101
Observational Study Medicine (Baltimore)
. 2020 May;99(20):e20337. doi: 10.1097/MD.0000000000020337.
Is Septal Deviation Associated With Headache?: A Nationwide 10-year Follow-Up Cohort Study
Sam Hyun Kwon 1 2, Eun Jung Lee 1 2, Cha Dong Yeo 1, Min Gul Kim 2 3, Jong Seung Kim 1 2 4, Sang Jae Noh 2 5, Eun Ji Kim 1 2, Su Geun Kim 1, Jong-Hwan Lee 1, Ji Seob Yoo 1, Ji Hoon Koh 1, Byeong Jin Kim 1
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PMID: 32443385 PMCID: PMC7253539 DOI: 10.1097/MD.0000000000020337
Free PMC article
Abstract
To investigate the potential relationship between septal deviation (SD) and headache using nationwide representative cohort sample data.This study used a nationwide cohort sample from the Korean National Health Insurance Service database. The cohort sample was composed of 1 million patients, which is obtained by propensity score matching from 2002 to 2013. There were 9171 individuals in the SD group and 28243 in the control or no SD group. The Kaplan-Meier survival analysis, the log-rank test, and Cox proportional hazard regression analysis were used to calculate the incidence, survival curve, and hazard ratio of headache for each group.There were no statistically significant differences in sex (P = .7708), age (P = .991), residential area (P = .9626), or socioeconomic status (P = .9982) between the 2 groups. The survival curve between SD and control or no SD showed a statistically significant difference. The adjusted hazard ratio for headache incidence during the 10-year follow-up period of the SD group was 1.37 (95% CI: 1.31-1.43).This cohort study suggests that SD is associated with headache. Therefore, these findings suggest that septoplasty can be considered as 1 of the treatment option in SD patients with headache.

Conflict of interest statement
The authors have no conflicts of interest to disclose.

25 references1 figure
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102
Anticancer Agents Med Chem
. 2020 Jun 15. doi: 10.2174/1871520620666200615132435. Online ahead of print.
Elevated O-GlcNAcylation Promotes Malignant Phenotypes of Hypopharyngeal Squamous Cell Carcinoma by Stabilizing Nrf2 Through Regulation of the PI3K/Akt Pathway
Wencheng Dai 1, Xiaoxia Jin 2, Bin Jiang 1, Weixian Chen 1, Zhenhua Ji 1, Xinjiang Xu 1, Mingming Tang 1, Kui Dai 2, Liang Han 1
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PMID: 32538734 DOI: 10.2174/1871520620666200615132435
Abstract
Background and purpose: O-GlcNAcylation is a significant protein posttranslational modification with O-linked β-N-acetylglucosamine (GlcNAc) for intracellular signaling. Elevated O-GlcNAcylation contributes to cell proliferation, cell migration, cell apoptosis and signal transduction in various cancers. However, the expression level and functional role of O-GlcNAcylation in Hypopharyngeal Squamous Cell Carcinoma (HSCC) is not clearly elucidated. Nuclear factor erythroid-2-related factor 2 (Nrf2) is a master transcriptional factor that has been found aberrant activated in HSCC. Here, we provide a molecular rationale between O-GlcNAcylation and Nrf2 in HSCC patients.

Methods: The protein levels of O-GlcNAcylation and Nrf2 in HSCC tissues were detected by immunohistochemistry technique and western blot analysis. Then, O-GlcNAcylation knockdown HSCC cells were applied in this study. Cell proliferation was detected by CCK8, colony-forming analysis, and cell cycle assays. Cell migration and invasion ability was evaluated by transwell assays. Cell apoptosis was measured by TUNEL analysis.

Results: O-GlcNAcylation was obviously up-regulated in HSCC tissues, which correlated with tumor size and lymph node metastasis. In addition, the protein level of Nrf2 was found to positively correlate with the expression of O-GlcNAcylation both in vivo and in vitro. Knockdown of O-GlcNAcylation significantly inhibited HSCC cell growth, suppressed cell migration, and promoted cell apoptosis, whereas overexpression of Nrf2 reversed these phenotypes. Mechanismly, upregulation of O-GlcNAcylation promoted the phosphorylation of Akt, leading to the stabilization of Nrf2; this could be attenuated by inhibition of the PI3K/Akt signaling pathway.

Conclusion: Here, we provide a molecular association between O-GlcNAcylation and Nrf2 in HSCC patients, thus providing valuable therapeutic targets for the disease.

Keywords: Akt; Hypopharyngeal squamous cell carcinoma; Nrf2; O-GlcNAcylation; cell proliferation; tumor progression.

Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.

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103
Ear Nose Throat J
. 2020 Jun 15;145561320934593. doi: 10.1177/0145561320934593. Online ahead of print.
Endoscopic Trans-Lateral Molar Approach to Infratemporal Fossa Lesions
Dan-Feng Li 1, Li Shi 1, Jian Wang 1, Bo Yue 1, Zhong-Jia Ding 1, Fu-Quan Chen 1
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PMID: 32538672 DOI: 10.1177/0145561320934593
Abstract
Background: To study the endoscopic trans-lateral molar (ETLM) approach to infratemporal fossa (ITF) lesions and analyze the advantages and disadvantages of this method.

Methods: Four cases of ITF lesions were analyzed retrospectively. The clinical features, diagnosis and treatments, the operative process, and clinical applications of this surgical approach were discussed.

Results: Postoperative pathologies were 2 pleomorphic adenomas, 1 schwannoma, and 1 inflammatory lesion. All patients had self-resolving cheek swelling and pharyngalgia in the short term, but 2 patients had numbness in the long term. There was no infection or bleeding in the postoperative period, and no difficulty in chewing after disease recovery. There was no tumor recurrence during the follow-up period.

Conclusion: The ETLM approach is convenient, minimally invasive, and allows complete excision of benign ITF lesions, posterior to the lateral pterygoid muscle and mainly below the level of the hard palate. It is a simple and direct access to the ITF, but it is a narrow access because of the limitations of bones and soft tissues. Appropriate patient selection is mandatory for successful surgery.

Keywords: endoscope; infratemporal fossa; lesions; trans-lateral molar approach.

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104
Eur Radiol
. 2020 Jun 15. doi: 10.1007/s00330-020-06980-w. Online ahead of print.
The Vestibular Aqueduct Ossification on Temporal Bone CT: An Old Sign Revisited to Rule Out the Presence of Endolymphatic Hydrops in Menière's Disease Patients
Jeanne Mainnemarre 1, Charlotte Hautefort 2, Michel Toupet 3, Jean-Pierre Guichard 1, Emmanuel Houdart 1, Arnaud Attyé 1 4, Michael Eliezer 5
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PMID: 32537729 DOI: 10.1007/s00330-020-06980-w
Abstract
Objectives: Menière's disease (MD) is associated with endolymphatic hydrops (EH), which is an accumulation of excessive endolymphatic fluid in the inner ear. However, using temporal bone CT, lower visualization rates of the vestibular aqueduct (VA) in these patients have also been reported.

Methods: In this retrospective single-center imaging study, we have included 25 healthy subjects and 47 patients having a definite, probable, or possible clinical diagnosis of MD that underwent temporal bone CT and inner ear MRI performed 4 h after contrast media administration. Two radiologists independently ranked the morphology of the VA in healthy subjects and in MD patients, using a three-level score (completely visible, discontinuous, and not visible). Each subject was then graded, based on both the VA's appearance and on EH presence.

Results: In healthy subjects, the VA was normal (grade 0) in 22/25 (88%) ears and discontinuous (grade I) in 3 healthy ears (12%). In the symptomatic ears of MD patients, we found 17/56 ears (30.3%) with VA grade 0, 15/56 ears (26.8%) with grade I, and 24/56 ears (42.8%) with grade II (p < 0.001). In MD patients, EH was observed in 46/94 ears (48.9%). A VA of grade 0 would eliminate the presence of EH with a negative predictive value of 88.6%, while a VA grade II would predict the presence of saccular hydrops with a positive predictive value of 93.1%.

Conclusion: The evaluation by temporal bone CT of the VA can predict the presence of EH on MRI with a high positive predictive value.

Key points: • The evaluation by temporal bone CT of the vestibular aqueduct can predict the presence of EH on MRI. • A vestibular aqueduct of grade 0 would eliminate the presence of EH on MRI with a negative predictive value of 88.6%. • A vestibular aqueduct grade II would predict the presence of endolymphatic hydrops on MRI with a positive predictive value of 93.1%.

Keywords: Endolymphatic hydrops (EH); Inner ear; Magnetic resonance imaging (MRI); Menière’s disease; Vestibular aqueduct.

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105
Aging (Albany NY)
. 2020 Jun 15;12. doi: 10.18632/aging.103316. Online ahead of print.
Integrative Analysis of miRNAs-mRNAs Reveals That miR-182 Up-Regulation Contributes to Proliferation and Invasion of Nasopharyngeal Carcinoma by Targeting PTEN
Zhaohui Shi 1, Rushi Wang 2, Ligui Huang 3, Xiaodong Chen 1, Min Xu 1, Dingjun Zha 1, Yanhong Ma 2
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PMID: 32541092 DOI: 10.18632/aging.103316
Free article
Abstract
Objective: Several miRNAs have been found to be abnormally expressed during nasopharyngeal carcinoma development. Nevertheless, the interaction between miRNAs and downstream genes remains unexploited. In this study, we aim to investigate miRNAs-mRNAs interaction and the mechanism of miR-182 in NPC.

Results: Integrative analysis identified several hub-miRNAs that drive NPC pathogenesis. The expression of miR-182 was notably increased in 32 NPC tissues and cell lines (CNE1 and 5-8F). Up-regulation of miR-182 was strongly correlated with poor prognosis of NPC patients. Moreover, the proliferation and invasion of NPC cells were notably increased in miR-182 mimics condition and decreased in miR-182 inhibitor condition. Furthermore, PTEN was verified to be a target of miR-182 and overexpression of PTEN could abrogate the promotion effect of miR-182 mimics on NPC invasion.

Conclusions: We identified several hub-miRNAs that may drive NPC pathogenesis. MiR-182 could promote proliferation and invasion of NPC cells via targeting PTEN, which provides a new insight into the clinical therapy of NPC.

Materials and methods: Genome-wide miRNAs of NPC tissues was analyzed using high-throughput sequencing and bioinformatics tools. QRT-PCR experiment was conducted to measure relative expression level. Dual-luciferase reporter assay was used to verify target relationship. The proliferation and invasion of transfected cells were measured by CCK-8 and transwell assay.

Keywords: PTEN; invasion; miR-182; nasopharyngeal carcinoma; proliferation.

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106
Observational Study Medicine (Baltimore)
. 2020 May;99(20):e20269. doi: 10.1097/MD.0000000000020269.
Increased Risk of Gallstones After Appendectomy: A Longitudinal Follow-Up Study Using a National Sample Cohort
So Young Kim 1, Hyoseob Lim 2, Bumjung Park 3, Hyun Lim 4, Miyoung Kim 5, Il Gyu Kong 2, Hyo Geun Choi 3
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PMID: 32443372 PMCID: PMC7253851 DOI: 10.1097/MD.0000000000020269
Free PMC article
Abstract
To evaluate the association between appendectomy and the occurrence of gallstones using a national sample cohort from Korea.The Korean National Health Insurance Service-National Sample Cohort was collected from 2002 to 2013. We extracted data for patients who had undergone appendectomy (n = 14,955) and a 1:4 matched control group (n = 59,820) and then analyzed the occurrence of gallstones. The patients were matched according to age, sex, income, region of residence, hypertension, diabetes mellitus, and history of dyslipidemia. Appendectomies were identified using operation codes (Q2860-Q2863) for appendicitis alone (International Classification of Disease-10: K35). Gallstones were diagnosed if the corresponding International Classification of Disease-10 code (K80) was reported ≥2 times. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using stratified Cox proportional hazard models, and 95% confidence intervals were calculated. Subgroup analyses were performed based on age, sex, and time period after appendectomy.The adjusted HR for gallstones was 1.78 (95% confidence interval = 1.51-2.09, P < .001) in the appendectomy group. Consistent HRs were found in the analyses of all the subgroups determined using age and sex, with the exception of men ≥60 years of age. The risk of gallstones was increased during the first year after appendectomy.The occurrence of gallstones was increased in the patients who had undergone appendectomy.

Conflict of interest statement
The authors declare that there are no conflicts of interest regarding the publication of this paper.

22 references1 figure
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107
Front Immunol
. 2020 May 27;11:990. doi: 10.3389/fimmu.2020.00990. eCollection 2020.
Lipo-Based Vaccines as an Approach to Target Dendritic Cells for Induction of T- And iNKT Cell Responses
Dorian A Stolk 1, Aram de Haas 1, Jana Vree 1 2, Sanne Duinkerken 1, Joyce Lübbers 1, Rieneke van de Ven 2 3, Martino Ambrosini 1, Hakan Kalay 1, Sven Bruijns 1, Hans J van der Vliet 2 4, Tanja D de Gruijl 2, Yvette van Kooyk 1
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PMID: 32536918 PMCID: PMC7267035 DOI: 10.3389/fimmu.2020.00990
Free PMC article
Abstract
In this study we developed a liposome-based vaccine containing palmitoylated synthetic long peptides (SLP) and alpha galactosylceramide (αGC) to specifically target dendritic cells (DC) for activation of both innate (invariant natural killer T-cells [iNKT]) and adaptive (CD8+ T-cells) players of the immune system. Combination of model tumor specific antigens (gp100/MART-1) formulated as a SLP and αGC in one liposome results in strong activation of CD8+ and iNKT, as measured by IFNγ secretion. Moreover, addition of lipo-Lewis Y (LeY) to the liposomes for C-type lectin targeting increased not only uptake by monocyte-derived dendritic cells (moDC), dermal dendritic cells and Langerhans cells but also enhanced gp100-specific CD8+ T- and iNKT cell activation by human skin-emigrated antigen presenting cells in an ex vivo explant model. Loading of moDC with liposomes containing LeY also showed priming of MART-126-35L specific CD8+ T-cells. In conclusion, chemically linking a lipid tail to a glycan-based targeting moiety and SLP combined with αGC in one liposome allows for easy generation of vaccine formulations that target multiple skin DC subsets and induce tumor antigen specific CD8+ T- and iNKT cells. These liposomes present a new vaccination strategy against tumors.

Keywords: DC-SIGN; T-cell priming; cancer vaccine; dendritic cell; iNKT; langerin; liposome; targeting.

Copyright © 2020 Stolk, de Haas, Vree, Duinkerken, Lübbers, van de Ven, Ambrosini, Kalay, Bruijns, van der Vliet, de Gruijl and van Kooyk.

77 references5 figures
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108
Head Neck
. 2020 Jun 16. doi: 10.1002/hed.26313. Online ahead of print.
Artificial Intelligence System for Detecting Superficial Laryngopharyngeal Cancer With High Efficiency of Deep Learning
Atsushi Inaba 1 2, Keisuke Hori 1, Yusuke Yoda 1 3, Hiroaki Ikematsu 1 4, Hiroaki Takano 3, Hiroki Matsuzaki 3, Yoshiki Watanabe 5, Nobuyoshi Takeshita 3, Toshifumi Tomioka 6, Genichiro Ishii 2 7, Satoshi Fujii 7, Ryuichi Hayashi 6, Tomonori Yano 1 3
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PMID: 32542892 DOI: 10.1002/hed.26313
Abstract
Background: There are no published reports evaluating the ability of artificial intelligence (AI) in the endoscopic diagnosis of superficial laryngopharyngeal cancer (SLPC). We presented our newly developed diagnostic AI model for SLPC detection.

Methods: We used RetinaNet for object detection. SLPC and normal laryngopharyngeal mucosal images obtained from narrow-band imaging were used for the learning and validation data sets. Each independent data set comprised 400 SLPC and 800 normal mucosal images. The diagnostic AI model was constructed stage-wise and evaluated at each learning stage using validation data sets.

Results: In the validation data sets (100 SLPC cases), the median tumor size was 13.2 mm; flat/elevated/depressed types were found in 77/21/2 cases. Sensitivity, specificity, and accuracy improved each time a learning image was added and were 95.5%, 98.4%, and 97.3%, respectively, after learning all SLPC and normal mucosal images.

Conclusions: The novel AI model is helpful for detection of laryngopharyngeal cancer at an early stage.

Keywords: artificial intelligence; endoscopy; narrow band imaging; object detection; superficial laryngopharyngeal cancer.

© 2020 Wiley Periodicals, Inc.

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109
Auris Nasus Larynx
. 2020 Jun 11;S0385-8146(20)30131-0. doi: 10.1016/j.anl.2020.05.011. Online ahead of print.
Postoperative Pain After Tonsillectomy - The Value of Standardized Analgesic Treatment Protocols
Antoniu-Oreste Gostian 1, Johannes Loeser 2, Christian Tholen 3, Philipp Wolber 3, Martin Otte 3, David Schwarz 3, Ludwig Maximilian Heindl 4, Matthias Balk 5, Magdalena Gostian 2
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PMID: 32536501 DOI: 10.1016/j.anl.2020.05.011
Abstract
Objective: To alleviate pain after tonsillectomy (TE) with escalating gradual treatment protocols in a prospective trial.

Materials & methods: Following TE, 83 consecutive adult patients were treated with two different four-staged escalating analgesic protocols. Metamizole served as basic medication in protocol 1 (PT1; n = 44), whereas with protocol 2 (PT2; n = 39) ibuprofen was applied as baseline analgesic. Both protocols were escalated according to the patient´s needs to metamizole and ibuprofen vice versa and additional weak to strong opioids. The primary efficacy endpoint was defined as the minimum and maximum pain as well as pain on ambulation (NRS, 0-10). Secondary endpoints comprised analgesic score, patient satisfaction and treatment-related side-effects.

Results: Both patient groups exhibited similar demographic characteristics (PT1: Ø 28.8 years; 64% ♀ and PT2: Ø 26.6 years; 56% ♀). Maximum pain (6.7 ± 1.9 vs. 7.6 ± 1.6, t(81) = -2.254, p = 0.027) and pain on ambulation (5.0 ± 1.8 vs. 5.8 ± 1.8, t(81) = -2.114, p = 0.038) were significantly higher with PT2. 68.2% of patients with PT1 needed an escalation of analgesic treatment compared to 100% with PT2 (p < 0.001). The opioid consumption was also significantly higher with PT2 (43.2% vs. 71.8%, p < 0.001). There were no significant differences regarding functional impairments, side-effects and patient satisfaction (7.0 ± 2.0 vs. 7.4 ± 2.4, t(79) = -0.897, p = 0.373).

Conclusion: Both treatment protocols yielded in a high degree of patient satisfaction but dissatisfactory pain relief following TE. Metamizole can be recommended as a basic medication allowing for improved pain relief. Reported pain intensities were independent of the amount of opioid intake. Further research is mandatory to standardize and improve analgesic treatment after TE.

Keywords: Non-opioid; Opioid; Pain therapy; Postoperative pain; QUIPS; Quality management; Tonsillectomy.

Copyright © 2020. Published by Elsevier B.V.

Conflict of interest statement
Declaration of Competing Interests There was no financial support, no funding and no conflict of interest during the preparation of this article. This material has never been published and is not currently under evaluation in any other peer-reviewed publication.

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110
J Craniofac Surg
. 2020 Jun 11. doi: 10.1097/SCS.0000000000006599. Online ahead of print.
Endoscopic Endonasal Transclival Approach to Spontaneous Hypertensive Brainstem Hemorrhage
Bolin Liu 1, Tao Zheng 1, Yanjun Mao 2, Ka Bian 3, Shiming He 1, Wenhai Lv 2
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PMID: 32541266 DOI: 10.1097/SCS.0000000000006599
Abstract
Surgical management of spontaneous hypertensive brainstem hemorrhage remains a challenge for neurosurgeons, especially when the hemorrhage is located the ventral brainstem. Recently endoscopic endonasal approach has been applied for resection of ventral brainstem lesions, though no published literature has explored its utility in treating brainstem hemorrhage. Here we reported a successful evacuation of severe hypertensive brainstem hemorrhage through endoscopic endonasal transclival approach. A 37 years-old male with a 5-year history of uncontrolled hypertension was brought to the Emergency Department with sudden vomiting, limb convulsions, and loss of consciousness for 2 hours. Computed tomography demonstrated a hemorrhage measuring 2.5 × 2.2 cm in the ventral midbrain and pontine. He presented with a Glasgow coma scale (GCS) score of 3 and disrupted vitals, and was intubated in the Emergency Department. Considering the ventral location of the hemorrhage and the need for emergent surgical decompression, an endoscopic endonasal approach was applied. Evacuation of the brainstem hemorrhage was achieved and his spontaneous respiration improved immediately after surgery. He was weaned off the ventilator and extubated on postoperative day 1, along with an improved GCS score of 5 (E2V1M2). At 1 month postoperatively his GCS score improved to 11 (E4V2M5) and he is currently under rehabilitation. Endoscopic endonasal approach is a feasible alternative for emergent surgery of ventrally located brainstem hemorrhage in carefully selected cases by providing direct visualization of the area and a good working angle, which facilitate evacuation of the hemorrhage with minimal damage to the brainstem.

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111
Editorial Arq Bras Oftalmol
. 2020 Jun;83(3):V-VI. doi: 10.5935/0004-2749.20200057. Epub 2020 May 29.
Coronavirus and the Eye: What Is Relevant So Far?
Roberto Lauande 1, Jayter Silva Paula 2
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PMID: 32490974 DOI: 10.5935/0004-2749.20200057
Free article
Comment on
Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China.
Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, Wu K.
JAMA Ophthalmol. 2020 Mar 31;138(5):575-8. doi: 10.1001/jamaophthalmol.2020.1291. Online ahead of print.
PMID: 32232433 Free PMC article.
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112
Ear Hear
. 2020 Jun 12. doi: 10.1097/AUD.0000000000000893. Online ahead of print.
Sonority-Related Novel Word Learning Ability of Children With Cochlear Implants With Optimal Oral Language Exposure
Yasmeen Hamza 1, Areti Okalidou 2, Ann Dierckx 3, Astrid van Wieringen 1
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PMID: 32541262 DOI: 10.1097/AUD.0000000000000893
Abstract
Objectives: The present study investigated how children with cochlear implants (CIs), with optimal exposure to oral language, perform on sonority-related novel word learning tasks. By optimal oral language exposure, we refer to bilateral cochlear implantation below the age of 2 years. Sonority is the relative perceptual prominence/loudness of speech sounds of the same length, stress, and pitch. The present study is guided by a previous study that investigated the sonority-related novel word learning ability of a group of children with CIs, in the Greek language, of which the majority were implanted beyond the age of 2 unilaterally.

Design: A case-control study with 15 Dutch-speaking participants in each of the three groups, i.e., children with CIs, normal-hearing children (NHC), and normal-hearing adults, was conducted using a sonority-related novel "CVC" word learning task. All children with CIs are implanted before the age of 2 years with preimplant hearing aids. Thirteen out of the 15 children had bilateral CIs. The CVC words were constructed according to four sonority conditions, where N is nonsonorous and S is a sonorous phoneme: NSN, NSS, SSN, and SSS. Outcome measures were accuracy and reaction times (RTs). In addition, the Peabody picture vocabulary test and the digit span forward test were administered to the children.

Results: There were no statistical differences in accuracy or RTs between the children groups on the overall score and across the different conditions. However, children with CIs, unlike NHC, scored statistically less accurately and with longer RTs relative to normal-hearing adults, on the overall task. Within-group comparisons showed that none of the groups performed statistically differently on any of the conditions. The NHC showed higher receptive vocabulary scores relative to children with CIs. In addition, the group of children with CIs entailed a statistically significantly higher number of children with "weak" short-term memory.

Conclusions: Children with CIs who have optimal oral language exposure showed age-appropriate sonority-related novel word learning abilities and strategies relative to their NH peers. However, children with CIs continue to show lower receptive vocabulary scores than NHC, despite the equivalent novel word learning ability. This suggests that children with CIs may have difficulties in retaining newly learned words. Future work should look into possible causes of the gap in performance. This would eventually aid in rehabilitation tailored to the needs of the individual.

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113
Auris Nasus Larynx
. 2020 Jun 11;S0385-8146(20)30133-4. doi: 10.1016/j.anl.2020.05.021. Online ahead of print.
Feather Foreign Body Caused Periparotid and Peritonsillar Abscess in a 9-month-old Girl
Mirko Gabelica 1, Robert Tafra 2, Marina Krnić Martinić 3, Mirko Kontić 2, Joško Markić 4, Tanja Kovačević 5, Ivana Čulo Čagalj 5, Željko Ninčević 6
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PMID: 32536499 DOI: 10.1016/j.anl.2020.05.021
Abstract
Migratory foreign body appeared to be bird feather, caused peritonsillar and periparotid abscess in a nine-month-old infant. Patient presented painful, tender and fluctuating red neck mass on the left neck region II, and refusal of oral intake, with no fever. Azithromycin was introduced four days before presentation for suspected urinary tract infection. ENT examination revealed left peritonsillar abscess; ultrasound confirmed periparotid abscess, MSCT verified both diagnoses. Under general anaesthesia, we performed abscess incision, after pus drainage, small foreign body spontaneously came through the wound. After washing it with saline, it appeared like a bird feather. Subsequently, peritonsillar abscess was incised and drained. After 24-hour postoperative care on pediatric intensive care unit, the patient continued three-day parenteral antibiotic treatment on the otolaryngology department; it was discharged with a recommendation to continue seven days of oral antibiotic therapy. Suggested mechanism was ingestion of bird feather from stuffed bedding, that got trapped in the tonsillar crypt. Afterwards, it started to migrate through the neck tissue. Households with children younger than three years should not have feather stuffed clothes or beddings.

Keywords: Feather; Migrating foreign body; Neck abscess; Periparotid abscess; Peritonsillar abscess.

Copyright © 2020. Published by Elsevier B.V.

Conflict of interest statement
Declaration Competing of Interest None declared.

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114
Case Reports Plast Reconstr Surg Glob Open
. 2019 Dec 30;7(12):e2583. doi: 10.1097/GOX.0000000000002583. eCollection 2019 Dec.
Total Nasal Reconstruction With a Nonlaminated Vascularized Free Temporal Fascia as the Lining
Shinsuke Akita 1, Yoshihisa Yamaji 1, Kazuki Yamasaki 2, Kentaro Kosaka 1, Takafumi Tezuka 1, Yoshitaka Kubota 1, Nobuyuki Mitsukawa 1
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PMID: 32537314 PMCID: PMC7288870 DOI: 10.1097/GOX.0000000000002583
Free PMC article
Abstract
Various methods to generate the lining for a full-thickness nasal reconstruction have been reported. We used bilateral septal mucoperichondrial flaps, the distal portion of an expanded median forehead flap, and a nonlaminated vascularized free temporal fascia flap as a lining during total nasal reconstruction of a total full-thickness nasal defect in a 45-year-old woman with a nasal squamous cell carcinoma. In the first step of the two-stage surgery, a tissue expander was inserted into the forehead simultaneously with tumor resection. In the second step, the expanded median forehead flap, cartilage graft, bilateral septal mucoperichondrial flaps, and short pedicle vascularized free temporal fascia transfer were performed. Total nasal reconstruction could be completed without any skin graft or skin paddle of the free flap. Epithelialization of the mucosa on the transferred vascularized free temporal fascia without contracture deformity of the nasal cavity was confirmed by endoscopic examination after 8 years of follow-up. In the surgical procedure described, the facial skin, including the lining of the nostril rim, and the mucous membrane of the nasal cavity were reconstructed using facial skin and mucous membrane without long-term contracture, respectively.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

Conflict of interest statement
Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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115
JCO Oncol Pract
. 2020 Jun 15;JOP1900577. doi: 10.1200/JOP.19.00577. Online ahead of print.
What Do Patients With Non-Small-Cell Lung Cancer Experience? Content Domain for the MD Anderson Symptom Inventory for Lung Cancer
Meagan S Whisenant 1, Loretta A Williams 1, Araceli Garcia Gonzalez 1, Tito Mendoza 1, Qiuling Shi 1, Charles Cleeland 1, Jianjun Zhang 2, John Heymach 2, George Simon 2
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PMID: 32539654 DOI: 10.1200/JOP.19.00577
Abstract
Purpose: Symptom monitoring has demonstrated improved outcomes in patients with cancer, including quality of life, resource utilization, ability to continue treatment, and survival. The use of disease-specific patient-reported outcome (PRO) measures facilitates symptom monitoring. While the MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC), a PRO measure of symptom burden in lung cancer, is psychometrically validated for use in patients with NSCLC, its content validity has not been verified through direct patient input. Our purpose is to describe the symptom experience of patients with NSCLC and to confirm that the MDASI-LC contains the key symptoms specific to NSCLC from the patient perspective.

Methods: Patients with NSCLC described their symptom experience in single qualitative interviews. Content analysis was used to define the content domain for a PRO measure of NSCLC symptom burden.

Results: Participants (N = 40) had a mean age of 66.1 years (standard deviation, 10.9 years); 60.0% were male, 77.5% were White, and 56.4% had stage IV disease. Thirty-two symptoms were described, with 6 reported by ≥ 20% of participants. Symptom variations were noted by treatment modality but not by stage of disease. Patients with NSCLC commonly reported shortness of breath, cough, distress, fatigue, pain, and constipation. In patients receiving chemotherapy, treatment-related symptoms, including neuropathy and sore mouth, were commonly noted. The presence of these symptoms resulted in interference with daily activities, relationships, life plans, treatment adherence, and mood.

Conclusion: The symptoms included in the MDASI-LC are important components of the content domain of an NSCLC symptom burden measure. The presence of these symptoms affect daily life and, therefore, is of clinical consequence.

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116
OTO Open
. 2020 Jun 2;4(2):2473974X20929008. doi: 10.1177/2473974X20929008. eCollection Apr-Jun 2020.
Ultrasound-Guided Fine-Needle Biopsy of First 1000 Consecutive Thyroid Nodules: Single-Surgeon Experience
Jagdish K Dhingra 1
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PMID: 32537553 PMCID: PMC7268147 DOI: 10.1177/2473974X20929008
Free PMC article
Abstract
Objective: To study the feasibility, safety, and learning curve of ultrasound-guided fine-needle biopsy (USGFNB) performed by a newly trained otolaryngologist in a community office in a setting.

Study design: Collect USGFNB data of all thyroid nodules in a prospective manner.

Setting: A dedicated ultrasound clinic in a large community-based practice, operated by a single surgeon with the purpose of providing office-based point-of-care diagnostic ultrasonography and USGFNB.

Subjects and methods: Data on the first 1000 unselected consecutive thyroid nodules that underwent USGFNB over a 3-year period were analyzed. Chi-square analysis was used to assess the statistical significance of characteristics of diagnostic vs nondiagnostic nodules. A multivariate regression analysis was conducted to determine nodule characteristics predictive of adequate sampling. Diagnostic yield and time efficiency data were plotted over a 3-year period to study the learning curve for the USGFNB procedure performed by an operator with no previous experience.

Results: A total of 1000 nodules in 734 patients including 142 males and 592 females (age range, 17-87 years) were studied. Of the patients, 188 of 734 had more than 1 nodule biopsied, with a maximum of 4 nodules biopsied in 1 setting. The procedure was successfully completed in all patients, with no major complications. A steep learning curve was observed, and adequate samples were obtained in 91.9% of the patients on the first attempt. The cystic nature of the nodule was the biggest predictor of a nondiagnostic yield.

Conclusions: Otolaryngologist-performed USGFNB of the thyroid is safe, effective, and desirable.

Keywords: FNA; USGFNB; office-based ultrasound; thyroid.

© The Authors 2020.

17 references6 figures
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117
Ann Surg
. 2020 Jun 11. doi: 10.1097/SLA.0000000000004166. Online ahead of print.
Outcomes After Tracheostomy in COVID-19 Patients
Tiffany N Chao 1, Sean P Harbison 2, Benjamin M Braslow 2, Christoph T Hutchinson 3, Karthik Rajasekaran 1, Beatrice C Go 4, Ellen A Paul 1, Leah D Lambe 5, James J Kearney 1, Ara A Chalian 1, Maurizio F Cereda 6, Niels D Martin 2, Andrew R Haas 3, Joshua H Atkins 6, Christopher H Rassekh 1
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PMID: 32541213 DOI: 10.1097/SLA.0000000000004166
Abstract
Objective: To determine the outcomes of patients undergoing tracheostomy for COVID-19 and of healthcare workers performing these procedures.

Background: Tracheostomy is often performed for prolonged endotracheal intubation in critically ill patients. However, in the context of COVID-19, tracheostomy placement pathways have been altered due to the poor prognosis of intubated patients as well as the risk of transmission to providers through this highly aerosolizing procedure.

Methods: A prospective single-system multi-center observational cohort study was performed on patients who underwent tracheostomy following acute respiratory failure secondary to COVID-19.

Results: Of the 53 patients who underwent tracheostomy, the average time from endotracheal intubation to tracheostomy was 19.7 days ± 6.9 days. The most common indication for tracheostomy was ARDS, followed by failure to wean ventilation and post-ECMO decannulation. 30 patients (56.6%) were liberated from the ventilator, 16 (30.2%) have been discharged alive, 7 (13.2%) have been decannulated, and 6 (11.3%) died. The average time from tracheostomy to ventilator liberation was 11.8 days ± 6.9 days (range 2 - 32 days). Both open surgical and percutaneous dilational tracheostomy techniques were performed utilizing methods to mitigate aerosols. No healthcare worker transmissions resulted from performing the procedure.

Conclusions: Alterations to tracheostomy practices and processes were successfully instituted. Following these steps, tracheostomy in COVID-19 intubated patients appears safe for both patients and healthcare workers performing the procedure.

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118
Head Neck
. 2020 Jun 16. doi: 10.1002/hed.26324. Online ahead of print.
Evaluation of Lymph Node Ratio and Lymph Node Yield as Prognosticators of Locoregional Recurrence in p16-associated Oropharyngeal Squamous Cell Carcinoma
Margaret Nurimba 1, William Hines 1, Uttam Sinha 2, Anna Mathew 3, Niels Kokot 2, Mark Swanson 2
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PMID: 32542889 DOI: 10.1002/hed.26324
Abstract
Background: The prognostic value of lymph node yield (LNY) and lymph node ratio (LNR), or the ratio of number of metastatic LNs to total number dissected, has not been well established in p16-associated oropharyngeal squamous cell carcinoma (OPSCC).

Methods: This retrospective cohort study evaluated locoregional disease-free survival (LRDFS) in 82 patients with p16+ OPSCC who underwent neck dissection at a single institution from 2009 to 2017. LNR and LNY cutoffs were estimated using time-dependent receiver operator characteristic (ROC) curves. Prognostic significance of these cutoffs was compared with Eighth Edition AJCC Nodal Staging.

Results: An increased LNR ≥ 0.129 was associated with worse 2-year LRDFS (66.9% vs 96.8%, P = .005). LNY was not significantly associated with LRDFS (P = .304). An LNR-based risk model was a better prognosticator than Eighth Edition AJCC Nodal Staging (Harrell's C, 0.9065 vs 0.7668).

Conclusions: LNR has good prognostic utility in predicting LRDFS in p16+ OPSCC, but further evaluation of this measure is warranted.

Keywords: HPV; lymph node ratio; lymph node yield; neck dissection; neck metastasis; oropharynx; p16.

© 2020 Wiley Periodicals, Inc.

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119
Otolaryngol Head Neck Surg
. 2020 Jun 16;194599820933595. doi: 10.1177/0194599820933595. Online ahead of print.
Aerosolization During Common Ventilation Scenarios
Roy Xiao 1 2, Alan D Workman 1 2, Elefteria Puka 1, Jeremy Juang 3 4, Matthew R Naunheim 1 2, Phillip C Song 1 2
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PMID: 32539661 DOI: 10.1177/0194599820933595
Abstract
Otolaryngologists are at increased risk for exposure to suspected aerosol-generating procedures during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In the present study, we sought to quantify differences in aerosol generation during common ventilation scenarios. We performed a series of 30-second ventilation experiments on porcine larynx-trachea-lung specimens. We used an optical particle sizer to quantify the number of 1- to 10-µm particles observed per 30-second period (PP30). No significant aerosols were observed with ventilation of intubated specimens (10.8 ± 2.4 PP30 vs background 9.5 ± 2.1, P = 1.0000). Simulated coughing through a tracheostomy produced 53.5 ± 25.2 PP30, significantly more than background (P = .0121) and ventilation of an intubated specimen (P = .0401). These data suggest that undisturbed ventilation and thus intubation without stimulation or coughing may be safer than believed. Coughing increases aerosol production, particularly via tracheostomy. Otolaryngologists who frequently manage patient airways and perform tracheostomy are at increased risk for aerosol exposure and require appropriate personal protective equipment, especially during the ongoing COVID-19 pandemic.

Keywords: COVID-19; aerosol; cough; intubation; tracheostomy; ventilation.

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120
PLoS One
. 2020 Jun 15;15(6):e0233974. doi: 10.1371/journal.pone.0233974. eCollection 2020.
Comparing Serum Protein Levels Can Aid in Differentiating HPV-negative and -Positive Oropharyngeal Squamous Cell Carcinoma Patients
Amy Dickinson 1 2, Mayank Saraswat 3 4, Stina Syrjänen 5 6, Tiialotta Tohmola 3, Robert Silén 3, Reija Randén-Brady 7, Timo Carpén 1 7, Jaana Hagström 5 7 8, Caj Haglund 8 9, Petri Mattila 1, Antti Mäkitie 1 2 10, Sakari Joenväärä 3 4, Suvi Silén 1 11
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PMID: 32542012 DOI: 10.1371/journal.pone.0233974
Free article
Abstract
Background: The surrogate immunohistochemical marker, p16INK4a, is used in clinical practice to determine the high-risk human papillomavirus (HPV) status of oropharyngeal squamous cell carcinomas (OPSCC). With a specificity of 83%, this will misclassify some patients compared with direct HPV testing. Patients who are p16INK4a-positive but HPV DNA-negative, or RNA-negative, may be unsuitable for treatment de-escalation aimed at reducing treatment-related side effects. We aimed to identify cost-effective serum markers to improve decision making for patients at risk of misclassification by p16INK4a alone.

Methods: Serum proteins from pre-treatment samples of 36 patients with OPSCC were identified and quantified using label-free mass spectrometry-based proteomics. HPV-status was determined using p16INK4a/HPV DNA and E6/E7 mRNA. Serum protein expressions were compared between groups of patients according to HPV status, using the unpaired t-test with a Benjamini-Hochberg correction. ROC curves (AUC) were calculated with SPSS (v25).

Results: Of 174 serum proteins identified, complement component C7 (C7), apolipoprotein F (ApoF) and galectin-3-Binding Protein (LGALS3BP) significantly differed between HPV-positive and -negative tumors (AUC ranging from 0.84-0.87). ApoF levels were more than twice as high in the E6/E7 mRNA HPV-positive group than HPV-negative.

Conclusions: Serum C7, ApoF and LGALS3BP levels discriminate between HPV-positive and HPV-negative OPSCC. Further studies are needed to validate these host immunity-related proteins as markers for HPV-associated OPSCC.

Conflict of interest statement
The authors have declared that no competing interests exist.

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121
Adv Skin Wound Care
. 2020 Jul;33(7):367-374. doi: 10.1097/01.ASW.0000666900.03111.c3.
Clinical Factors Influencing the Outcomes of an Acellular Dermal Matrix for Skin Cancer Treatment: A Retrospective Study
Barbara Ferrari 1, Camilla Reggiani, Mariangela Francomano, Pierantonio Bellini, Federica Ferrari, Luca Giacomelli, Alice Mannocci, Cristina Magnoni
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PMID: 32544116 DOI: 10.1097/01.ASW.0000666900.03111.c3
Abstract
Objective: To evaluate the efficacy and safety of a biologically engineered dermal matrix used in reconstructive surgery after skin tumor resection, focusing on the frequency of successful grafting and identifying potential factors influencing treatment outcomes.

Design and participants: This retrospective analysis involved consecutive patients diagnosed with skin cancer in any area of the body and for which treatment with a dermal skin template was recommended as alternative to traditional surgery.

Main outcome measures: Percentage of successful grafting and the patient and tumor characteristics influencing treatment outcome via univariate analysis.

Main results: A total of 302 patients were included. Surgical reconstruction with the matrix was effective in 88.9% of the patients within 21 days of surgery. Notably, the matrix was successful regardless of tumor location, type, or size. Infection was the only variable significantly associated with graft failure (P < .001).

Conclusions: The studied dermal matrix provides an efficient alternative to traditional reconstructive surgery in patients who present specific comorbidities or risk factors. The only variable significantly associated with graft failure was infection, which should be properly controlled through appropriate treatment.

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122
Ear Nose Throat J
. 2020 Jun 15;145561320927525. doi: 10.1177/0145561320927525. Online ahead of print.
Delayed Infection of Porous Polyethylene Implants After Oncologic Maxillectomy and Reconstruction: 2 Case Reports and Review of Literature
Mark Landry 1, Miriam Hankins 1, Juraj Berkovic 2, Cherie-Ann Nathan 1 3
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PMID: 32538671 DOI: 10.1177/0145561320927525
Abstract
Medpor porous polyethylene implants are commonly used for facial skeletal reconstruction due to reported biocompatibility, fibrovascularization, and durability. While uncommon, late implant infections are an important consideration. We report delayed infections in 2 patients after unilateral total oncologic maxillectomy and reconstruction using Medpor implants for an ossifying fibroma and squamous cell carcinoma, respectively. In the first patient, annual interval computed tomography (CT) scans showed no recurrence of tumor or inflammatory changes. The second was lost to follow-up after adjuvant chemoradiation 1 year after resection. Patients both presented with swelling, drainage, and erythema around the implant at a mean of 4.5 years following maxillectomy. Both failed several attempts at conservative treatment. Cultures of implants removed at a mean of 2.5 months after infection grew α-hemolytic Streptococcus in the first and multiple organisms in the second, showing that the potential for delayed infection should be considered years after reconstruction.

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123
Sci Adv
. 2020 May 27;6(22):eaba5090. doi: 10.1126/sciadv.aba5090. eCollection 2020 May.
ASPM-lexical Tone Association in Speakers of a Tone Language: Direct Evidence for the Genetic-Biasing Hypothesis of Language Evolution
Patrick C M Wong 1 2 3, Xin Kang 1 2, Kay H Y Wong 1 2 3, Hon-Cheong So 2 4, Kwong Wai Choy 2 5, Xiujuan Geng 1 2
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PMID: 32537487 PMCID: PMC7253162 DOI: 10.1126/sciadv.aba5090
Free PMC article
Abstract
How language has evolved into more than 7000 varieties today remains a question that puzzles linguists, anthropologists, and evolutionary scientists. The genetic-biasing hypothesis of language evolution postulates that genes and language features coevolve, such that a population that is genetically predisposed to perceiving a particular linguistic feature would tend to adopt that feature in their language. Statistical studies that correlated a large number of genetic variants and linguistic features not only generated this hypothesis but also specifically pinpointed a linkage between ASPM and lexical tone. However, there is currently no direct evidence for this association and, therefore, the hypothesis. In an experimental study, we provide evidence to link ASPM with lexical tone perception in a sample of over 400 speakers of a tone language. In addition to providing the first direct evidence for the genetic-biasing hypothesis, our results have implications for further studies of linguistic anthropology and language disorders.

Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution License 4.0 (CC BY).

71 references2 figures
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124
Case Reports Eplasty
. 2020 May 29;20:e5. eCollection 2020.
Eye Comfort and Physiological Reconstruction of an Entire Upper Eyelid Defect
Yasuhiro Sakata 1, Katsuya Okuda 2, Yoshitaka Wada 1, Shinji Kumegawa 1, Hirohisa Kusuhara 3, Noritaka Isogai 3, Shinichi Asamura 1
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PMID: 32537044 PMCID: PMC7270324
Free PMC article
Abstract
Objective: Reconstruction of an extensive full-thickness upper eyelid defect is challenging. The purpose of this report is to introduce this procedure with emphasis on reconstruction of the eyelid margin to obtain eye comfort.

Methods: We designed a technique using a radial forearm flap for the outer layer to reconstruct the entire eyelid after resection of Merkel cell carcinoma. In additional, the inner layer and the eyelid margin were reconstructed with a buccal mucosal graft and a reverse Hughes flap.

Results: There has been no recurrence of the tumor, opening and closing functions of the eyelid are maintained, and the patient has not complained of eye discomfort.

Conclusion: Maintenance of mobility, flexibility, and a good ocular surface in contact with the sensitive cornea are the main foci of upper eyelid reconstruction, with an optimal fissure height and an appropriate contour of the eyelid. In addition, to obtain eye comfort, it is important to protect the cornea without significantly restricting eyelid mobility.

Keywords: Merkel cell carcinoma; forearm flap; free flap; reconstruction; upper eyelid.

Copyright © 2020 The Author(s).

10 references3 figures
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125
Case Reports Anaesth Rep
. 2020 Jun 8;8(1):48-51. doi: 10.1002/anr3.12045. eCollection Jan-Jun 2020.
Paratracheal Abscess After Traumatic Tracheal Intubation
P Leader 1, S Curry 2, S Pate 2
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PMID: 32537611 PMCID: PMC7279999 (available on 2021-06-08) DOI: 10.1002/anr3.12045
Abstract
Major complications of laryngoscopy and tracheal intubation are rare. However, mucosal trauma during airway management can lead to the introduction of oropharyngeal bacterial flora into the deep neck spaces, with the potential for fatal complications. This report describes the development of a paratracheal abscess in a healthy 62-year-old man following an outpatient herniorrhaphy. The patient was treated with intravenous antibiotics and underwent ultrasound-guided needle aspiration of the abscess. He was later re-admitted to the hospital with re-accumulation of the abscess, which was successfully treated by open surgical drainage. Though deep neck space infection following laryngoscopy is more common in patients with significant comorbidities and when tracheal intubation has been difficult, this case highlights the need for careful airway management in all patients.

Keywords: neck infection; paratracheal abscess; tracheal intubation; upper airway anatomy.

© 2020 Association of Anaesthetists.

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126
Cancer Biol Ther
. 2020 Jun 16;1-9. doi: 10.1080/15384047.2020.1776581. Online ahead of print.
LINC00641/miR-4262/NRGN Axis Confines Cell Proliferation in Glioma
Jinghui Yang 1, Duo Yu 2, Xueshibojie Liu 3, E Changyong 1, Shan Yu 4
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PMID: 32543324 DOI: 10.1080/15384047.2020.1776581
Abstract
Glioma is the most prevalent brain malignancy with high mortality. In recent decades, the regulatory role of long noncoding RNAs (lncRNAs) has been unmasked in glioma. In this study, we focused on the function and mechanism of LINC00641 in glioma. First of all, we found that LINC00641 was expressed at a low level in glioma cell lines. Importantly, overexpression of LINC00641 prevented cell proliferation but enhanced cell apoptosis. Meanwhile, NRGN, a previously-reported downregulated mRNA in GBM, was disclosed as a tumor suppressor in glioma cells. Besides, we verified that NRGN could be positively regulated by LINC00641 in glioma cells. Moreover, the cellular distribution of LINC00641 was identified to be cytoplasmic. Therefore, bioinformatics analysis and mechanism experiments were carried out and we determined that miR-4262 was the shared miRNA between LINC00641 and NRGN. In contrast to LINC00641 and NRGN, miR-4262 was dramatically upregulated in glioma cells. Furthermore, we confirmed that LINC00641 acted as a ceRNA in glioma cells via absorbing miR-4262 to upregulate NRGN. More importantly, silenced NRGN countervailed the repression on glioma cell proliferation caused by LINC00641 upregulation. Collectively, our findings unveiled that LINC00641 serves as a tumor inhibitor in glioma by targeting miR-4262/NRGN axis, providing a new potential therapeutic target for glioma patients.

Keywords: LINC00641; NRGN; glioma; miR-4262; proliferation.

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127
Head Neck
. 2020 Jun 15. doi: 10.1002/hed.26294. Online ahead of print.
Platysma Skin Flap: Laryngeal Repair Material to Produce Phonatory Flap Vibrational Wave
Ling Chen 1, Renhui Chen 1, Zhong Guan 1, Peiliang Lin 1, Faya Liang 1, Ping Han 1, Jinshan Yang 1, Wenying Zhu 1, Qian Cai 1
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PMID: 32539190 DOI: 10.1002/hed.26294
Abstract
The platysma skin flap was used for laryngeal reconstruction after vertical partial laryngectomy to improve the postoperative voice quality of patients with T2 and T3 glottic laryngeal carcinoma. Sixty-nine patients with unilateral T2 and T3 glottic laryngeal carcinoma were included. Forty-six patients received vertical partial laryngectomy, and a platysma skin flap was used for laryngeal reconstruction. The other 23 patients underwent transoral laser microsurgery. Subjective and objective examinations were performed to evaluate laryngeal morphology after the surgery. Acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Flap vibrational waves occurred in 19 cases (41.3%). The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of T2 and T3 unilateral glottic laryngeal carcinoma.

Keywords: flap vibrational wave; laryngeal carcinoma; laryngeal reconstruction; platysma skin flap; vocal function.

© 2020 Wiley Periodicals, Inc.

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128
Int J Pediatr Otorhinolaryngol
. 2020 May 29;136:110138. doi: 10.1016/j.ijporl.2020.110138. Online ahead of print.
Moral Distress in Pediatric Otolaryngology: A Pilot Study
Andrew J Redmann 1, Matthew Smith 2, Dan Benscoter 3, Catherine K Hart 2
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PMID: 32544639 DOI: 10.1016/j.ijporl.2020.110138
Abstract
Objectives: SUBJECTS/METHODS: Moral distress is defined as "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action". The Moral Distress Survey-Revised (MDS-R) is a validated 21-question survey measuring moral distress in pediatrics. The MDS-R was anonymously distributed to pediatric otolaryngology faculty and fellows at a tertiary institution. Descriptive statistics, bivariate and multivariate analysis were performed.

Results: Response rate was 89% (16/18). Overall MDS-R score was 40 (range 14-94), which is lower than that found in the literature for pediatric surgeons (reported mean 72), pediatric intensivists (reported means 57-86), and similar to pediatric oncologists (reported means 42-52). Fellows had a significantly higher level of moral distress than faculty (mean 69 vs. 26, p < 0.05). Factors leading to higher degrees of distress involved communication breakdowns and pressure from administration/insurance companies to reduce costs.

Conclusion: Pediatric Otolaryngologists at our institution have lower degrees of moral distress compared to other pediatric subspecialists. Fellows had higher levels of distress compared to faculty. Further research is necessary to determine degrees of distress across institutions and to determine its impact on the wellness of pediatric otolaryngologists.

Keywords: MDS-R; Moral distress; Pediatric otolaryngology.

Copyright © 2020 Elsevier B.V. All rights reserved.

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129
Auris Nasus Larynx
. 2020 Jun 11;S0385-8146(20)30135-8. doi: 10.1016/j.anl.2020.05.015. Online ahead of print.
"Gas" Laryngopharyngeal Reflux Cause Unexplained Chronic Cough
Takeshi Suzuki 1, Yosuke Seki 2, Tomoaki Matsumura 3, Jun Ikari 4, Makoto Arai 5, Toyoyuki Hanazawa 1, Yoshitaka Okamoto 6, Haruhiko Suzuki 7, Yoshimoti Kurokawa 2, Akiko Umezawa 2, Kazunori Kasama 2, Toshitaka Hoppo 8
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PMID: 32536500 DOI: 10.1016/j.anl.2020.05.015
Abstract
Hypopharyngeal multichannel intraluminal impedance (HMII) that can measure laryngopharyngeal reflux (LPR) events has supported the causal relationship between chronic cough (CC) and LPR containing liquid. However the role of "gas" LPR associated with CC has been poorly understood. We present two cases of patients with CC who had negative LPR containing liquid but had multiple episodes of "gas" LPR on HMII. The majority of "gas" LPR events had a minor pH drop at hypopharynx. Since any etiology of CC was excluded and medical therapy failed, both patients underwent laparoscopic antireflux surgery (LARS). Both of the patients had complete resolution of cough postoperatively. The present cases demonstrated successful outcome of LARS to treat the patients with CC who had documented "gas" LPR on HMII, thus suggesting the causal relationship between CC and "gas" LPR. The number of "gas" LPR events may need to be considered as an important diagnostic parameter.

Keywords: Chronic cough; Gas reflux; Hypopharyngeal multichannel intraluminal impedance; Laparoscopic antireflux surgery; Laryngopharyngeal reflux.

Copyright © 2020. Published by Elsevier B.V.

Conflict of interest statement
Declaration of Competing Interest Drs. Takeshi Suzuki, Yosuke Seki, Tomoaki Matsumura, Jun Ikari, Makoto Arai, Toyoyuki Hanazawa, Yoshitaka Okamoto, Haruhiko Suzuki, Yoshimoti Kurokawa, Akiko Umezawa, Kazunori Kasama and Toshitaka Hoppo have no conflicts of interest.

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130
J Vis Exp
. 2020 May 30;(159). doi: 10.3791/61183.
Identification and Characterization of Immunogenic RNA Species in HDM Allergens That Modulate Eosinophilic Lung Inflammation
Hamad H Alanazi 1, Li She 2, Xiao-Dong Li 3
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PMID: 32538919 DOI: 10.3791/61183
Abstract
Environmental allergens such as house dust mites (HDM) are often in complex forms containing both allergic proteins that drive aberrant type 2 responses and microbial substances that induce innate immune responses. These allergen-associated microbial components play an important role in regulating the development of type 2 inflammatory conditions such as allergic asthma. However, the underlying mechanisms remain largely undefined. The protocol presented here determines the structural characteristics and in vivo activity of allergen-associated immunostimulatory RNA. Specifically, common allergens are examined for the presence of double-stranded RNA (dsRNA) species that can stimulate IFN responses in lungs and restrain the development of severe lung eosinophilia in a mouse model of HDM-induced allergic asthma. Here, we have included the following three assays: Dot blot to show the dsRNA structures in total RNA isolated from allergens including HDM species, RT-qPCR to measure the activities of HDM RNA in interferon stimulating genes (ISGs) expression in mouse lungs and FACS analysis to determine the effects of HDM RNA on the number of eosinophils in BAL and lung, respectively.

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131
Rhinology
. 2020 Jun 15. doi: 10.4193/Rhin20.199. Online ahead of print.
Acute Smell and Taste Loss in Outpatients: All Infected With SARS-CoV-2?
M Renaud 1, A Leon 1, G Trau 1, L Fath 1, S Ciftci 1, Y Bensimon 1, A Venkatasamy 2, C Debry 1 3
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PMID: 32542238 DOI: 10.4193/Rhin20.199
Abstract
During SARS-CoV-2 pandemic, our region (Alsace, East of France) became a Covid-19 cluster quite early in Europe. Loss of smell and taste was quickly flagged by the Ears-Nose and Throat scientific community as a potential warning signs of SARS-CoV-2 infection (1). Many patients and medical/paramedical workers with mild to moderate form of SARS-CoV-2 infection complained about their loss of sense of smell and taste to our ENT department. The aim of our study was to compare the characteristics of loss of smell and taste between patients with a clinical diagnosis of SARS-CoV-2 infection to patients with a RT-PCR diagnosis.

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132
Int J Pediatr Otorhinolaryngol
. 2020 May 28;136:110144. doi: 10.1016/j.ijporl.2020.110144. Online ahead of print.
Parental Concern as an Indicator of the Severity of Obstructive Sleep Apnea in Children
Mali Lavi 1, Riva Tauman 2, Michal Greenfeld 2, Gadi Fishman 3, Oshri Wasserzug 3, Ari DeRowe 4
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PMID: 32544642 DOI: 10.1016/j.ijporl.2020.110144
Abstract
Introduction: An accepted screening question for Obstructive Sleep Apnea (OSA) in children is "Does your child snore". However, this has no correlation to severity. The purpose of this study is to evaluate a simple 2-item questionnaire that reflects the degree of parental concern to predict the severity of Obstructive Sleep Apnea (OSA) in children as measured by Polysomnography (PSG).

Methods: Prospective analysis of parental concern regarding their children referred for PSG due to suspected OSA. Parents of all study children completed the brief Parental Concern Scale (PCS) questionnaire that we devised and the validated Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD). The PCS consisted of 1 question on the need for surgery and 1 question on concerns about the child's breathing. Both questionnaires were compared to PSG results.

Results: Ninety-five children (mean age 4.2 ± 2.5 years, 52% males, mean body mass index z score 0.45 ± 1.8) were recruited. Twenty-three children (24%) had moderate-severe OSA and were referred for adenotonsillectomy. Correlations were found between the need for surgery score and the apnea-hypopnea index (r = 0.22, P = .029), as well as the mean SpO2 levels (r = -0.24, P = .02). The likelihood for the diagnosis of moderate-severe OSA by PSG increased as parental ranking for the need for surgery increased (P = .003). The need for surgery score was the only predictor for moderate-severe OSA (P = .039).

Conclusion: Querying parents on their perception of their child's need for surgery is a practical, and easy-to-use tool that can help the clinician in prioritizing referral to PSG.

Keywords: Adenoidectomy; Parental Concern Questionnaire; Pediatric Obstructive Sleep Apnea; Polysomnography; Tonsillectomy.

Copyright © 2020 Elsevier B.V. All rights reserved.

Conflict of interest statement
Declaration of competing interest The authors report no conflict of interest regarding the research.

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133
Eur J Dent
. 2020 Jun 15. doi: 10.1055/s-0040-1713306. Online ahead of print.
Metastatic Biphasic Primitive Tumor in the Mandible of a Child
Tiago Novaes Pinheiro 1, Milena Gomes Melo Leite 1, Fábio Arruda Bindá 2, André Luiz Tannus Dutra 3, Naelka Sarmento 3, Lioney Nobre Cabral 4, Alberto Consolaro 5, Carlos Eduardo Bacchi 6
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PMID: 32542629 DOI: 10.1055/s-0040-1713306
Abstract
Pediatric mandibular tumors present an aggressive biological behavior and difficult diagnosis. A wide range of odontogenic and nonodontogenic tumors comprise the spectrum of these lesions. We report a case of a 1-year-old male child patient showing facial asymmetry symptomatic of an expansive lesion extending throughout the body and ramus of the left hemimandible with a diameter of 8 cm. The histopathological report suggested a high-grade mucoepidermoid carcinoma (MEC), recommending further immunohistochemical investigation of the ectomesenchymal or neuroectodermal origin of the tumor cells. The patient evolved with extensive bilateral pleural effusion followed by metastasis in the middle third of the right humerus, and died 2 months after the first biopsy procedure by acute renal failure with tubular necrosis, before a final inconclusive immunohistochemical report was reached. The lack of resources for less-favored regions of Brazil impairs rapid biomolecular examinations such as immunohistochemical resulting in delay of appropriate therapeutic procedures.

Conflict of interest statement
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by T.N.P and M.G.M.L. The first draft of the manuscript was written by T.N.P.L.N.C., A.L.T.D., F.A.B., and N.S. operated and treated the patients studied, and reviewed the manuscript. All authors read and approved the final manuscript for publication. T.N.P. takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee (03878718.8.0000.5016 CEP/CONEP - Brazilian Research Ethics Committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Patient included in the study couldn't be contacted due to death and change of registration data that prevent his contact; it was requested to waive the informed consent form of these cases.None declared.

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134
Ear Nose Throat J
. 2020 Jun 16;145561320934217. doi: 10.1177/0145561320934217. Online ahead of print.
Otogenic Pneumocephalus After Tegmen Bone Reconstruction: A Case Report
Tawfiq Khurayzi 1, Bayan Jan 1, Reenad Bedaiwi 1, Abdulrazaq Ajlan 2, Sherif Elwatidy 2, Salman Alhabib 1, Abdurrhaman Alsanosi 1
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PMID: 32543228 DOI: 10.1177/0145561320934217
Abstract
Pneumocephalus is usually induced by trauma, infections, tumors of the skull base, and surgical interventions. Spontaneous pneumocephalus occurs due to a defect in the temporal bone with no obvious cause. Few cases have been reported with spontaneous otogenic pneumocephalus. However, delayed postoperative pneumocephalus is rarely reported in the literature. Here, we present a case of otogenic pneumocephalus through Eustachian tube (ET) preceded by nose blowing 10 days after surgical treatment of meningoencephalocele of the right middle ear (ME) cleft and reconstruction of tegmen and dural defects. Pneumocephalus was provoked by decreased intracranial pressure (ICP) secondary to placement of lumbar drain, which caused direct communication between unsutured dural defect and the defective posterior wall of external auditory canal skin. A revision surgery of combined transmastoid/middle cranial fossa approach was performed for intracranial decompression followed by appropriate closure by suturing the dura, obliterating the ET and ME.

Keywords: Eustachian tube obliteration; combined mastoid/middle fossa approach; meningoencephalocele; pneumocephalus; tegmen bone defect.

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135
Auris Nasus Larynx
. 2020 Jun 11;S0385-8146(20)30137-1. doi: 10.1016/j.anl.2020.05.016. Online ahead of print.
Surgical Management in a Severe OSA Patient Diagnosed With Stickler Syndrome
So Young Jeon 1, Oh Eun Kwon 2, Jin Woo Jang 3, Sang Yoon Kang 3, Jin-Young Min 1, Sung Wan Kim 4
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PMID: 32536504 DOI: 10.1016/j.anl.2020.05.016
Abstract
Stickler syndrome is a genetic disorder of connective tissue. One of the major symptoms associated with this disorder is an oro-facial malformation, which may cause a submucous cleft or a complete cleft of the hard palate. A 32-year-old man diagnosed with Stickler syndrome and a submucosal cleft palate (SMCP) visited our hospital with a chief complaint of excessive daytime sleepiness. The patient was diagnosed with severe obstructive sleep apnea (OSA), and administration of a polysomnography test revealed an apnea-hypopnea index (AHI) of 30.9 events/hour (h). Auto-titrating continuous positive airway pressure was initiated to control the OSA symptoms and subsequently the patient showed some improvement. However, due to continuous velopharyngeal insufficiency symptoms, intravelar veloplasty was performed. Three months after surgery, the AHI had decreased to 12.4 events/h. Recent studies have described a greater risk for OSA in individuals with cleft palate, than in the general population. The present case demonstrates surgical success in a patient with OSA and SMCP, suggesting that palatal surgery may be considered an optional surgical treatment for OSA patients with SMCP.

Keywords: Obstructive sleep apnea; Palatal surgery; Stickler syndrome; Submucosal cleft palate; Surgical success.

Copyright © 2020. Published by Elsevier B.V.

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136
Editorial Ear Nose Throat J
. 2020 Jul;99(6):351-352. doi: 10.1177/0145561319827727.
Interviews: Less Helpful Than We Think, or Harmful
Robert T Sataloff 1
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PMID: 32539559 DOI: 10.1177/0145561319827727
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137
Headache
. 2020 Jun 16. doi: 10.1111/head.13866. Online ahead of print.
Endolymphatic Hydrops Secondary to Spontaneous Intracranial Hypotension
Guillaume Poillon 1, Charlotte Hautefort 2, Daniel Levy 3, Michael Eliezer 4
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PMID: 32542657 DOI: 10.1111/head.13866
Abstract
Background: Spontaneous intracranial hypotension may be associated with neuro-otological symptoms that might mimic Menière's disease.

Case presentation: We report the case of a 53-year-old male presenting bi-frontal headache with recurrent spells of vertigo, left fluctuating hearing loss, and tinnitus. Dedicated brain and inner ear Magnetic Resonance Imaging, including a post-contrast 4 hours delayed FLAIR sequence, revealed typical signs of spontaneous intracranial hypotension associated with endolymphatic hydrops involving the left saccule and cochlea.

Conclusions: Audio vestibular manifestations mimicking Menière's disease in spontaneous intracranial hypotension could be explained by endolymphatic hydrops, which can be detected using dedicated magnetic resonance imaging sequences.

Keywords: case report; endolymphatic hydrops; inner ear; intracranial hypotension; magnetic resonance imaging.

© 2020 American Headache Society.

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138
OTO Open
. 2020 Jun 2;4(2):2473974X20924342. doi: 10.1177/2473974X20924342. eCollection Apr-Jun 2020.
Patient-Specific 3-Dimensional Printed Models for Planning Nasal Osteotomy to Correct Nasal Deformities Due to Trauma
Yong Gi Jung 1, Hanaro Park 2, Jiwon Seo 2
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PMID: 32537552 PMCID: PMC7268141 DOI: 10.1177/2473974X20924342
Free PMC article
Abstract
Nasal deformities due to trauma are more challenging to correct with rhinoplasty than nasal deformities of nontraumatic causes. Nasal osteotomy is an essential procedure for bone deviations. Preoperative planning is vital in these cases, but it is challenging to comprehend 3-dimensional (3D) structures of the nasal bone on 2-dimensional facial photographs and computed tomography images. We used a 3D-printing technique to fabricate real-size facial bone models with similar physical properties and texture as the actual bone. Furthermore, we established a precise surgical plan using simulated osteotomy on the 3D-printed model. Fused deposition modeling-type desktop 3D printer with polylactic acid filaments was used. A surgical plan was established using simulated osteotomy in 11 cases, and the actual surgery was performed as planned in 10 cases (90.9%). The 3D-printed model and stimulated osteotomy were useful for precise planning of osteotomy to correct nasal deformities due to trauma.

Keywords: 3-dimensional printing; acquired nose deformity; osteotomy; planning techniques; rhinoplasty; simulation training.

© The Authors 2020.

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139
Case Reports Int J Surg Case Rep
. 2020 Jun 11;72:233-236. doi: 10.1016/j.ijscr.2020.06.014. Online ahead of print.
A Large Sublingual Epidermoid Cyst With Parapharyngeal Space Extension: A Case Report
Hanpon Klibngern 1, Chanisa Pornchaisakuldee 2
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PMID: 32544835 DOI: 10.1016/j.ijscr.2020.06.014
Free article
Abstract
Introduction: Epidermoid and dermoid cysts in the floor of the mouth are uncommon. A large cyst can lead to functional morbidities including airway, swallowing and speech problems. The treatment of choice is surgical excision. To obtain a good result, the decision for optimal surgical technique is valuable.

Case presentation: A young female patient presented with a slowly growing mass at the submandibular area and swelling in the floor of mouth. The MRI showed large sublingual cyst extended posteriorly to the parapharyngeal space. She underwent surgical excision of the cyst size 6.5 × 3.2 × 2.5 cm via an intraoral approach. The pathological examination revealed a benign stratified squamous epithelium-lined cyst with no evidence of adnexal structure consistent with an epidermoid cyst. The patient remained disease-free after two years of follow-up.

Discussion: Generally, large sublingual cysts over 6 cm located or transgress below the mylohyoid muscle are removed by an extraoral approach. Our team reported the first case of a large lateral sublingual epidermoid cyst with parapharyngeal extension removed by an intraoral approach. Preoperative imaging is important for surgical approach selection.

Conclusion: Successful management of sublingual epidermoid cyst extended to the parapharynx is feasible by an intraoral approach with excellent functional and cosmetic outcomes.

Keywords: Case report; Epidermoid cyst; Sublingual; Transoral.

Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Conflict of interest statement
Declaration of Competing Interest The authors declare that we have no conflict of interest.

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140
J Infect
. 2020 Jun 13;S0163-4453(20)30401-1. doi: 10.1016/j.jinf.2020.06.020. Online ahead of print.
Math and Aftermath of COVID-19 Pandemic and Its Interrelationship From the Resilience Perspective
Ćurković Marko 1, Košec Andro 2, Ćurković Danijela 3
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PMID: 32544412 DOI: 10.1016/j.jinf.2020.06.020
Abstract
No abstract available
Keywords: COVID-19; pandemic; resilience; response.

Conflict of interest statement
Conflict of interest disclosures MĆ received lecture honoraria from Lundbeck, Sandoz, Janssen, Pliva (Teva) and Alkaloid. None of these relationships is related to the content of this manuscript. AK and DĆ have no conflicts of interest to declare.

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141
J Pediatr
. 2020 Jun 12;S0022-3476(20)30730-7. doi: 10.1016/j.jpeds.2020.06.029. Online ahead of print.
Neonatal Antibiotics and Infantile Colic in Term Born Infants
Kim Kamphorst 1, Berthe C Oosterloo 2, Arine M Vlieger 3, Ruurd M van Elburg 4
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PMID: 32540254 DOI: 10.1016/j.jpeds.2020.06.029
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142
Ann Surg
. 2020 Jun 11. doi: 10.1097/SLA.0000000000004167. Online ahead of print.
Comment on "Tracheotomy in Ventilated Patients With COVID-19"
George Garas 1, Ali Sameer Mallick, Gerard O'Donoghue
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PMID: 32541212 DOI: 10.1097/SLA.0000000000004167
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143
Cell Mol Immunol
. 2020 Jun 15. doi: 10.1038/s41423-020-0483-y. Online ahead of print.
Systemically Comparing Host Immunity Between Survived and Deceased COVID-19 Patients
Feng Wang 1, Hongyan Hou 1, Yin Yao 2, Shiji Wu 1, Min Huang 1, Xiao Ran 3, Hongmin Zhou 4, Zheng Liu 5, Ziyong Sun 6
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PMID: 32541836 DOI: 10.1038/s41423-020-0483-y
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144
Laryngoscope
. 2020 Jun 16. doi: 10.1002/lary.28783. Online ahead of print.
In Reference to Awake Thyroidectomy-"Squeeze" Technique for Nerve Monitoring
Tzu-Yen Huang 1, Feng-Yu Chiang 2, Che-Wei Wu 3
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PMID: 32542813 DOI: 10.1002/lary.28783
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145
Gan To Kagaku Ryoho
. 2020 Jun;47(6):913-916.
[Ⅴ. Rehabilitation for Cognitive Dysfunction in Brain Tumor Patients]
[Article in Japanese]
Wataru Nagazumi 1
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PMID: 32541167
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146
Laryngoscope
. 2020 Jun 16. doi: 10.1002/lary.28782. Online ahead of print.
Is Antral Choanal Polyp Best Managed by an Endoscopic or Caldwell-Luc Approach?
Erika Mercier 1, Michael J Cunningham 1
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PMID: 32542713 DOI: 10.1002/lary.28782
5 references
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147
Ann Surg
. 2020 Jun 9. doi: 10.1097/SLA.0000000000004126. Online ahead of print.
The Surgical Health Services Research Agenda for the COVID-19 Pandemic
Molly P Jarman 1 2, Regan W Bergmark 1 3 4, Karan Chhabra 4 5 6, John W Scott 6 7, Mark Shrime 8 9, Zara Cooper 1 2, Thomas Tsai 1 2 9 10
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PMID: 32541230 DOI: 10.1097/SLA.0000000000004126
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148
Front Neurol
. 2020 May 27;11:452. doi: 10.3389/fneur.2020.00452. eCollection 2020.
Tribute to Bernard Cohen - Whose Pioneering Work Made the Vestibular Implant Possible
Jean-Philippe Guyot 1, Nils Guinand 1, Angelica Perez Fornos 1
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PMID: 32536904 PMCID: PMC7267219 DOI: 10.3389/fneur.2020.00452
Free PMC article
Abstract
No abstract available
Keywords: cochlear implant; electrical stimulation; neuroprosthesis; nystagmus; vestibular implant; vestibular loss; vestibular system; vestibulopathy.

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149
J Infect
. 2020 Jun 12;S0163-4453(20)30399-6. doi: 10.1016/j.jinf.2020.06.018. Online ahead of print.
Prognostic Value of Carcinoembryonic Antigen on Outcome in Patients With Coronavirus Disease 2019
Jing Yu 1, Zhifeng Yang 2, Xia Zhou 3, Dongde Wu 4, Jian Chen 5, Ling Zhang 6, Luqing Tong 7, Lei Nie 8
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PMID: 32540459 DOI: 10.1016/j.jinf.2020.06.018
Conflict of interest statement
Declaration of Competing Interest The authors declare no conflicts of interest in this letter.

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150
Eur J Dermatol
. 2020 Apr 1;30(2):182-183. doi: 10.1684/ejd.2020.3718.
Rosai-Dorfman Disease: Earlier Spontaneous Regression of Skin Lesions Relative to Nasal, Pharyngeal, and Bone Lesions
Kazumasa Sato 1, Hideyuki Ujiie 1, Shinichi Nakazato 1, Mika Watanabe 1, Erika Watanabe 1, Teruki Yanagi 1, Yuji Nakamaru 2, Dai Takagi 2, Ryuta Arai 3, Tomohiro Onodera 3, Takeshi Kondo 4, Takanori Teshima 4, Hiroshi Shimizu 1
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PMID: 32538360 DOI: 10.1684/ejd.2020.3718
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151
Geriatr Gerontol Int
. 2020 Jun;20(6):647-648. doi: 10.1111/ggi.13912.
Double Lumen Endotracheal Tube, Flexible Lightwand and Ultrasound to Safely Carry Out Percutaneous Tracheostomy
Maria Vargas 1, Gennaro Russo 2, Giuseppe Servillo 1
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PMID: 32537870 DOI: 10.1111/ggi.13912
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