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Objectives: to propose a remotely, real-time way to measure electrode electric impedances components (Ra, Cp and Rp) on cochlear implant recipients and to determine their standard values in the immediate postoperative period and one year after the implantation. We also propose a practical standardize colorimetric graph of the cochlea as a way to visualize results of these impedance parameters. Material and Methods : We developed a software using NIC library, approved by the Ethics Committe, that allows the measurement of impedance in implanted patients, including monopolar, common ground, 3- and 4-point modes. The software is capable of remotely getting this information in real-time. The data is stored in a cloud, and further analyzed to get the voltage response. Two patients who had received a cochlear implant at least one year ago and two patients who were implanted on the same day were studied using this tool, and standard values of the access resistance and polarization component of the impedance were calculated. Results : With the employment of the aforementioned tool, we were able to calculate the access resistance and the polarization component in every specific electrode in different modes, thus in every specific region of the cochlea of implanted patient. The mean access resistance value in the one-year group was around 5.08 KΩ (SD = 1.4 KΩ) and the mean polarization component was 5.61 nF (SD = 1.62 nF). In the one-day group, the mean access resistance value was 3.32 KΩ (SD = 0.76 KΩ) and the mean polarization component was 6.04 nF (SD = 1.14 nF). Rp mean values per group was 6.99 KΩ (SD = 0,9 KΩ) and 6.21 KΩ (SD = 1.77 KΩ) respectively. Conclusions : Routinary use of this tool may allow in-situ constant assessment of cochlear health and could be eventually used to monitor the effect of systemic and local drugs delivery in the inner ear. The methodology presented here provides an in-vivo „electrical view" of the inside of the cochlea. [ABSTRACT FROM AUTHOR]

Objective: Adolescent firearm violence poses a serious public health concern. The aim of this study is to explore correlates of access to firearms and firearm carrying patterns among adolescents in 2022. While previous research has documented correlates and risk factors for firearm carrying, the majority of this research has relied on samples collected prior to the COVID-19 pandemic and recent shifts in national patterns of firearm violence., Methods: We analysed data from the 2022 Florida Youth and Substance Use Survey (FYSAS) (N=41 768). Logistic regression models were used to examine associations between demographic, familial, temperamental, and behavioural factors and both ease of perceived firearm access and patterns of firearm carrying., Results: The results suggest that gender, grade level, race, residential setting, having a parent in the military, delinquency, depression, bullying and substance use are associated with perceived firearm access. In addition, gender, grade level, residential setting, ease of firearm access, delinquency, substance use, and bullying are all associated with firearm carrying., Conclusions: Our findings suggest a host of demographic features and behavioural factors are associated with both perceived ease of firearm access and patterns of firearm carrying. Implications of these findings for reducing access to firearms is discussed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Among people with cystic fibrosis (CF), illness burden is multifaceted, and symptoms may fluctuate in intensity across a lifespan. Caregivers of people with CF may also experience distressing symptoms. Recent developments in CF care, including the availability of highly effective modulator therapies (HEMTs) and new palliative care guidelines promoting palliative care screening may help alleviate symptoms. The objective of this review was to present a narrative view of the recent literature on symptom burden in CF, new screening approaches informed by the Cystic Fibrosis Foundation (CFF) palliative care guidelines, and early data from studies examining the impact of HEMTs on CF symptom burden. A review of the relevant literature was conducted using Google Scholar and PubMed. Included articles covered approaches to burden assessment in CF and other chronic illnesses, epidemiology of CF symptom burden, the impact of HEMTs on symptom burden, and the CFF palliative care guidelines. A primary palliative care model implementing the CFF guidelines was also described. Results of this review show that while recent developments in CF care have led to a reduction in physical symptoms, mental health symptoms remain prevalent. Ongoing screening and triage can ensure that physical symptoms, psychological symptoms, social needs, practical problems, and communication concerns are addressed by care teams.

Objectives: Electrocochleography (ECochG) is emerging as a tool for monitoring cochlear function during cochlear implant (CI) surgery. ECochG may be recorded directly from electrodes on the implant array intraoperatively. For low-frequency stimulation, its amplitude tends to rise or may plateau as the electrode is inserted. The aim of this study was to explore whether compromise of the ECochG signal, defined as a fall in its amplitude of 30% or more during insertion, whether transient or permanent, is associated with poorer postoperative acoustic hearing, and to examine how preoperative hearing levels may influence the ability to record ECochG. The specific hypotheses tested were threefold: (a) deterioration in the pure-tone average of low-frequency hearing at the first postoperative follow-up interval (follow-up visit 1 [FUV1], 4 to 6 weeks) will be associated with compromise of the cochlear microphonic (CM) amplitude during electrode insertion (primary hypothesis); (b) an association is observed at the second postoperative follow-up interval (FUV2, 3 months) (secondary hypothesis 1); and (c) the CM response will be recorded earlier during electrode array insertion when the preoperative high-frequency hearing is better (secondary hypothesis 2)., Design: International, multi-site prospective, observational, between groups design, targeting 41 adult participants in each of two groups, (compromised CM versus preserved CM). Adult CI candidates who were scheduled to receive a Cochlear Nucleus CI with a Slim Straight or a Slim Modiolar electrode array and had a preoperative audiometric low-frequency average thresholds of ≤80 dB HL at 500, 750, and 1000 Hz in the ear to be implanted, were recruited from eight international implant sites. Pure tone audiometry was measured preoperatively and at postoperative visits (FUV1 and follow-up visit 2 [FUV2]). ECochG was measured during and immediately after the implantation of the array., Results: From a total of 78 enrolled individuals (80 ears), 77 participants (79 ears) underwent surgery. Due to protocol deviations, 18 ears (23%) were excluded. Of the 61 ears with ECochG responses, amplitudes were < 1 µV throughout implantation for 18 ears (23%) and deemed "unclear" for classification. EcochG responses >1 µV in 43 ears (55%) were stable throughout implantation for 8 ears and compromised in 35 ears. For the primary endpoint at FUV1, 7/41 ears (17%) with preserved CM had a median hearing loss of 12.6 dB versus 34/41 ears (83%) with compromised CM and a median hearing loss of 26.9 dB ( p < 0.014). In assessing the practicalities of measuring intraoperative ECochG, the presence of a measurable CM (>1 µV) during implantation was dependent on preoperative, low-frequency thresholds, particularly at the stimulus frequency (0.5 kHz). High-frequency, preoperative thresholds were also associated with a measurable CM > 1 µV during surgery., Conclusions: Our data shows that CM drops occurring during electrode insertion were correlated with significantly poorer hearing preservation postoperatively compared to CMs that remained stable throughout the electrode insertion. The practicality of measuring ECochG in a large cohort is discussed, regarding the suggested optimal preoperative low-frequency hearing levels ( < 80 dB HL) considered necessary to obtain a CM signal >1 µV., Competing Interests: K. P., R. E., and R. A. are Cochlear employees. B. G. is a consultant to Cochlear Corporation and EarLens Corporation. F. V. has been granted by the « Fondation pour l’Audition « (RD- 2020-10). Stephen O’Leary was funded by the National Health and Medical Research Council (Australia), GNT0628679 and GNT1078673. Stephen O’Leary and Christofer Bester’s department of Otolaryngology at the University of Melbourne received research grants from Cochlear Ltd. All the other authors have no conflicts of interest to disclose., (Copyright © 2022 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Background: Emerging research suggests that adverse childhood experiences (ACEs) may be a risk factor for prenatal marijuana use. This study is the first to use a representative sample from state surveillance systems to assess the connection between accumulating ACEs and marijuana use during pregnancy., Methods: Data are from the North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2017-2019 (N = 5399). The bivariate association between number of ACEs and marijuana use during pregnancy is assessed using a chi-square test. The multivariable association is assessed using linear probability modeling., Results: Only 0.9% of women with zero ACEs reported marijuana use during pregnancy, compared to 11.7% of women with four or more ACEs. Findings from linear probability models showed that mothers reporting two ACEs (b =0.023, 95% CI =0.003,.043), three ACEs (b =0.042, 95% CI =0.014,.069), and four or more ACEs (b =0.053, 95% CI =0.035,.071) are more likely to report marijuana use during pregnancy relative to those with zero ACEs, net of demographic and socioeconomic control variables., Conclusions: Accumulating maternal ACEs -especially four or more- is associated with increased likelihood of using marijuana during pregnancy. These findings demonstrate the early life trauma is a key social determinant of health over the life course and highlights how ACEs can contribute to intergenerational harm via the worsening of health behaviors during pregnancy., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Rationale: Smoking during pregnancy poses a significant health risk for infant well-being. Prior research has linked experiencing stressful life events (SLEs) during pregnancy to prenatal smoking. However, extant research has not assessed whether SLEs experienced during pregnancy are a risk factor for prenatal electronic cigarette use., Objective: This study investigates the association between SLEs and electronic cigarette use during the third trimester of pregnancy., Methods: We employ data on 70,626 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic and multinomial logistic regression models were used to examine the association between SLEs and electronic cigarette use during the third-trimester of pregnancy., Results: The prevalence of electronic cigarette use increased alongside an accumulating history of SLEs (0 SLEs = 0.4%; 1-2 SLEs = 0.9%; 3-5 SLEs = 1.9%; 6+ SLEs = 5.0%). Logistic regression models found 6 or more SLEs were associated with 4.7 times higher odds of electronic cigarette use relative to 0 SLEs after adjusting for demographic and socioeconomic characteristics (AOR = 4.705, 95% CI = 2.960, 7.479). Study findings also showed that women who experienced greater levels of SLEs had a higher prevalence of using any nicotine products (i.e., exclusive electronic cigarette user, exclusive cigarette user, dual user), relative to being a non-smoker. Findings from multinomial logistic regression models revealed that a higher number of SLEs was associated with an increased relative risk of all smoking outcomes. Still, these associations were particularly pronounced in the case of exclusive electronic cigarette user (ARR = 8.485, 95% CI = 4.900, 14.692) and dual-use (ARR = 8.348, 95% CI = 4.113, 16.945) when participants experienced 6 or more SLEs (relative to 0 SLEs)., Conclusions: Considering the potentially harmful ramifications of electronic cigarette use during pregnancy there is a need for interventions that reduce stressful experiences and decrease smoking during pregnancy., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Smoking during pregnancy is a serious public health concern that poses risks for maternal and infant health. Considering the rise of electronic cigarette use in recent years, there is also growing concern about electronic cigarette use during pregnancy. Recent research has begun to explore correlates of electronic cigarette use among pregnant women. While research has revealed a strong connection between incarceration and smoking, scholars have yet to examine the connection between a woman's exposure to incarceration in the year prior to birth - either personally or vicariously through her husband or partner - and prenatal electronic cigarette use. The current study uses data from 74,554 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic regression and multinomial logistic regression models were used to assess the association between incarceration exposure and electronic cigarette use. The findings indicate a robust association between incarceration exposure and electronic cigarette use during pregnancy. Specifically, analyses demonstrate that incarceration-exposed women were approximately 2.7 times (AOR = 2.699, 95% CI = 1.939, 3.755) as likely to use electronic cigarettes after adjusting for a host of demographic, economic, health, and pregnancy related characteristics. Additional analyses reveal this association remains after accounting for conventional cigarette use during pregnancy. Considering the potential harmful health ramifications for electronic cigarette use during pregnancy, these findings suggest a need for interventions targeting electronic cigarette use among incarceration-exposed populations and point to electronic cigarette use among pregnant women in particular as an important area of focus for both criminal justice and public health practitioners., (Copyright © 2020 Elsevier Inc. All rights reserved.)

A substantial body of research examining the role that attractiveness plays in a wide range of outcomes has revealed that attractiveness is a beneficial characteristic across multiple domains of life, including some related to crime and the criminal justice system. The current study uses these findings as a springboard to examine the potential association between attractiveness and multiple measures of criminal justice processing, including being arrested, being convicted, being sentenced to probation and being incarcerated. Analysis of data drawn from the National Longitudinal Study of Adolescent to Adult Health revealed that more attractive persons were less likely to be arrested and convicted than less attractive persons, but there was no association with odds of being sentenced to probation or incarcerated. Follow-up analyses revealed that the beneficial effect of being attractive was confined solely to females. We discuss possible reasons for these results and provide suggestions for future research., Competing Interests: Kevin Beaver has declared no conflicts of interest Cashen Boccio has declared no conflicts of interest Sven Smith has declared no conflicts of interest Chris Ferguson has declared no conflicts of interest, (© 2019 The Australian and New Zealand Association of Psychiatry, Psychology and Law.)

Tonsil malignancy is uncommon in children. Tonsillar asymmetry is usually secondary to a benign process, either inflammatory conditions, differences in the tonsillar fossa depth or anterior pillar asymmetry. However, it may indicate a serious underlying disorder such as lymphoma. Lymphoma is the most common childhood malignancy in the head and neck. Approximately, 15% of the cases affect the Waldeyer's ring. The most common clinical manifestations of palatine tonsils lymphoma are unilateral tonsillar hypertrophy, alteration in the appearance of the mucosa and ipsilateral cervical lymphadenopathy. Early diagnosis and appropriate treatment are of great importance in the prognosis. We present a case of palatine tonsil lymphoma in a child with tonsillar asymmetry and we emphasize the importance of the examination of the oral cavity and the neck to identify suspicious alterations compatible with tonsillar lymphoma.

Hemoptysis is the expectoration of blood from the subglottic airway. The main causes in children are infections of the lower respiratory tract and aspiration of foreign bodies. Pulmonary arteriovenous malformation is a rare etiology of hemoptysis, which involves abnormal communication between the arterial and venous system. Most vascular malformations are present at birth and enlarge proportionately with the growth of the child. Signs and symptoms include dyspnea, exercise intolerance, cyanosis and hemorrhagic or neurologic complications. We describe the clinical manifestations, diagnostic methods and treatment of a child with this disease. We emphasize the importance of efficient systematic evaluation in every child with hemoptysis to identify the underlying etiology, since immediate treatment is essential because of the potential severity of this condition.

In recent years, computer-assisted surgery tools have become more versatile. Having access to a 3D printed model expands the possibility for surgeons to practice with the particular anatomy of a patient before surgery and improve their skills. Optical navigation is capable of guiding a surgeon according to a previously defined plan. These methods improve accuracy and safety at the moment of executing the operation. We intend to carry on a validation process for computed-assisted tools. The aim of this project is to propose a comparative validation method to enable physicians to evaluate differences between a virtual planned approach trajectory and a real executed course. Summarily, this project is focused on decoding data in order to obtain numerical values so as to establish the quality of surgical procedures.

Nasal obstruction in neonates is a potentially fatal condition due to their exclusive nasal breathing. The main cause is inflammatory or infectious rhinitis. Congenital, neoplastic, traumatic or iatrogenic causes are less frequent. Choanal atresia is the most common congenital nasal anomaly. A less common etiology of congenital nasal obstruction is pyriform aperture stenosis. Suspicion might arise in any newborn with varying degrees of stridor and respiratory distress, associated with the difficulty of passing a probe through anterior nares. Diagnosis should be confirmed by a computed tomography of the craniofacial massif. The therapeutic approach will depend on the severity of symptoms. We describe our experience with 5 patients with this condition, treated surgically using a sub-labial approach, and followed by nasal stenting., (Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Acute pharyngotonsillitis is one of the most common diseases in children and adolescents. The most frequent etiology is virus, followed by bacteria. The main bacterial agent is beta hemolytic Streptococcus group A. A rare complication of pharyngeal infectious processes is septic thrombophlebitis of the internal jugular vein. The diagnosis is suspected in the presence of an inflammatory unilateral neck swelling. The diagnosis is confirmed by contrast computed tomography. Treatment consists of prolonged administration of antibiotics, being the use of anticoagulants controversial. Early diagnosis and appropriate treatment are essential to prevent persistent vascular occlusion and progression of the thrombus, which can cause pulmonary emboli. In the present study, we present a teenager with thrombophlebitis of the internal jugular vein secondary to acute streptococcal pharyngotonsillitis. Clinical manifestations, diagnostic methods and treatment of this rare vascular complication are described herein.

Ankyloglossia is a congenital anomaly characterized by an abnormally short lingual frenulum resulting in varying degrees of difficulty of tongue mobility. It may be asymptomatic or it may present with breastfeeding difficulties, speech and dentition disorders, and social problems related to the functional limitation of the tongue. While it is a common and known pathology, controversies and diversity of opinions persist regarding the indication, timing and method of surgical correction. We describe our experience with 35 children presenting this condition; they underwent successful surgical treatment.

Objectives: We evaluated the quality of life following cochlear implantation in elderly postlingually deaf adults., Methods: Data were studied concerning demographics and audiometric evaluation in postlingually deaf adults at least 60 years of age who underwent cochlear implantation in 3 institutions. The Glasgow Benefit Inventory was used to quantify the quality of life. The patients were divided into 2 groups (those less than 70 years of age and those at least 70 years of age), and the results were also compared to those of younger adult cochlear implant recipients (less than 60 years of age)., Results: Eighty-one patients were included in this study. The mean age at implantation was 68 years (range, 60 to 82 years). Cochlear implantation significantly improved the patients' audiometric outcomes (pure tone average and speech perception; p < 0.05). The Glasgow Benefit Inventory showed a benefit overall (+36) and on the individual subscales (+49, +20, and +1). The difference in quality of life was not significant between those less than 70 and those at least 70 years of age (p = 0.90). The results were similar to those of younger postlingually deaf implant recipients., Conclusions: Elderly cochlear implant users experience an improvement in their quality of life, with outcomes similar to those achieved in younger adults. Particular attention must be paid to the possibility of age-related conditions in the elderly that may increase the risks of surgery.

Angiomyolipoma (AML) is a benign clonal neoplasm that consists of varying amounts of mature adipose tissue, smooth muscle, and thick-walled vessels. Approximately 20% of AMLs are found in patients with tuberous sclerosis syndrome (TS), an autosomal-dominant disorder characterized by mental retardation, epilepsy, and adenoma sebaceous, a distinctive skin lesion. Massive retroperitoneal hemorrhage from AML, also known as Wunderlich's syndrome, has been found in up to 10% of patients and represents the most significant and feared complication. The presence of even a small amount of fat within a renal lesion on CT scan (confirmed by Hounsfield unit's < or = 10) is considered diagnostic of AML. Intervention should be considered for larger tumors, particularly if the patient is symptomatic, taking into account patient age, comorbidities, and other related factors. A nephron-sparing approach, via either partial nephrectomy or selective embolization, is clearly preferred. We present the case of a fifty-nine-year old patient with an angiomyolipoma and massive retroperitoneal hemorrhage with Lenk syndrome.