A Proof-of-Concept Computer Vision Approach for Measurement of Tympanic Membrane Perforations

OBJECTIVE

Size, an important characteristic of a tympanic membrane perforation (TMP), is commonly assessed with gross estimation via visual inspection, a practice which is prone to inaccuracy. Herein, we demonstrate feasibility of a proof-of-concept computer vision model for estimating TMP size in a small set of perforations.

METHODS

An open-source deep learning architecture was used to train a model to segment and calculate the area of a perforation and the visualized tympanic membrane (TM) in a set of endoscopic images of mostly anterior and relatively small TMPs. The model then computed relative TMP size by calculating the ratio of perforation area to TM area. Model performance on the test dataset was compared to ground-truth manual annotations. In a validation survey, otolaryngologists were tasked with estimating the size of TMPs from the test dataset. The primary outcome was the average absolute error of model size predictions and clinician estimates compared to sizes determined by ground-truth manual annotations.

RESULTS

The model's average absolute error for size predictions was a 0.8% overestimation for all test perforations. Conversely, among the 38 survey respondents, the average clinician error was a 11.0% overestimation (95% CI, 5.2-16.7%, p = 0.003).

CONCLUSIONS

In a small sample of TMPs, we demonstrated a computer vision approach for estimating TMP size is feasible. Further validation studies must be done with significantly larger and more heterogenous datasets.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:2906-2911, 2024.

Statistical optimized production of Phytase from Hanseniaspora guilliermondii S1 and studies on purification, homology modelling and growth promotion effect

This investigation was performed to obtain a promising phytase enzyme producing yeast. In this regard, the PSM was used to isolate the phytase-producing Hanseniaspora guilliermondii S1 (MG663578) from sugarcane juice. The SSF optimum conditions for phytase generation were optimized using (OVAT) one-variable-at-a-time strategy using both Box-Behnken design and shake flask method (g/100 ml: 0.05 yeast extract, 0.15 Peptone, 0.05 malt extract 0.50 dextrose, pH 5.8 and 28ᵒC). The protein model developed was shown to be adequate for phytase production (91% accuracy), with the greatest phytase productivity in shake flask with substrate jack fruit seed powder being 395 ± 0.43 U/ml compared to 365U/ml for the BBD projected value. Crude Phytase was partially purified with a protein recovery of 43%, revealing a molecular weight of 120 kDa. It had an enzyme kinetic value of Km 3.3 mM and a Vmax of 19.1 mol/min. The 3D structure of PhyS1 amino acid sequences (PhyS1. B99990002) was simulated using Modeler 9.23, and the validated result revealed that 86.7% were in the favored region by Ramachandran plot. The SAVES server verified the 3D PDB file as satisfactory, and the model (in.pdb format) was uploaded in the PMDB database with the accession number ID: PM0082974. At the lab level, Hanseniaspora guilliermondii S1 (MG663578) producing phytase exhibited successful plant growth promotion activity in Ragi - CO 19 (Eleusine coracana L.) and Rice -Navarai - IR 64 (Oryza sativa L.). As a result, a phytase-based formulation for sustainable agriculture must be developed and tested on a large scale in diverse geographical areas of agricultural lands to determine its effect and potential on plant development.

Surgical Navigation in the Anterior Skull Base Using 3-Dimensional Endoscopy and Surface Reconstruction

Importance

Image guidance is an important adjunct for endoscopic sinus and skull base surgery. However, current systems require bulky external tracking equipment, and their use can interrupt efficient surgical workflow.

Objective

To evaluate a trackerless surgical navigation system using 3-dimensional (3D) endoscopy and simultaneous localization and mapping (SLAM) algorithms in the anterior skull base.

Design, Setting, and Participants

This interventional deceased donor cohort study and retrospective clinical case study was conducted at a tertiary academic medical center with human deceased donor specimens and a patient with anterior skull base pathology.

Exposures

Participants underwent endoscopic endonasal transsphenoidal dissection and surface model reconstruction from stereoscopic video with registration to volumetric models segmented from computed tomography (CT) and magnetic resonance imaging.

Main Outcomes and Measures

To assess the fidelity of surface model reconstruction and accuracy of surgical navigation and surface-CT model coregistration, 3 metrics were calculated: reconstruction error, registration error, and localization error.

Results

In deceased donor models (n = 9), high-fidelity surface models of the posterior wall of the sphenoid sinus were reconstructed from stereoscopic video and coregistered to corresponding volumetric CT models. The mean (SD; range) reconstruction, registration, and localization errors were 0.60 (0.24; 0.36-0.93), 1.11 (0.49; 0.71-1.56) and 1.01 (0.17; 0.78-1.25) mm, respectively. In a clinical case study of a patient who underwent a 3D endoscopic endonasal transsphenoidal resection of a tubercular meningioma, a high-fidelity surface model of the posterior wall of the sphenoid was reconstructed from intraoperative stereoscopic video and coregistered to a volumetric preoperative fused CT magnetic resonance imaging model with a root-mean-square error of 1.38 mm.

Conclusions and Relevance

The results of this study suggest that SLAM algorithm-based endoscopic endonasal surgery navigation is a novel, accurate, and trackerless approach to surgical navigation that uses 3D endoscopy and SLAM-based algorithms in lieu of conventional optical or electromagnetic tracking. While multiple challenges remain before clinical readiness, a SLAM algorithm-based endoscopic endonasal surgery navigation system has the potential to improve surgical efficiency, economy of motion, and safety.

An External Validation Study for Automated Segmentation of Vestibular Schwannoma

OBJECTIVE

To validate how an automated model for vestibular schwannoma (VS) segmentation developed on an external homogeneous dataset performs when applied to internal heterogeneous data.

PATIENTS

The external dataset comprised 242 patients with previously untreated, sporadic unilateral VS undergoing Gamma Knife radiosurgery, with homogeneous magnetic resonance imaging (MRI) scans. The internal dataset comprised 10 patients from our institution, with heterogeneous MRI scans.

INTERVENTIONS

An automated VS segmentation model was developed on the external dataset. The model was tested on the internal dataset.

MAIN OUTCOME MEASURE

Dice score, which measures agreement between ground truth and predicted segmentations.

RESULTS

When applied to the internal patient scans, the automated model achieved a mean Dice score of 61% across all 10 images. There were three tumors that were not detected. These tumors were 0.01 ml on average (SD = 0.00 ml). The mean Dice score for the seven tumors that were detected was 87% (SD = 14%). There was one outlier with Dice of 55%-on further review of this scan, it was discovered that hyperintense petrous bone had been included in the tumor segmentation.

CONCLUSIONS

We show that an automated segmentation model developed using a restrictive set of siloed institutional data can be successfully adapted for data from different imaging systems and patient populations. This is an important step toward the validation of automated VS segmentation. However, there are significant shortcomings that likely reflect limitations of the data used to train the model. Further validation is needed to make automated segmentation for VS generalizable.

Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome

Objective

Patients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair.

Study design

Retrospective chart review.

Setting

Tertiary neurotology single-institution care center.

Main outcome measures

The primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (cVEMP) thresholds were compared via univariate χ2 and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups.

Results

Of 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution (n = 82, 62.1%) or improvement (n = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4-28), 1-124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, p = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, p = 0.043) and higher cervical vestibular evoked myogenic potential (cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, p = 0.033). A migraine diagnosis (14.0% vs. 41.9% p < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, p = 0.034) and revision cases (0.0% vs. 14.0%, p = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05).

Conclusions

Surgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds, cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.

Identification and physico-chemical characterization of microplastics in marine aerosols over the northeast Arabian Sea

Microplastics (MPs) in the atmosphere can undergo long-range transport from emission regions to pristine terrestrial and oceanic ecosystems. Due to their inherent toxic and hazardous characteristics, MPs pose serious risks to both human well-being and the equilibrium of ecosystem. The present study outlines the comprehensive characterization, spanning physical and chemical attributes of MPs associated with atmospheric aerosols. Total suspended particulates (TSPs) were collected on a quartz fibre filter by operating a high-volume sampler for 24 h during distinct years (March, 2016 and November, 2020) at a coastal location in the northeast Arabian Sea. Subsequent to the sampling, a series of techniques were applied including density separation. The assessment and scrutiny of the MPs was carried out using stereo-zoom microscopy with supplementary validation using advanced fluorescence microscopy for enhanced precision in identification. Our comparative assessment suggests peroxide treatment followed by density separation could be a robust procedure for the definitive identification and characterization of MPs in the atmosphere. Average total abundance of MPs was found to be 1.30 ± 0.14 n/m3 in 2016 and 1.46 ± 0.12 n/m3 in 2020 with fibres, fragments and films having similar relative contributions (41 %, 31 %, 28 % in 2016 and 40 %, 35 %, 25 % in 2020). Fibres were found to be dominant morphotype followed by fragments and films over the coastal region of the Arabian Sea. In order to unravel the detailed chemical nature of these MPs, spectral analysis using μ-FTIR was carried out. The outcome of the analysis showed prevailing polymers as polyvinyl chloride and polymethyl methacrylate (50545 %) as dominant polymers followed by polyester (15 %), styrene butyl methacrylate (11 %), and polyacetal (9 %). MPs present in the vicinity of the Arabian Sea have potential to supply nutrients and toxicants, consequently can contribute to the modulation of the surface water biogeochemical processes.

A randomized controlled study to compare first stick success with Instaflash technology: The FIRSST study

BACKGROUND

Peripheral intravenous catheters (PIVCs) are frequently used in clinical settings for intravenous access. Multiple attempts of PIVC insertions leads to patient discomfort, delay in treatment, associated complications, and extensive expenditure cost. Reduced number of attempts causes patient/nursing personnel satisfaction and expenditure costs. The present study evaluated performance efficacy of BD Venflon™ I with Instaflash needle technology (investigational device) as compared to the BD Venflon™ without Instaflash needle technology (control device).

METHODOLOGY

The PIVC insertions were randomized in the ratio 1:1 using either investigational or control device and were monitored for first stick success rate, ease of insertion, and patient satisfaction. Data was analyzed using R 4.0.3 and Microsoft Excel. Chi square test was used to establish association between two categorical variables.

RESULTS

In total, 1402 patients were analyzed for first attempt insertion success which showed 98.72% success rate in investigational device as compared to 88.87% success rate in case of the control device (p = 0.0004). Marginal differences were observed in ease of insertion in investigational (98.71%) and control devices (99%) signifying high satisfaction levels of nursing personnels. Positive responses were observed in investigational (98.01%) and control devices (99%) underlining satisfactory performances of overall patient experiences.

CONCLUSION

The present study showed that BD Venflon™ I with Instaflash needle technology enhanced first attempt insertion success rate along with marginal differences in its efficacy in comparison with the BD Venflon™ without Instaflash needle technology thus enhancing patient and nursing personnel satisfaction in turn making it a better alternative to be used in hospitals.

Proof-of-Concept Computer Vision Model for Instrument and Anatomy Detection During Transcanal Endoscopic Ear Surgery

High-definition video captured during transcanal endoscopic ear surgery (TEES) can serve as imaging data for computer vision algorithms. This report describes a proof-of-concept model for automated anatomy and instrument detection during TEES.

Development of a Predictive Model for Persistent Dizziness Following Vestibular Schwannoma Surgery

OBJECTIVE

In an era of vestibular schwannoma (VS) surgery where functional preservation is increasingly emphasized, persistent postoperative dizziness is a relatively understudied functional outcome. The primary objective was to develop a predictive model to identify patients at risk for developing persistent postoperative dizziness after VS resection.

METHODS

Retrospective review of patients who underwent VS surgery at our institution with a minimum of 12 months of postoperative follow-up. Demographic, tumor-specific, preoperative, and immediate postoperative features were collected as predictors. The primary outcome was self-reported dizziness at 3-, 6-, and 12-month follow-up. Binary and multiclass machine learning classification models were developed using these features.

RESULTS

A total of 1,137 cases were used for modeling. The median age was 67 years, and 54% were female. Median tumor size was 2 cm, and the most common approach was suboccipital (85%). Overall, 63% of patients did not report postoperative dizziness at any timepoint; 11% at 3-month follow-up; 9% at 6-months; and 17% at 12-months. Both binary and multiclass models achieved high performance with AUCs of 0.89 and 0.86 respectively. Features important to model predictions were preoperative headache, need for physical therapy on discharge, vitamin D deficiency, and systemic comorbidities.

CONCLUSION

We demonstrate the feasibility of a machine learning approach to predict persistent dizziness following vestibular schwannoma surgery with high accuracy. These models could be used to provide quantitative estimates of risk, helping counsel patients on what to expect after surgery and manage patients proactively in the postoperative setting.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:3534-3539, 2023.

AI Model Versus Clinician Otoscopy in the Operative Setting for Otitis Media Diagnosis

Prior work has demonstrated improved accuracy in otitis media diagnosis based on otoscopy using artificial intelligence (AI)-based approaches compared to clinician evaluation. However, this difference in accuracy has not been shown in a setting resembling the point-of-care. In this study, we compare the diagnostic accuracy of a machine-learning model to that of pediatricians using standard handheld otoscopes. We find that the model is more accurate than clinicians (90.6% vs 59.4%, P = .01). This is a step towards validation of AI-based diagnosis under more real-world conditions. With further validation, for example on different patient populations and in deployment, this technology could be a useful addition to the clinician's toolbox in accurately diagnosing otitis media.

Cold atmospheric plasma mediated cell membrane permeation and gene delivery-empirical interventions and pertinence

Delivery of genetic material to cells is an integral tool to analyze and reveal the genetic interventions in normal cellular processes and differentiation, disease development and for gene therapy. It has profound applications in pharmaceutical, agricultural, environmental and biotechnological sectors. The major methods relied for gene delivery or transfection requires either viral vectors or xenogenic carrier molecules, which renders probabilistic carcinogenic, immunogenic and toxic effects. A newly evolved physical method, Cold atmospheric plasma induced transfection neither needs vector nor carriers. The 4th state of matter 'Plasma' is a quasineutral ionized gas-containing ions, neutral atoms, electrons and reactive radical molecules; and possess electric and magnetic field, along with emanating photons and UV radiations. Plasma produced at atmospheric pressure conditions, and having room temperature is conferred as Low temperature plasma or Cold atmospheric plasma. Selective and controlled application of cold atmospheric plasma on tissues creates temporary, restorable pores on cell membranes that could be diligently manipulated for gene delivery. Research in this regard attained pace since 2016. Cold atmospheric plasma induces transfection by lipid peroxidation, electroporation, and clathrin dependent endocytosis in cell membranes, by virtue of its reactive radicals and electric field. Plasma formed reactive radicals, especially 'OH' penetrates to the cell membrane and cleaves the phosphate head group of membrane lipids, peroxidize and detaches fatty acid tails. This decreases membrane thickness, increases membrane fluidity and permeability. Simultaneously plasma formed ions, electrons and reactive radicals accumulate over cells, generating local electric field and neutralize the negative charge of cell membrane. This induces stress on cell membrane and disrupts its structural integrity, by infringing the dynamic equilibrium between surface tension, spatial repulsion and linear tension between the head groups of phospholipids, generating minute pores. Neutralization of membrane charge promote foreign, external plasmid and gene movement towards cells and its enhanced binding with ligands and receptors on cell membrane, instigating clathrin dependent endocytosis. In vitro and in vivo studies have successfully delivered plasmids, linear DNA, siRNA and miRNA to several established cell lines like, HeLa, PC12, CHL, HUVEC, Jurkat, MCF, SH-SY5Y, HT, B16F10, HaCaT, LP-1, etc., and live C57BL/6 and BALB/c mice, using cold atmospheric plasma. This review delineates the cell surface mechanism of plasma-induced transfection, critically summarizes the research progress in this context, plasma devices used, and the inimitable features of this method. Metabolic activity, cell function, and viability are not adversely affected by this process; moreover, the cell permeating plasma-formed reactive radicals are effectively defended by cellular antioxidant mechanisms like superoxide dismutase, glutathione reductase and cytokines, alleviating its toxicity. A deeper understanding on mechanism of plasma action on cells, its aftermath, and the research status in this field would provide a better insight on future avenues of research.

Auditory and Vestibular Symptom Improvement With Surgery for Superior Canal Dehiscence Syndrome

OBJECTIVE

(1) To measure the change in auditory and vestibular symptoms following superior canal dehiscence (SCD) surgery, and (2) to determine differences in clinical features and surgical outcomes between superior canal dehiscence syndrome (SCDS) patients with primarily auditory or vestibular complaints.

STUDY DESIGN

Retrospective cohort study.

SETTING

Single surgeon series at the tertiary academic medical center from 2002 to 2021.

METHODS

Retrospective review of SCDS patients who underwent surgical repair. (1) Patients were administered a standardized symptom questionnaire at preoperative and follow-up visits, and results were compared with paired statistical testing. (2) Patients were divided into 2 cohorts based on either auditory or vestibular chief complaint and differences in demographic, clinical, and outcome variables were examined.

RESULTS

Our study included 113 patients with 118 operated ears. Twenty-seven patients (24%) had radiographic bilateral dehiscence. 10/11 auditory symptoms (91%) and 5/8 vestibular symptoms (63%) solicited on the questionnaire improved significantly with surgery, except for nonpulsatile tinnitus, sense of imbalance, positional dizziness, and oscillopsia. Analyses stratified by chief complaint (auditory vs vestibular) revealed overall similar characteristics and surgical outcomes. Patients with chief vestibular complaints underwent surgery at an earlier age (45.5 vs 53.9 years, p < 0.05).

CONCLUSION

SCD surgery alleviates a wide range of auditory and vestibular symptoms. Overall, we did not find significant differences between patients with chief auditory versus vestibular complaints, and both groups benefited from surgery. Symptoms are not directly linked to third-window physiology and certain vestibular symptoms may be more likely to persist. Bilateral dehiscence may play an important role in persistent symptoms as well.

A Systematic Review and Network Meta-Analysis Assessing the Impact of Adding First Generation Non-Steroidal Anti-Androgens (NSAA) to LHRH Agonists (LHRHa) in Men Receiving Radiotherapy for Localized Prostate Cancer

PURPOSE/OBJECTIVE(S)

Randomized clinical trials consistently demonstrate that the addition of androgen deprivation therapy (ADT) to prostate radiation therapy improves overall survival (OS). However, there is substantial heterogeneity regarding the type of ADT: LHRHa alone, first generation NSAA alone (e.g., bicalutamide) or combination androgen blockade (CAB) with NSAA and LHRHa. There are no published randomized trials in localized disease that specifically compare the efficacy of NSAA to LHRHa, nor the utility of CAB over monotherapy ADT. We herein performed a systematic review and network meta-analysis to assess the impact of NSAA in relation to LHRHa in men receiving radiotherapy for localized prostate cancer.

MATERIALS/METHODS

We performed a systematic literature search in PubMed to identify clinical trials of patients with localized prostate cancer for which ADT duration was the primary randomization variable. Both definitive and salvage radiation trials were included. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from data extracted from published survival curves. A network meta-analysis was performed to compare OS by ADT regimens. We defined NSAA toxicity as early discontinuation of any ADT agent due to side effects given the inconsistent reporting of specific related toxicity. A meta-regression was performed to assess association with NSAA toxicity, adjusted for study year, patient age, T stage, Gleason score and total ADT duration. NSAA duration was assessed as a continuous variable.

RESULTS

Of the 11 trials (8,169 patients) with OS data, the median duration of any ADT was 3 months (range 0-36 months) and the median duration of NSAA specifically was 3.5 months (range 0-24 months). There was no significant difference in OS between those treated with LHRHa (n = 369) vs. CAB (n = 4,792; HR 1.10, 95% CI 0.78-1.55). Among those receiving CAB, increased NSAA duration did not improve OS (versus 0 months; 1-6 months HR 1.41, 95% CI 0.94-2.13; 7-12 months HR 1.43, 95% CI 0.87-2.34) when controlling for total ADT duration. Of the 19 trials (15,067 patients) with toxicity data, patients on NSAA (n = 503) appeared more likely to discontinue treatment early compared to those receiving LHRHa (n = 902), though this was not statistically significant (odds ratio [OR] 4.20, 95% CI 0.16-109.19). A longer duration of NSAA did not adversely affect ADT compliance. Patients were more likely to discontinue ADT prematurely, regardless of type, if the planned duration was longer (OR 1.08, 95% CI 1.07-1.09).

CONCLUSION

We did not detect an overall survival benefit to adding NSAA to LHRHa, and NSAA appeared less well tolerated than LHRHa in men receiving radiation therapy for localized prostate cancer. These data suggest that providers should consider LHRHa without the addition of a NSAA as optimal when clinically appropriate.

Cellular temperature probing using optically trapped single upconversion luminescence

BACKGROUND

The thermally coupled energy states that contribute to the upconversion luminescence of rare earth element-doped nanoparticles have been the subject of intense research due to their potential nanoscale temperature probing. However, the inherent low quantum efficiency of these particles often limits their practical applications, and currently, surface passivation and incorporation of plasmonic particles are being explored to improve the inherent quantum efficiency of the particle. However, the role of these surface passivating layers and the attached plasmonic particles in the temperature sensitivity of upconverting nanoparticles while probing the intercellular temperature has not been investigated thus far, particularly at the single nanoparticle level.

RESULTS

The analysis of the study on the thermal sensitivity of oleate-free UCNP, UCNP@SiO₂, and UCNP@SiO₂@Au particles is carried out at a single particle level in a physiologically relevant temperature range (299 K-319 K) by optically trapping the particle. The thermal relative sensitivity of the as-prepared upconversion nanoparticle (UCNP) is found to be greater than that of UCNP@SiO₂ and UCNP@SiO₂@Au particles in an aqueous medium. An optically trapped single luminescence particle inside the cell is used to monitor the temperature inside the cell by measuring the luminescence from the thermally coupled states. The absolute sensitivity of optically trapped particles inside the biological cell increases with temperature, with a greater impact on the bare UCNP, which exhibits higher values for thermal sensitivity than UCNP@SiO₂ and UCNP@SiO₂@Au. The thermal sensitivity of the trapped particle inside the biological cell at 317 K indicates the thermal sensitivity of UCNP > UCNP@SiO₂@Au > UCNP@SiO₂ particles.

SIGNIFICANCE AND NOVELTY

Compared to bulk sample-based temperature probing, the present study demonstrates temperature measurement at the single particle level by optically trapping the particle and further explores the role of the passivating silica shell and the incorporation of plasmonic particles on thermal sensitivity. Furthermore, thermal sensitivity measurements inside a biological cell at the single particle level are investigated and illustrated that thermal sensitivity at a single particle is sensitive to the measuring environment.

Hospital-Negotiated Pricing of Cochlear Implants

Access to cochlear implantation can be restricted by financial burden, and little is known about the extent to which cochlear implant (CI) devices prices may vary between hospitals or manufacturers. We performed a cross-sectional analysis of private payer-negotiated prices for CI devices. In total, 161 hospitals were analyzed. Prices varied widely across hospitals and between payers. Despite clinical equipoise between manufacturers with regards to CI user outcomes, significant differences in prices were identified, with higher prices for MED-EL ($38,478 ± 2633) than for Cochlear Ltd. ($34,150 ± 2418, p < .001). Markup analysis for Cochlear Ltd. devices revealed a mean 58.5% ± 7.4% markup in excess of the company's average sales price ($24,649). Negotiated prices were also at least $5000 lower when all 3 brands were offered at the same center (p < .05). Further research examining the influence of patient outcomes and hospital volume on prices are needed.

Custom-designed 3D printed feed spacers and TFN membranes with MIL-101(Fe) for water recovery by forward osmosis

ABSTRACTIn this work, a dual-pronged approach- (i) novel thin-film nanocomposite polyether sulfone (PES) membrane with MIL-101 (Fe) and (ii) 3D printed spacers were explored to enhance water recovery by forward osmosis. The concentration of PES, pore former, draw solution, and MIL-101(Fe) was optimized for maximum pure water flux (PWF) and minimum specific reverse solute flux (SRSF). The best membrane exhibited a PWF of 7.52 Lm^-2h^-1 and an SRSF of 0.33 ± 0.03 gL^-1 using 1.5 M NaCl. The M₂₂ membrane with the diamond-type spacer demonstrated a PWF of 2.53 Lm^-2h^-1 and SRF of 0.75 gL^-1. The novel spacer design imparted significant turbulence to the feed flow and a lower foulant resistance of 1.3 m^-1 as compared to the ladder type (1.5 m^-1) or commercial spacer (1.7 m^-1). This arrangement could recover 19% pure water within 12 h of operation (98% oil rejection) with a ∼ 94% flux recovery after water wash.

Making Use of Artificial Intelligence-Generated Synthetic Tympanic Membrane Images

This diagnostic study examines the application of generative artificial intelligence in clinical tool research and development.

Geochemical tracing of synoptic scale modern dust transport over the Northeast Arabian Sea during the southwest monsoon

During the Southwest monsoon (SWM), aeolian dust is mainly supplied via wet deposition over the north-eastern Arabian Sea (NEAS). To understand their impact on the biogeochemistry of the Arabian Sea, it is important to identify their sources and characteristics. In this context, wet deposit particulate (WDP) samples were collected at a coastal station (Goa; 15.4° N, 73.8° E) in the NEAS during the SWM for three years. These samples were used to characterize and identify mineral dust sources using mineralogical, elemental, and isotopic (Sr and Nd) signatures. The WDP samples were classified as Beginning of Monsoon (BM, June samples), Mid Monsoon (MM, July-August samples) and End of Monsoon (EM, September samples). Clay mineralogical composition indicate high palygorskite content during BM, which subsequently found to decrease in MM, and almost negligible in EM. However, smectite is highest during MM, with moderate presence of palygorskite during this period. The considerable variation in the relative percentages of clay minerals suggests significant temporal variability in dust sources which is further corroborated by the radiogenic isotopic composition. A strong seasonality in the isotopic composition is observed with ⁸⁷Sr/⁸⁶Sr ratio being relatively less radiogenic during MM than the BM and highly radiogenic at the EM. Whereas Ɛ_Nd values show an opposite trend to ⁸⁷Sr/⁸⁶Sr ratios throughout the monsoon, with more radiogenic Ɛ_Nd in the MM, and less radiogenic at the EM. End member mixing plot indicate dominant contribution of dust from the Arabian Peninsula (ARB) and Northeast African (NEA) sources during BM and MM, while a shift towards the Thar desert and Southwest Asian (SWA) sources at the EM. Trace elements associated with different sources were quantified and suggest high Fe concentration is associated with NEA dust sources, despite of ARB is the major supplier of aeolian dust to the Arabian Sea.

Roid Rage: Historical Perspective on the Emergence of Oral Steroids as a Treatment of Idiopathic Sudden Sensorineural Hearing Loss

OBJECTIVES

To review the historical circumstances that led to the emergence of corticosteroid therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) and to discuss how this history has influenced current perspectives on the condition.

METHODS

PubMed and Google scholar were used to identify articles of ISSNHL and oral corticoid steroid use. Historical articles accessed through our institutional medical library were also reviewed.

RESULTS

The use oral corticosteroids as a treatment for ISSNHL was seemingly influenced by three key historical circumstances that, together, provided the substrate for the treatment's use in ISSNHL. First, ISSNHL was a frustrating condition with uncertainty regarding its etiology and few reliable treatment options. Second, the discovery of corticosteroids was awarded the Nobel Prize in 1950, which led to widespread application of this therapy. Third historical circumstance was the evolution and emergence of more rigorous methodological study designs in clinical research. In 1980, these events culminated in a double-blind study evaluating the effectiveness of oral steroids for treatment of ISSNHL. Interestingly, this study is often misrepresented as a randomized controlled trial, which ultimately contributed to adoption of a new standard for treatment in ISSNHL. Research subsequent to these historical events has challenged the notion of corticosteroids as a gold standard but has not altered the historically established paradigm of corticosteroid treatment.

CONCLUSIONS

The use of steroids as a treatment for ISSNHL evolved from our specialty's need to address a complex condition, a novel therapeutic discovery, and a landmark study that met emerging methodological standards. Despite these strong historical foundations, ISSNHL remains a condition with an unknown etiology and the therapeutic value of corticosteroids remains unpredictable despite their gold standard label.

Generation of synthetic tympanic membrane images: Development, human validation, and clinical implications of synthetic data

Synthetic clinical images could augment real medical image datasets, a novel approach in otolaryngology-head and neck surgery (OHNS). Our objective was to develop a generative adversarial network (GAN) for tympanic membrane images and to validate the quality of synthetic images with human reviewers. Our model was developed using a state-of-the-art GAN architecture, StyleGAN2-ADA. The network was trained on intraoperative high-definition (HD) endoscopic images of tympanic membranes collected from pediatric patients undergoing myringotomy with possible tympanostomy tube placement. A human validation survey was administered to a cohort of OHNS and pediatrics trainees at our institution. The primary measure of model quality was the Frechet Inception Distance (FID), a metric comparing the distribution of generated images with the distribution of real images. The measures used for human reviewer validation were the sensitivity, specificity, and area under the curve (AUC) for humans' ability to discern synthetic from real images. Our dataset comprised 202 images. The best GAN was trained at 512x512 image resolution with a FID of 47.0. The progression of images through training showed stepwise "learning" of the anatomic features of a tympanic membrane. The validation survey was taken by 65 persons who reviewed 925 images. Human reviewers demonstrated a sensitivity of 66%, specificity of 73%, and AUC of 0.69 for the detection of synthetic images. In summary, we successfully developed a GAN to produce synthetic tympanic membrane images and validated this with human reviewers. These images could be used to bolster real datasets with various pathologies and develop more robust deep learning models such as those used for diagnostic predictions from otoscopic images. However, caution should be exercised with the use of synthetic data given issues regarding data diversity and performance validation. Any model trained using synthetic data will require robust external validation to ensure validity and generalizability.

Pediatric Endoscopic Endonasal Skull Base Surgery: A Retrospective Review Over 11 Years

OBJECTIVE

To show the safety and efficacy of the endoscopic endonasal approach (EEA) for skull base surgery in pediatric patients through descriptive analysis of cases over an 11-year period.

METHODS

The study comprised 94 patients undergoing EEA for skull base surgery, between January 2007 and June 2018, at 2 tertiary pediatric hospitals. Descriptive statistics are presented regarding the presentation, intraoperative details, and complications.

RESULTS

Over the study period, 130 surgeries were performed in 94 patients: 94 primary surgeries and 36 reoperations. The mean patient age was 13.8 years and 48.9% of patients were female. Presenting signs/symptoms included endocrinopathies (56.4%), vision abnormalities (37.2%), and cranial nerve deficits (20.2%). EEA alone was used in 95.7% of primary surgeries and 91.7% of reoperations. Diseases treated included craniopharyngioma (18.1%), pituitary adenoma (17.0%), Rathke cleft cyst (13.8%), chordoma (9.6%), osteosarcoma (5.3%), juvenile nasopharyngeal angiofibroma (4.3%), skull base fracture (4.3%), and encephalocele (3.2%). A lumbar drain was used in 20.2% of primary surgeries and 25% of reoperations. A nasoseptal flap was used in 36.2% of primary surgeries and 25% of reoperations. Postoperative complications included cerebrospinal fluid leak (12.8%), sinusitis (7.4%), bacterial meningitis (3.2%), and carotid artery injury in 1 reoperation.

CONCLUSIONS

EEA for anterior cranial base disease is safe and efficacious in pediatric patients and can be used to treat many of the rare and heterogenous diseases that arise in this anatomic location. Management strategies and rates of sinonasal and intracranial complications including cerebrospinal fluid leak rate are similar to those reported in adult cohorts.

Optically trapped SiO2@Au particle-dye hybrid-based SERS detection of Hg2+ ions

The selective ultra-sensitive detection of a very low concentration of analyte in a liquid environment using surface-enhanced Raman spectroscopy (SERS) is a challenging task owing to the poor reproducibility of the Raman signals arising from the nonstationary nature of the substrate. However, plasmonic metal particle-incorporated microparticles can be effectively 3-D arrested in a liquid environment that can serve as a stable SERS substrate by employing an optical trapping force. Herein, we demonstrate a 3-D optically trapped Au-attached SiO₂ microparticle as an efficient SERS substrate that can detect 512 pM for Rhodamine6G and 6.8 pM for crystal violet. Further, the substrate allows the simultaneous detection of multiple analytes. By utilizing the Raman signal from Rhodamine 6G as the probe beam, the selective detection of Hg²⁺ ions as low as 100 pM is demonstrated.

Development of a Predictive Model for Individualized Hearing Aid Benefit

OBJECTIVES

To develop a model to predict individualized hearing aid benefit. To provide interpretations of model predictions on global and individual levels.

METHODS

We compiled a data set of patients with hearing loss who trialed hearing aids and completed the Client Oriented Scale of Improvement (COSI) questionnaire, a validated patient-reported outcome measure of hearing aid benefit. Features included demographic, medical, and audiological measures. The outcome was the COSI score for change in listening ability with hearing aids, scaled from 1 to 5. Model development was performed using fivefold cross-validation repeated three times with hyperparameter tuning. Model performance was assessed using the root mean squared error (RMSE) of the COSI scores. Model interpretation was performed using Shapley Additive Explanations.

RESULTS

The data set comprised 1,286 patients across 3,523 listening situations. The best performing model was random forest with an RMSE of 0.80, found to be significantly better than the next best model (eXtreme gradient boosting with RMSE of 0.85, p < 0.01). The most important features in predicting hearing aid benefit were shorter duration of hearing aid use, higher pure-tone average in the better hearing ear, and younger age.

CONCLUSION

We have developed a predictive model for hearing aid benefit that can also provide individualized explanations of model predictions. Predictive modeling could be a useful tool in assessing a patient's candidacy and predicted benefit from hearing aids.

Assessment of aeolian dust concentration, elemental composition, and their wet and dry deposition fluxes over the Northeast Arabian Sea

Atmospheric aerosol over the Arabian Sea is significantly impacted by the long-range transported mineral dust from the surrounding continents. This transported mineral dust is hypothesized and tested during several studies to see the impacts on the surface ocean biogeochemical processes and subsequently to the Carbon cycle. It is, thus important to quantify dust contributions and their fluxes to the Arabian Sea. Here we assess temporal variability of dust concentration, their elemental characteristics as well as quantify their dry and wet deposition fluxes over the North-eastern Arabian Sea. The dust concentrations were found to vary from 59 to 132 µg m^-3 which accounts for 50% to 90% of total mass during dusty days. However, its contribution during pre and post dust storms ranges between 6% and 60%. Relatively higher dust dry deposition flux of 28 ± 7 mg m^-2 day^-1 (range: 20-44) is estimated for dusty days compared to pre and post dusty days (range: 0.4-22 mg m^-2 day^-1). In contrast to dry deposition fluxes, significantly higher fluxes are estimated from wet deposition, averaging around 240 ± 220 mg m^-2 day^-1. These values are five times higher than those reported from cruise samples collected over the Arabian Sea. The contribution of dust to aerosol mass is further ascertained using elemental composition, wherein a significant correlation was observed between Fe and Al (r² = 0.77) for samples collected during the dusty period, highlighting their similar crustal sources. Our estimation of dust flux over this region has implications for the supply of nutrients associated with natural dust to the surface water of the Arabian Sea.Implications: The Arabian Sea, one of the productive oceanic regions among the global oceans, has been identified as a perennial source of atmospheric CO₂. This basin is heavily impacted by atmospheric dust deposition/inputs owing to its geographical location being surrounded by arid and semi-arid regions. It has been hypothesized that aeolian dust plays a significant role in modulating surface water biogeochemical processes including primary productivity, in the Arabian Sea. Furthermore, modelling studies have highlighted on the role of dust (containing Fe) in fueling and enhancing primary productivity in the Arabian Sea. However, quantification of dust deposition fluxes (wet and dry) on seasonal time scale is missing in the literature. This paper aims to partially fulfil this research gap by providing a long-term data of wet and dry deposition fluxes over the northeastern Arabian Sea. We have also discussed their seasonal variability and factors affecting this flux. Thus, this study will be valuable contribution to the aeolian research community and have significant implication toward the role of aeolian deposition to the surface water biogeochemical processes in the Arabian Sea.

"Human vs Machine" Validation of a Deep Learning Algorithm for Pediatric Middle Ear Infection Diagnosis

OBJECTIVE

We compared the diagnostic performance of human clinicians with that of a neural network algorithm developed using a library of tympanic membrane images derived from children taken to the operating room with the intent of performing myringotomy and possible tube placement for recurrent acute otitis media (AOM) or otitis media with effusion (OME).

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary academic medical center from 2018 to 2021.

METHODS

A training set of 639 images of tympanic membranes representing normal, OME, and AOM was used to train a neural network as well as a proprietary commercial image classifier from Google. Model diagnostic prediction performance in differentiating normal vs nonpurulent vs purulent effusion was scored based on classification accuracy. A web-based survey was developed to test human clinicians' diagnostic accuracy on a novel image set, and this was compared head to head against our model.

RESULTS

Our model achieved a mean prediction accuracy of 80.8% (95% CI, 77.0%-84.6%). The Google model achieved a prediction accuracy of 85.4%. In a validation survey of 39 clinicians analyzing a sample of 22 endoscopic ear images, the average diagnostic accuracy was 65.0%. On the same data set, our model achieved an accuracy of 95.5%.

CONCLUSION

Our model outperformed certain groups of human clinicians in assessing images of tympanic membranes for effusions in children. Reduced diagnostic error rates using machine learning models may have implications in reducing rates of misdiagnosis, potentially leading to fewer missed diagnoses, unnecessary antibiotic prescriptions, and surgical procedures.

Luminescence studies of a Li2 Ca1-x SiO4 :xSm3+ phosphor for the generation of white light under NUV-excited phosphor converting LEDs

In this paper, we present new aspects of Sm³⁺ -doped pure Li₂ CaSiO₄ as a suitable candidate for white light emitting diode (WLED) applications. The samples were mainly prepared using a conventional modified solid-state synthesis technique. The structural studies were done using X-ray diffraction and Rietveld refinement. Instruments such as a scanning electron microscope (SEM) were used to obtain information about the morphology of the as-prepared samples. Photoluminescence (PL) analysis of phosphor samples for variable concentrations of doping ions with variable excitations were presented. When doped with Sm³⁺ in host Li₂ CaSiO₄ it emitted intense blue, green and red emissions and a more intense red emission peak (605 nm) under 408 nm excitation (near-UV-blue). Our study shows that the as-prepared phosphor may be useful for optical devices and mainly for WLEDs. The corresponding transitions of doping ions and concentration quenching effect were studied in detail. The 1931 Commission Internationale de l'Eclairage (x, y) chromaticity coordinates showed the distribution of spectral regions calculated from PL emission spectra and this was found (0.63, 0.36) in the red region, so the phosphor may be useful for near-UV-blue excited WLED applications.

Economic analysis of a hybrid intelligent optimization-based renewable energy system using smart grids

Renewable energy has seen a substantial increase in deployment as an alternative to traditional power sources. However, two fundamental constraints exist that preclude widespread adoption: the availability of the generated power and the expense of the equipment. One of the most critical difficulties with this sort of hybrid system is to appropriately design the Hybrid Renewable Energy System (HRES) elements so that they fulfill all load requirements while requiring the least amount of investment and running expenditures. This research proposes a novel technique for evaluating the optimal smart grid linking Hybrid Renewable Energy (Solar photovoltaic and wind) with battery, to increase profitability, dependability, and feasibility. A multiobjective function is suggested and constructed to be optimized utilizing two optimization algorithms: Enhanced Particle Swarm Optimization (EPSO) and Harris Hawks Optimization (HHO) algorithm with Fuzzy-Extreme Learning Machine (ELM). The primary goal for the HRES is to operate optimally to reduce the cost of energy generat ion through hourly day-ahead. Here, the Fuzzy-ELM is utilized to predict the required load of the smart grid-connected system and hybrid EPSO-HHO, which are introduced to solve the problem of HRES economic analysis. Finally, the suggested EPSO-EHO method is implemented in the MATLAB software, and its performance comparison is made with other existing methods such as PSO, WOA, and HHO. The simulation result shows that the cost of the newly suggested EPSO-HHO technique-based Hybrid Renewable Energy System is less than PSO, WOA, and HHO by 4.89 %, 4.51 %, and 4.05 %, respectively.

Two-factor-based RSA key generation from fingerprint biometrics and password for secure communication

In an asymmetric-key cryptosystem, the secure storage of private keys is a challenging task. This paper proposes a novel approach for generating the same public and private key pair on a need basis. Hence, the need for secure storage of the private key is done away with. The proposed approach for generating the key pair is based on two factors: fingerprint biometrics and password. A stable binary string is generated from the distances among pairs of minutiae points in a fingerprint using a gray code-based method. Experiments show that gray code representation significantly reduces the number of inconsistencies between the generated bit strings from two instances of the same fingerprint as against the binary code representation. Hence, the Reed–Solomon error correction code successfully corrects errors due to variations in multiple instances of the same fingerprint to induce stability in the generated string. Hash of the stable string generated from the fingerprint and the string generated from hashed password are XORed to derive a stable seed value. The proposed approach uses this seed value to generate two large prime numbers. These prime numbers are used to generate the public and private key pair using the RSA key generation method. This seed value ensures the generation of the same key pair every time. The experimental results show that the proposed approach can ensure a stable generation of the key. It is not required to store either the fingerprint template or the password. Moreover, the generated private key is also not stored. It can be regenerated on a need basis.

Antioxidant Activities and Hepatoprotective Potential of Ethanol Leaf Extract of Justicia quinqueangularis against Selected Hepatotoxins Induced Hepatotoxicity in Albino Wistar Rats

Background: The objective of this research was to see whether the ethanolic extract of Justicia quinqueangularis leaves had antioxidant and hepatoprotective properties against paracetamol (PCT), ethanol (ETN), and isoniazid and rifampicin (IR)-induced hepatotoxicity in Albino Wistar rats. Methods: The leaves of Justicia quinqueangularis were dried in the shade at room temperature, pulverised, and extracted by soxhlet using ethanol. Quantitative phytochemical experiments were carried out as a first step. The ethanol extract's hepatoprotective activity was evaluated in Albino Wistar rats. PCT (3 g/kg), ETN (5 g/kg), and IR (100 mg/kg) reduced the levels of serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase (ALP) and bilirubin, which are all biochemical indicators of liver injury. Both hepatotoxin-treated and untreated group of animals determined for their antioxidant levels. SGOT, SGPT, ALP, bilirubin, antioxidant function of DPPH (2,2-diphenyl-1-picrylhydrazyl), hydrogen peroxide (H2O2), lipid peroxidation methods, hydroxyl radicals, and nitric oxide scavenging activities were among the biochemical and histopathological tests performed. Results: The altered levels of biochemical markers were restored to near normal levels in a dose-dependent fashion after treatment with J. quinqueangularis ethanol leaf extract (100 mg / kg, 200 mg / kg, and 400 mg / kg body weight). Conclusion: The findings of the current research indicated that the ethanol leaf extract of J. quinqueangularis had potent antioxidant and hepatoprotective properties against standard drug.

Feeding Tube Placement Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

OBJECTIVE

To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting.

STUDY DESIGN

Retrospective chart review.

SETTING

Academic tertiary center.

METHODS

A retrospective series of patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) was identified between October 2016 and November 2019 at a single tertiary academic center. Patient data were gathered, such as frailty information, tumor characteristics, and treatment, including need for adjuvant therapy. Multiple logistic regression was performed to identify factors associated with feeding tube placement following TORS.

RESULTS

A total of 138 patients were included in the study. The mean age was 60.2 years (range, 37-88 years) and 81.9% were male. Overall 82.9% of patients had human papilloma virus-associated tumors, while 28.3% were current or former smokers with a smoking history ≥10 pack-years. Eleven patients (8.0%) had a nasogastric or gastrostomy tube placed at some point during their treatment. Five patients (3.6%) had feeding tubes placed perioperatively (<4 weeks after TORS), of which 3 were nasogastric tubes. Six patients (4.3%) had feeding tubes placed in the periadjuvant treatment setting for multifactorial reasons; 5 of which were gastrostomy tubes. Only 1 patient (0.7%) was gastrostomy dependent 1 year after surgery. Multiple logistic regression did not demonstrate any significant predictive variables affecting perioperative feeding tube placement following TORS for OPSCC.

CONCLUSIONS

Feeding tubes are seldom required after TORS for early-stage OPSCC. With appropriate multidisciplinary planning and care, patients may reliably avoid the need for feeding tube placement following TORS for OPSCC.

Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma

BACKGROUND

The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear.

METHODS

Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan-Meier method.

RESULTS

Ninety-nine patients were included (median follow-up 21 months, range 6-121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins.

CONCLUSIONS

Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.

Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

Importance

The Merit-Based Incentive Payment System (MIPS) for Medicare is the largest pay-for-performance program in the history of health care. Although the Centers for Medicare & Medicaid Services (CMS) launched the MIPS in 2017, the participation and performance of otolaryngologists in this program remain unclear.

Objective

To characterize otolaryngologist participation and performance in the MIPS in 2017.

Design, Setting, and Participants

Retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS from January 1 through December 31, 2017, using the publicly available CMS Physician Compare 2017 eligible clinician public reporting database.

Main Outcomes and Measures

The number and proportion of active otolaryngologists who participated in the MIPS in 2017 were determined. Overall 2017 MIPS payment adjustments received by participants were determined and stratified by reporting affiliation (individual, group, or alternative payment model [APM]). Payment adjustments were categorized based on overall MIPS performance scores in accordance with CMS methodology: penalty (<3 points), no payment adjustment (3 points), positive adjustment (between 3 and 70 points), or bonus for exceptional performance (≥70 points).

Results

In 2017, CMS required 6512 of 9526 (68.4%) of active otolaryngologists to participate in the MIPS. Among these otolaryngologists, 5840 (89.7%) participated; 672 (10.3%) abstained and thus incurred penalties (-4% payment adjustment). The 6512 participating otolaryngologists reported MIPS data as individuals (1990 [30.6%]), as groups (3033 [46.6%]), and through CMS-designated APMs (964 [14.8%]). The majority (4470 of 5840 [76.5%]) received bonuses (maximum payment adjustment, +1.9%) for exceptional performance, while a minority received only a positive payment adjustment (1006 of 5840 [17.2%]) or did not receive an adjustment (364 of 5840 [6.2%]). Whereas nearly all otolaryngologists reporting data via APMs (936 of 964 [97.1%]) earned bonuses for exceptional performance, fewer than 70% of otolaryngologists reporting data as individuals (1124 of 1990 [56.5%]) or groups (2050 of 3033 [67.6%]) earned such bonuses. Of note, nearly all otolaryngologists incurring penalties (658 of 672 [97.9%]) were affiliated with groups.

Conclusions and Relevance

Most otolaryngologists participating in the 2017 MIPS received performance bonuses, although variation exists within the field. As CMS continues to reform the MIPS and raise performance thresholds, otolaryngologists should consider adopting measures to succeed in the era of value-based care.

Evaluation of Hepatoprotective and Antioxidant Activity of Ethanolic Extract of Artabotrys zeylanicus Stem against Various Hepatotoxins Induced Hepatotoxicity in Albino Wister Rats

The objective of the present study was to investigate the antioxidant and hepatoprotective activity of ethanolic stem extract of Artabotrys zeylanicus against paracetamol (PCT), Ethanol (ETN) and Isoniazid and Rifampicin (IR) induced hepatotoxicity in Albino wister rats. Methodology: The material was dried in shade, they were powdered and extracted with ethanol. Preliminary Phytochemical tests were done. The hepatoprotective activity of the ethanol extract was assessed in Albino wister rats. PCT (3 g/kg), ETN (5 gm/kg) and IR (100 mg/kg) has enhanced the levels of various biochemical markers of hepatic damage like Serum Glutamic Oxaloacetic Trasaminase (SGOT), Serum Glutamic pyruvic transaminase (SGPT), Alkaline phosphatise (ALP), bilirubin. Antioxidant levels were tested in all the Hepatotoxins treated and untreated groups. Results: The various biochemical and Histopathological investigations done were Serum Glutamic Oxaloacetic Trasaminase (SGOT), Serum Glutamic pyruvic transaminase (SGPT), Alkaline phosphatise (ALP), Bilirubin, antioxidant activity by 1,1-diphenyl 2-picryl hydrazyl (DPPH), Nitro Blue Tetrazolium (NBT), Hyderogen peroxide (H2O2), lipid perioxidation, hyderoxil radical and nitric oxide. Treatment of ethanolic extract of stem of A. zeylanicus (100mg/kg, 200mg/kg and 400mg/kg body weight) has brought back the altered levels of biochemical markers to the near normal levels in the dose dependent manner. Ethanolic extract of A. zeylanicus were observed to inhibit oxidant stress with the maximum value of 71% and 62% at the concentration of 100 µg/mL. The crude ethanolic extract of A. zeylanicus had a calculated IC50 value of 62.2 and 63.25 μg/mL, which is nearly similar to the calculated IC50 value of the known antioxidant, ascorbic acid, ie 65.3 μg/mL. While the rats treated with AZ extract (100, 200 and 400 mg/kg) which were shown as reduction/absence of inflammatory cells, vascular congestion, cellular degeneration, necrosis and vacuoles. In contrast, the lower doses (100 mg/kg) of ethanolic extract of AZ stem shown low protection than at higher dose 400 mg/kg. Conclusion: Our findings suggested that A. zeylanicus ethanol stem extract possessed a potent antioxidant and hepatoprotective activity.

Tool Wear and Temperatures Analysis While Machining Ti-6Al-4V in MQCL-MIST Environment

Sustainable machining of titanium alloys have deficiency of studies on the built-up edges over the cutting tools and temperature correlation in minimum quantity cooling lubrication (MQCL) environment. Researchers focused on experimentation in dry, wet, and MQL (minimum quantity lubrication) conditions to analyze surface finish, cutting forces, and metal removal rates. This work focuses on the study of cutting parameters effects on temperatures and tool wear analysis by consideration of individual response and their optimality basing on signal-to-noise ratios. Efficacy of process parameters on wear of tool and temperatures requires a comprehensive understanding. An elaborated tool wear analysis is carried based on the microscopic flank wear investigations. Machining of Ti-6Al-4V alloy is carried in the environment of MQCL in form of mist using semi-synthetic fluid. Correlation study of tool wear with regard to temperatures is analyzed and regression models generated on tool wear and cutting temperatures individually showed 83% of goodness-of-fit and correlation regression is 85%.

In situ hybridization for high risk HPV E6/E7 mRNA in oropharyngeal squamous cell carcinoma

OBJECTIVES

To report a single institution's experience using human papillomavirus (HPV) E6/E7 mRNA in-situ hybridization (mRNA ISH) for HPV detection in oropharyngeal squamous cell carcinoma (OPSCC). To review the literature on HPV detection methods.

STUDY DESIGN

Retrospective chart review, literature review.

SETTING

Tertiary care academic hospital.

SUBJECTS AND METHODS

We conducted a retrospective chart review of 122 OPSCC biopsy specimens. mRNA ISH was performed on formalin-fixed paraffin-embedded (FFPE) tissue with a pool of 18 high risk HPV probes using an automated stainer; p16 immunohistochemistry (IHC) was also performed. We conducted a literature review on HPV detection methods including p16 IHC, mRNA ISH, DNA ISH, and PCR.

RESULTS

In our cohort, mRNA ISH had a sensitivity and specificity of 100% and 100% with reference to p16 (100% concordance). 2-year OS was 87.5% vs. 94.5% for p16/HPV-negative vs. positive patients. 2-year DFS was 60.0% vs. 84.2%. On literature review, mRNA ISH demonstrated consistently high sensitivity and specificity ranging from 88-98% and 90-100% respectively. In comparison, the specificity of p16 was 85-95%.

CONCLUSIONS

Our report supports the use of mRNA ISH for HPV detection in OPSCC and validates its feasibility using automated tissue staining methods on FFPE tissue. Our findings and literature review support that mRNA ISH may have superior specificity and be easier to interpret than p16. Further study on the prognostic value and cost-effectiveness of mRNA ISH is warranted and may establish this HPV detection method as the "gold standard."

Opioid Usage and Prescribing Predictors Following Transoral Robotic Surgery for Oropharyngeal Cancer

OBJECTIVE/HYPOTHESIS

Pain management following transoral robotic surgery (TORS) varies widely. We aim to quantify opioid usage following TORS for oropharyngeal squamous cell carcinoma (OPSCC) and identify prescribing predictors.

STUDY DESIGN

Retrospective cohort study.

METHODS

A consecutive series of 138 patients undergoing TORS for OPSCC were reviewed from 2016 to 2019. Opioid usage (standardized to morphine milligram equivalents [MME]) was gathered for 12 months post-surgery via prescribing record cross-check with the Massachusetts Prescription Awareness Tool.

RESULTS

Of 138 OPSCC TORS patients, 92.8% were human papillomavirus (HPV) positive. Adjuvant therapy included radiation (XRT;67.4%) and chemoradiation (cXRT;6.5%). Total MME usage from start of treatment averaged 1395.7 MMEs with 76.4% receiving three prescriptions or less. Categorical analysis showed age <65, male sex, overweight BMI, lower frailty, former smokers, HPV+, higher T stage, and BOT subsite to be associated with increased MMEs. Adjuvant therapy significantly increased MMEs (TORS+XRT:1646.2; TORS+cXRT:2385.0; TORS alone:554.7 [P < .001]) and 12-month opioid prescription totals (TORS+XRT:3.2; TORS+cXRT:5.5; TORS alone:1.6 [P < .001]). Adjuvant therapy increased time to taper (total MME in TORS alone versus TORS+XRT/cXRT: 0 to 3 months:428.2 versus 845.5, 4 to 6 months:46.8 versus 541.8, 7 to 9 months:12.4 versus 178.6, 10 to 12 months:11.0 versus 4.4,[P < .001]). Positive predictors of opioid prescribing at the 4- to 6-month and 4- to 12-month intervals included adjuvant therapy (odds ratio [OR]:5.56 and 4.51) and mFI-5 score ≥3 (OR:36.67 and 31.94). Following TORS at 6-, 9-, and 12-month, 15.7%, 6.6%, and 4.1% were still using opioids.

CONCLUSIONS

In OPSCC treated with TORS, opioid use tapers faster for surgery alone versus with adjuvant therapy. Opioid prescribing risks include adjuvant therapy and higher frailty index.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E1888-E1894, 2021.

Evaluation of bactericidal and virucidal activity of novel disinfectant Aaride AGT-1 compared to other commercially available disinfectants against hospital-acquired infections (HAIs)

Hand hygiene is the topmost crucial procedure to prevent hospital-acquired infections. Choosing an effective hand disinfectant is necessary in enforcing good hand hygiene practice especially in hospital settings. The aim of the study was to investigate the efficacy of Aaride AGT-1 as a hand disinfectant for the inhibition of pathogenic microorganisms' transmission among both patients and personnel in the health care system compared to other commercially available disinfectants. In the present study, a new hand disinfectant Aaride AGT-1 was tested against several bacterial and viral pathogens to evaluate its antimicrobial activity profile. The results revealed that Aaride AGT-1 displayed the highest antibacterial activity against five pathogenic bacteria including MRSA when compared to other commercially available hand sanitizers. Aaride AGT-1 showed the lowest percentage needed to inhibit the growth of bacterial pathogens. In addition, results obtained from time killing assay revealed that Aaride AGT-1 demonstrated the best killing kinetics, by eradicating the bacterial cells rapidly within 0.5 min with 6 log reduction (>99.99% killing). Also, Aaride AGT1 was able to reduce 100% plaque formed by three viruses namely HSV-1, HSV-2 and EV-71. In conclusion, Aaride AGT-1 is capable of killing wide-spectrum of pathogens including bacteria and viruses compared to other common disinfectants used in hospital settings. Aaride AGT-1's ability to kill both bacteria and viruses contributes as valuable addition to the hand disinfection portfolio.

Geochemical characterization of modern aeolian dust over the Northeastern Arabian Sea: Implication for dust transport in the Arabian Sea

The Arabian Sea, one of the most biologically productive oceanic regions, receive significant amount of nutrients through aeolian dust deposition which have potential to modulate surface water biogeochemical processes. Identification of dust sources is important to assess role of dust deposition to surface water biogeochemistry. Here we report geochemical characteristics (major elements and trace metals composition, clay mineralogy and radiogenic isotopes of Sr and Nd) of aeolian dust, derived from dust storms in Middle East and South West Asia, to decipher its sources and possible transport pathways over the Arabian Sea. Twelve bulk aerosol samples were collected, during dusty period, at a coastal station (Goa; 15.4^o N, 73.8^o E) located in the Northeastern Arabian Sea, spanning over three years in different seasons. A preliminary estimation of sources for dust storms was done using satellite imagery and air mass back trajectory analyses. Major element and trace metal compositions of storm derived dust samples indicate insignificant contribution from anthropogenic sources. Illite and chlorite are major clay minerals found in all dust samples, however, high palygorskite content were observed for dust sourced from the Arabian Peninsula. A more uniform Sr-Nd signature is found for those derived from Arabia, however, highly variable Sr-Nd isotope signatures were observed for those derived from the South West Asia (Iran and Makran coast). The reported comprehensive data set on geochemical characteristics of mineral dust, is the first attempt that provides important information to understand present and past dust emission and deposition over the Arabian Sea.

Epitope variances demonstrated by Blastocystis sp. ST3 symptomatic and asymptomatic isolates

Blastocystis sp. is an enteric protozoan parasite of humans and many animals. Blastocystis sp. subtype 3 (ST3) proves to be the highest frequency case in most populations around the world and it is further distinguished into symptomatic and asymptomatic isolates based on the clinical symptoms exhibited by infected individuals. Phenotypic and genotypic studies implicate the distinctiveness of this parasite which may describe its pathogenesis. However, the antigenic distinctiveness which describes the antibody mediated cell lysis of this parasite has not been explored. This study was aimed to identify the cross-reactivity and cytotoxicity effect between three isolates of symptomatic and asymptomatic Blastocystis sp. ST3 respectively. Antigen specificity and diversity of this parasite was performed by coculturing sera (10-fold dilution) obtained from mice immunised with Blastocystis sp. symptomatic and asymptomatic antigens and the respective Blastocystis sp. ST3 live cells through complement dependant cell cytotoxicity (CDC) assay. The results obtained has shown that, the sera (at 10-fold diluted concentration) from symptomatic and asymptomatic solubilised antigen immunised mice were able to specifically lyse the respective live parasites with an average percentage of 82% and 86% respectively. There were almost 50% crossreactivity observed between the three isolates of Blastocystis sp. ST3 from symptomatic and asymptomatic group proving high antigen diversity or rather low antigen specificity within the same group. However, there was only 17% cross-reactivity observed between the mice sera and parasitic cells of different groups (symptomatic vs asymptomatic isolates) suggesting high specificity between these two groups. We, for the first time have proven that through CDC analysis there were epitopes dissimilarities between Blastocystis sp. ST3 symptomatic and asymptomatic isolates which may allow the parasite to set up diverse immune modulations such as imbalanced Th1/Th2 responses in an infected host.

Completion lymph node dissection for merkel cell carcinoma

BACKGROUND

Sentinel lymph node biopsy (SLNB) is widely used for Merkel cell carcinoma (MCC), however in SLNB positive MCC the role of completion lymph node dissection (CLND) with or without adjuvant radiation therapy is unclear.

OBJECTIVE

Our goal was to determine the impact of CLND and adjuvant radiation therapy on survival in SLNB positive MCC.

MATERIALS AND METHODS

We examined 447 patients with MCC with a positive SLNB in the National Cancer Data Base from 2012 to 2015. We compared patients who underwent CLND versus observation with or without adjuvant radiation.

RESULTS

Compared with CLND and adjuvant radiation (reference) treatment with observation (HR 3.54, CI 1.36-9.18) or CLND alone (HR 2.54, CI 1.03-6.27) were associated with worse overall survival after adjusting for clinicopathologic differences. In contrast treatment with adjuvant radiation alone without CLND was not associated with worse overall survival (HR 1.70, CI 0.74-3.92) compared with CLND and adjuvant radiation (reference).

CONCLUSIONS

In SLNB positive MCC, CLND alone is associated with worse survival compared with treatment with adjuvant radiation or both CLND and adjuvant radiation.

Effect of processing delay on bifurcation delay in a network of slow-fast oscillators

Bifurcation delay or slow passage effect occurs in dynamical systems with slow-fast time-varying parameters. In this work, we report the impact of processing delay on bifurcation delay in a network of locally coupled slow-fast systems with self-feedback delay. We report that the network exhibits coexisting coherent (synchronized) and incoherent (desynchronized) states among the oscillators as a function of various parameters like self-feedback delay, processing delay, and amplitude of the external current. In particular, we show the decrease of the synchronized region (control of synchronization) for (i) a fixed value of processing delay with varying self-feedback delay and (ii) fixed self-feedback delay with increasing processing delay. In contrast, we observe the increase of the synchronized region (control of desynchronization) for fixed processing delay and self-feedback delay while varying the amplitude of the external current. Finally, we have also analyzed the effect of processing delay on bifurcation delay with the presence of noise and we report that the inhomogeneity in the additional noise does not affect the asymmetry in a bifurcation delay.

Genotoxic effects of tobacco use in residents of hilly areas and foot hills of Western Ghats, Southern India

Smoking and smokeless tobacco consumption is a significant risk factor that provokes genetic alterations. The present investigation was to evaluate the biomarkers of genotoxicity including micronucleus (MN), chromosome aberrations (CA) and DNA strand breaks among tobacco consumers and control individuals residing in hilly areas of Western Ghats, Tamilnadu, South India. This study included 268 tobacco consumers with equal number of controls. The tobacco consumers were divided into Group I (<10 years of tobacco consumption with an age range from 15 to 35 years) and group II (>10 years consumption above 35 years of age). Chromosome aberration (CA) and comet assay were performed using blood and micronucleus assay from exfoliated buccal epithelial cells obtained from tobacco consumers and controls. Elevated levels of CA were found in group II (Chromatid type: 2.39 ± 1.13 and chromosome type: 1.44 ± 1.24) exposed subjects, high micronucleus and DNA damage (TL:4.48 ± 1.24 and TM:3.40 ± 1.58) levels were significantly (p < 0.05) observed in both smoking and smokeless tobacco consumers when comparison with group I and controls. This study also observed a lack of awareness among the tobacco consumers about the harmful health effects of tobacco. Tobacco consumption contributes to the significant alteration in genetic materials. In addition, a high rate of spontaneous abortion was also seen in the studied population.