Objectives/Hypothesis
To evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage, and associated healthcare cost for pediatric ...adenotonsillectomy.
Study Design
Retrospective chart analysis.
Methods
Chart data were collected from pediatric patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and χ analysis was utilized to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed.
Results
A total of 1,280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the three instrumentation groups. When examining the various instruments' effect on procedure time in minutes, univariate ANOVA demonstrated a significant difference overall among the three groups (F = 8.79; P < .001). Post‐hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either PlasmaBlade (P = .03) or radiofrequency ablation (P < .001). The difference in the number of patients who experienced a postoperative bleed by instrument was not statistically significant (χ2 = 2.36; P = .31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated to be $30.04 for monopolar cautery, $246.95 for PlasmaBlade, and $244.32 for radiofrequency ablation.
Conclusions
The ideal surgical instrumentation should be cost and time efficient with a low complication rate. Monopolar cautery was associated with a statistically significant lower intraoperative surgical time, similar postoperative hemorrhage rates, and lower operative costs when compared to radiofrequency ablation and PlasmaBlade.
Level of Evidence
4 Laryngoscope, 125:475–479, 2015
Abstract Purpose To define the association between pre-operative general emergency department visits, gender, and pre-operative diagnosis with post-operative emergency department return following ...adenotonsillectomy. Methods Retrospective chart review of 1468 pediatric patients who underwent adenotonsillectomy at a tertiary pediatric hospital between 2011 and 2013. Results There was a significant relationship between patients who visited the ED pre-operatively, 25% ( N = 96) returned to the ED post-procedure, compared to 10% who did not have a pre-operative ED visit. There was an overall significant relation between having a pre-operative visit ( χ2 = 53.6, df = 1, p < 0.001), female gender (female = 56.9%; male = 43.1%; χ2 = 4.2, df = 1, p = 0.04), and having a preoperative diagnosis of recurrent strep tonsillitis (OSA and RST = 18%; RST = 17.5%; OSA = 11.8%; χ2 = 12.8, p = 0.002) and having a post-operative ED visit. Conclusion Generalized pre-operative visits along with gender and diagnosis of recurrent streptococcal tonsillitis were found to be positively associated with post-operative ED visits for common post-operative complaints.
Oral Cancer Carole Fakhry, Karen T. Pitman, Ana P. Kiess
2020
eBook
A state-of-the-art guide on oral cancer management from distinguished experts! Oral Cancer: Evaluation, Therapy, and Rehabilitation edited by prominent Johns Hopkins clinicians and educators Carole ...Fakhry, Karen Pitman, Ana Kiess, and David Eisele provides a comprehensive, state-of-the-art review on the diagnosis and management of oral cancer. This unique resource fills a void in the literature by exploring surgical and reconstructive issues specific to each subsite of the oral cavity. Important pre- and post-treatment evaluations by dental, speech language pathology, and the oncologic care team are reviewed. The comprehensive book is divided into 10 sections, each focused on different facets of the patients' trajectory. The text starts with epidemiology of oral cavity cancer and discussion of patient populations at increased risk of oral cavity cancer. The book details pre-cancers, multidisciplinary diagnostic evaluations, treatment, post-treatment, recurrent and metastatic oral cancer, and palliative care, concluding with future directions such as chemoprevention. A full spectrum of oral neoplasms are covered in depth, including different types of squamous cell cancer, primary malignancies of the mandible, and sublingual and minor salivary gland malignancies. Key Features * All oral cavity subsites are approached from both an ablative and reconstructive standpoint, with dedicated chapters focused on specific oral cancer reconstructive techniques * Discussion of oncologic considerations encompassing radiation and medical oncology including definitive radiation therapy, brachytherapy, adjuvant radiation therapy, and adjuvant chemotherapy/novel therapeutics * Clinical pearls cover complications of both surgery and radiation therapy, as well as psychological and dental implications of therapy * High-quality illustrations, photographs, and videos further elucidate impacted anatomy and techniques Residents and clinicians in otolaryngology-head and neck surgery, oral and maxillofacial surgery, head and neck reconstructive surgery, medical oncology, and radiation oncology will benefit from reading this excellent resource. Dentists who wish to further their knowledge about oral cancers will also find it an invaluable reference.
This research investigates grades kindergarten - 5 English as a Second Language (ESL) and General Education (GE) co-teachers' perceptions of one another's roles, strengths, and areas for improvement ...in co-teaching academic language and content to English language learners (ELLs) in the GE classroom. Theories of social constructivism and cooperative learning guide this study, which approaches co-teachers' perceptions as a function of how they make meaning of their social interaction and experiences (Vyogotsky, 1978; Villa, Thousand, & Nevin, 2004). Using QUAN-qual sequential explanatory design, this descriptive study uses survey methodology and small-scale follow-up interviews to create an illustrative, descriptive portrait of ESL and GE teachers' perceptions of one another's roles and professional development needs. Quantitative and qualitative survey results are triangulated with qualitative interview findings. The integrated findings illuminate the areas of convergence and divergence in ESL and GE teachers' perceptions as co-teachers of ELLs in the GE classroom. The main conclusions are discussed with regard to existing literature on co-teaching. Overall, ESL and GE teachers appeared to have a general understanding of one another's roles, yet some perceptions diverged with regard to sharing responsibilities and whether the GE teacher was the "primary instructor". In addition, this study concludes that despite availability of some common planning time, co-teachers frequently desired to improve the quality and quantity of their co-planning, co-teaching, and reflection on students' needs. Co-teaching strengths that were identified include openness, flexibility, and the ability to differentiate instruction. However, in order to improve co-teaching, both ESL and GE teachers perceive the need to gain skills and knowledge in one another's areas of expertise. Data analysis shows that co-teachers' desired professional development topics and types of offerings interrelate thematically with perceived strengths and areas for improvement. The study concludes with a discussion of implications for school administrators and teacher educators, including pre-service teacher educators, who want to support ESL and GE co-teachers. The discussion also addresses the implications for ESL and GE teachers whose co-teaching practice may benefit from reflection on the findings of the study. Finally, directions for future research emanating from this study are offered. The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.
This research investigates grades kindergarten - 5 English as a Second Language (ESL) and General Education (GE) co-teachers' perceptions of one another's roles, strengths, and areas for improvement ...in co-teaching academic language and content to English language learners (ELLs) in the GE classroom. Theories of social constructivism and cooperative learning guide this study, which approaches co-teachers' perceptions as a function of how they make meaning of their social interaction and experiences (Vyogotsky, 1978; Villa, Thousand, & Nevin, 2004). Using QUAN-qual sequential explanatory design, this descriptive study uses survey methodology and small-scale follow-up interviews to create an illustrative, descriptive portrait of ESL and GE teachers' perceptions of one another's roles and professional development needs. Quantitative and qualitative survey results are triangulated with qualitative interview findings. The integrated findings illuminate the areas of convergence and divergence in ESL and GE teachers' perceptions as co-teachers of ELLs in the GE classroom. The main conclusions are discussed with regard to existing literature on co-teaching. Overall, ESL and GE teachers appeared to have a general understanding of one another's roles, yet some perceptions diverged with regard to sharing responsibilities and whether the GE teacher was the "primary instructor". In addition, this study concludes that despite availability of some common planning time, co-teachers frequently desired to improve the quality and quantity of their co-planning, co-teaching, and reflection on students' needs. Co-teaching strengths that were identified include openness, flexibility, and the ability to differentiate instruction. However, in order to improve co-teaching, both ESL and GE teachers perceive the need to gain skills and knowledge in one another's areas of expertise. Data analysis shows that co-teachers' desired professional development topics and types of offerings interrelate thematically with perceived strengths and areas for improvement. The study concludes with a discussion of implications for school administrators and teacher educators, including pre-service teacher educators, who want to support ESL and GE co-teachers. The discussion also addresses the implications for ESL and GE teachers whose co-teaching practice may benefit from reflection on the findings of the study. Finally, directions for future research emanating from this study are offered.
SARS-CoV-2 infection is characterized by peak viral load in the upper airway prior to or at the time of symptom onset, an unusual feature that has enabled widespread transmission of the virus and ...precipitated a global pandemic. How SARS-CoV-2 is able to achieve high titer in the absence of symptoms remains unclear. Here, we examine the upper airway host transcriptional response in patients with COVID-19 (n = 93), other viral (n = 41) or non-viral (n = 100) acute respiratory illnesses (ARIs). Compared with other viral ARIs, COVID-19 is characterized by a pronounced interferon response but attenuated activation of other innate immune pathways, including toll-like receptor, interleukin and chemokine signaling. The IL-1 and NLRP3 inflammasome pathways are markedly less responsive to SARS-CoV-2, commensurate with a signature of diminished neutrophil and macrophage recruitment. This pattern resembles previously described distinctions between symptomatic and asymptomatic viral infections and may partly explain the propensity for pre-symptomatic transmission in COVID-19. We further use machine learning to build 27-, 10- and 3-gene classifiers that differentiate COVID-19 from other ARIs with AUROCs of 0.981, 0.954 and 0.885, respectively. Classifier performance is stable across a wide range of viral load, suggesting utility in mitigating false positive or false negative results of direct SARS-CoV-2 tests.
Galectin-3 (Gal-3) has been associated with heart failure (HF) and poor cardiovascular outcomes. However, the effect of longitudinal changes in Gal-3 on clinical outcomes remains unclear.
The authors ...sought to study clinical determinants of change in Gal-3 among community-dwelling individuals. Further, they sought to examine the role of serial Gal-3 measurements in predicting risk of future HF, cardiovascular disease (CVD), and mortality.
A total of 2,477 participants in the Framingham Heart Study Offspring cohort underwent measurement of plasma Gal-3 levels at 2 examinations (1995 to 1998 and 2005 to 2008). Linear regression models were used to examine clinical correlates of change in Gal-3. Proportional hazards models were used to relate future clinical outcomes with change in Gal-3.
The following clinical correlates were associated with greater longitudinal increases in Gal-3 levels: age, female sex, hypertension, diabetes, body mass index, interim development of chronic kidney disease, and HF (p < 0.0001 for all in multivariable model). Change in Gal-3 was associated with future HF (hazard ratio HR: 1.39 per 1-SD increase; 95% confidence interval CI: 1.13 to 1.71), CVD (HR: 1.29; 95% CI: 1.11 to 1.51), and all-cause mortality (HR: 1.30; 95% CI: 1.17 to 1.46). Change in Gal-3 was associated with both HF with preserved as well as reduced ejection fraction (p < 0.05 for both).
Longitudinal changes in Gal-3 are associated with traditional cardiovascular risk factors and renal disease. In turn, change in Gal-3 predicts future HF, CVD, and mortality in the community. Future studies are needed to determine whether serial Gal-3 measures may be useful in disease prevention.
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Derivation of Oocytes from Mouse Embryonic Stem Cells Hübner, Karin; Fuhrmann, Guy; Christenson, Lane K. ...
Science (American Association for the Advancement of Science),
05/2003, Letnik:
300, Številka:
5623
Journal Article
Recenzirano
Continuation of mammalian species requires the formation and development of the sexually dimorphic germ cells. Cultured embryonic stem cells are generally considered pluripotent rather than ...totipotent because of the failure to detect germline cells under differentiating conditions. Here we show that mouse embryonic stem cells in culture can develop into oogonia that enter meiosis, recruit adjacent cells to form follicle-like structures, and later develop into blastocysts. Oogenesis in culture should contribute to various areas, including nuclear transfer and manipulation of the germ line, and advance studies on fertility treatment and germ and somatic cell interaction and differentiation.
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