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* Context.--Recent data support that low-risk submucosally invasive (pT1) colonic adenocarcinomas (ie, completely resected tumors that lack high-grade morphology, tumor budding, and lymphovascular invasion) are considered cured via endoscopic resection, provided that the submucosal invasion is less than 1000 [micro]m. Hence, the pathologists' assessment of depth of submucosal invasion may guide further management (ie, surveillance versus colectomy). Objective.--To assess interobserver concordance among gastrointestinal pathologists in measuring submucosal depth of invasion in colonic endoscopic resections. Design.--Six gastrointestinal pathologists from 5 academic centers independently measured the greatest depth of submucosal invasion in micrometers on 52 hematoxylineosin-stained slides from colonic endoscopic specimens with pT1 adenocarcinomas, per published guidelines (round 1 scoring). Two separate measurements (round 2 scoring) were subsequently performed by each pathologist following a consensus meeting, (1) from the surface of the lesion and (2) from the muscularis mucosae, and pathologists were asked to choose their (3) 'real-life (best)' assessment between the first 2 measurements. Interobserver agreement was assessed by the intraclass correlation coefficient (ICC) and Cohen [kappa] statistics. Results.--Round 1 had poor ICC (0.43; 95% CI, 0.31-0.56). Round 2 agreement was good when measuring from the surface (ICC = 0.83; 95% CI, 0.76-0.88) but moderate (ICC = 0.59; 95% CI, 0.47-0.70) when measuring from the muscularis mucosae and became poor (ICC = 0.49; 95% CI, 0.36-0.61) for the best-assessment measurement. Conclusions.--Our findings indicate that clearer and reproducible guidelines are needed if clinical colleagues are to base important management decisions on pathologists' estimate of the depth of submucosal invasion in colonic endoscopic resections. doi: 10.5858/arpa.2021-0598-OA, Widespread screening colonoscopy procedures and advances in definitive endoscopic therapy call for precise and reproducible criteria for the evaluation of superficially invasive colorectal adenocarcinoma (CRC) in endoscopic resections. Submucosa-invasive CRC [...]

Objective: Hypoparathyroidism and associated hypocalcemia are well‐established complications following laryngectomy. This study further characterizes the rates of hypocalcemia in patients undergoing total laryngectomy (TL) with and without thyroidectomy and hemithyroidectomy. Study Design: Retrospective cohort study. Setting: TriNetX. Methods: We queried TriNetX, a deidentified patient database, to identify patients who underwent TL with and without thyroidectomy and hemithyroidectomy. Rates of hypocalcemia, low parathyroid hormone (PTH), calcium, and calcitriol supplementation were compared between groups with multivariable repeated measures logistic regression. Results: We identified 870 patients in the TL without thyroidectomy cohort, 158 patients in the hemithyroidectomy cohort, and 123 in the total thyroidectomy cohort. Rates of hypocalcemia differed between patients receiving total thyroidectomy versus TL alone for 0 to 1 month (odds ratio [OR]: 2.88 [1.95‐4.26]) 1 to 6 months (OR: 5.08 [2.29‐11.3]), and 6 to 12 months (OR: 2.63 [1.003‐6.88]) postoperatively, with adjustment for age at laryngectomy, race, ethnicity, and gender. Results were similar among those who received calcium supplementation. The rate of low PTH levels differed in these groups for 0 to 1 month (OR: 5.13 [3.10‐8.51]), 1 to 6 months (OR: 3.47 [1.46‐8.22]), and 6 to 12 months (OR: 3.63 [1.40‐9.38]) following surgery. Rates of postoperative calcium supplementation were increased for patients receiving total thyroidectomy versus TL for 1 to 6 months (OR: 2.44 [1.62‐3.68]), and 6 to 12 months following surgery (OR: 1.79 [1.18‐2.72]). Conclusion: Patients undergoing TL with total thyroidectomy have a higher risk of postoperative hypocalcemia compared to patients receiving TL alone. Risk of parathyroid injury in these patients may warrant further emphasis on PTH measurement after surgery and a multidisciplinary approach to management. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to discuss the feasibility of developing, and the challenges of implementing, a structured dysphagia program in a rural patient population with preliminary data. Method: The Dysphagia Pathway Program (DPP) is a standardized, prophylactic swallow therapy program for head and neck cancer patients initiated in 2019 as a multidisciplinary approach at Penn State Hershey Medical Center. An interrupted time series study was conducted comparing the swallow and nutritional status of patients pre- and postimplementation of the DPP. Data were analyzed using the chi-square test and linear mixed-effects models to determine statistical significance for categorical and continuous variables, respectively. Results: The DPP group included 52 patients, and the pre-implementation group included 109 patients. A higher percentage of patients in the DPP group tolerated a by mouth (PO)-only diet at the last day of treatment time point (p < .001). The DPP group showed similar changes in body mass index and albumin over time but had lower rates of gastrostomy tube placements (p = .002) compared to the pre-implementation group. The average adherence to speech and swallow therapy in the DPP group decreased over time. Conclusions: Although we encountered many obstacles in the development of the DPP, we found prophylactic swallow therapy to be feasible to implement and beneficial in our rural patient population. In this pilot study, our results demonstrated that prophylactic swallow therapy shows a favorable trend in swallowing and nutritional status. Future improvements include improving documentation of swallowing outcomes, patient adherence, and utilizing telehealth. [ABSTRACT FROM AUTHOR]

Objective: Smoking cessation is critical in reducing incidence of head and neck cancers (HNC) and improving postoperative outcomes. Accurate documentation of tobacco usage is necessary to understand prevalence in patients to target smoking cessation. This study aims to characterize tobacco usage documentation, including electronic nicotine delivery systems (ENDS) use, among otolaryngology patients. Study Design: Retrospective chart review. Setting: Penn State Health Milton S. Hershey Medical Center (PSHMC). Methods: A retrospective chart review was conducted on adult otolaryngology patients seen from January 1, 2020 – December 31, 2020. Patient demographics, details of alcohol and tobacco usage, including type of tobacco, and subspecialty seen were collected. Associations were evaluated using chi-square tests and a multivariable logistic regression model. Results: Patients (n = 2137) were an average of 58.4 years old ±18.0, 59.3% female, and 78.0% white. Of participants with documented tobacco history (n = 944), 56.7% were never users, 28.9% were former users, and 14.4% were current users. Among current users (n = 308), 86.4% used cigarettes, and 5.2% used ENDS. The remainder used chew (4.9%) and cigars (3.25%). Odds of tobacco use were 1.5x greater for males (95% CI 1.19-2.00), 1.6x greater for unmarried patients (95% CI 1.24-2.09), 2.1x greater for those with no insurance vs government (95% CI 1.43-3.18), and 2.4x greater for those diagnosed with HNC (95% CI 1.64-3.49). Conclusion: Most patients report cigarette smoking when asked about tobacco use. Taking into consideration the rise of ENDS use, our sample showed ENDS use that was higher than the national average. There is significant opportunity for improved history taking, especially within general and head and neck oncology subspecialties for more comprehensive treatment. [ABSTRACT FROM AUTHOR]

Background: Differences in treatment outcomes between community or academic centers are incompletely understood. Methods: Retrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan–Meier curves and log‐rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence. Results: Two hundred and forty‐eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002). Conclusion: Our findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, examines the use of fibrin sealants in reducing postoperative complications in skull base surgery. The study conducted a systematic review and meta-analysis of published studies that assessed patients who had undergone skull base surgery with the use of fibrin sealants. The results showed that patients who received fibrin sealants had a lower incidence of postoperative cerebrospinal fluid (CSF) leak and drain placement compared to those who did not receive fibrin sealants. However, there was no significant difference in the incidence of revision surgery or infection between the two groups. Overall, the findings suggest that fibrin sealants may be effective in reducing CSF leaks and related complications in skull base surgery. [Extracted from the article]

High frequency hearing loss (HFHL), often related to hazardous noise, affects one in six U.S. adolescents. Yet, only 20 states include school-based hearing screens for adolescents. Only six states test multiple high frequencies. Study objectives were to (1) compare the sensitivity of state school-based hearing screens for adolescents to gold standard sound-treated booth testing and (2) consider the effect of adding multiple high frequencies and two-step screening on sensitivity/specificity. Of 134 eleventh-grade participants (2013-2014), 43 of the 134 (32%) did not pass sound-treated booth testing, and 27 of the 43 (63%) had HFHL. Sensitivity/specificity of the most common protocol (1,000, 2,000, 4,000 Hz at 20 dB HL) for these hearing losses was 25.6% (95% confidence interval [CI] = [13.5, 41.2]) and 85.7% (95% CI [76.8, 92.2]), respectively. A protocol including 500, 1,000, 2,000, 4,000, 6,000 Hz at 20 dB HL significantly improved sensitivity to 76.7% (95% CI [61.4, 88.2]), p < 0.001. Two-step screening maintained specificity (84.6%, 95% CI [75.5, 91.3]). Adolescent school-based hearing screen sensitivity improves with high frequencies.

Background: This study aimed to mimic the changes from Charcot neuropathic arthropathy in humans by examining the effects of exposing diet-induced obese (DIO) mice to neurotrauma through a regimented running protocol. Methods: Forty-eight male wild-type C57BL/6J mice were obtained at age 6 weeks and separated into 2 groups for diet assignment. After a 1-week acclimation period, half of the mice consumed a high-fat diet (60% fat by kcal) ad libitum to facilitate neuropathic diet-induced obesity whereas the other half were control mice and consumed an age-matched standard low-fat control diet (10% fat by kcal). At age 12 weeks, half of the animals from each group were subjected to a high-intensity inclined treadmill running protocol, which has been previously demonstrated to induce neurotrauma. Sensory testing and radiographic analyses were periodically performed. Histopathologic analyses were performed post killing. Results: DIO mice had significantly higher bodyweights, higher body fat percentages, and lower bone mineral density than wildtype control mice that were fed a normal diet throughout the experiment (P <.001 for each). DIO mice displayed significantly reduced sensory function in week 1 (P =.005) and this worsened over time, requiring 20.6% more force for paw withdrawal by week 10 (P <.001). DIO mice that ran demonstrated greater midfoot subluxation and tarsal instability over all time points compared with normal-diet mice that ran (P <.001). Histopathologic analyses revealed that DIO mice that ran demonstrated significant changes compared with controls that ran (P <.001 for each parameter). Conclusion: Changes akin to the earliest changes observed in or before joint destruction identified in diabetic Charcot neuropathic arthropathy in humans were observed. Clinical Relevance: There is currently no standard of treatment for patients with Charcot neuropathic arthropathy. This study establishes a protocol for an animal model that can be used to study and compare interventions to treat this disease. [ABSTRACT FROM AUTHOR]

Objective: Identify risk factors and perioperative morbidity for pediatric patients undergoing septoplasty. Methods: The American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database was retrospectively queried to identify patients who underwent septoplasty (CPT 30520) for a diagnosis of deviated nasal septum (ICD J34.2) from 2018 to 2019. Outcomes analyzed include patient demographics, medical comorbidities, surgical setting, operative characteristics, length of stay, and postoperative outcomes. Results: A total of 729 children were identified. Median age at time of surgery was 15.8 years, with most patients (82.8%) >12 years of age; no significant association was identified between age at time of surgery and adverse surgical outcomes. Overall, postoperative complications were uncommon (0.6%), including readmission (0.4%), septic shock (0.1%), and surgical site infection (0.1%). A history of asthma was found to be a significant risk factor for postoperative complications (P =.035) as well as BMI (P =.028). Conclusion: The 30-day postoperative complications following pediatric septoplasty in children reported in the NSQIP-P database are infrequent. Special considerations regarding young age, complex sinonasal anatomy, and surgical technique remain important features in considering corrective surgery for the pediatric nose and certainly warrant further investigation in subsequent studies. [ABSTRACT FROM AUTHOR]

Objectives Endoscopic endonasal anterior skull base surgery has expanding use in the pediatric population, but the anatomy of pediatric patients can lead to limitations. This study aims to characterize the important anatomical implications of the pediatric skull base using computed tomography (CT) scans. Design This study is designed as retrospective analysis. Setting The study setting comprises of tertiary academic medical center. Participants In total, 506 patients aged 0 to 18 who had undergone maxillofacial and or head CTs between 2009 to 2016 were involved. Methods Measurements included piriform aperture width, nare to sella distance (NSD), sphenoid pneumatization, olfactory fossa depth, lateral lamella cribriform plate angles, and intercarotid distances (ICD) at the superior clivus and cavernous sinus. These patients were then subdivided into three age groups adjusting for sex. Analysis of covariance (ANCOVA) models were fit comparing between all age groups and by sex. Results Piriform aperture width, NSD, sphenoid sinus pneumatization as measured using lateral aeration and anterior sellar wall thickness, olfactory fossa depth, and ICD at the cavernous sinus were significantly different among all age groups (p <0.0001). Our results show that mean piriform aperture width increased with each age group. The mean olfactory fossa depth also had consistent age dependent growth. In addition, ICD at the cavernous sinus showed age dependent changes. When comparing by sexes, females consistently showed smaller measurements. Conclusion The process of skull base development is age and sex dependent. During preoperative evaluation of pediatric patients for skull base surgery piriform aperture width, sphenoid pneumatization in both the anterior posterior and lateral directions, and ICD at the cavernous sinus should be carefully reviewed. [ABSTRACT FROM AUTHOR]

Background: A prior study reported that over half of patients with HNSCC initiated PORT after 6 weeks from surgery during 2006–2014. In 2022, the CoC released a quality metric for patients to initiate PORT within 6 weeks. This study provides an update on time to PORT in recent years. Methods: The NCDB and TriNetX Research Network were queried to identify patients with HNSCC who received PORT during 2015–2019 and 2015–2021, respectively. Treatment delay was defined as initiating PORT beyond 6 weeks after surgery. Results: In NCDB, PORT was delayed for 62% of patients. Predictors of delay included age >50, female sex, black race, nonprivate insurance/uninsured status, lower education, oral cavity site, negative surgical margins, increased postoperative length of stay, unplanned hospital readmissions, IMRT radiation modality, treatment at an academic hospital or in the Northeast, and surgery and radiation at different facilities. In TriNetX, 64% experienced treatment delay. Additional associations with prolonged time to treatment included never married/divorced/widowed marital status, major surgery (neck dissection/free flaps/laryngectomy), and gastrostomy/tracheostomy dependence. Conclusions: There continue to be challenges to timely initiation of PORT. [ABSTRACT FROM AUTHOR]

The American Academy of Pediatrics has previously expressed concerns about the thematic content of television (TV) and the amount of time children spend viewing TV. The objective of this study was to determine the positive and negative themes depicted in a select number of TV shows targeted toward adolescents. We analyzed the thematic content depicted in the first season of 26 Netflix TV shows. The mean occurrences/h for positive and negative themes were 39.53 and 47.20, respectively. The most common positive themes were "encouragement from a friend/peer," "demonstrating honesty," and "staying true to oneself" (5.98, 5.38, and 3.72 mean occurrences/h, respectively). The most common negative themes were "dishonesty," "cursing," and "selfishness," (5.30, 4.96, and 4.85 mean occurrences/h, respectively). We suggest that health care providers become aware of TV thematic content and promote media education, and we encourage co-viewing and active mediation by parents/guardians with their children. [ABSTRACT FROM AUTHOR]

A survey of 468 practicing family physicians, general internists, and pediatricians examined relationships between educational debt and specialty choice, practice location choice, and types of patients treated. Results indicate that the high costs of medical training promoted rural work and care for poor patients by prompting generalists to commit to programs with service requirements. Contains 32 references. (TD)

The efficacy of intermittent short-course corticosteroid treatment guided by a symptom-based action plan alone or in addition to daily treatment with either inhaled budesonide or oral zafirlukast is evaluated. Mild persistent asthma could be treated with short, intermittent courses of inhaled or oral corticosteroids taken when symptoms worsen.