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Abstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ( $$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract

Abstract Background Otolaryngology–head and neck surgical (OHNS) trainees’ operating exposure is supplemented by a combination of didactic teaching, textbook reading, and cadaveric dissections. Conventional teaching, however, may not adequately equip trainees with an understanding of complex visuospatial relationships of the middle ear. Both face and content validation were assessed of a novel three-dimensional (3D) photorealistic virtual ear simulation tool underwent face and content validation as an educational tool for OHNS trainees. Methods A three-dimensional mesh reconstruction of open access imaging was generated using geometric modeling, which underwent global illumination, subsurface scattering, and texturing to create photorealistic virtual reality (VR) ear models were created from open access imaging and comiled into a educational platform. This was compiled into an educational VR platform which was explored to validate the face and content validity questionnaires in a prospective manner. OHNS post-graduate trainees were recruited from University of Toronto and University of Calgary OHNS programs. Participation was on a voluntary basis. Results Total of 23 OHNS post-graduate trainees from the two universities were included in this study. The mean comfort level of otologic anatomy was rated 4.8 (± 2.2) out of 10. Senior residents possessed more otologic surgical experience (P

Due to the obvious minimal doses of drugs in biological matrices as well as the societal difficulties caused by methamphetamine usage, methamphetamine identification is critical in clinical and forensic laboratories. Because of their simple and inexpensive production procedure, as well as their excellent selectivity and sensitivity, polymeric carbon-based nanocomposites are strong contenders for the diffusive solid-phase extraction approach. The diffusive solid-phase extraction absorbent nanographene oxide polypyrrole composite was produced and used to recover methamphetamine from a complicated urine substrate. The generated NGPPC was fully characterized, and the significant extracting parameters have been explored using the one-parameter-at-a-time strategy. NGOPC is being used to extract methamphetamine using a urine medium with high efficiency. The NGPPC synthesizing procedure was easy, and the extraction method will demonstrate good repeatability. Moreover, the practical and efficient synthesis process stimulates the use of carbon-based compounds in various extraction procedures. As for detecting and quantifying equipment, HPLC monitors are being used. 300 mL methanol, 7 min extracting and desorption duration, 5000 mixing frequency, urinary pH value of 20, 40 mg adsorption, and 5 mL amount of urine were the optimal extraction variables. Following tracing the calibration graph, the method’s linear ranges were determined to be 40-600 ng/ml. The detection limits (LOD) and quantitation limits (LOQ), correspondingly, were 10 and 35.80 ng/mL. The proposed methodology seemed to have a detection range of 9 ng/mL. The suggested approach’s applicability in numerous characterization and medical facilities was proven by the examination of addicted subjects using the proposed technique. For successful extraction of methamphetamine using biological urine samples, the carbon-based adsorbent was being used as diffusive solid-phase extraction adsorption.

The sorption mechanisms, point of zero charge, and isosteric heats involved in the adsorptive dephenolization of aqueous solutions using thermally modified corn cob (TMCC) were studied at different initial phenol concentrations (100–500 mg/l), TMCC dosage (0.4–2.0 g), contact time (5–60 min), pH (2–10), and temperature (30–60°C). Analysis of the adsorbent material showed that it possessed the properties typical of a good adsorbent. The adsorption experiments revealed that phenol uptake is favored by an increase in TMCC dosage and contact time and a decrease in temperature and concentration of phenol in the solution. The experimental data were well-fitted to the Sips, Langmuir, Toth, and Redlich–Peterson isotherm models. Thermodynamic studies suggested that the sorption of phenol onto TMCC is feasible, spontaneous, and endothermic. The isosteric heats of adsorption obtained are in the range 47.43-79.38 kJ/mol, confirming that the adsorption process is predominantly a physical process depicting the van der Waals interactions, and it is inversely proportional to surface loading. The analysis of the adsorption mechanisms showed that the intraparticle, film, and pore diffusion mechanisms were significantly involved in the phenol adsorption process. The involvement of electrostatic attraction, π‐π electron-donor interaction, and hydrogen bonding was also demonstrated. The point of zero charge (pHpzc) was obtained at a pH of 5.83; being slightly lower than the optimum pH of 6 indicates that the sorbent surface is obviously not negatively charged at pHpzc. The discoveries of this study have shown that the dephenolization process is feasible, spontaneous, endothermic, dominated by a physical process, and governed by intraparticle, film, and pore diffusion mechanisms.

Abstract Background Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952). Conclusion Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications. Graphical abstract