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A 12‐week longitudinal study with 247 US menopausal women was undertaken to investigate the perceptual efficacy of a tablet formulated with an extract of Siberian rhubarb to provide relief from menopausal symptoms. The 5‐point menopause rating scale (MRS) (0 = none; 1 = mild; 2 = moderate; 3 = severe; 4 = extremely severe) was used to measure symptom intensity. The MRS scale, an ordinal categorical scale, was transformed into an R‐index, a ratio scale, using the frequencies of the MRS categories. Symptom relief was compared to an initial week baseline measure; defined as R‐index = 0.5. An index, A.RDEX, which is based on area under the R‐index curve (AUC) in the range of 0–84 days was used to measure percentage efficacy of symptom relief. Results show that symptom relief occurs through the first 17 days in terms of R‐index = 0.64 for the total score and improves with continued use, reaching an A.RDEX = 0.42 by 84 days, suggesting about 42% relief considering all 11 MRS attributes. Practical Applications: MRS ratings data can be transformed into an R‐index using MRS category frequencies at an initial week and a subsequent week. Functional data analysis for R‐index values provides an advanced statistical model for analysis of perceptual differences throughout longitudinal studies that can examine MRS attribute effects over time. R codes are developed and provided in the paper to transform MRS data into R‐index measures and to conduct functional data analysis for R‐index measures obtained from different time points (weeks or days). [ABSTRACT FROM AUTHOR]

The sparse hierarchical clustering (SHC) method and the R package "sparcl" are used for consumer segmentation with 247 perimenopausal and postmenopausal US women. The data includes 11 menopause rating scale (MRS) attributes measuring severity of symptoms collected in the first week of a 12‐week extended use menopause tablet perceptual efficacy study. SHC is one of the advanced statistical clustering approaches for high‐dimensional data with potential noise variables. Sparse clustering is an important topic of the actively developing field of statistical learning with sparsity. An advantage of the SHC method is that it simultaneously finds the clusters of subjects and the important clustering variables. It allows clustering the data in low‐dimensional subspaces without dimension reduction of the data before clustering. The SHC method is particularly applicable to consumer segmentation based on high‐dimensional consumer data. Practical Applications: Sparse hierarchical clustering (SHC) provides advantages in consumer segmentation based on high‐dimensional consumer data with potential noise variables. This advanced clustering method finds the relative importance of attributes in clustering, helping to identify homogeneous clusters and enhance understanding of how consumer responses/needs vary among clusters. [ABSTRACT FROM AUTHOR]

Objective: Vocal fold movement impairment (VFMI) due to neuronal injury occurs in 20% to 30% of surgeries in the region of the aortic arch. Early injection laryngoplasty can aid with postoperative pulmonary toilet in these high-risk cardiovascular patients. The purpose of this study is to determine whether continuing antiplatelet and anticoagulation therapy during awake transcervical injection laryngoplasty surgery is safe, and if there is any increase in bleeding complications in these patients.Methods: This is a retrospective review of patients undergoing awake injection laryngoplasty surgery for VFMI between 2013 and 2016 at a tertiary academic center specializing in aortic and mediastinal diseases. Records were reviewed for patients regarding baseline antiplatelet or anticoagulation therapy, and whether these medications were stopped or continued preoperatively. The primary outcome was bleeding complications.Results: Of the 95 surgeries reviewed, 44 (46%) were performed for patients on antiplatelet therapy, and 71 (75%) for patients on anticoagulation therapy. None of the patients on antiplatelet therapy had their treatment discontinued. Of the patients on anticoagulation, 13 (16.4%) had their therapy held prior to surgery. There was no observed difference in bleeding complications between patients who were continued on antiplatelet or anticoagulation treatment versus those whose therapy was withheld.Conclusion: These results suggest that patients undergoing awake transcervical injection laryngoplasty for VFMI can be maintained on antiplatelet or anticoagulation therapy without increased risk of bleeding. Further larger studies are needed to confirm these findings.Level Of Evidence: 4. Laryngoscope, 127:1850-1854, 2017. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Dysphagia and esophageal stricture are frequent consequences of treatment for head and neck cancer. This study examines the effectiveness of the anterograde-retrograde rendezvous procedure and serial dilations in reestablishing esophageal patency to allow return to oral diet and gastrostomy tube removal in a cohort of patients with complete or near-complete esophageal stricture following nonsurgical cancer treatment. Study Design Retrospective review of patients treated with radiation therapy with or without concurrent chemotherapy presented with complete or near-complete esophageal stricture. Patients underwent serial dilations using combined anterograde-retrograde dilation (rendezvous) techniques. Methods Medical records of patients having undergone treatment between 2006 and 2012 were reviewed, and semistructured interviews were also conducted to determine current swallowing function and actual patient experience. The primary outcome was swallowing improvement that allowed for return to oral diet and/or gastrostomy tube removal. Outcomes were compared between patients with complete and near-complete (<5 mm in diameter) strictures and univariate analysis performed to identify associations between patient, cancer, and treatment characteristics on odds of gastrostomy tube removal. Results Twenty-four patients (median age 59.5 years, 63% male, 91% Caucasian) underwent treatment. Fifty percent of patients had complete occlusion of the esophageal lumen. The majority of patients (92%) underwent either anterograde (54%) or combined antero-retrograde (38%) approach. Following a median (interquartile range) of 9 (6-20) dilation sessions, 42% of patients were able to return to an oral diet and/or had their gastrostomy tube removed. This outcome was independent of whether the stricture was complete or near complete ( P = .67). Of patients who had their gastrostomy tubes removed, only 33.3% had ever smoked, compared to 92.3% of those whose tubes were not discharged ( P = .007). Conclusions Recannulation is possible even in cases of complete or near-complete stricture. Several factors appear to impact the likelihood of successful outcome, but in this study, only patients with a history of smoking had a significantly lower likelihood of return to full oral diet. Level of Evidence 4 Laryngoscope, 125:856-862, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Indications for antiplatelet and anticoagulation use are expanding. There is no evidence to direct therapeutic management in patients undergoing microlaryngeal surgeries. Our aim was to compare bleeding complications between microlaryngeal surgeries performed for patients preoperatively taken off and maintained on antiplatelet and/or anticoagulation therapy. Study Design Retrospective cohort study. Methods Patients undergoing microlaryngeal surgeries (2008-2009) on baseline antiplatelet and/or anticoagulation therapy were identified. Records were reviewed to determine whether therapy was stopped preoperatively. The primary outcome, bleeding complication, was compared between those taken off and maintained on therapy. Patient characteristics, surgical data, and outcomes were assessed. Results Of 287 microlaryngeal surgeries, 26% were performed for patients on antiplatelet (23%) and/or anticoagulation (3%) therapy. There was no difference in bleeding complications between patients' naïve to and on baseline antiplatelet or anticoagulation therapy [naïve: 3.8% vs. on: 5.3%, P = 0.58] and no thromboembolic events. Among surgeries performed for patients on baseline antiplatelet therapy, 35% preoperatively stopped therapy. No observed difference in bleeding complications was observed between those taken off or maintained on therapy [off: 8.0% vs. on: 4.9%, P = 0.63]. Of 3% of surgeries performed for patients on warfarin, no bleeding complications occurred, even among the 8/10 with therapeutic international normalized ratios. Conclusions Perioperative management decisions regarding antiplatelet and anticoagulation therapy are becoming more common. Results suggest that antiplatelet therapy can be maintained during microlaryngeal surgery without increasing bleeding risk. Further prospective research is required to confirm findings and rigorously investigate the safety of continuing warfarin and other anticoagulation therapy in these surgeries. Level of Evidence 4. Laryngoscope, 124:928-934, 2014 [ABSTRACT FROM AUTHOR]

Although they are extremely effective in maintaining tracheal and subglottic patency, T-tubes themselves can result in airway obstruction from plugging. Many practitioners educate patients on placing a small (5.0) endotracheal tube (ETT) through the tracheal limb of the T-tube if they develop airway obstruction. Unfortunately, this can be a difficult task to complete during acute airway obstruction. In this article, we describe a simple set of steps for rapid relief of airway obstruction and stabilization of the airway in the event of T-tube obstruction. This method requires removal of the T-tube with a Kelly clamp and stabilization of the airway with a tracheostomy tube. Although it is simple, we hope that this technique will prevent morbidity and mortality from acute airway obstructions related to T-tubes. [ABSTRACT FROM AUTHOR]

Objective: 1) Understand the indications for use of the cervicofacial and cervicothoracic advancement flaps in head and neck reconstruction. 2) Learn the surgical technique for constructing cervicofacial and cervicothoracic advancement flaps in head and neck reconstruction. 3) Describe the varying defects that can be reconstructed with cervicofacial and cervicothoracic advancement flaps. Method: Retrospective review of medical records at a university‐based head and neck cancer center. Patients were operated on between 2001 and 2012. Patients had varying lesions that were amenable to cervicofacial and/or cervicothroacic advancement flaps. After a thorough description of indications and defect locations, complications and flap viability were evaluated. Results: Sixty‐nine patients were identified, with a mean age of 66 years. Primary or recurrent skin neoplasms made up the most common surgical indication, followed by primary parotid tumors and cervical metastases from aerodigestive tract malignancies. Defects of the cheek, orbit, periauricular region, and neck were reconstructed with cervicofacial or cervicothoracic flaps. Larger wounds required extension of the incision onto the chest wall. Other reconstructive modalities were used in 38 cases to increase tissue bulk or provide internal lining. Minor wound complications occurred in 15 patients. There was no statistically significant association between wound complications and smoking or previous radiation therapy. Conclusion: Compound cervicofacial and cervicothoracic rotation flaps provide a straightforward, reliable, and efficient means to reconstruct compledefects of the face, lateral skull. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of bilateral vocal fold paralysis (BVFP) includes cordotomy, suture lateralization, arytenoidectomy, or tracheostomy. Laryngeal pacing, a novel method of treating BVFP, works by direct electrical stimulation of the Posterior Cricoarytenoid Muscle (PCA), thereby resulting in abduction of the vocal fold Methods: A total of seven patients with iatrogenic BVFP were assessed in the study. The laryngeal pacing patients have previously been published on in 1999. Four patients were in the laryngeal pacing arm and three were in the cordotomy arm. All patients underwent pulmonary function testing (PFTs) for peak inspiratory flow (PIF) measurement as well as voice testing using the GRBAS scale. Results: Patients in the laryngeal pacing arm had an average PIF of 1.53 L/s, while the cordotomy arm had an average of 1.02 L/s. The average GRBAS of the cordotomy group was 2.66 compared to 1.25 in the laryngeal pacing group. Discussion: The results of our study show that laryngeal pacing provides an adequate airway while preserving voice in patients with iatrogenic BVFP. The structure of the endolarynx and the true vocal folds is preserved while allowing for functional abduction of the vocal folds through direct electrical stimulation of the PCA muscle. Conclusions: In a subset of patients who have iatrogenic injury to the RLN and subsequent BVFP, laryngeal pacing may be an option for providing an adequate airway while preserving voice.. With the advent of newer, more reliable NMS devices, an upcoming clinical trial comparing bilateral laryngeal pacing to bilateral cordotomy will hopefully prove the benefit of laryngeal pacing for treatment of BVFP. [ABSTRACT FROM AUTHOR]

INTRODUCTION: While there are several theories for peritonsillar abscess (PTA) development, their exact pathogenesis is unknown. We propose that PTAs develop secondary to salivary stasis in the face of tonsillar inflammation. Patients who have a combination of dehydration and poor baseline salivary flow will be at a greater risk to subsequently develop ductal obstruction of Weber's glands (minor salivary glands of the superior tonsillar pillar), leading to further inflammation, cellulitis and PTA formation. METHODS: We compared the unstimulated and stimulated salivary flow rates in three groups of patients: (1) patients who have developed PTAs, (2) patients with chronic tonsillitis and no PTA history, (3) controls - patients who do not have chronic tonsillitis and have never developed a PTA. RESULTS: The average age for the PTA patients was 30, CT without PTA was 27, and controls was 24. The preliminary results showed that there is no significance between the three groups; further study with more patients is currently underway. CONCLUSIONS: Our study failed to find a different in salivary flow in our three groups of patients. We hope that when we reach our final patient count of 50/group the results may be different. If not, salivary flow may not play a role in the development of PTA. [ABSTRACT FROM AUTHOR]