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Objectives  The aim of this study was to determine the clinical characteristics and cephalometric risk factors associated with decreased postoperative olfaction in patients in whom the transplanum and transtuberculum expanded endonasal approach (EEA) was performed. Methods  A retrospective cohort of 41 patients treated with the transplanum and transtuberculum EEA was divided into two groups based on the maximum change in the postoperative 22-item Sino-Nasal Outcome Test (SNOT22) olfaction score: prolonged olfactory loss group ( n  = 5) with a ΔSNOT22 olfaction score of ≥ 4 without a return to baseline and a preserved olfaction group ( n  = 36) with a ΔSNOT22 olfaction score ≤ 3 with return to baseline on follow-up of at least 3 months. Demographics, operative details, and cephalometric measurements were compared between the two groups. Results  There were no differences in terms of the type of surgical approach (transplanum and transtuberculum), resection of turbinates (middle and superior), use of reconstructive flap (nasoseptal flap and reverse flap), or tumor pathology between the two groups. In the prolonged olfactory loss group, there was a smaller angle between the planum and the face of the sella (89.75 ± 9.18 vs. 107.17 ± 16.57 degrees, p  = 0.05) and a smaller angle between the anterior nasal spine and the sphenoid sinus face (21.20 ± 2.49 vs. 25.89 ± 4.90 degrees, p  = 0.047) compared with the preserved olfaction group. Conclusion  Patients with a narrow angle between the planum and the face of the sella or that between the anterior nasal spine and the sphenoid sinus face are at a higher risk of prolonged olfactory dysfunction with the transplanum and transtuberculum approaches. Level of Evidence  IV., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Background: Fine-needle aspiration (FNA) of thyroid nodules suspicious for Hürthle cell neoplasms (HCN) have uncertain rate of malignancy. We aim to characterize rate and predictors of malignancy at our institution and compare these findings with established literature to help guide management., Methods: Single tertiary-referral center, retrospective study of 166 adults who underwent hemithyroidectomy or total thyroidectomy following FNA suspicious for HCN from 1998-2018. Demographic information and surgical histopathologic results were collected. Preoperative ultrasonography was independently scored on the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) by a board-certified head and neck radiologist., Results: There were 39 males and 127 females. Overall, 25 (15.1%) patients had carcinoma, with 15 (9%) being Hürthle cell carcinoma (HCC). Men had higher incidence of carcinoma (25.6% v. 11.8%, P = .035), and especially older males. Contralateral carcinoma was seen in 3 of 13 (23.1%) patients that underwent completion thyroidectomy. Patients with carcinoma had larger nodules (average diameter 3.3 cm versus 2.5 cm, respectively, P = .01), but no association with TI-RADS., Conclusion: Adults with nodules suspicious for HCN have significant risk of malignancy consistent with prior studies. Older males and larger nodule diameter are associated with malignancy in this cohort, but TI-RADS grade is not. These findings provide a framework for management and counseling for lesions suspicious for HCN., Competing Interests: The authors declare no potential conflict of interest., (© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society.)

The 2019 Coronavirus Pandemic challenges the delivery of care for patients with head and neck cancer. An important aspect of this care has been the evolution of enhanced survivorship services, which include surveillance for recurring cancer and prevention of second primaries. The application of evidence-based approaches to the identification and management of treatment and tumor-related toxicities has embraced the use of validated patient-reported outcomes instruments, health promotion, and care coordination. In this manuscript, we describe how our multidisciplinary team of survivorship providers has accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship., (© 2020 Wiley Periodicals, Inc.)

The extensor apparatus, an aponeurosis that covers the dorsal side of each finger, transmits force from a number of musculotendons to the phalanges. Multiple tendons integrate directly into the structure at different sites and the extensor apparatus attaches to the phalanges at multiple points. Thus, prediction of the force distribution within the extensor apparatus, or hood, and the transmission to the phalanges is challenging, especially as knowledge of the underlying mechanical properties of the tissue is limited. We undertook quantification of some of these properties through material testing of cadaver specimens. We punched samples at specified locations from 19 extensor hood specimens. Material testing was performed to failure for each sample with a custom material testing device. Testing revealed significant differences in ultimate load, ultimate strain, thickness, and tangent modulus along the length of the extensor hood. Specifically, thickness, ultimate load, and ultimate strain were greater in the more proximal sections of the extensor hood, while the tangent modulus was greater in the more distal sections. The variations in mechanical properties within the hood may impact prediction of force transmission and, thus, should be considered when modeling the action of the extensor apparatus. Across the extensor hood, tangent modulus values were substantially smaller than values reported for other soft tissues, such as the Achilles tendon and knee ligaments, while ultimate strains were much greater. Thus, the tissue in the extensor apparatus seems to have greater elasticity, which should be modeled accordingly., Competing Interests: All authors of this manuscript have no conflicts of interest to declare., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Castrating male rats in adulthood increased the duration of stereotyped behavior in responses of 5 mg/kg injections of d-amphetamine sulfate; exogenous treatment with testosterone propionate (TP) reversed this effect. Ovariectomy in adulthood had no effect on stereotypy, but TP injections reduced stereotyped responding by ovariectomized females. Thus testosterone exerts comparable effects on stereotypy elicited by amphetamine in both sexes. Males castrated at 1, 6 or 10 days of age but not males castrated in adulthood displayed levels of stereotyped behavior comparable to those of ovariectomized females when all animals were given TP in adulthood. Control experiments indicated that age of castration rather than time since castration was the critical factor, implying that secretions of the testes early in life exert effects on systems that regulate the responses of adults to amphetamine.