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In an initial experiment (Wilson and Weakley, 2004), word recognition was assessed with six digit triplets presented at 14 signal-to-babble ratios (S/B) in 2 dB steps. An abbreviated version of the protocol was developed for clinic use involving three digit triplets at 7 S/Bs in 4 dB steps. The purpose of this experiment was to examine the relationship between the two digit protocols with comparisons made with other variables including age, pure-tone thresholds, subjective measures of understanding speech in quiet and in noise, and word recognition of monosyllabic words in quiet and in babble. Ninety-six listeners with sensorineural hearing loss participated. For equivalent performance, the short version of the digit triplets required (1) a 2.6 dB more favorable S/B than the long version and (2) a 15.1 dB less favorable S/B than the words. Age, hearing loss, and subjective evaluation of the ability to understand speech in quiet and in noise were not related to performance on digits or words in multitalker babble. [ABSTRACT FROM AUTHOR]

Data from earlier studies that presented 70 words at 24 to 0 dB signal-to-babble (S/B) ratios indicated that most young listeners with normal hearing required 0 to 6 dB S/B ratios to attain 50% correct word recognition. Older listeners with hearing loss often required a >12 dB S/B ratio to attain 50% correct word recognition. In our study, we converted the Words in Noise test from one 70-word list into two 35-word lists for quicker administration by clinicians. Using baseline data from previous studies, we used two strategies to randomize the 35-word lists: based on recognition performance at each S/B ratio and based on recognition performance only. With the first randomization strategy, the 50% correct word-recognition points on the two lists differed by 0.5 dB for 72 listeners with hearing loss. With the second randomization strategy, 48 listeners with hearing loss performed identically on the two lists. [ABSTRACT FROM AUTHOR]

The purpose of this experiment was to determine the relationship between psychometric functions for words presented in multitalker babble using a descending presentation level protocol and a random presentation level protocol. Forty veterans (mean = 63.5 years) with mild-to-moderate sensorineural hearing losses were enrolled. Seventy of the Northwestern University Auditory Test No. 6 words spoken by the VA female speaker were presented at seven signal-to-babble ratios from 24 to 0 dB (10 words/step). Although the random procedure required 69 sec longer to administer than the descending protocol, there was no significant difference between the results obtained with the two psychophysical methods. There was almost no relation between the perceived ability of the listeners to understand speech in background noise and their measured ability to understand speech in multitalker babble. Likewise, there was a tenuous relation between pure-tone thresholds and performance on the words in babble and between recognition performance in quiet and performance on the words in babble. [ABSTRACT FROM AUTHOR]

This study compares, for listeners with normal hearing and listeners with hearing loss, the recognition performances obtained with digit-pair and digit-triplet stimulus sets presented in multitalker babble. Digits 1 through 10 (excluding 7) were mixed in approximately 1,000 ms segments of babble from 4 to -20 dB signal-to-babble (S/B) ratios, concatenated to form the pairs and triplets, and recorded on compact disc. Nine and eight digits were presented at each level for the digit-triplet and digit-pair paradigms, respectively. For the listeners with normal hearing and the listeners with hearing loss, the recognition performances were 3 dB and 1.2 dB better, respectively, on digit pairs than on digit triplets. For equal intelligibility, the listeners with hearing loss required an approximately 10 dB more favorable S/B than the listeners with normal hearing. The distributions of the 50% points for the two groups had no overlap. [ABSTRACT FROM AUTHOR]

Facial paralysis significantly impacts the form and function of patients. Assessment of the face in zones is important to ensure no functional area of the face is neglected. Nasal valve compromise in patients with facial paralysis, for example, is often overlooked yet should be addressed to correct nasal obstruction. In flaccid facial paralysis, inferomedial displacement of the alar base and lateral nasal sidewall insufficiency contribute to nasal valve compromise. For surgical candidates, static suspension of the nasal valve in a superolateral vector is an ideal technique to address the etiology of nasal obstruction in patients with facial paralysis., Competing Interests: Disclosures The authors have nothing to disclose. No funding., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To study the clinical and neonatal outcomes of embryos derived from frozen oocytes relative to fresh oocytes in both autologous and donor oocyte cycles after fresh embryo transfer (ET)., Design: This is a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database between 2014 and 2015., Setting: The Society for Assisted Reproductive Technology Clinic Outcome Reporting System database was used to identify autologous and donor oocyte cycles that resulted in a fresh ET during 2014 and 2015., Patients: There were 154,706 total cycles identified that used embryos derived from fresh or frozen oocytes and resulted in a fresh ET, including 139,734 autologous oocyte cycles and 14,972 donor oocyte cycles., Interventions: Generalized linear regression models were used to compare the clinical and neonatal outcomes of frozen oocytes relative to fresh oocytes. Models were adjusted for maternal age, body mass index, smoking status, parity, infertility diagnosis, number of embryos transferred, and preimplantation genetic testing. An additional sensitivity analysis was performed to examine singleton pregnancies separately., Main Outcome Measures: The live birth (LB) rate was the primary outcome. Secondary outcomes include pregnancy and birthweight outcomes., Results: Differences in clinical and neonatal outcomes between fresh and frozen-thawed oocytes after fresh ET were observed. Specifically, our study found a higher incidence of high-birthweight infants after the use of frozen oocytes relative to fresh oocytes in both autologous oocytes (12.5% [frozen] vs. 4.5% [fresh], adjusted risk ratio [aRR] 2.67, 95% confidence interval [CI] 1.65-4.3) and donor oocyte cycles (6.2% [frozen] vs. 4.6% [fresh], aRR 1.42, 95% CI 1.1-1.83). This finding remained true when the analysis was restricted to singleton gestations only for both groups: autologous (17.3% [frozen] vs. 7.1% [fresh], aRR 2.77, 95% CI 1.74-4.42) and donor oocytes (9.4% [frozen] vs. 7.8% [fresh], aRR 1.38, 95% CI 1.07-1.77). Additionally, we observed a decrease in LB (aRR 0.81, 95% CI 0.77-0.85); clinical pregnancy (aRR 0.83, 95% CI 0.8-0.87); and an increase in biochemical pregnancy loss (aRR 1.22, 95% CI 1.05-1.43) after the use of frozen oocytes in donors, but not autologous cycles., Conclusions: Our findings of an increased incidence of high-birthweight infants after the transfer of embryos derived from frozen oocytes in both autologous and donor oocyte cycles raise questions about oocyte vitrification and deserve further study. Additionally, the finding of a decreased likelihood of LB with frozen-donor oocytes compared with fresh donor oocytes is an important finding, especially because more patients are seeking to use frozen oocytes in their donor egg cycles. Future research should be directed toward these findings to optimize the use of frozen oocytes in clinical practice., Competing Interests: C.A.B. has nothing to disclose. A.P.S. has nothing to disclose. E.D. has nothing to disclose. S.M. has nothing to disclose. R.W. reports funding from the SREI research grant and 10.13039/100012324University Hospitals/Case Western Reserve R&E Rapid Response COVID Pilot grant; honoraria from Einstein/Montefiore Hospital and Midwest Reproductive Society International; stock options Sermonix Pharmaceuticals outside the submitted work., (© 2023 Published by Elsevier Inc. on behalf of American Society for Reproductive Medicine.)

Purpose of Review: The purpose of this review is to summarize some of the recent research studies on healthcare disparities across various subspecialties within otolaryngology. This review also highlights the impact of COVID-19 pandemic on disparities and proposes potential interventions to mitigate disparities., Recent Findings: Significant healthcare disparities in care and treatment outcomes have been reported across all areas of otolaryngology. Notable differences in survival, disease recurrence, and overall mortality have been noted based on race, ethnicity, socioeconomic status (SES), insurance status, etc. This is most well-researched in head and neck cancer (HNC) within otolaryngology., Summary: Healthcare disparities have been identified by numerous research studies within otolaryngology for many vulnerable groups that include racial and ethnic minority groups, low-income populations, and individuals from rural areas among many others. These populations continue to experience suboptimal access to timely, quality otolaryngologic care that exacerbate disparities in health outcomes., Competing Interests: Conflict of InterestSana Batool has nothing to disclose. Ciersten A. Burks reports United Against Racism Subspeciality Grant, Mass General Brigham. Regan W. Bergmark reports Nesson Fellow, Brigham and Women’s Hospital (Institutional faculty grant funding and salary support for research on disparities in timely access to high quality surgical care); United Against Racism Subspeciality Grant, Mass General Brigham; Grant funding, I-Mab Biopharma., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Hair loss causes significant psychosocial distress to patients. Health utility measurements offer an objective, quantitative assessment of health-related quality of life (QOL)., Methods: We performed a prospective cohort study on patients with hair loss between January 1, 2018 and December 31, 2020. Patient metrics were compared with layperson perception of alopecia, prospectively collected between August 1 and December 31, 2017. Health utility measures were quantified using the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) in quality-adjusted life-years (QALYs) and relative to the minimal clinically important difference (MCID). Bonferroni correction to the significance threshold was performed., Results: Thirty-one patients with alopecia were compared with 237 laypeople. Patient metrics for female hair loss were all significantly lower than laypeople measures (VAS QALYs 0.65 ± 0.21 vs. 0.83 ± 0.18, p = 0.0001). Mean SG QALYs were lower for patients in the male alopecia state (0.86 ± 0.23 vs. 0.96 ± 0.12, p = 0.0278). Post-hair transplant improvement in TTO was significantly greater for patients (+ 0.08 ± 0.12 vs. + 0.02 ± 0.09, p = 0.0070) and significantly more often exceeded the MCID (45.2% vs. 16.9%, p = 0.0006)., Conclusions: Alopecia negatively impacts QOL, and the true patient experience is more taxing than what is perceived by laypeople. Hair transplantation improves QOL more for male patients than common perception., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Objective: This study aimed to evaluate functional and aesthetic patient-reported outcomes using validated metrics after component dorsal hump reduction (DHR) with spreader graft placement, which have not been previously reported., Study Design: Prospective cohort study., Methods: This prospective cohort study was conducted in a tertiary care medical center. Participants underwent septorhinoplasty (SRP) with spreader graft placement with cosmetic, component DHR (cosmetic DHR), or SRP with spreader graft placement without dorsal hump reduction (noncosmetic, non-DHR). The Nasal Obstruction Symptom Evaluation (NOSE) scale and the FACE-Q Satisfaction with Nose, Nostrils, and Social Functioning scales were administered to patients preoperatively and postoperatively (at 2, 4, 6, and/or 12 months). Pre- and postoperative NOSE and FACE-Q scores were compared., Results: A total of 226 patients underwent SRP with spreader graft placement; 113 (50.0%) with cosmetic DHR and 113 (50.0%) noncosmetic, non-DHR (control). Patients who completed the NOSE and FACE-Q surveys preoperatively and at least at one postoperative time point were included. Both cohorts had a statistically and clinically significant improvement in NOSE and FACE-Q scores. There were similar improvements in NOSE scores in both cohorts. Postoperative FACE-Q scores were higher in the cosmetic DHR cohort despite lower preoperative FACE-Q scores when compared to the control cohort., Conclusions: Although there are multiple techniques for DHR, component DHR with spreader graft placement has long been considered the standard. Therefore, it is important to note the significant postoperative cosmetic and functional improvements reported by patients who have undergone this procedure to compare to newer techniques as they evolve., Level of Evidence: 3 Laryngoscope, 132:2157-2161, 2022., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

This commentary emphasizes health disparities related to systemic racism, highlighted by the COVID-19 pandemic, and provides recommendations to mitigate these disparities, including increasing racial and ethnic diversity in the surgical workforce.

Objective: To evaluate strategies to increase racial and ethnic diversity in the surgical workforce among trainees and faculty across surgical specialties., Data Sources: Embase, OVID/Medline, and Web of Science Core Collection., Review Methods: A review of US-based, peer-reviewed articles examining the effect of targeted strategies on racial and ethnic diversity in the surgical workforce was conducted from 2000 to 2020 with the PRISMA checklist and STROBE tool. Studies without an outlined strategy and associated outcomes were excluded. Eleven studies met inclusion criteria and were completed in general surgery, orthopaedic surgery, and otolaryngology-head and neck surgery., Conclusions: Efforts to increase exposure to surgery through internship programs and required clerkships with efforts to improve mentorship were common (6 of 11 [54.5%] and 3 of 11 [27.3%] studies, respectively). Three (27.3%) studies aimed to diversify the recruitment and selection process for the residency match and faculty hiring, and 2 (18.2%) aimed to increase representation among trainees, faculty, and leadership through holistic review processes paired with departmental commitment. Outcome metrics included surgical residency applications for individuals underrepresented in medicine, interview and match rates, faculty hiring, measures of a successful academic surgical career, and leadership representation. All strategies were successful in increasing diversity in the surgical workforce., Implications for Practice: A convincing yet limited body of literature exists to describe strategies and outcomes that address racial and ethnic diversity in the surgical workforce. While future inquiry is needed to move this field of interest forward, the evidence presented provides a framework for surgical residency programs/departments to develop approaches to increase racial and ethnic diversity.

Objective: To compare the patient-reported outcomes among patients with nasal obstruction undergoing two rhinoplasty techniques to a control group. Methods: Prospective longitudinal study in a university-based tertiary care medical center. All patients undergoing functional septorhinoplasty for correction of lateral wall insufficiency between October 2015 and March 2019 were included; n  = 704, mean age (standard deviation) 39.0 (15.4) years, 52.7% females. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) and FACE-Q subscales pre- and postoperatively. Patients were divided into three cohorts: spreader and lateral crural strut (LCS) grafts ( n  = 141), spreader and alar rim (AR) grafts ( n  = 104), and the control spreader grafts alone ( n  = 218). Results: The median NOSE scores at last postoperative visit were improved from baseline ( p  < 0.001) for all cohorts. The FACE-Q nasal satisfaction median scores also improved postoperatively in all cohorts, AR, LCS, and spreader, respectively ( p  = 0.001, p  < 0.001, and p  < 0.0001). Conclusions: There was no detectable difference in the improved subjective nasal function, nor adverse aesthetic outcomes in the patients with lateral wall insufficiency treated with functional rhinoplasty techniques in this study.

Competing Interests: We have no relevant conflicts of interest. Three authors have grant support. Dr Bergmark has active grant support from Mass General Brigham (United Against Racism Specialty Program Grant) and from Brigham Health (Faculty Career Development Award) for work on access to surgical care. Dr Schnipper has active support from the National Institutes of Health and the Agency for Healthcare Research and Quality for research on transitions of care, medication safety, and hospital readmissions (R01AG058911, R34DA048268). Dr Weissman is funded by the National Institutes of Health and has recent funding from the National Institute on Minority Health and Health Disparities (1R01MD011695-01) for research on the measurement of surgical disparities, and current funding by the National Institute on Aging (R01AG067507) for work unrelated to the subject matter. The remaining author has no conflicts to disclose.

Objectives: The majority of patients with head and neck squamous cell carcinoma (HNSCC) do not commence postoperative radiation treatment (PORT) within the recommended 6 weeks. We explore how delayed PORT affects survival outcomes, what factors are associated with delayed PORT initiation, and what interventions exist to reduce delays in PORT initiation., Methods: We conducted a PubMed search to identify articles discussing timely PORT for HNSCC. We performed a narrative review to assess survival outcomes of delayed PORT as well as social determinants of health (SDOH) and clinical factors associated with delayed PORT, using the PROGRESS-Plus health equity framework to guide our analysis. We reviewed interventions designed to reduce delays in PORT., Results: Delayed PORT is associated with reduced overall survival. Delays in PORT disproportionately burden patients of racial/ethnic minority backgrounds, Medicaid or no insurance, low socioeconomic status, limited access to care, more comorbidities, presentation at advanced stages, and those who experience postoperative complications. Delays in PORT initiation tend to occur during transitions in head and neck cancer care. Delays in PORT may be reduced by interventions that identify patients who are most likely to experience delayed PORT, support patients according to their specific needs and barriers to care, and streamline care and referral processes., Conclusions: Both SDOH and clinical factors are associated with delays in timely PORT. Structural change is needed to reduce health disparities and promote equitable access to care for all. When planning care, providers must consider not only biological factors but also SDOH to maximize care outcomes., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2021 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objective: To describe the retrograde removal of a tracheoesophageal (TE) prosthesis embedded in the common wall between the trachea and esophagus with preservation of the original tracheoesophageal puncture (TEP) tract with subsequent placement of new tracheoesophageal prosthesis for voice restoration., Methods: The Blom-Singer TEP Set (InHealth Technologies, Carpinteria, CA) was used to facilitate this procedure. The coated wire leader cable was threaded through the small opening in the posterior tracheal wall and into the lumen of the old TE prosthesis. The wire was pulled through the mouth in retrograde fashion - bringing the old TE prosthesis out with it and dilating the existing TEP tract. A new prosthesis was then placed over the end of the wire and returned through the stoma, delivering the prosthesis through the TE tract and into the stoma., Results: Safe, voice restoration with avoidance of need for multiple procedures., Conclusion: Removal of an embedded prosthesis and simultaneous replacement of a new prosthesis was safely and efficiently achieved using a retrograde technique which maintained the patency of the prior TE tract and restored voice.

Background: Identifying and linking barriers to access to head and neck cancer care, specifically provider density, to stage of diagnosis and survival outcomes is important to serve as a foundation for policy interventions., Methods: Retrospective cohort study using patients with head and neck squamous cell (HNSCC) in the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2016 and Area Resource File. Primary outcomes included stage of presentation and cancer-specific 5-year survival and relation to provider density., Results: The initial cohort consisted of 18 342 patients with oral cavity, 21 809 oropharyngeal, 15 860 laryngeal, and 2887 patients with hypopharyngeal malignancy. Non-Hispanic Black race and being uninsured increased the odds of presenting with advanced stage HNSCC and increased hazard of death. There was no significant and consistent association identified between Health Service Areas provider density and advanced stage at diagnosis or cancer-specific 5-year mortality., Conclusions: Provider density of otolaryngologists and primary care physicians and dentists was not significantly associated with stage of presentation or cancer-specific survival for HNSCC while race and insurance status remained independent predictors for worse outcomes., (© 2020 Wiley Periodicals LLC.)

Objective/hypothesis: To assess the long-term decannulation outcomes of bioresorbable microplates as an external stent for pediatric tracheostomy patients with suprastomal collapse., Study Design: Retrospective cohort study., Methods: Hospital records of all patients who underwent a bioresorbable microplate for suprastomal collapse from 2016 to 2019 were reviewed at a single institution. The primary outcome measure was tracheostomy decannulation., Results: A total of nine patients underwent placement of bioabsorbable microplates to treat suprastomal collapse. After initial tracheostomy, four patients received a laryngotracheal reconstruction prior to their external stent placement, and one patient received a mandibular distraction. The average age at the time of external stent placement was 32 (±21) months, excluding one patient who received a stent at the age of 29 years. Eight patients (88.9%) were successfully decannulated following the procedure. Decannulated patients were followed for an average of 21 (±12.5) months postoperatively, and all these patients have remained decannulated since their initial procedure. This is a total of 173 months (14.4 years) of observation postprocedure in which these patients have remained decannulated. One patient experienced postoperative crepitus requiring washout but still maintained decannulation., Conclusion: Bioabsorbable microplates have a reasonable chance of long-term successful decannulation when an appropriate patient is selected. Decannulation is maintained beyond the 6-month time frame in which the 85:15 poly(L-lactide-co-glycolide) polymer that comprises the external stent takes to bioabsorb. This procedure should be considered for the often difficult problem of pediatric tracheostomy with isolated suprastomal collapse., Level of Evidence: 4 Laryngoscope, 131:E631-E634, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Congenital anomalies are one component of the overwhelming surgical disease burden in low- and middle-income countries (LMICs). Lymphatic malformations (LMs) are a common congenital deformity of the head and neck in which the utilization of sclerotherapy may avoid surgery and yield superior outcomes. To be useful in LMICs, sclerosing agents must be widely available, inexpensive, and effective., Methods: A retrospective review of 10 pediatric patients with macrocystic or mixed LMs who were treated with self-compounded doxycycline sclerotherapy at Rwanda's Central University Teaching Hospital of Kigali was performed. Doxycycline oral tablets were crushed by hand, mixed with normal saline at a concentration of doxycycline 10 mg/mL, and injected directly into LMs of the head and neck., Results: Ten pediatric patients underwent 21 sclerotherapy sessions with a mean of 2.1 sessions per patient (SD 1.3, range 1-5). Of the 8 patients that were seen in follow-up, all achieved at least 80% resolution, 6 of 8 achieved 100% resolution, and none required surgery. One patient developed an infection at the injection site which resolved with antibiotics., Conclusions: Self-compounded doxycycline sclerotherapy is a safe, effective, and widely available treatment option for sclerotherapy of LMs in LMICs.

Importance: Women comprise an increasing proportion of the otolaryngology workforce. Prior studies have demonstrated gender-based disparity in physician practice and income in other clinical specialties; however, research has not comprehensively examined whether gender-based income disparities exist within the field of otolaryngology., Objective: To determine whether diversity of practice, clinical productivity, and Medicare payment differ between male and female otolaryngologists and whether any identified variation is associated with practice setting., Design, Setting, and Participants: Retrospective cross-sectional analysis of publicly available Medicare data summarizing payments to otolaryngologists from January 1 through December 31, 2017. Male and female otolaryngologists participating in Medicare in facility-based (FB; hospital-based) and non-facility-based settings (NFB; eg, physician office) for outpatient otolaryngologic care were included., Main Outcomes and Measures: Number of unique billing codes (diversity of practice) per physician, number of services provided per physician (physician productivity), and Medicare payment per physician. Outcomes were stratified by practice setting (FB vs NFB)., Results: A total of 8456 otolaryngologists (1289 [15.2%] women; 7167 [84.8%] men) received Medicare payments in 2017. Per physician, women billed fewer unique codes (mean difference, -2.10; 95% CI, -2.46 to -1.75; P < .001), provided fewer services (mean difference, -640; 95% CI, -784 to -496; P < .001), and received less Medicare payment than men (mean difference, -$30 246 (95% CI, -$35 738 to -$24 756; P < .001). When stratified by practice setting, women in NFB settings billed 1.65 fewer unique codes (95% CI, -2.01 to -1.29; P < .001) and provided 633 fewer services (95% CI, -791 to -475; P < .001). In contrast, there was no significant gender-based difference in number of unique codes billed (mean difference, 0.04; 95% CI, -0.217 to 0.347; P = .81) or number of services provided (mean difference, 5.1; 95% CI, -55.8 to 45.6; P = .85) in the FB setting. Women received less Medicare payment in both settings compared with men (NFB: mean difference, -$27 746; 95% CI, -$33 502 to -$21 989; P < .001; vs FB: mean difference, -$4002; 95% CI, -$7393 to -$612; P = .02), although the absolute difference was lower in the FB setting., Conclusions and Relevance: Female sex is associated with decreased diversity of practice, lower clinical productivity, and decreased Medicare payment among otolaryngologists. Gender-based inequity is more pronounced in NFB settings compared with FB settings. Further efforts are necessary to better evaluate and address gender disparities within otolaryngology.

Objective: To analyze the prevalence of pediatric allergic airway disease (PAA) and recognize its impact on cognitive function, childhood activities, use of early intervention, and missed school days., Study Design: Cross-sectional analysis of National Health Interview Survey (NHIS), 2014 to 2017., Setting: US households., Subjects and Methods: An NHIS survey of US children and responding caregivers was analyzed to determine the prevalence of PAA, including allergic rhinitis and allergic asthma. Associations were determined between the presence of PAA and activities limited by difficulty remembering, limitation in the amount of childhood play, use of special education/early intervention, and number of missed school days in the past 12 months. Multivariate analysis was used to adjust for age, sex, race, ethnicity, and income level., Results: An estimated 11.1 million (10.6-11.6 million, 95% confidence interval) children (mean age, 9.9 years; 56.9% male) reported a diagnosis of PAA (15.1% [14.6-15.6%]). Children with PAA missed 4.0 (3.7-4.4) school days per year vs 2.2 (2.1-2.4) days for those without PAA ( P < .001, adjusted). PAA was associated with limited daily activities due to difficulty with memory (odds ratio, 1.8 [1.2-2.9]), limitations in childhood play (3.2 [2.2-4.7]), and need for special education/early intervention services (1.6 [1.4-1.8]) after adjusting for age, sex, race, ethnicity, and income level., Conclusion: PAA is a common condition and is associated with declines in cognitive function and school attendance as well as increased use of special education/early intervention. Given the significant prevalence and burden of illness of PAA, further attention is needed to ensure timely diagnosis and treatment.

Neurofibromatosis Type 1 (NF1) is one of the most common genetic tumor predisposition syndromes in humans. Mutant NF1 results in dysregulated RAS allowing neoplasms throughout the neuroaxis. Plexiform neurofibromas (pNF) afflict up to 50% of patients with NF1. They are complex tumors of the peripheral nerve that cause major morbidity via nerve dysregulation and mortality via conversion to malignant sarcoma. Genetically engineered mouse models (GEMM) of NF1 provide valuable insights for the identification of therapies that have utility in people with pNF. Preclinical studies in GEMMs implicate mast cells and the c-Kit/Kit ligand pathway in pNF tumorigenesis. Kit ligand is a potent chemokine secreted by tumorigenic, Nf1 -deficient Schwann cells. Ketotifen is an FDA-approved drug for the treatment of allergic conjunctivitis and asthma that promotes mast cell stabilization and has been used in prior case studies to treat or prevent pNFs. This study investigated the effect of ketotifen on mast cell infiltration and degranulation in the presence and absence of Kit ligand provocation and the effect of ketotifen on shrinking or preventing pNF formation in the Nf1 flox/flox ; PostnCre + GEMM. Ketotifen decreased mast cell infiltration in response to exogenous Kit ligand administration, but did not affect mast cell degranulation. Importantly, ketotifen did not reduce mast cells numbers or activity in pNF and did not prevent pNF formation or decrease the volume of established pNF despite administration of pharmacologically active doses. These findings suggest that ketotifen has limited use as monotherapy to prevent or reduce pNF burden in the setting of Nf1 mutations., (©2019 American Association for Cancer Research.)

Study Design: Retrospective database analysis., Objective: To determine the impact of obesity on the rate of incidental durotomy in lumbar spine surgery., Summary of Background Data: There is a paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery, specifically with regard to the type of procedure performed., Methods: A large administrative database was queried for all patients who underwent lumbar spine surgery for decompression and/or fusion. They were then stratified into separate cohorts on the basis of body mass index and by procedural codes. Documentation of incidental durotomy was noted. Patient demographics and associated comorbidities were assessed. Odds ratios and 95% confidence intervals were calculated and χ test was used to assess for statistical significance., Results: The incidental durotomy ranged from 0.5% to 2.6%, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression only procedures, nonobese patients had a significantly lower rate of durotomy than the obese and morbidly obese cohorts. For patients who underwent fusion with or without decompression, there was a significantly increased rate of durotomy in obese patients compared with nonobese patients. The morbidly obese cohort also had significantly higher rates of incidental durotomy than the nonobese cohort in both revision decompression and revision fusion procedures., Conclusion: This analysis of a large administrative database demonstrates that obesity is associated with increased rates of incidental durotomy in lumbar spine surgery. Furthermore, obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery. Surgeons must be aware of these increased risks as the rate of obesity increases in the population., Level of Evidence: 3.

In order to gain insight into the molecular mechanisms that allow taste cells to respond to changes in their osmotic environment, we have used primarily immunocytochemical and molecular approaches to look for evidence of the presence of aquaporin-like water channels in taste cells. Labeling of isolated taste buds from the fungiform, foliate, and vallate papillae in rat tongue with antibodies against several of the aquaporins (AQPs) revealed the presence of AQP1, AQP2, and AQP5 in taste cells from these areas. AQP3 antibodies failed to label isolated taste buds from any of the papillae. There was an apparent difference in the regional localization of AQP labeling within the taste bud. Antibodies against AQP1 and AQP2 labeled predominantly the basolateral membrane, whereas the AQP5 label was clearly evident on both the apical and basolateral membranes of cells within the taste bud. Double labeling revealed that AQP1 and AQP2 labeled many, but not all, of the same taste cells. Similar double-labeling experiments with anti-AQP2 and anti-AQP5 clearly showed that AQP5 was expressed on or near the apical membranes whereas AQP2 was absent from this area. The presence of these 3 types of AQPs in taste buds but not in non-taste bud-containing epithelia was confirmed using reverse transcription-polymerase chain reaction. Experiments using patch clamp recording showed that the AQP inhibitor, tetraethylammonium, significantly reduced hypoosmotic-induced currents in rat taste cells. We hypothesize that the AQPs may play roles both in the water movement underlying compensatory mechanisms for changes in extracellular osmolarity and, in the case of AQP5 in particular, in the gustatory response to water.

Abdominal aortic aneurysms occur in 5-7% of men over the age of 60 and their incidence is rising. Current therapies remove the affected tissue or prevent blood flow through the aneurysm, but do not repair the underlying structural changes of the vascular wall. Adipose tissue derived stem cells (ADSCs) seeded on a biodegradable thin film and delivered endoluminally to the aneurysm site could potentially repair the vessel wall, preventing growth and rupture of the aneurysm. In this study, the mechanical and degradation properties of a novel 75:25 poly(l-lactide-co-epsilon-caprolactone) (PLCL) thin film, as well as, the effects of different surface structures on stem cell adherence and resistance to shear stress was investigated. It was possible to reproducibly create films of consistent physical properties. These films degraded approximately 50% in 6 month, which would be a sufficient time to allow cells to engraft in the aortic wall. Ethylene oxide treatment significantly increased the stiffness and yield stress of the films, which exhibit >700% elongation. Treatment of the films with NaOH and HCl induced the formation of surface texture on the films; however, this texture did not affect stem cell adherence or resistance to delamination by shear stress when compared to nontreated or fibronectin-coated films. These results indicate that PLCL thin films have a sufficient degradation time and mechanical strength to serve as a scaffold in vivo for ADSCs, and that ADSCs seeded on the thin film can withstand a range of physiologic shear stresses.

One of the transduction mechanisms for the chemoreception of fat has been proposed to involve the inhibition of delayed rectifying potassium (DRK) channels by polyunsaturated free fatty acids (PUFAs). In the present study we have compared the responsiveness of fungiform taste receptor cells (TRCs) to fatty acids in obesity-prone (Osborne-Mendel; O-M) and obesity-resistant (S5B/Pl) rat strains using patch clamp recording. TRCs from S5B/Pl rats were markedly more responsive to PUFAs than those from O-M, yet with identical inhibition constants. Moreover, addition of PUFAs to subthreshold concentrations of saccharin enhanced preference for the mixture in two-bottle preference tests compared to the saccharin alone in S5B/Pl but not O-M rats. The correlation between electrophysiological and behavioral effects of PUFAs suggested that differences in fatty acid-sensitive DRK expression may underlie the phenotypic differences between S5B/Pl and O-M rats. Consistent with this hypothesis, O-M rats exhibit a greater DRK current density and express quantitatively more DRK channels as assayed using quantitative real-time PCR. No differences were found when comparing expression of fatty acid activated two pore domain potassium channels. We propose that the ratio of fatty acid-sensitive DRK channels to fatty acid-insensitive DRK channels may be important to contributing to overall peripheral fatty acid sensitivity and in that way influence the strength of the resulting chemosensory response to fat.

The purpose of this mixed model design was to examine recognition performance differences when measuring speech recognition in multitalker babble on listeners with normal hearing (n = 36) and listeners with hearing loss (n = 72) utilizing stimulus of varying linguistic complexity (digits, words, and sentence materials). All listeners were administered two trials of two lists of each material in a descending speech-to-babble ratio. For each of the materials, recognition performances by the listeners with normal hearing were significantly better than the performances by the listeners with hearing loss. The mean separation between groups at the 50% point in signal-to-babble ratio on each of the three materials was approximately 8 dB. The 50% points for digits were obtained at a significantly lower signal-to-babble ratio than for sentences or words that were equivalent. There were no interlist differences between the two lists for the digits and words, but there was a significant disparity between QuickSIN lists for the listeners with hearing loss. A two-item questionnaire was used to obtain a subjective measurement of speech recognition, which showed moderate correlations with objective measures of speech recognition in noise using digits (r = .641), sentences (r = .572), and words (r = .673).

Two-pore domain K+ channels encoded by genes KCNK1-17 (K2p1-17) play important roles in regulating cell excitability. We report here that rat taste receptor cells (TRCs) highly express TASK-2 (KCNK5; K2p5.1), and to a much lesser extent TALK-1 (KCNK16; K2p16.1) and TASK-1 (KCNK3; K2p3.1), and suggest potentially important roles for these channels in setting resting membrane potentials and in sour taste transduction. Whole cell recordings of isolated TRCs show that a leak K+ (Kleak) current in a subset of TRCs exhibited high sensitivity to acidic extracellular pH similar to reported properties of TASK-2 and TALK-1 channels. A drop in bath pH from 7.4 to 6 suppressed 90% of the current, resulting in membrane depolarization. K+ channel blockers, BaCl2, but not tetraethylammonium (TEA), inhibited the current. Interestingly, resting potentials of these TRCs averaged -70 mV, which closely correlated with the amplitude of the pH-sensitive Kleak, suggesting a dominant role of this conductance in setting resting potentials. RT-PCR assays followed by sequencing of PCR products showed that TASK-1, TASK-2, and a functionally similar channel, TALK-1, were expressed in all three types of lingual taste buds. To verify expression of TASK channels, we labeled taste tissue with antibodies against TASK-1, TASK-2, and TASK-3. Strong labeling was seen in some TRCs with antibody against TASK-2 but not TASK-1 and TASK-3. Consistent with the immunocytochemical staining, quantitative real-time PCR assays showed that the message for TASK-2 was expressed at significantly higher levels (10-100 times greater) than was TASK-1, TALK-1, or TASK-3. Thus several K2P channels, and in particular TASK-2, are expressed in rat TRCs, where they may contribute to the establishment of resting potentials and sour reception.

Nearly half a million bone-grafting procedures occurred in the United States in the year 2000. Tissue-engineered bone substitutes may mitigate difficulties associated with current grafting options. Embryonic stem cells (ESCs) could be a potential cell source for bone substitutes; however, direct comparisons between ESCs and other cell sources are lacking. Here we provide a direct, long-term, in vitro comparison of mineralization processes in adult, marrow-derived, mesenchymal stem cells (MSCs) and ESCs from the 129/Sv+c/+p mouse strain. MSCs were observed to grow at a slower rate than ESCs. MSCs expressed seven times more alkaline phosphatase (AP) per cell than did ESCs and immediately showed type I collagen and osteocalcin production. ESCs also produced type I collagen and osteocalcin, but production was delayed. Mineral deposition by ESCs was nearly 50 times higher than by MSCs. Spectroscopic analysis showed the calcium-to-phosphorus ratio (Ca:P) of the ESC mineral (1.26:1) to be significantly higher than that of the MSCs (0.29:1), but still 25% lower than hydroxyapatite (1.67:1). Addition of basic fibroblast growth factor significantly inhibited AP expression, mineral deposition, and Ca:P ratios in MSCs and had little effect on ESCs. These functional characteristics may assist with cell selection for purposes of bone tissue engineering.