Objective/Hypothesis
To assess the ability of ultra‐short echo time (UTE)‐MRI to detect subglottic stenosis (SGS) and evaluate response to balloon dilation. To correlate measurements from UTE‐MRI ...with endotracheal‐tube (ETT)‐sizing and to investigate whether SGS causes change in airway dynamics.
Study Design
Animal research study.
Methods
Eight adult New‐Zealand white rabbits were used as they approximate neonatal airway‐size. The airways were measured using ETT‐sizing and 3D UTE‐MRI at baseline, 2 weeks post‐cauterization induced SGS injury, and post‐balloon dilation treatment. UTE‐MR images were acquired to determine airway anatomy and motion. Airways were segmented from MR images. Cross‐sectional area (CSA), major and minor diameters (Dmajor and Dminor), and eccentricity were measured.
Results
Post‐injury CSA at SGS was significantly reduced (mean 38%) compared to baseline (P = .003) using UTE‐MRI. ETT‐sizing correlated significantly with MRI‐measured CSA at the SGS location (r = 0.6; P < .01), particularly at the post‐injury timepoint (r = 0.93; P < .01). Outer diameter from ETT‐sizing (OD) correlated significantly with Dmajor (r = 0.63; P < .01) from UTE‐MRI at the SGS location, especially for the post‐injury timepoint (r = 0.91; P < .01). Mean CSA of upper trachea did not change significantly between end‐expiration and end‐inspiration at any timepoint (all P > .05). Eccentricity of the upper trachea increased significantly post‐balloon dilation (P < .05).
Conclusions
UTE‐MRI successfully detected SGS and treatment response in the rabbit model, with good correlation to ETT‐sizing. Balloon dilation increased CSA at SGS, but not to baseline values. SGS did not alter dynamic motion for the trachea in this rabbit model; however, tracheas were significantly eccentric post‐balloon dilation. UTE‐MRI can detect SGS without sedation or ionizing radiation and may be a non‐invasive alternative to ETT‐sizing.
Level of Evidence
NA Laryngoscope, 131:E1971–E1979, 2021
Suicide attempts (SA) among African Americans have increased at a greater rate than any other racial/ethnic group. Research in European ancestry populations has indicated that SA are genetically ...influenced; however, less is known about the genetic contributors that underpin SA among African Americans. We examined whether genetic propensity for depression and risky behaviors (assessed via polygenic risk scores; PRS) independently and jointly are associated with SA among urban, African Americans and whether sex differences exist in these relations. Participants (N = 1,157, 45.0% male) were originally recruited as part of two first grade universal school‐based prevention trials. Participants reported in adolescence and young adulthood on whether they ever attempted suicide in their life. Depression and risky behaviors PRS were created based on large‐scale genome‐wide association studies conducted by Howard et al. (2019) and Karlson Línner et al. (2019), respectively. There was a significant interaction between the risky behavior PRS and depression PRS such that the combination of high risky behavior polygenic risk and low/moderate polygenic risk for depression was associated with greater risk for lifetime SA among the whole sample and African American males specifically. In addition, the risky behavior PRS was significantly positively associated with lifetime SA among African American males. These findings provide preliminary evidence regarding the importance of examining risky behavior and depression polygenic risk in relation to SA among African Americans, though replication of our findings in other African American samples is needed.
Atrial fibrillation (AF) is the most common cardiovascular disease (CVD), and most existing algorithms are usually designed for the diagnosis (i.e., feature classification) or prediction of AF. ...Artificial intelligence (AI) algorithms integrate the diagnosis of AF electrocardiogram (ECG) and predict the possibility that AF will occur in the future. In this paper, we utilized the MIT-BIH AF Database (AFDB), which is composed of data from normal people and patients with AF and onset characteristics, and the AFPDB database (i.e., PAF Prediction Challenge Database), which consists of data from patients with Paroxysmal AF (PAF; the records contain the ECG preceding an episode of PAF), and subjects who do not have documented AF. We extracted the respective characteristics of the databases and used them in modeling diagnosis and prediction. In the aspect of model construction, we regarded diagnosis and prediction as two classification problems, adopted the traditional support vector machine (SVM) algorithm, and combined them. The improved quantum particle swarm optimization support vector machine (IQPSO-SVM) algorithm was used to speed the training time. During the verification process, the clinical FZU-FPH database created by Fuzhou University and Fujian Provincial Hospital was used for hybrid model testing. The data were obtained from the Holter monitor of the hospital and encrypted. We proposed an algorithm for transforming the PDF ECG waveform images of hospital examination reports into digital data. For the diagnosis model and prediction model trained using the training set of the AFDB and AFPDB databases, the sensitivity, specificity, and accuracy measures were 99.2% and 99.2%, 99.2% and 93.3%, and 91.7% and 92.5% for the test set of the AFDB and AFPDB databases, respectively. Moreover, the sensitivity, specificity, and accuracy were 94.2%, 79.7%, and 87.0%, respectively, when tested using the FZU-FPH database with 138 samples of the ECG composed of two labels. The composite classification and prediction model using a new water-fall ensemble method had a total accuracy of approximately 91% for the test set of the FZU-FPH database with 80 samples with 120 segments of ECG with three labels.
Objective
Total laryngectomy (TL) is a life‐saving procedure for individuals with advanced laryngeal cancer and those suffering from recurrence after initial treatment. The present study aimed to ...evaluate the differences between stapler closure (SC) and manual closure (MC) of the pharynx during TL for patients with laryngeal cancer.
Design/Setting
A systematic literature search was performed using the PubMed, EMBASE and Cochrane Library databases. The data were analysed using Comprehensive Meta‐Analysis software (Version 3; Biostat). Dichotomous data were calculated as odds ratios (ORs), and continuous data were calculated as mean differences (MD) with 95% confidence intervals (CI).
Main Outcome/Results
A total of seven studies (535 patients) were included in this meta‐analysis. Pooled analysis showed that the operative time of TL was significantly reduced in the SC group (MD, −63.2; 95% CI, −106.0 to −20.4). Moreover, the SC group had a lower incidence of pharyngocutaneous fistula (OR = 0.38; 95% CI, 0.18 to 0.83; P = .016) and hospital stay (MD, −2.9; 95% CI, −5.6 to −0.1). The incidence of postoperative surgical site infection (OR = 0.41; 95% CI, 0.02 to 8.73; P = .565) was comparable between the two groups.
Conclusion
Based on these results, SC may be a useful option for patients who need TL.
Congenital webs are rare and represent <5% of all congenital laryngeal anomalies. They are usually a partial laryngeal atresia rather than a true web, and present as a thick and fibrotic web with ...subglottic extension and associated subglottic stenosis. All patients with a congenital anterior glottic web should be evaluated for chromosome 22q11.2 deletion syndrome. Management strategies are mainly based on the severity of airway obstruction and the anatomical extension of the webs. Simple division of the web endoscopically may be adequate for rare thin webs, however, an open approach is usually warranted for thick glottic webs regardless of Cohen grades. Open repair can be either with keel placement or reconstruction of the anterior commissure.
Genome‐wide association studies are rapidly advancing our understanding of the genetic architecture of complex disorders, including many psychiatric conditions such as major depression, ...schizophrenia, and substance use disorders. One common goal of genome‐wide association studies is to use findings for enhanced clinical prediction in the future, which can aid in identifying at‐risk individuals to enable more effective prevention screening and treatment strategies. In order to achieve this goal, we first need to gain a better understanding of the issues surrounding the return of complex genetic results. In this article, we summarize the current literature on: (a) genetic literacy in the general population, (b) the public's interest in receiving genetic test results for psychiatric conditions, (c) how individuals react to and interpret their genotypic information for specific psychiatric conditions, and (d) gaps in our knowledge that will be critical to address as we move toward returning genotypic information for psychiatric conditions in both research and clinical settings. By reviewing extant studies, we aim to increase awareness of the potential benefits and consequences of returning genotypic information for psychiatric conditions.
For the return of polygenic risk scores to become an acceptable clinical practice in psychiatry, receipt of polygenic risk scores must be associated with minimal harm and changes in behavior that ...decrease one's risk for developing a psychiatric outcome. Data from a randomized controlled trial was used to assess the impact of different levels of hypothetical polygenic risk scores for alcohol use disorder on psychological distress, risk perception, and intentions to change drinking behaviors. The analytic sample consisted of 325 participants recruited from an urban, public university. Results demonstrated that there were significant increases in psychological distress as the level of genetic risk for alcohol use disorder increased. In addition, the perceived chance of developing alcohol use disorder significantly increased as the level of genetic risk increased. Promisingly, a greater proportion of participants indicated that they would intend to engage in follow‐up behaviors, such as seeking additional information, talking to a healthcare provider about risk, and reducing drinking behaviors, as the level of genetic risk increased. Returning polygenic risk scores for alcohol use disorder in a clinical setting has the potential to promote risk‐reducing behavior change, especially with increasing levels of genetic risk. The study was registered on ClinicalTrials.gov (Identifier: NCT05143073).
Premature ventricular contraction (PVC) is one of the most common arrhythmias which can cause palpitation, cardiac arrest, and other symptoms affecting the work and rest activities of a patient. ...However, patients hardly decipher their own feelings to determine the severity of the disease thus, requiring a professional medical diagnosis. This study proposes a novel method based on image processing and convolutional neural network (CNN) to extract electrocardiography (ECG) curves from scanned ECG images derived from clinical ECG reports, and segment and classify heartbeats in the absence of a digital ECG data. The ECG curve is extracted using a comprehensive algorithm that combines the OTSU algorithm with erosion and dilation. This algorithm can efficiently and accurately separate the ECG curve from the ECG background grid. The performance of the classification model was evaluated and optimized using hundreds of clinical ECG data collected from Fujian Provincial Hospital. Additionally, thousands of clinical ECG reports were scanned to digital images as the test set to confirm the accuracy of the algorithm for practical application. Results showed that the average sensitivity, specificity, positive predictive value, and accuracy of the proposed model on the MIT-BIH dataset were 95.47%, 97.72%, 98.75%, and 98.25%, respectively. The classification average sensitivity, specificity, positive predictive value, and accuracy based on clinical scanned ECG images can reach to 97.24%, 81.6%, 83.8%, and 89.33%, respectively, and the clinical feasibility is high. Overall, the proposed method can extract ECG curves from scanned ECG images efficiently and accurately. Furthermore, it performs well on heartbeat classification of normal (N) and ventricular premature heartbeat.
The aim of this study was to assess associations between fat pad areas at various anatomic levels and the sites of lateral wall collapse and disease severity in adult patients with obstructive sleep ...apnea (OSA). Forty-one patients with OSA who prospectively underwent drug-induced sleep computed tomography were included. Areas of parapharyngeal fat pads and degrees of lateral wall collapse at three representative anatomic levels (nasopharynx, oropharynx, and subglosso-supraglottis), and apnea-hypopnea index (AHI) were measured. In the subglosso-supraglottic region, the parapharyngeal fat pad area in 17 (41%) patients with complete lateral wall collapse was significantly larger than that in 24 (59%) patients without complete collapse (median, 236.0 mm
vs 153.0 mm
; P = 0.02). In multivariate regression analysis, the parapharyngeal fat pad area at the subglosso-supraglottic level (β = 0.02; P = 0.01) and body mass index (β = 3.24; P = 0.01) were independently associated with AHI. Our preliminary results supported that parapharyngeal fat pads at the subglosso-supraglottic level may be involved in the development of lateral wall collapse and then determine the severity of OSA. Further studies are warranted to investigate the effect of reducing parapharyngeal fat pads in the treatment of OSA.
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