Adjuvant-dependent impact of inactivated SARS-CoV-2 vaccines during heterologous infection by a SARS-related coronavirus

Whole virus-based inactivated SARS-CoV-2 vaccines adjuvanted with aluminum hydroxide have been critical to the COVID-19 pandemic response. Although these vaccines are protective against homologous coronavirus infection, the emergence of novel variants and the presence of large zoonotic reservoirs harboring novel heterologous coronaviruses provide significant opportunities for vaccine breakthrough, which raises the risk of adverse outcomes like vaccine-associated enhanced respiratory disease. Here, we use a female mouse model of coronavirus disease to evaluate inactivated vaccine performance against either homologous challenge with SARS-CoV-2 or heterologous challenge with a bat-derived coronavirus that represents a potential emerging disease threat. We show that inactivated SARS-CoV-2 vaccines adjuvanted with aluminum hydroxide can cause enhanced respiratory disease during heterologous infection, while use of an alternative adjuvant does not drive disease and promotes heterologous viral clearance. In this work, we highlight the impact of adjuvant selection on inactivated vaccine safety and efficacy against heterologous coronavirus infection.

Animal Models for the Study of SARS-CoV-2-Induced Respiratory Disease and Pathology

Emergence of the betacoronavirus SARS-CoV-2 has resulted in a historic pandemic, with millions of deaths worldwide. An unprecedented effort has been made by the medical, scientific, and public health communities to rapidly develop and implement vaccines and therapeutics to prevent and reduce hospitalizations and deaths. Although SARS-CoV-2 infection can lead to disease in many organ systems, the respiratory system is its main target, with pneumonia and acute respiratory distress syndrome as the hallmark features of severe disease. The large number of patients who have contracted COVID-19 infections since 2019 has permitted a detailed characterization of the clinical and pathologic features of the disease in humans. However, continued progress in the development of effective preventatives and therapies requires a deeper understanding of the pathogenesis of infection. Studies using animal models are necessary to complement in vitro findings and human clinical data. Multiple animal species have been evaluated as potential models for studying the respiratory disease caused by SARSCoV-2 infection. Knowing the similarities and differences between animal and human responses to infection is critical for effective translation of animal data into human medicine. This review provides a detailed summary of the respiratory disease and associated pathology induced by SARS-CoV-2 infection in humans and compares them with the disease that develops in 3 commonly used models: NHP, hamsters, and mice. The effective use of animals to study SARS-CoV-2-induced respiratory disease will enhance our understanding of SARS-CoV-2 pathogenesis, allow the development of novel preventatives and therapeutics, and aid in the preparation for the next emerging virus with pandemic potential.

Smoking Behaviors of General Educational Development (GED) Recipients

OBJECTIVE

Cigarette smoking is inversely associated with education, and despite this gradient effect, individuals with a General Educational Development (GED) diploma, obtained through a high school equivalency test, have the highest smoking prevalence. Considered the high school equivalency credential, it is unclear why individuals with a GED have a substantially higher smoking prevalence compared to high school graduates and dropouts. We conducted a qualitative study to understand life experiences, tobacco use patterns, and perceptions of tobacco among GED smokers and attitudes and behaviors around smoking cessation.

METHODS

We recruited 40 GED smokers aged 18 to 35 years and conducted surveys and semi-structured individual interviews. Transcripts were independently coded, then coding differences were resolved and reviewed by a third team member. We independently determined themes within and between codes and met to determine final themes.

RESULTS

GED recipients had many early life experiences and characteristics that made them highly vulnerable to tobacco dependence. With perceived high cognitive abilities, GED smokers were knowledgeable of many evidence-based smoking cessation strategies and were aware of health risks. Health risks and the financial burden of smoking were motivation to quit. The majority were uninterested or lacked confidence that nicotine replacement therapy, medications, counseling, or the quitline could help them quit. Nearly all were enthusiastic and confident that financial incentives had the potential to help them quit.

CONCLUSIONS

Research is needed to determine whether financial incentives could improve smoking cessation outcomes in this unique population with an unequal burden of smoking.

The safety and effectiveness of a long-acting transdermal fentanyl solution compared with oxymorphone for the control of postoperative pain in dogs: a randomized, multicentered clinical study

A prospective, double-blinded, positive-controlled, multicenter, noninferiority study was conducted to evaluate the safety and effectiveness of transdermal fentanyl solution (TFS) compared with oxymorphone for the control of postoperative pain in dogs. Five hundred and two (502) client-owned dogs were assigned to a single dose of TFS (2.7 mg/kg) applied 2–4 h prior to surgery or oxymorphone hydrochloride (0.22 mg/kg) administered subcutaneously 2–4 h prior to surgery and q6h through 90 h. Pain was evaluated over 4 days by blinded observers using a modified Glasgow composite pain scale, and the a priori criteria for treatment failure was a pain score ≥8 or adverse event necessitating withdrawal. Four TFS- and eight oxymorphone-treated dogs were withdrawn due to lack of pain control. Eighteen oxymorphone-treated, but no TFS-treated dogs were withdrawn due to severe adverse events. The one-sided upper 95% confidence interval of the difference between TFS and oxymorphone treatment failure rates was −5.3%. Adverse events associated with oxymorphone were greater in number and severity compared with TFS. It was concluded that a single administration of TFS was safe and noninferior to repeated injections of oxymorphone for the control of postoperative pain over 4 days at the dose rates of both formulations used in this study.

Cross-sensitization between cocaine and acute restraint stress is associated with sensitized dopamine but not glutamate release in the nucleus accumbens

Repeated administration of psychostimulant drugs or stress can elicit a sensitized response to the stimulating and reinforcing properties of the drug. Here we explore the mechanisms in the nucleus accumbens (NAc) whereby an acute restraint stress augments the acute locomotor response to cocaine. This was accomplished by a combination of behavioral pharmacology, microdialysis measures of extracellular dopamine and glutamate, and Western blotting for GluR1 subunit of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor (AMPAR). A single exposure to restraint stress 3 weeks before testing revealed that enduring locomotor sensitization to cocaine was paralleled by an increase in extracellular dopamine in the core, but not the shell subcompartment, of the NAc. Wistar rats pre-exposed to acute stress showed increased basal levels of glutamate in the core, but the increase in glutamate by acute cocaine was blunted. The alterations in extracellular glutamate seem to be relevant, as blocking AMPAR by 6-cyano-7-nitroquinoxaline-2,3-dione microinjection into the core prevented both the behavioral cross-sensitization and the augmented increase in cocaine-induced extracellular dopamine. Further implicating glutamate, the locomotor response to AMPAR stimulation in the core was potentiated, but not in the shell of pre-stressed animals, and this was accompanied by an increase in NAc GluR1 surface expression. This study provides evidence that the long-term expression of restraint stress-induced behavioral cross-sensitization to cocaine recapitulates some mechanisms thought to underpin the sensitization induced by daily cocaine administration, and shows that long-term neurobiological changes induced in the NAc by acute stress are consequential in the expression of cross-sensitization to cocaine.

Effects of a 98% solution of glycerol or sterilization with ethylene oxide on FeLV in bone allografts and effects on bone incorporation of allografts in cats

OBJECTIVES

To compare virucidal effects and bone incorporation properties of cortical bone allografts transplanted into specific-pathogen-free (SPF) cats. Allografts consisted of untreated bone from a SPF cat (negative-control group) and bone from 5 FeLV-infected cats that was subjected to sterilization with ethylene oxide (ETO), preservation with glycerol, or no treatment (positive-control group).

SAMPLE POPULATION

Bones from the aforementioned groups and twenty 8-week-old SPF cats (5 cats/group) implanted with an allograft from 1 of the aforementioned groups.

PROCEDURE

After implantation, blood samples were collected weekly to monitor FeLV p27 antigen and antibody titers. Quantification of FeLV provirus was performed on blood samples at weeks 0, 4, and 8 and donor bone samples at time of implantation. Cats were euthanatized 8 weeks after transplantation, and graft sites were evaluated.

RESULTS

All results for negative-control cats were negative. All ETO group cats had negative results for antigen and provirus in blood, whereas 1 cat had a low antibody titer. Although 3 ETO-treated allografts were positive for provirus, the DNA appeared denatured. One cat in the glycerol group had positive results for all tests in blood samples. All glycerol-preserved allografts were positive when tested for provirus. All results for positive-control group cats were positive. Differences in incorporation of bone grafts were not observed.

CONCLUSIONS AND CLINICAL RELEVANCE

Glycerol preservation of FeLV-infected bone allografts did not eliminate transmission of retrovirus to recipients. In contrast, ETO sterilization appeared to denature DNA and prevent infection. Treatments did not affect incorporation of bone grafts in young cats.

Pelvic actinomycosis presenting as malignant large bowel obstruction: a case report and a review of the literature

Actinomycosis is an infrequent chronic infectious disease. In most cases the diagnosis is made postoperatively because of its unusual clinical presentation. Moreover, abdominal actinomycosis may mimic cancer, inflammatory bowel disease, or diverticulitis. Delay in diagnosis leading to inadequate management and unnecessary procedures has been reported. We report the case of a 49-year-old woman with large bowel obstruction secondary to extensive pelvic actinomycosis involving the rectosigmoid and cecum. She required emergency surgery, which involved both resection and colostomy. A review of the literature on abdominal actinomycosis during the last 50 years is also reported. Rarely has emergency surgery been described in this condition. Although the incidence of actinomycosis has decreased, the abdominal-pelvic form has been increasing over the past 10 years secondary to increased prolonged use of the intrauterine device. As the clinical spectrum of actinomycosis has dramatically changed, so have the therapeutic considerations. Aggressive surgical management in advanced cases with multiorganic involvement seems to have reemerged in recent years. Consideration of actinomycosis in a woman with prolonged use of an intrauterine device and symptoms of bowel obstruction could help to improve the preoperative diagnosis and management of this rare disease.

Bone grafts

Bone grafting provides a method of enhancing bone healing in veterinary orthopedic patients. Specifically, autogenous cancellous bone graft provides the cellular components and matrix proteins that can accelerate bone healing, dramatically. Allografts provide immediate mechanical support for fracture repair and patient function, but these grafts do not create the osteogenic environment seen with the use of autogenous cancellous bone graft. Xenograft bone implants may also hold a place for use in fracture management. With the advent of recombinant bone-derived tissue growth factor technology, bone grafting may some day become a practiced technique of the past. For now, however, bone grafting still holds a strong place in orthopedic surgery when dealing with bone defects in animals.

Gasless laparoscopic-assisted intestinal stoma creation through a single incision

Intestinal stoma creation has been performed using both open and laparoscopic surgery. However, each technique still has disadvantages. We created the intestinal stoma through one incision, with the use of the laparoscope in a gasless fashion. This method has not been reported previously. Fourteen adult patients underwent this technique between February 1996 and December 1998. Indications for stoma creation were for various anorectal disease processes, most commonly for purposes of hygiene in patients with spinal cord injury. The average operative time to perform the stoma was 58 (range, 15-78) minutes, with minimal blood loss (<35 ml). Follow-up ranged from 1 to 22 months. Two cases (14 percent) were converted secondary to severe adhesions. All nonconverted patients were able to tolerate a regular diet within two days of surgery. There was only one stoma-related complication. Two patients (14 percent) died of comorbidities during follow-up. In conclusion, the initial experience with gasless laparoscopic-assisted intestinal stoma creation through a single incision is encouraging. Patients requiring ostomy creation as a single intervention may benefit from this approach.

Staged laparoscopic resection for complicated sigmoid diverticulitis

Previous studies have utilized different regimens of laparoscopic surgery for treatment of both acute and chronic diverticular diseases. Our aims were to assert that laparoscopic-assisted sigmoid resection and anastomosis for sigmoid diverticulitis after acute attacks is safe and feasible, provided the inflammatory process has subsided. A chart review was undertaken of patients who underwent laparoscopic sigmoid resection after resolution of the acute attack of diverticulitis at hospitals affiliated with the University of Miami. Thirty-eight patients, median age 52 years, were identified. Laceration of the spleen was the only intraoperative complication (one patient). Seven patients (18%) were converted due to severe adhesions. Regular diet was tolerated on the third postoperative day, and the length of hospital stay was 4 days. No major complications or deaths occurred. In conclusion, laparoscopic surgery for sigmoid diverticulitis after resolution of the acute process seems safe and feasible and provides excellent immediate postoperative recovery.

Prospective comparison of four sampling methods (cystocentesis, bladder mucosal swab, bladder mucosal biopsy, and urolith culture) to identify urinary tract infections in dogs with urolithiasis

A prospective study was conducted on 27 dogs with recurrent urinary tract infections (UTIs) and urolithiasis. Four sampling methods (i.e., urine obtained by cystocentesis, bladder mucosal swab, bladder mucosal biopsy, and urolith) were compared to identify UTI. Identical culture results were obtained from urine collected by cystocentesis and from the swab of bladder mucosa. In the presence of a positive urine culture, the same organism also was cultured from the bladder mucosal biopsy and urolith. However, in the presence of a negative urine culture, an organism was cultured from the bladder mucosal biopsy or the urolith in 18.5% of the cases. Therefore, when the culture from urine obtained by cystocentesis is negative, it is recommended that aerobic cultures of a bladder mucosal biopsy and a urolith be performed in cases of urolithiasis.

Intraoperative endoscopy during colorectal surgery

In cases where preoperative studies may have been inadequate or could not be performed, intraoperative endoscopy (IOE) becomes an essential investigative tool for identification of synchronous lesions, of nonpalpable lesions, of sources of bleeding, and localization of lesions during laparoscopic colonic surgery. We report our experience with IOE, and describe our techniques of transabdominal colonoscopy. A review of the IOE performed in hospitals affiliated with the University of Miami was done. Fifty-eight patients received IOE from July 1994 to August 1996. There were 47 colonoscopies (38 transanal and 9 transabdominal), and 11 flexible sigmoidoscopies. Colorectal cancer, diverticulitis, inflammatory bowel disease, and lower gastrointestinal bleeding represented 83% of cases. In 10% of cases IOE changed the extent of the surgical procedure. There were no complications related to IOE. We conclude that in selected patients undergoing colorectal procedures, IOE is an essential tool. It can be performed safely, effectively, and rapidly.

Congenital conditions that lead to osteoarthritis in the dog

Several congenital arthropathies exist in the canine that can lead to the development of degenerative joint disease. Nevertheless, early diagnosis and treatment generally will afford the patient a favorable prognosis for limb function. There is still a great need to develop controlled studies to evaluate the long-term efficacy of many of the surgical and medical treatment modalities that are currently available and will be made available in the future to treat the patient with a congenital arthropathy.

Dissipation of heat during polymerization of acrylics used for external skeletal fixator connecting bars

OBJECTIVE

To determine the amount of heat conducted by transfixation intramedullary pins (IP) and Kirschner wires (KW) during polymerization of acrylics used for external skeletal fixator (ESF) connecting bars.

STUDY DESIGN

Thermal conduction was measured using thermistors applied to IP and KW surfaces during the polymerization phase of acrylics.

METHODS

Type II ESF were created from IP or KW placed into wooden dowels and plastic tubing used to create connecting bars filled with one of two types of acrylic (Acrylic Pin External Fixation System or Technovit, Jorgensen Laboratories, Loveland, CO). Thermistors were positioned on the acrylic column surface and on IP or KW surfaces 5 or 10 mm from the acrylic column. Five ESF test groups were created. The maximum temperature (Tmax) of the acrylic column (Tmax-A), IP (Tmax-IP), KW (Tmax-KW), and duration that Tmax-IP or Tmax-KW remained greater than or equal to 55 degrees C were calculated.

RESULTS

All IP and KW thermistors placed 5 mm from acrylic columns reached mean temperatures greater than 50 degrees C and had peak temperature ranges greater than 55 degrees C compared with all IP and KW thermistors placed 10 mm from the acrylic columns in all groups. Thermistors placed 5 mm from the acrylic column in two groups maintained temperatures greater than 55 degrees C for greater than or equal to 0.5 minute.

CONCLUSIONS

Acrylic columns positioned 5 mm from a thermistor on a IP or KW had the potential to reach or exceed temperatures that have been reported to cause thermal necrosis of tissues.

CLINICAL RELEVANCE

Acrylic Pin External Fixation System or Technovit acrylic connecting bars used in ESF designs have the potential to cause thermal injury to soft and bony tissue by thermal conduction along transfixation pins or wires.

Acquired conditions that lead to osteoarthritis in the dog

There are many acquired arthopathies that will result in some degree of osteoarthritis, even after proper management. Once the articular cartilage is damaged, it is unlikely that the architecture of the original cartilage surface will return to the normal conditions that existed prior to injury. The purpose of timely and meticulous management of traumatic joint events is to stop the progression of osteoarthritic development. When dealing with articular fractures or other forms of trauma to articular cartilage, three important principles to remember are anatomic reduction of the articular surfaces, stable fixation, and limited weight bearing on the affected limb as soon as possible after surgery. Even after strict adherence to these principles, the pet owner should always be warned that the animal will develop some degree of osteoarthritis in the affected joint at some future time; at that time, chronic medical management may be indicated.

Effect of volume variations on osteogenic capabilities of autogenous cancellous bone graft in dogs

OBJECTIVE

To evaluate the osteogenic effect of differing volumes of autogenous cancellous bone graft (ACBG) placed into partial cortical defects of the ulna.

ANIMALS

15 healthy, mature Beagles.

PROCEDURE

Weekly radiographic views of defects were obtained over 8 weeks and were analyzed for bone density by use of radiographic optical densitometry. Histologic sections were obtained 8 weeks after surgery and were planimetrically evaluated for area of total, lamellar, and woven bone.

RESULTS

Defects receiving 0.3 and 0.75 g of ACBG had rapid initial bone production, and dogs receiving 0.3 g of ACBG had faster bone ingrowth than did those receiving 0.1 g of ACBG or controls. Defects receiving 0.75 g of ACBG had a rate of bony ingrowth equal to 0.3 g of ACBG. There was no difference in the histomorphometric area fractions of total, lamellar, or woven bone between defects treated with 0.1 or 0.75 g of ACBG, and between grafted or control defects, 8 weeks after surgery.

CONCLUSIONS

Overfilling a cortical defect with ACBG does not enhance early osteogenesis within the defect, and underfilling will delay the onset of osteogenesis within the defect.

CLINICAL RELEVANCE

A volume of ACBG sufficient only to fill a cortical defect is required to obtain a clinical osteogenic effect from the graft.

4NQO carcinogenesis: a mouse model of oral cavity squamous cell carcinoma

BACKGROUND

A murine model of oral cavity carcinogenesis is needed to study the molecular aspects of malignant transformation. 4-Nitroquinoline-1-oxide (4NQO), a water-soluble carcinogen, produces squamous cell carcinoma in rodents. Protocols were designed to investigate the temporal aspects of neoplastic transformation.

METHODS

4NQO was applied topically to mouse palates for up to 16 weeks. Mice were observed and killed from 24 to 49 weeks.

RESULTS

A spectrum of lesions ranging from atypia to moderately differentiated invasive squamous cell carcinoma (SCC) was produced. The severity of the lesions corresponded to the duration of treatment and the length of observation. There was no gross or microscopic evidence of an inflammatory reaction to 4NQO. The lesions were focal and normal mucosa predominated in the treated mice.

CONCLUSION

4NQO reliably produced preneoplastic and malignant oral cavity lesions, which morphologically and histologically mimic human head and neck cancer. Lesions develop long after 4NQO exposure and without an inflammatory response. Thus, the model should be useful for molecular analysis of neoplastic transformation.

Pantarsal arthrodesis in dogs and a cat: 11 cases (1983-1991)

Bone plates applied to the cranial surfaces of the tibia, the tarsus, and the metatarsus were used in 10 dogs and 1 cat that underwent pantarsal arthrodesis. Lengthening plates were used in 7 dogs, and 2.7- and 3.5-mm dynamic compression plates were used in the remaining dogs and the cat. Radiography was used to determine whether bone plates became loose or broke, and whether the joint fused completely. Bone plates became loose in 5 dogs; mean time between surgery and development of radiographic evidence of plate loosening was 19.4 months. The bone plate used in the cat broke 4 months after surgery. Overall, 9 of 11 animals had evidence of complete bony fusion of the tarsus at the time of the last radiographic evaluation. One dog had incomplete healing of the talocalcaneocentral joint and another dog had incomplete healing of the tarsometatarsal joint.

Eustachian tube dysfunction and its sequelae in patients with cleft palate

The incidence of middle ear disorders in patients with cleft palate deformities was determined in a retrospective review of 110 children with palate or palate and lip involvement. Ages ranged from 2 months to 18 years and included patients with associated abnormalities such as Pierre Robin syndrome and Treacher Collins syndrome. Clinical manifestations of eustachian tube dysfunction were found in 79% in the form of effusions, retraction pockets, adhesions, and ossicular erosion. Only two patients had confirmed cholesteatoma formation. Despite the low incidence of acquired cholesteatoma in these patients, the frequent occurrence of other disorders that affect hearing warrants early and aggressive otologic management to prevent long-term sequelae.

HIV wasting syndrome in the United States

OBJECTIVE

To describe the characteristics of individuals > or = 13 years of age with HIV wasting syndrome in the United States and US territories.

DESIGN

Retrospective review of national AIDS case surveillance data.

METHODS

Data for the 147,225 individuals with AIDS reported to the Centers for Disease Control from 1 September 1987 to 31 August 1991 were reviewed. The frequency of HIV wasting syndrome and its association with demographic and exposure category variables and with other AIDS-indicator diseases were assessed.

RESULTS

A total of 10,525 (7.1%) had wasting syndrome as the only AIDS-indicator condition, and 15,726 (10.7%) had wasting syndrome plus at least one other AIDS-indicator condition. Patients with wasting syndrome as the only AIDS diagnosis were more likely to be female, to be black or Hispanic, and to have a mode of HIV exposure reported as injecting drug use, heterosexual contact, or transfusion/hemophilia. The proportion of AIDS patients reported with wasting syndrome varied by geographic distribution, ranging from 11% in the northeastern United States to 47% in Puerto Rico. The association between HIV wasting syndrome and Hispanic ethnicity was due to the much higher prevalence of wasting syndrome reported in Puerto Rican AIDS patients. The other AIDS-indicator conditions most strongly associated with wasting syndrome were isosporiasis, pulmonary candidiasis, esophageal candidiasis, HIV encephalopathy, chronic mucocutaneous herpes simplex, and coccidioidomycosis.

CONCLUSIONS

The association between HIV wasting syndrome and injecting drug use, and the significant racial/ethnic and geographic differences in prevalence of this AIDS diagnosis may reflect differences in diagnostic and reporting practices and/or access to medical care.

Effects of a fixed compression load on the osteogenic effect of autogenous cancellous bone grafts in dogs

A standardized cortical defect was created on the caudal cortex of the proximal portion of each ulna in 5 adult mixed-breed dogs. One gram of autogenous cancellous bone graft (ACBG) was obtained from the greater tubercle of the ipsilateral humerus. The cortical defect in the ulna of 1 limb was filled with 1 g of ACBG that had been compressed with 2-MPa pressure for 30 seconds. One gram of noncompressed ACBG was placed into the contralateral ulnar cortical defect. The compressed and noncompressed ACBG recipient sites were radiographed at weekly intervals. Dogs were euthanatized 8 weeks after surgery, and the ACBG recipient sites were harvested for histomorphometric analysis. Optical densitometry was performed on all radiographs. There was no significant difference between compressed and noncompressed ACBG with optical densitometry or histomorphometric analysis for total bone area. We concluded that there was no difference in osteogenic capability between compressed and noncompressed ACBG of equal mass.

Surgical and nonsurgical complications associated with cochlear prosthesis implantation

Relatively few complications have been reported for cochlear implant surgery in spite of a recent report detailing a complication rate of 11.8 percent. This report highlights both the surgical and nonsurgical complications we have encountered that have resulted in either replacement of the implanted prosthesis or compromise of the sound processing strategy employed by the external unit. These complications make a strong argument for the use of preoperative, intraoperative, and postoperative radiologic examinations. Since the complications reported herein have not been attributed to the implant device proper, we feel cochlear implantation remains a safe and effective procedure for those patients who are untreatable by traditional methods.

Impact of diagnosis-related groups on the quality of postoperative care of patients with neck dissections

Two hundred eighty patients underwent neck dissection over a 10-year period: 138 during the 5-year period before the institution of Diagnosis-Related Group (DRG) reimbursement and 142 during the 5 years after DRG regulations. A comparison of these two groups by site of tumor, stage of disease, histopathology, previous treatment, type of neck dissection, whether neck dissection was carried out alone or in combination with another procedure, presence of preexisting disease, postoperative complications, and mortality revealed no significant differences. A 35% reduction in the length of hospital stay from 16 to 10 days was identified in the post-DRG group with no detrimental effects on patient care. The variables found to have the greatest impact on length of hospital stay were the extent of operation and postoperative complications.

The resident selection process in otolaryngology-head and neck surgery

This study was undertaken to characterize the objective information available about applicants to otolaryngology-head and neck surgery residency positions, and to determine the influence of these factors on obtaining a residency position. Applicants to the otolaryngology-head and neck surgery programs at University of Utah, Salt Lake City, University of Texas Medical Branch, Galveston, and University of Louisville (Ky) were studied. Thirty-one variables were examined, representing demographic and academic factors. Excellent academic performance in medical school (as represented by medical school grade-point average greater than 3.4, National Board part I score greater than 650, class percentile rank greater than 85th percentile, honors grades in both junior medicine and surgery clinical clerkships, or [5] election to Alpha Omega Alpha) was significantly correlated with success in obtaining an otolaryngology-head and neck surgery residency position.

Epidermal growth factor binding and action on tympanic membranes

A significant percentage of tympanic membrane (TM) perforations require some form of therapy to heal. Topical application of epidermal growth factor (EGF), a potent mitogen for epidermal and mesodermal cells, promotes healing of injuries in tissues histologically similar to TM, such as cornea and skin. We evaluated TM as a target tissue for EGF action. Specific, high affinity receptors for EGF were detected in TM (Kd = 3.1 nM, 150 fmol receptor/mg protein). Autoradiography of iodine 125-EGF binding to intact TMs revealed that EGF receptors were present on cells in the stratified squamous epithelial layer and in the stromal/mucoepithelial layer. Repetitive treatment of perforated cat TMs with 20 micrograms of EGF formulated in saline induced substantial hyperplasia of epithelial and stromal layers compared to paired TMs treated with saline. A single treatment of perforated cat TMs with 50 micrograms of EGF formulated in a hydrogel or in shredded Gelfoam produced significantly (p less than .05) smaller perforations at 6 days following the operation compared to paired TMs treated with vehicles. These results demonstrate that TM is a target tissue for EGF and that topical treatment with EGF stimulates healing of TM perforations.

Are we teaching medical students what they need to know?

If our broad goal for undergraduate education is to prepare students for residency and the eventual practice of medicine, the specific knowledge and skills we teach should reflect those that will be required of them to perform well as residents and practicing physicians. To determine and compare priority goals and objectives, we surveyed otolaryngology educators, a representative group of physicians in practice, and a representative group of residents. Participants were asked to evaluate the level of knowledge and skills necessary for students to attain in various areas of otolaryngology by ranking each item by a score of 0 to 3 according to its required depth of knowledge or skill. A rank "order of importance" was developed based on mean scores. The highest-ranking areas of knowledge were otitis media, airway obstruction, tonsillitis, and croup/epiglottitis, whereas the highest-ranking skills were history and physical examination of the head and neck, throat cultures, and use of the otoscope and pneumatoscope. The lowest-ranking areas of knowledge were voice disorders and ear deformities, whereas the lowest-ranking skills were interpreting electronystagmograms and stapedial reflex testing. We review the findings of our survey and comment on their role in undergraduate curriculum planning for otolaryngology.

Magnetically evoked facial nerve potential

Facial nerve stimulation by electrical current is painful and tends to discourage serial studies. Transcutaneous magnetic stimulation of the facial nerve is painless, easily reproducible, and elicits facial muscle responses identical to electrical stimulation.

Nasal fractures. What to do for a successful outcome

Nasal trauma is common in both children and adults. Most nasal fractures are easily reduced and do not result in long-term discomfort or disfigurement. However, care must be taken to avoid delay of treatment, especially in children, and to identify any associated cervical, paranasal, or intracranial injuries. Septal hematomas are not uncommon following nasal fracture and should be treated as soon as detected. The most common long-term sequela of nasal trauma is septal deviation with partial obstruction of the airway.

Laser tonsillectomy and adenoidectomy

The use of the laser for performing tonsillectomy and adenoidectomy has proved to be a very effective method in terms of reducing postoperative pain, bleeding, and operative time. With use of the laser, most patients can be treated on an outpatient basis. However, the treating physician must balance the medical gains against the increase in cost for laser use before embarking on this approach for patient care.

Reassessment of high-frequency air-bone gaps in older adults

In order to assess whether a high-frequency air-bone gap characteristically exists in older adults, air- and bone-conduction thresholds were measured for 147 ears from subjects ranging in age from 19 to 87 years. Results indicated that there were no apparent age-related effects, as evidenced by the mean data, the SDs, and scatterplots showing individual data points. However, a small number of older adults did have high-frequency air-bone gaps. In order to gain a better understanding of underlying causes, additional subjects over 50 years of age with high-frequency air-bone gaps were recruited. Ear-canal collapse did not appear to be a predominant underlying factor. Cerumen obstruction, healed tympanic membrane perforations, and an apparent loosening in the middle-ear system all were observed in ears with high-frequency air-bone gaps.

Nasal turbinate resection for relief of nasal obstruction

Surgical correction of mechanical nasal airway obstruction is commonly attempted by means of septoplasty or submucous resection. In spite of these procedures, patients continue to present postoperatively with inadequate nasal airflow due to hypertrophied turbinates. Partial resection of turbinate mucosa, submucous turbinate resection, electrocautery and outfracture of turbinates provide additional improvement but are incomplete procedures. Total inferior turbinectomies have been performed on 40 patients over the past 5 years; 29 of these patients have been followed from 2 to 60 months postoperatively by clinical examination and by formal questionnaire. Twenty-five patients described a marked improvement of their nasal breathing, 3 had mild improvement, and 1 had no improvement at all. Only 1 patient, 1 year postoperatively, described excessive dryness, 2 described mild dryness, 3 described excessive secretions and none complained of foul smell or pain postoperatively. All patients had patent airways by clinical examination by at least 2 otolaryngologists. The inferior turbinates play a role in humidification and temperature regulation of inspired air. The removal of them, however, does not seem to be fraught with the morbidity which has heretofore been attributed to this procedure.

Acute upper airway obstruction in the adult. 1. Causative disease processes

Infectious processes that can cause acute upper airway obstruction in adults include Ludwig's angina, retropharyngeal infection, acute epiglottis, diphtheria, tetanus, and peritonsillar abscess. They are uncommon but potentially lethal. Ludwig's angina in particular quickly progresses to airway obstruction. In most cases, the mainstays of management are antibiotics, surgical drainage, and if necessary, airway maintenance by tracheostomy, cricothyrotomy, or nasotracheal or endotracheal intubation. Hereditary angioneurotic edema causes episodes of laryngeal edema that may lead to suffocation. In an acute episode the airway must be maintained by endotracheal intubation.

Acute upper airway obstruction in the adult. 2. Causative events

Acute obstruction of the upper airway can be caused by several events. With some, such as anaphylaxis and trauma, obstruction may not be immediate and the physician may be able to take steps to avert it. Intubation is a common cause of upper airway injury. The most serious complication of this procedure is chronic subglottic stenosis. Vocal cord paralysis may result from tumor or neck trauma but especially from neck or mediastinal surgery, and the vocal cords should always be examined before and after such surgery.

Ophthalmoplethysmography in head and neck surgery

Ophthalmoplethysmography (OPG) is a simple, noninvasive diagnostic test in which the cerebral hemispheric blood flow can be indirectly measured. Its use in head and neck surgery is invaluable because it enables the surgeon to predict preoperatively whether a patient will survive carotid artery resection. In a three-year period, nine patients have survived carotid resection on the basis of favorable OPGs, without a death or permanent neurologic complication. A comparison of the results of OPG testing with intraoperative measurement of internal carotid artery pressure showed close correlation in 14 of 20 patients who were tested. Lack of correlation in four patients can be explained by the circumstances of the intraoperative test. This study's findings demonstrate that this test has high clinical reliability.

Noninvasive chronic recording of auditory nerve potentials

A system is described which allows repeated, noninvasive recording of auditory nerve responses in the cat to transient acoustic stimuli using a closed acoustic system. N1 responses to clicks are recorded from a stainless steel ring electrode at the end of a hollow earbar, the tapered end of which is made of insulating plastic. Acoustic stimuli are generated by a dynamic earphone coupled to the earbar. A calibrated probe microphone is also imcorporated into the earbar to measure sound pressure near the tympanic membrane. This allows better stimulus control than is available with free-field systems. To facilitate insertion of the earbar, meatoplasties were performed on all animals. Responses recorded with this system in anesthetized cats are described and compared with those recorded at the round window. Good repeatability of measurements is described for an animal population of 20 domestic cats over a period of several months. For some of these animals, response amplitude varied from one session to another, but response latency, especially for condensation clicks, was consistent. By comparing statistics of multiple measurement of both N1 amplitude and latency for rarefaction and condensation clicks, it is concluded that the N1 latency vs click-level function for condensation clicks provides the most reliable measure of the cat's auditory nerve function.

Effects of Eustachian tube ligation on auditory nerve responses to clicks

Auditory nerve responses to condensation and rarefaction clicks were recorded from the external ear canal of cats using a closed acoustic system. Repeated control recordings from both ears formed a baseline for each of four animals used in this study. After a baseline had been established, the Eustachian tube on one side was ligated and serial recordings of N1 responses were performed for up to 140 days postligation. By comparing the shift which occurred in the N1 latency-vs-click level plots after ligation, the equivalent hearing loss was determined. In all cases where the Eustachian tube was successfully ligated, the loss was progressive for the first 20 days, then usually showed some transitory improvement. The loss stabilized after 60 days, varying from 15 to 40 dB in different animals. In addition to N1 recordings, serial tympanograms were also measured. These indicated negative middle ear pressure in the first two days postligation and the presence of middle ear fluid by one week postligation.