multiple brain areas, and (2) a cocktail of fluorescent reporters for Brainbow-like labeling throughout the macaque brain, circumventing the need for germline manipulations in Old World primates. Given its capabilities for systemic gene transfer in NHPs, CAP-Mac promises to help unlock non-invasive access to the brain.

Multi-modal characterization and simulation of human epileptic circuitry

Temporal lobe epilepsy is the fourth most common neurological disorder, with about 40% of patients not responding to pharmacological treatment. Increased cellular loss is linked to disease severity and pathological phenotypes such as heightened seizure propensity. While the hippocampus is the target of therapeutic interventions, the impact of the disease at the cellular level remains unclear. Here, we show that hippocampal granule cells change with disease progression as measured in living, resected hippocampal tissue excised from patients with epilepsy. We show that granule cells increase excitability and shorten response latency while also enlarging in cellular volume and spine density. Single-nucleus RNA sequencing combined with simulations ascribes the changes to three conductances: BK, Cav2.2, and Kir2.1. In a network model, we show that these changes related to disease progression bring the circuit into a more excitable state, while reversing them produces a less excitable, "early-disease-like" state.

A Sparse Sampling Sensor Front-End IC for Low Power Continuous SpO 2 & HR Monitoring

Photoplethysmography (PPG) is an attractive method to acquire vital signs such as heart rate and blood oxygenation and is frequently used in clinical and at-home settings. Continuous operation of health monitoring devices demands a low power sensor that does not restrict the device battery life. Silicon photodiodes (PD) and LEDs are commonly used as interface devices in PPG sensors; however, using of flexible organic devices can enhance the sensor conformality and reduce the cost of fabrication. In most PPG sensors, most of system power consumption is concentrated in powering LEDs, traditionally consuming mWs. Using organic devices further increases this power demand since these devices exhibit larger parasitic capacitances and typically need higher drive voltages.This work presents a sensor IC for continuous SpO ₂ and HR monitoring that features an on-chip reconstruction-free sparse sampling algorithm to reduce the overall system power consumption by  ∼ 70% while maintaining the accuracy of the output information. The designed frontend is compatible with a wide range of devices from silicon PDs to organic PDs with parasitic capacitances up to 10 nF. Implemented in a 40 nm HV CMOS process, the chip occupies 2.43 mm ² and consumes 49.7 μW and 15.2 μW of power in continuous and sparse sampling modes respectively. The performance of the sensor IC has been verified in vivo with both types of devices and the results are compared against a clinical grade reference. Less than 1 bpm and 1% mean absolute errors were achieved in both continuous and sparse modes of operation.

Simulation of laryngotracheal reconstruction with 3D ‐printed models and porcine cadaveric models

Objectives

Laryngotracheal reconstruction (LTR) is a complex operation used to treat subglottic stenosis. The use of simulator models is a valuable tool in surgical trainee education, particularly for operations such as LTR that are less common outside high‐volume centers. Three‐dimensional (3D) printing of the human airway may provide an effective and more accessible alternative to porcine cadaveric models. The objective of this study is to compare the educational value of a 3D‐printed model and a porcine cadaveric model as LTR simulation methods.

Methods

Simulated LTR procedures were completed by 12 otolaryngology residents and a faculty physician on the cadaveric model and the 3D‐printed simulator model. Both models were evaluated by fellowship‐trained pediatric otolaryngologists to establish construct validity. Pre‐procedure surveys of participants evaluated confidence and attitude toward models and post‐procedure surveys evaluated confidence, overall impressions, relevance, content validity, and face validity.

Results

Participants reported a similar mean increase in confidence after performing LTR on the 3D‐printed model (14%) and cadaveric model (11%). Participants rated both models similarly for utility as an overall training tool and in teaching surgical planning and improving operative techniques. However, participants found the 3D‐printed model more useful for teaching anatomy (p = .047).

Conclusion

3D‐printed models have practical benefits over cadaveric models; they do not decompose and can be custom made to model a disease state such as subglottic stenosis. Participants reported a similar mean increase in confidence after using either simulation. The 3D‐printed model is a promising simulation candidate as it compares well to an animal model and has the advantage of being more anatomically true to pediatric patients.

Level of Evidence: Level 2.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

COVID-19 Vaccine Safety in Cancer Patients: A Single Centre Experience

Emergency approval of vaccines against COVID-19 provides an opportunity for us to return to pre-pandemic oncology care. However, safety data in cancer patients is lacking due to their exclusion from most phase III trials. We included all patients aged less than 65 years who received a COVID-19 vaccine from 8 December 2020 to 28 February 2021 at our London tertiary oncology centre. Solicited and unsolicited vaccine-related adverse events (VRAEs) were collected using telephone or face-to-face consultation. Within the study period, 373 patients received their first dose of vaccine: Pfizer/BioNTech (75.1%), Oxford/AstraZeneca (23.6%), Moderna (0.3%), and unknown (1.1%). Median follow-up was 25 days (5-85). Median age was 56 years (19-65). Of the patients, 94.9% had a solid malignancy and 76.7% were stage 3-4. The most common cancers were breast (34.0%), lung (13.4%), colorectal (10.2%), and gynaecological (10.2%). Of the patients, 88.5% were receiving anti-cancer treatment (36.2% parenteral chemotherapy and 15.3% immunotherapy), 76.1% developed any grade VRAE of which 2.1% were grade 3. No grade 4/5 or anaphylaxis were observed. The most common VRAEs within 7 days post-vaccination were sore arm (61.7%), fatigue (18.2%), and headaches (12.1%). Most common grade 3 VRAE was fatigue (1.1%). Our results demonstrate that COVID-19 vaccines in oncology patients have mild reactogenicity.

YouTube Videos Demonstrating the Nasopharyngeal Swab Technique for SARS-CoV-2 Specimen Collection: Content Analysis

BACKGROUND

Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates.

OBJECTIVE

The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures.

METHODS

We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique.

RESULTS

In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat-related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020).

CONCLUSIONS

Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures.

Endoscopic Orbital Decompression: Technical Pearls and Pitfalls of an Evolving Technique

BACKGROUND

First described in the early 1990s, endoscopic orbital decompression has become increasingly popular and has been shown to be a safe and effective approach for surgical decompression of the medial and inferior orbit.

METHODS

We present our preferred technique for performing an endoscopic orbital decompression, highlighting key pearls and pitfalls.

RESULTS

An endoscopic wide maxillary antrostomy and sphenoethmoidectomy is performed in standard fashion. We prefer to resect the middle turbinate for optimal exposure and access. The medial orbital wall is skeletonized and the lamina papyracea is carefully elevated, preserving the underlying periorbita. The orbital floor medial to the infraorbital nerve is resected. Once the periorbita is fully exposed, parallel axial incisions along the medial orbit and orbital floor are made from posterior to anterior using a sickle knife, taking care not to bury the tip to avoid injuring underlying orbital contents. The remaining fibrous bands are incised and prolapse of orbital fat is observed. Post extubation bag mask ventilation is limited to avoid subcutaneous emphysema.

CONCLUSION

Compared to open techniques, endoscopic orbital decompression provides superior visualization of critical anatomical landmarks, assures healthy sinus functioning post procedure, offers a lower complication rate, and avoids external incisions.

Highly Flexible Transparent Micromesh Electrodes via Blade-Coated Polymer Networks for Organic Light-Emitting Diodes

The availability of transparent conductive thin films that exhibit mechanical flexibility and are adapted to low-cost and large-area fabrication is a major obstacle for high-performance flexible thin-film optoelectronics. Here, by combining printing, thin-film deposition, and wet-etching processes, interconnected transparent metal micromesh (TMM) electrodes are reported. Blade-coating is used to generate self-assembled polymer micromesh networks on flexible substrates. The network structures are subsequently converted into conductive metal networks. As-fabricated TMM films display a surface roughness of around 20 nm with thickness down to 50 nm. A transmittance of 86% and a conductance of 80 Ω sq^-1 are achieved at the described optimal blade-coating suspension concentration. The electrodes show mechanical flexibility with no conductivity degradation with the smallest bending radius of 1 mm or at repeated bending over 3000 cycles at a bending radius of 15 mm. We successfully demonstrate organic light-emitting diodes (OLEDs) using TMM electrodes via the blade-coating technique. The printed OLEDs have a low turn-on voltage of 3.4 V and can achieve a luminance of over 4000 cd/m² at 6.5 V. At a luminance of 100 cd/m², the OLEDs show a current density of 7.6 mA/cm², an external quantum efficiency (EQE) of 3.6%, and a luminous efficacy of 1.4 lm/W.

A New Frontier of Printed Electronics: Flexible Hybrid Electronics

The performance and integration density of silicon integrated circuits (ICs) have progressed at an unprecedented pace in the past 60 years. While silicon ICs thrive at low-power high-performance computing, creating flexible and large-area electronics using silicon remains a challenge. On the other hand, flexible and printed electronics use intrinsically flexible materials and printing techniques to manufacture compliant and large-area electronics. Nonetheless, flexible electronics are not as efficient as silicon ICs for computation and signal communication. Flexible hybrid electronics (FHE) leverages the strengths of these two dissimilar technologies. It uses flexible and printed electronics where flexibility and scalability are required, i.e., for sensing and actuating, and silicon ICs for computation and communication purposes. Combining flexible electronics and silicon ICs yields a very powerful and versatile technology with a vast range of applications. Here, the fundamental building blocks of an FHE system, printed sensors and circuits, thinned silicon ICs, printed antennas, printed energy harvesting and storage modules, and printed displays, are discussed. Emerging application areas of FHE in wearable health, structural health, industrial, environmental, and agricultural sensing are reviewed. Overall, the recent progress, fabrication, application, and challenges, and an outlook, related to FHE are presented.

Correlations in Trends of Sinusitis-Related Online Google Search Queries in the United States

BACKGROUND

Online search query trends have been shown to correlate with real-life epidemiologic phenomena.

OBJECTIVE

The aim of this study was to analyze correlations in trends in Google online search volumes of sinusitis-related terms, including symptomatology and similar disease states.

METHODS

Terms clinically associated with "sinusitis" were determined by consensus. Terms of symptomatology were derived from the validated 22-item sinonasal outcome test (SNOT-22) as well as terminology encountered with the authors' clinical experience. Terms of disease states that could overlap in symptomatology with sinusitis were then chosen. Google Trends, an online tool for extracting relative frequencies from a public database of search queries, was used to query normalized monthly volumes in the United States from January 2004 to September 2017 of searches related to the topics decided upon by consensus. Bivariate Pearson correlation was used to compare the search queries.

RESULTS

Online search volumes of "sinusitis" have a distinct seasonal variation, with consistent annual peaks and troughs. In terms of symptomatology, "postnasal drip," "nasal congestion," "cough," "rhinorrhea," and "sore throat" most highly correlated with "sinusitis" search volumes with statistical significance. "sinusitis" search query volume had a higher positive correlation with "common cold" and "acute sinusitis" than "chronic sinusitis" with regard to disease states.

CONCLUSIONS

Trends in Google online search volumes over time of "sinusitis" symptomatology mimic real-world clinical phenomena and provide insight into the issues affecting the general population.

Low Misrepresentation Rates of Scholarly Work in Otolaryngology-Head and Neck Surgery Residency Applications

Objectives

To evaluate research trends, including rates of misrepresentation of scholarly work, in otolaryngology residency applications received by a single institution during the 2018-2019 residency application cycle.

Methods

After obtaining Institutional Review Board approval, all residency applications to the Department of Otolaryngology-Head and Neck Surgery at Indiana University School of Medicine, Indianapolis, IN for the 2018-2019 cycle were de-identified and analyzed. Demographic and research information including the number of listed peer-reviewed articles/abstracts, types of research projects, and misrepresentations were retrospectively evaluated.

Results

Our institution received 321 applications, which represented 69.5% of the entire 2018-2019 otolaryngology applicant pool. The average United States Medical Licensing Examination (USMLE) Step 1 score was 246 ±12.4. There were 203 (62.2%) applicants who reported 591 published citations with 20 (6.2%) applicants misrepresenting 26 items (4.4%). Applicants who misrepresented research output had lower average Step 1 scores (237.4 vs 246.4, p: <0.05). Self-promotion to higher authorship status was the most common form of misrepresentation (61.5%).

Conclusions

The role of scholarly work in stratifying applicants continues to expand. Although a competitive application climate motivates a minority of applicants to misrepresent scholarly work, rates of misrepresentation in otolaryngology applications are low and continue to decline. The level of evidence assigned to this study is III.

Facing Facts: Facial Injuries from Stand-up Electric Scooters

Background

Stand-up electric scooters (SES) are a popular public transportation method. Numerous safety concerns have arisen since their recent introduction.

Methods

A retrospective chart review was performed to identify patients presenting to the emergency departments in Indianapolis, who sustained SES-related injuries.

Results

A total of 89 patients were included in our study. The average patient age was 29 ± 12.9 years in a predominantly male cohort (65.2%). No patient was documented as wearing a helmet during the event of injury. Alcohol intoxication was noted in 14.6% of accidents. Falling constituted the leading trauma mechanism (46.1%). Injuries were most common on Saturday (24.7%) from 14h00 to 21h59 (55.1%). Injury types included: abrasions/contusions (33.7%), fractures (31.5%), lacerations (27.0%), or joint injuries (18.0%). The head and neck region (H&N) was the most frequently affected site (42.7%). Operative management under general anesthesia was necessary for 13.5% of injuries. Nonoperative management primarily included conservative orthopedic care (34.8%), pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) (34.8%) and/or opioids (4.5%), bedside laceration repairs (27.0%), and wound dressing (10.1%). Individuals sustaining head and neck injuries were more likely to be older (33.8 vs. 25.7 years, p=0.003), intoxicated by alcohol (29.0% vs. 3.9%, p=0.002), and requiring CT imaging (60.5% vs. 9.8%, p <0.001).

Conclusion

Although SESs provide a convenient transportation modality, unregulated use raises significant safety concerns. More data need to be collected to guide future safety regulations.

Sinonasal Chondromyxoid Fibroma: Case Report and Literature Review

Chondromyxoid fibroma (CMF) is a rare, benign neoplasm of the chondroid, myxoid, and fibrous tissue. It characteristically affects the lower extremity long bones, although it may rarely arise within the craniofacial skeleton. We report the diagnosis and management of a 31-year-old male with a large, incidentally discovered CMF originating from the sphenoid sinus. A subsequent review of the literature reveals the need to differentiate from more aggressive neoplasms, such as chondrosarcoma and chondroma, which share radiographic features. A histopathologic examination is crucial for proper diagnosis and treatment. We discuss clinical sequelae, highlight the importance of a thorough pre-operative evaluation, and summarize previously suggested treatment paradigms.

Sports interest mediating exercise and compulsive internet use among undergraduates

With the massive growth in Internet technologies, people have become wary of excessive Internet usage, known as compulsive Internet usage or Internet addiction. This study looks into how exercise is related to compulsive Internet usage. Previous research showed varying results regarding the relationship between sports habit and Internet usage; this project clarifies the relationship by investigating mediating variables in terms of interest in different aspects of sports, such as physical education, mastering sport skills, sports participation, and watching sports. Two survey studies were conducted. The participants were 232 male and 107 female Taiwanese undergraduate students in the first survey, totaling 339 students. The second survey had 233 males, 98 female students, and 2 who did not disclose their gender, with a final total of 333. The results reveal that interest in physical education (IPE) mediates sports habit and compulsive Internet usage. As long as the student had a habit of doing sports that increased IPE, this would in turn decrease compulsive Internet use. The importance of igniting students' IPE is discussed.

A Systematic Review of Sellar and Parasellar Brown Tumors: An Analysis of Clinical, Diagnostic, and Management Profiles

OBJECTIVE

To systematically review and analyze clinical, diagnostic, and management trends in sellar and parasellar brown tumors reported in existing literature.

METHODS

In this systematic review, PubMed, Ovid MEDLINE, Scopus, and Google Scholar databases were searched for reported cases of sellar/parasellar brown tumors. Relevant titles and abstracts were screened in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles meeting inclusion criteria were subjected to data extraction, summarization, and analysis. A rare case of parasellar brown tumor was also presented.

RESULTS

Eight reports (including the current report) were eligible for inclusion. Mean patient age was 42.75 years. Reported symptoms included visual disturbances (n = 6), headache (n = 5), fatigue (n = 3), nausea/vomiting (n = 2), chest pain (n = 1), neck pain (n = 1), and dysphagia (n = 1). In cases where computed tomography findings were provided (n = 6), lesions were noted to be expansile and lytic. Lesions were hyperintense on T2-weighted magnetic resonance imaging (66.7%) and demonstrated contrast enhancement (83.3%). Histology unanimously showed multinucleated giant cells in a fibrovascular connective tissue stroma. Dramatic symptom resolution was noted in all patients who underwent resection of the sellar/parasellar brown tumor (n = 4; 50%).

CONCLUSIONS

Sellar/parasellar brown tumors are a rare, tertiary manifestation of hyperparathyroidism and can be elusive to diagnose. Diagnosis requires a high index of clinical suspicion in addition to comprehensive biochemical testing, imaging, and histopathologic analysis. Surgical extirpation is favored in cases where the lesion is causing compressive symptoms, or if it is unresponsive to management of hyperparathyroidism.

Classification of electrophysiological and morphological neuron types in the mouse visual cortex

Understanding the diversity of cell types in the brain has been an enduring challenge and requires detailed characterization of individual neurons in multiple dimensions. To systematically profile morpho-electric properties of mammalian neurons, we established a single-cell characterization pipeline using standardized patch-clamp recordings in brain slices and biocytin-based neuronal reconstructions. We built a publicly accessible online database, the Allen Cell Types Database, to display these datasets. Intrinsic physiological properties were measured from 1,938 neurons from the adult laboratory mouse visual cortex, morphological properties were measured from 461 reconstructed neurons, and 452 neurons had both measurements available. Quantitative features were used to classify neurons into distinct types using unsupervised methods. We established a taxonomy of morphologically and electrophysiologically defined cell types for this region of the cortex, with 17 electrophysiological types, 38 morphological types and 46 morpho-electric types. There was good correspondence with previously defined transcriptomic cell types and subclasses using the same transgenic mouse lines.

Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: a review of cohort studies

AIMS

The aims of the study were to review and analyse the reported series of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip arthroplasties (THAs) to establish the overall success and the influencing factors.

PATIENTS AND METHODS

Using a standardised recognised study protocol, meta-analysis of observational studies in epidemiology guidelines, a comprehensive review and analysis of the literature was performed. The primary outcome measure was the success of treatment. The search strategy and inclusion criteria which involved an assessment of quality yielded 39 articles for analysis, which included 1296 patients.

RESULTS

The proportion of success following DAIR in the management of an infected THA appeared to improve after 2004 with a pooled mean proportion of success of 72.2%. For all reported series, from 1977 onwards, there was improved success with early debridement (< 7 days; 75.7%) and exchange of modular components (77.5%). There was a statistically non-significant improvement if debridement was performed within four weeks of the initial procedure (73.0%).

CONCLUSION

The reported success following DAIR has improved since 2004. The only determinants of outcome which we found were the timing of debridement after the onset of symptoms of infection and the exchange of modular components. Cite this article: Bone Joint J 2017;99-B:1488-66.

Flexible Blade-Coated Multicolor Polymer Light-Emitting Diodes for Optoelectronic Sensors

A method to print two materials of different functionality during the same printing step is presented. In printed electronics, devices are built layer by layer and conventionally only one type of material is deposited in one pass. Here, the challenges involving printing of two emissive materials to form polymer light-emitting diodes (PLEDs) that emit light of different wavelengths without any significant changes in the device characteristics are described. The surface-energy-patterning technique is utilized to print materials in regions of interest. This technique proves beneficial in reducing the amount of ink used during blade coating and improving the reproducibility of printed films. A variety of colors (green, red, and near-infrared) are demonstrated and characterized. This is the first known attempt to print multiple materials by blade coating. These devices are further used in conjunction with a commercially available photodiode to perform blood oxygenation measurements on the wrist, where common accessories are worn. Prior to actual application, the threshold conditions for each color are discussed, in order to acquire a stable and reproducible photoplethysmogram (PPG) signal. Finally, based on the conditions, PPG and oxygenation measurements are successfully performed on the wrist with green and red PLEDs.

Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants

BACKGROUND

To learn words and acquire language, children must be able to discriminate and correctly perceive phonemes. Although there has been much research on the general language outcomes of children with cochlear implants (CIs), little is known about the development of speech perception with regard to specific speech processes, such as speech discrimination.

PURPOSE

The purpose of this study was to investigate the development of speech discrimination in infants with CIs and identify factors that might correlate with speech discrimination skills.

RESEARCH DESIGN

Using a Hybrid Visual Habituation procedure, we tested infants with CIs on their ability to discriminate the vowel contrast /i/-/u/. We also gathered demographic and audiological information about each infant.

STUDY SAMPLE

Children who had received CIs before 2 yr of age served as participants. We tested the children at two post cochlear implantation intervals: 2-4 weeks post CI stimulation (N = 17) and 6-9 mo post CI stimulation (N = 10).

DATA COLLECTION AND ANALYSIS

The infants' mean looking times during the novel versus old trials of the experiment were measured. A linear regression model was used to evaluate the relationship between the normalized looking time difference and the following variables: chronological age, age at CI stimulation, gender, communication mode, and best unaided pure-tone average.

RESULTS

We found that the best unaided pure-tone average predicted speech discrimination at the early interval. In contrast to some previous speech perception studies that included children implanted before 3 yr of age, age at CI stimulation did not predict speech discrimination performance.

CONCLUSIONS

The results suggest that residual acoustic hearing before implantation might facilitate speech discrimination during the early period post cochlear implantation; with more hearing experience, communication mode might have a greater influence on the ability to discriminate speech. This and other studies on age at cochlear implantation suggest that earlier implantation might not have as large an effect on speech perception as it does on other language skills.

Neurodevelopmental Outcomes Following Extensive Cardiopulmonary Resuscitation in the Delivery Room for Infants Born &lt;29 Weeks’ Gestational Age

BACKGROUND: Neurodevelopmental outcomes of preterm infants who receive extensive CPR (ECPR), defined as chest compression with or without epinephrine in the delivery room, remain unclear.

OBJECTIVES: To compare the neurodevelopmental outcomes of preterm infants admitted to Canadian NICUs requiring ECPR versus those who did not require ECPR in the delivery room.

DESIGN/METHODS: Preterm infants born at &lt;29 weeks GA between January 1, 2010 and September 30, 2011 and evaluated at CNFUN centers were retrospectively evaluated. The primary outcome was a composite of death or neurodevelopmental impairment (NDI) at 18-21 months CA defined as presence of any one or more of the following: definitive cerebral palsy or Bayley- III cognitive, language, motor scores &lt;85 on any one of the components or hearing impairment or visual impairment. Demographic factors, neurodevelopmental status including Bayley III cognitive, language and motor scores and sensory impairments were compared between the ECPR and the no ECPR group using univariate and multivariate analyses. RESULTS: Of 2488 eligible infants, 197 (7.9%) received ECPR. 83% of surviving infants had follow-up data. Demographic and outcomes data are summarized below in Table 1 and 2 respectively.

Association of rhinosinusitis with nasopharyngeal carcinoma: a population-based study

OBJECTIVES/HYPOTHESIS

Although it is already known that the inflammation process elevates the risk of developing cancer, to date the association between rhinosinusitis and nasopharyngeal carcinoma (NPC) remains unknown. This study aimed to evaluate the association between rhinosinusitis and NPC based on a nationwide database.

STUDY DESIGN

Case-control study.

METHODS

In total, the cases comprised of 2,242 subjects with NPC and 6,726 randomly selected subjects as controls. Separate conditional logistic regression analyses were used to calculate the odds ratio (OR) for having been previously diagnosed with chronic and acute rhinosinusitis between the cases and controls.

RESULTS

Of the total sample, 607 subjects (6.77%) had been diagnosed with chronic rhinosinusitis prior to the index date: 322 (14.36%) cases with NPC and 285 (4.24%) controls (P<.001). A conditional logistic regression analysis revealed that the OR of prior chronic rhinosinusitis for subjects with NPC is 3.83 (95% confidence interval [CI], 3.23-4.53) as compared to controls after adjusting for the factors of income, urbanization, geographic location, tobacco use disorder, and alcohol abuse/dependence syndrome. Furthermore, 1,199 (53.48%) cases and 2,938 (42.19%) controls had been diagnosed with acute rhinosinusitis prior to the index date (P<.001).The adjusted OR of prior acute rhinosinusitis for subjects with NPC was 1.57 (95% CI, 1.43-1.73) that of controls.

CONCLUSIONS

This study detected an association between NPC and rhinosinusitis. We recommend that patients who are diagnosed with rhinosinusitis, either acute or chronic, seek out aggressive management to reduce the tissue burden and lower the risk of subsequently developing NPC.

LEVEL OF EVIDENCE

3b.

Endoscopic endonasal transplanum transtuberculum resection of a large solid choroid plexus papilloma of the third ventricle

Choroid plexus papilloma (CPP) is a highly vascular solid or mixed solid-cystic tumor. Previously described resection techniques for the more common solid CPP in the third ventricle have all been through the transcranial route. The authors review the literature and describe a patient who, to their knowledge, is the first successful resection of a large, completely solid CPP of the third ventricle through an entirely endoscopic, extended transphenoidal approach. Using modern neuroendoscopic methods and closure techniques, a gross total resection was accomplished and a successful closure without postoperative cerebrospinal fluid leak was achieved despite the presence of preoperative hydrocephalus. For appropriately selected lesions, an extended endonasal skull base resection can be performed successfully for vascular tumors despite the presence of preoperative hydrocephalus.

Multiple human papillomavirus infections and HIV seropositivity as risk factors for abnormal cervical cytology among female sex workers in Nairobi

We estimated type-specific prevalence of human papillomavirus (HPV) and examined risk factors for abnormal cervical cytology among 296 female sex workers from Nairobi, Kenya. Over half (54%) were infected with a high-risk (HR) HPV type, of which HPV16 and 52 were the most common types. HIV-1 prevalence was 23% and HIV-1 sero-positivity was associated with high-grade cervical lesions, particularly among women with CD4 count less than 500 cells/mm(3) (odds ratio [OR] = 6.9; 95% confidence interval [CI]: 1.7-24.9). Among women who had normal cytology at the time of entry into the study, the risk of having an abnormal Pap smear within one year was significantly elevated for women with multiple HPV types at study entry (adjusted odds ratio [aOR] = 6.0; 95% CI: 2.3-15.7) and with a subset of HR HPV types (aOR = 4.2; 95% CI: 1.6-11.2). Detection of multiple concurrent HPV infections may be a useful marker to identify women at risk of developing precancerous lesions in populations of high HPV prevalence.

The accessory posterolateral nerve: an immunohistological analysis

BACKGROUND

Recent endoscopic dissection studies have redefined the postganglionic pterygopalatine autonomic pathways suggesting that neurovascular rami, termed "accessory posterolateral nerves," project directly through the palatine bone to innervate the posterolateral nasal mucosa rather than traveling with trigeminal arborizations. The goal of this study was to characterize these accessory posterolateral nerves by immunohistochemistry to determine their morphology and composition.

METHODS

This is an Institutional Review Board approved study in seven patients in whom the presence of accessory posterolateral nerves were surgically identified exiting the perpendicular plate of the palatine bone and sampled. The presence of neural tissue was confirmed by hematoxylin and eosin and S-100 protein staining. Nerves were then stained with anti-human choline acetyl-transferase (ChAT; 1:100) and anti-human dopamine beta-hydroxylase (DBH; 1:100) followed by a fluorescein isothiocyanate-labeled secondary antibody to test for the presence of peripheral parasympathetic and sympathetic fibers, respectively. Human cadaveric sensory nerves were used as a negative control.

RESULTS

All seven samples contained neural elements. Two specimens were also associated with arteries. All nerves were comprised of a single fascicle containing an approximately equal distribution of ChAT(+) and DBH(+) fibers.

CONCLUSION

This histological study supports prior descriptions defining a newly recognized neural pathway for innervation of the nasal mucosa. Our data confirm that these accessory posterolateral nerves project directly through the perpendicular plate of the palatine bone and are composed of autonomic fibers. Recognition of this pathway may be exploited in the treatment of sinonasal disease resulting from autonomic dysregulation.

MO-A-BRB-02: Facts and Fiction of Flattening Filter Free (FF-FFF) X-Rays Beams

The primary purpose of the FFF X-rays is to provide much higher dose rates available for treatments. For example, FFF X-rays from Varian TrueBEAM can deliver 1400 MU/minute for 6 MV X-rays and 2400 MU/minutes for 10 MV X-rays. Higher dose rates have definite clinical benefits in organ motion management. For example, larger dose fractions can be delivered in a single breath-hold or gated portion of a breathing cycle. In SRS or SBRT treatments, large MUs are often required and FFF X-ray beams can deliver these large MUs in much shorter "beam-on" time. With shorten treatment time, these FFF X-rays improve patient comfort and dose delivery accuracy. FFF X-ray beams may become one of the necessary equipment configurations for SBRT and/or SRS treatments, in the future. This presentation will address some unique issues dealing with the FFF X-rays: (1) FIELD SIZES flattening Filter Free (FFF) X-ray beam has been in clinical use for quite some time. However, not until recently, these FFF beams are used in limited, small field sizes, for example, in Tomotherapy and CyberKnife machines.Varian TrueBEAM allows the FFF X-ray beam to have up to 40 × 40 cm field sizes for both 6 and 10 MV X-rays (15 MV FFF X-rays are not yet released for clinical use). For large treatment fields, the dose uniformity within an irradiated treatment field will need to be "modulated" by MLC movements (IMRT) to cut down the higher beam intensity near the central portion of the FFF X-ray beam. Thus, larger MUs are required compared with a conventional (flattened) X-ray beam. Or, MLC movements (EVIRT) are now being used to "flatten" the FFF X-rays to provide dose uniformity within those large PTVs. The high dose rates from the FFF X-rays are now being off-set by the larger MUs requirements. Therefore, FFF X-rays can bring clinical advantages over conventional X-rays when used with small field sizes, such as in SBRT and/or SRS applications. (2) DOSEVIETRY MEASUREMENT EQUIMENT: Because of the more than 2 to 4 fold increases in dose rate (MU/minute), the radiation measurement equipment and techniques need to be carefully evaluated, such as ionization chamber characteristics, electrometers, scanning equipment. First comes to mind is the ion-recombination characteristics of the ionization chamber (P-ion). This will determine the accuracies of the measured percentage depth doses and penumbra of these FFF X-ray fields. And, it will also affect the absolute dose measurements (Gy/MU) using the TG-51 formulations. The measured PDDs and profiles should be corrected for the P-ion effect. However, it is not a simple task for physicists to perform the P-ion corrections for PDDs and profiles using the presently available methods associated in commercial 3-D scanning equipment and algorithm. It may become necessary for physicists to adapt and get accustom to the use of "standard beam data" provided by manufacturers in the future. In addition, because of the use of FFF X-rays are focused on SBRT and/or SRS applications, beam data acquisition, scanning techniques, and beam modeling are vitally important. There are many publications addressing the "output factors" from small fields, but none pay enough attention to the penumbra characteristics of these small X-ray beams. Because of the proximity to critical organs, the penumbra characteristics of small fields are often more clinically important than output factors. FFF X-rays play an important role in SBRT and SRS applications. Therefore, careful penumbra measurements should be addressed. Again, it may become necessary for physicists to adapt the use of "standard beam data" provided by manufacturers. (3) RADIO-BIOLOGICAL QUESTION: Though there is a lack of controlled clinical studies with FFF X-ray beams, there are several scientific articles addressing the radiobiological concerns of high dose rate deliveries, especially when it is used to deliver large doses per fraction, such as 10 Gy/faction. This type of dose per fraction is often used in SBRT or SRS treatments. Radiobiological concerns are not in the cell kill effect within the target volume. It is the normal tissue damages surrounding the target. There are concerns about the late toxicities of these high dose rate and high dose per fraction deliveries using FFF X-ray beams. (4) SKIN (ENTRANCE) DOSE DISCUSSIONS: In conventional X-ray beams, the low energy components of the X-ray beam are removed by the in-line X-ray flattening filter. But, in Flatten Filter Free X-ray beams, these low energy components are exiting the X-ray collimators. This is clearly documented by the difference in the percentage depth doses for these FFF X-ray beams. The FFF X-ray beams have a lower "effective energy" compared to conventional X-rays. Therefore, it is important to study the skin (entrance) dose from these FFF X-rays. In the literature, reported skin (entrance) doses from different linear accelerator manufacturers vary widely. Skin doses from Varian TrueBEAM have been studied and have found to be marginally higher than the conventional X-rays. However this margin increase is not clinically significant.(5) Summary / conclusions / discussions: The FFF X-rays improve the treatment delivery by their very high dose rates (1400 and 2400 MU/minute) and shortened treatment time. FFF X-ray beams are most applicable and the high dose rates are most advantageous when the treatment field sizes are small. The dosimetry of FFF-X-rays is made more complex by the P-ion determination and necessary corrections to X-ray beam percentage depth doses and profiles. There are radiobiological concerns about late toxicity of normal tissue irradiated by FFF X-rays when large dose per faction treatment applications are used. There are wide ranges of skin doses from these FFF X-rays reported in the literature.

LEARNING OBJECTIVES

1. Flattening Filter Free X-rays have been in clinical use for many years but mostly for small field sizes. 2. Flattening Filter Free X-rays have significantly shorter treatment time if is used for small field applications, such as: SBRT or SRS. 3. Because of the high dose rate (MU/minute), dosimetric properties of these FFF X-rays need to be carefully studied. Ion-recombination of ionization chambers is a concern. Beam data acquisition, beam modeling, and absolute dosimetry need to be done with great care, especially in small field applications. 4. Late toxicities of normal tissue may be a concern and need to be studied by organized clinical protocols.