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Objectives: A small number of Idiopathic subglottic stenosis (iSGS) patients are treated at institutions across the country. Divergence in operative techniques for endoscopic dilation (ED) of iSGS has been anecdotally recognized but not formally characterized. Additionally, the relationship between procedural variation and clinical outcome has not been studied. Methods: Secondary analysis of the NoAAC iSGS1000 cohort investigated variation in procedural techniques and treatment outcomes in patients treated with ED across high‐enrolling treatment centers (enrolled >10 patients in PR‐02 trial). Results: Thirteen NoAAC centers each enrolled >10 patients treated with ED for a total of 281 subjects. There was significant variation in procedural details and rate of recurrence among institutions. Hierarchal cluster analysis revealed significant heterogeneity among institutions and clusters in all procedural variables. However, analysis demonstrated a transient delay in disease recurrence in cluster 2 which disappeared with longer longitudinal follow‐up. Patient‐reported outcome and peak expiratory flow data supported the potential benefit of the technical variation in Cluster 2. Distinct to cluster 2, however, was routine use of adjuvant triple medical therapy (proton pump inhibitor (PPI), antibacterial agent, and steroid inhaler). Conclusions: Both outcome and procedural technique vary among centers employing ED to treat iSGS. A transient delay in recurrence was observed among centers that routinely prescribed adjuvant medical therapy (antibiotic, inhaled corticosteroid, and PPI) to iSGS patients after endoscopic dilation, which was further supported by patient‐reported data and peak expiratory flow data. Prospective studies are needed to understand the effects of adjuvant medical therapy on recurrence after endoscopic dilation. Level of Evidence: 4 Laryngoscope, 134:3260–3266, 2024 [ABSTRACT FROM AUTHOR]

Purpose: Diagnosing pediatric induced laryngeal obstruction (ILO) requires equipment typically available in specialist settings, and patients often see multiple providers before a diagnosis is determined. This study examined the financial burden associated with the diagnosis and treatment of ILO in pediatric patients with reference to socioeconomic disadvantage. Methods: Adolescents and children (<18 years of age) diagnosed with ILO were identified through the University of Madison Voice and Swallow Outcomes Database. Procedures, office visits, and prescribed medications were collected from the electronic medical record. Expenditures were calculated for two time periods (1) pre‐diagnosis (first dyspnea‐related visit to diagnosis), and (2) the first year following diagnosis. The Area Deprivation Index (ADI) was used to estimate patient socioeconomic status to determine if costs differed with neighborhood‐level disadvantage. Results: A total of 113 patients met inclusion criteria (13.9 years, 79% female). Total pre‐diagnosis costs of ILO averaged $6486.93 (SD = $6604.14, median = $3845.66) and post‐diagnosis costs averaged $2067.69 (SD = $2322.78; median = $1384.12). Patients underwent a mean of 3.01 (SD = 1.9; median = 2) procedures and 5.8 (SD = 4.7; median = 5) office visits prior to diagnosis. Pharmaceutical, procedure/office visit, and indirect costs significantly decreased following diagnosis. Patients living in neighborhoods with greater socioeconomic disadvantage underwent fewer procedures and were prescribed more medication than those from more affluent areas. However, total expenditures did not differ based on ADI. Conclusions: Pediatric ILO is associated with considerable financial costs. The source of these costs, however, differed according to socioeconomic advantage. Future work should determine how ILO diagnosis and management can be more efficient and equitable across all patients. Laryngoscope, 134:3384–3390, 2024 [ABSTRACT FROM AUTHOR]

Improving feed suitability and bolstering the global upsurge in fish production is a strategic challenge for aquaculture. The utilization of plant and animal derived ingredients in aquafeed for achieving sustainable in finfish aquaculture is affected by various factors, including the presence of antinutritional factors, lowered nutrient bioavailability, indigestible particles and microbial contaminants. Applying fermentation to overcome these problems in aquafeed ingredients has received considerable attention in recent years as fermentation provides health‐promoting probiotic benefits to host organisms. Fermentation has also been shown in many studies to improve nutrient availability and bioavailability of feed, increased palatability and digestibility and eliminate anti‐nutritional compounds in dietary feed ingredients, making them more easily digestible which eventually improve growth and health performance of fish. Therefore, it is imperative to accelerate the use of fermented feedstuffs as aquafeed if sustainable aquaculture is to be achieved. This review reported the various methods of fermentation, characteristics of fermented feed ingredients, factors that are considered during fermentation and overall nutritional quality of fermented feed ingredients for aquaculture production. The role of fermented feed ingredients for various farmed species in terms of growth, feed utilization, gut microbiota composition, immunity and disease resistance in fish is thoroughly discussed. The possible drawbacks associated with the fermentation process are also discussed in the article. [ABSTRACT FROM AUTHOR]

Critical genes involved in embryonic development are often transcription factors, regulating many downstream genes. LMX1B is a homeobox gene that is involved in formation of the limbs, eyes and kidneys, heterozygous loss‐of‐function sequence variants and deletions cause Nail‐Patella syndrome. Most of the reported variants are localised within the gene's coding sequence, however, approximately 5%–10% of affected individuals do not have a pathogenic variant identified within this region. In this study, we present a family with four affected individuals across two generations with a deletion spanning a conserved upstream LMX1B‐binding sequence. This deletion is de novo in the mother of three affected children. Furthermore, in this family, the manifestations appear limited to the nails and limbs, and therefore may reflect an attenuated phenotype of the classic Nail‐Patella phenotype that includes ophthalmological and renal manifestations. [ABSTRACT FROM AUTHOR]

Objective: Idiopathic subglottic stenosis (iSGS) is a rare, recurrent, fibroinflammatory disease affecting the larynx and proximal trachea. Given it occurs primarily in adult females, estrogen is speculated to play a central pathophysiological role. This study aimed to evaluate relationships between estrogen exposure, disease progression, and recurrence. Methods: North American Airway Collaborative (NoAAC) data of adults with iSGS obstructive airway lesions, who underwent index endoscopic airway dilation, were used to identify associations between estrogen exposure, disease characteristics, and time to recurrence (TTR), and interventions were analyzed using Kruskal–Wallis test and Pearson coefficient. Cox proportional hazards regression models compared hazard ratios by estrogen exposure. Kaplan–Meier curves were plotted for TTR based on menopausal status. Results: In all, 533 females had complete estrogen data (33% premenopausal, 17% perimenopausal, 50% postmenopausal). Median estrogen exposure was 28 years. Overall, there was no dose–response relationship between estrogen exposure and disease recurrence. Premenopausal patients had significantly shorter time from symptom manifestation to diagnosis (1.17 vs. 1.42 years perimenopausal vs. 2.08 years postmenopausal, p < 0.001), shorter time from diagnosis to index endoscopic airway dilation (1.90 vs. 2.50 vs. 3.76 years, p = 0.005), and higher number of procedures (1.73 vs. 1.20 vs. 1.08 procedures, p < 0.001). Conclusions: We demonstrate premenopausal patients may have a more aggressive disease variant than their peri‐ and postmenopausal counterparts. However, it is unclear as to whether this is related to reduced estrogen in the peri‐ and postmenopausal states or the age‐related physiology of wound healing and inflammation, regardless of estrogen. Level of Evidence: 3 Laryngoscope, 134:825–830, 2024 [ABSTRACT FROM AUTHOR]

Objective: Idiopathic subglottic stenosis is a rare disease, and time to diagnosis is often prolonged. In the United States, some estimate it takes an average of 9 years for patients with similar rare disease to be diagnosed. Patient experience during this period is termed the diagnostic odyssey. The aim of this study is to use qualitative methods grounded in behavioral‐ecological conceptual frameworks to identify drivers of diagnostic odyssey length that can help inform efforts to improve health care for iSGS patients. Methods: Qualitative study using semi‐structured interviews. Setting consisted of participants who were recruited from those enrolled in a large, prospective multicenter trial. We use directed content analysis to analyze qualitative semi‐structured interviews with iSGS patients focusing on their pathways to diagnosis. Results: Overall, 30 patients with iSGS underwent semi‐structured interviews. The patient‐reported median time to diagnosis was 21 months. On average, the participants visited four different health care providers. Specialists were most likely to make an appropriate referral to otolaryngology that ended in diagnosis. However, when primary care providers referred to otolaryngology, patients experienced a shorter diagnostic odyssey. The most important behavioral‐ecological factors in accelerating diagnosis were strong social support for the patient and providers' willingness to refer. Conclusion: Several factors affected time to diagnosis for iSGS patients. Patient social capital was a catalyst in decreasing time to diagnosis. Patient‐reported medical paternalism and gatekeeping limited specialty care referrals extended diagnostic odysseys. Additional research is needed to understand the effect of patient–provider and provider–provider relationships on time to diagnosis for patients with iSGS. Level of Evidence: 4 Laryngoscope, 134:815–824, 2024 [ABSTRACT FROM AUTHOR]

SUMMARY: By conducting hierarchical clustering along a sliding window, we generated haplotypes across hundreds of re‐sequenced genomes in a few hours. We leveraged our method to define cryptic introgressions underlying disease resistance in tomato (Solanum lycopersicum L.) and to discover resistant germplasm in the tomato seed bank. The genomes of 9 accessions with early blight (Alternaria linariae) disease resistance were newly sequenced and analyzed together with published sequences for 770 tomato and wild species accessions, most of which are available in germplasm collections. Identification of common ancestral haplotypes among resistant germplasm enabled rapid fine mapping of recently discovered quantitative trait loci (QTL) conferring resistance and the identification of possible causal variants. The source of the early blight QTL EB‐9 was traced to a vintage tomato named 'Devon Surprise'. Another QTL, EB‐5, as well as resistance to bacterial spot disease (Xanthomonas spp.), was traced to Hawaii 7998. A genomic survey of all accessions forecasted EB‐9‐derived resistance in several heirloom tomatoes, accessions of S. lycopersicum var. cerasiforme, and S. pimpinellifolium PI 37009. Our haplotype‐based predictions were validated by screening the accessions against the causal pathogen. There was little evidence of EB‐5 prevalence in surveyed contemporary germplasm, presenting an opportunity to bolster tomato disease resistance by adding this rare locus. Our work demonstrates practical insights that can be derived from the efficient processing of large genome‐scale datasets, including rapid functional prediction of disease resistance QTL in diverse genetic backgrounds. Finally, our work finds more efficient ways to leverage public genetic resources for crop improvement. Significance Statement: We introduce a powerful windowed haplotype classification method that can efficiently detect local homology across genomes and predict biological traits in germplasm. We co‐analyzed hundreds of genomic sequences to define and predict introgressions conferring resistance to early blight disease of tomato. These predictions were validated in planta with pathology experiments, demonstrating the functional prediction of quantitative resistance of breeding and research significance. Our haplotype clustering and prediction method is broadly applicable to crops with large genomic datasets. [ABSTRACT FROM AUTHOR]

Utilising novel ingredients in aquafeeds is necessary for the continued expansion and intensification of aquaculture production. Microalgae are utilised widely in aquaculture for a variety of purposes; as live feed for fish and shellfish larvae and juveniles, for the production of algae‐based meals and oils to replace marine derived raw materials in aquafeeds, and for the production of astaxanthin, the carotenoid that gives salmon flesh its characteristic reddish colour. Notably, long‐chain polyunsaturated fatty acids, amino acids, proteins, fibres, antioxidant pigments, vitamins and minerals are among the compounds in microalgae with great biological value. A growing collection of experimental data has demonstrated that these substances are crucial for increasing larval survival and enhancing the growth and well‐being of fish and shellfish. In this review, the processing of microalgae utilised as aquafeed ingredient, the health promoting compounds in microalgae and their role in growth, immunity and disease resistance of fish and shellfish are described and discussed. Simultaneously, major hurdles in the commercial use of microalgae in aquafeed, and future research and development perspectives are all critically discussed. [ABSTRACT FROM AUTHOR]

Background/Objectives: As surgical techniques evolve, there remains underutilisation of secondary intention healing as a valid reconstruction option. This is largely due to concerns regarding inferiority of wound cosmesis, increased downtime with wound healing and infection risk (Dermatol Surg. 2020; 46(12): 1492–97). Methods: We sought to look at the outcome of secondary intention healing in a cohort of patients seen at a private dermatology practice with small to medium sized scalp defects. All patients completed a satisfaction survey that further evaluated its feasibility. Results: Excellent cosmetic outcome was noted with secondary intention healing for small to medium scalp defects, specifically in patients with thinning scalps that allowed healing without patchy alopecia. Conclusions: Secondary intention healing should be considered as a reconstructive option for scalp defects, especially in the right patient cohort. [ABSTRACT FROM AUTHOR]

Objectives: Serial intralesional steroid injection (SILSI) has been increasingly used to treat idiopathic subglottic stenosis (iSGS). Prior studies have shown effectiveness, but not in all patients. This multi‐institutional study evaluates the effect of SILSI on time to recurrent operation, peak expiratory flow (PEF), and dyspnea. Methods: Post‐hoc secondary analysis of the North American Airway Collaborative data were performed to evaluate the outcomes of iSGS patients undergoing and not undergoing SILSI. The primary outcome was time to recurrent operation, evaluated using Kaplan–Meier curves and Cox regression analysis. Secondary outcomes were change in PEF and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score. Within patients undergoing SILSI, demographics, time from last procedure, and PEF at initiation of SILSI were evaluated to determine the effect on recurrence. Results: Two hundred and ninety patients were included, 238 undergoing endoscopic dilation alone and 52 undergoing dilation and SILSI. No differences in baseline characteristics were observed. There was no difference in time to recurrence (hazard ratio: 0.64; p = 0.183). There were no differences in PEF or CCQ across the 2.5‐year study period. Among 52 patients undergoing SILSI, PEF at the time of starting SILSI did not affect recurrence (χ2 = 0.09, p = 0.77). Conclusion: Patients undergoing and not undergoing SILSI had similar times to recurrence, PEF, and CCQ. Factors predicting recurrence among patients undergoing SILSI were not identified. These results support a randomized controlled trial with a uniform SILSI protocol to quantify the effects of SILSI on objective and subjective outcomes and help determine which iSGS patients benefit most. Level of Evidence: 3 Laryngoscope, 133:2255–2263, 2023 [ABSTRACT FROM AUTHOR]

The aims of this review are to describe the role of 'blue‐food production' (animals, plants and algae harvested from freshwater and marine environments) within a circular bioeconomy, discuss how such a framework can help the sustainability and resilience of aquaculture and to summarise key examples of novel nutrient sources that are emerging in the field of fed‐aquaculture species. Aquaculture now provides >50% of the global seafood supply, a share that is expected to increase to at least 60% within the next decade. Aquaculture is an important tool for reducing resource consumption in global protein production and increasing resilience to climate change and other global disruptions (i.e. pandemics, geo‐political instability). Importantly, blue foods also provide essential nutrition for a growing human population. Blue foods are helping to help the global goal of 'zero hunger' (United Nation's Sustainable Development Goal 2) while reducing the dependency on finite natural resources but further refinement and new solutions are needed to make the industry more 'circular' and sustainable, particularly with respect to sourcing raw materials for aquafeeds. This review describes the feed resources that are available or may be created within a circular bioeconomy framework, their role within the framework and in aquaculture and ultimately, how these resources contribute to de‐risking and establishing a resilient aquaculture production chain. [ABSTRACT FROM AUTHOR]

Objective: WWOX is an autosomal recessive cause of early infantile developmental and epileptic encephalopathy (WWOX‐DEE), also known as WOREE (WWOX‐related epileptic encephalopathy). We analyzed the epileptology and imaging features of WWOX‐DEE, and investigated genotype–phenotype correlations, particularly with regard to survival. Methods: We studied 13 patients from 12 families with WWOX‐DEE. Information regarding seizure semiology, comorbidities, facial dysmorphisms, and disease outcome were collected. Electroencephalographic (EEG) and brain magnetic resonance imaging (MRI) data were analyzed. Pathogenic WWOX variants from our cohort and the literature were coded as either null or missense, allowing individuals to be classified into one of three genotype classes: (1) null/null, (2) null/missense, (3) missense/missense. Differences in survival outcome were estimated using the Kaplan–Meier method. Results: All patients experienced multiple seizure types (median onset = 5 weeks, range = 1 day–10 months), the most frequent being focal (85%), epileptic spasms (77%), and tonic seizures (69%). Ictal EEG recordings in six of 13 patients showed tonic (n = 5), myoclonic (n = 2), epileptic spasms (n = 2), focal (n = 1), and migrating focal (n = 1) seizures. Interictal EEGs demonstrated slow background activity with multifocal discharges, predominantly over frontal or temporo‐occipital regions. Eleven of 13 patients had a movement disorder, most frequently dystonia. Brain MRIs revealed severe frontotemporal, hippocampal, and optic atrophy, thin corpus callosum, and white matter signal abnormalities. Pathogenic variants were located throughout WWOX and comprised both missense and null changes including five copy number variants (four deletions, one duplication). Survival analyses showed that patients with two null variants are at higher mortality risk (p‐value =.0085, log‐rank test). Significance: Biallelic WWOX pathogenic variants cause an early infantile developmental and epileptic encephalopathy syndrome. The most common seizure types are focal seizures and epileptic spasms. Mortality risk is associated with mutation type; patients with biallelic null WWOX pathogenic variants have significantly lower survival probability compared to those carrying at least one presumed hypomorphic missense pathogenic variant. [ABSTRACT FROM AUTHOR]

Aims: By analysing cattle‐ and sheep‐grazed sand grasslands, we tested the following hypotheses: (i) livestock type has a stronger effect on the vegetation characteristics than grazing intensity; (ii) sheep grazing results in lower biomass and species and functional diversity than cattle grazing, regardless of intensity; and (iii) increased grazing intensity causes a shift of the trait composition in grasslands. Location: Sand grasslands in the Nyírség region, East Hungary. Methods: We selected 26 sand grassland sites grazed by cattle or sheep and classified them into four intensity levels. Vegetation composition was surveyed in 2 m × 2 m plots. We harvested the above‐ground biomass from 20 cm × 20 cm plots; then dried and sorted it to live biomass, litter, moss, and lichen. We compared Rao dissimilarity index, species richness, Shannon diversity, evenness, and the community‐weighted means of nine vegetative and generative traits along a grazing intensity gradient. We calculated functional richness, evenness, and divergence for comparison. Results: We found that some diversity metrics and community‐weighted means of most studied traits were significantly affected by grazing intensity. Several characteristics were also affected by the interaction of grazing intensity and livestock type, but none of the studied characteristics was affected by livestock type in itself. Increasing Rao dissimilarity index peaking at the fourth grazing intensity level was detected, but for other multitrait indices, no such changes were proven, except for functional divergence, which was the lowest at the first intensity level. Graminoid, forb, and litter biomass were significantly affected by intensity, but none of the biomass fractions was affected by livestock type. Conclusions: We suggest that for the management of sand grasslands, grazing intensity should be carefully adjusted, considering not only livestock units per hectare. For practical recommendations, well‐defined, long‐term experiments studying different livestock and habitat types along an intensity gradient would be essential. [ABSTRACT FROM AUTHOR]

Fragile X syndrome (FXS) is caused by hypermethylation of the FMR1 promoter due to the full mutation expansion (full mutation [FM]: CGG ≥ 200 repeats) and silencing of FMR1. Assessment of mosaicism for active‐unmethylated alleles has prognostic utility. This study examined relationships between FMR1 methylation in different tissues with FMR1 messenger ribonucleic acid (mRNA) and intellectual functioning in 87 males with FXS (1.89–43.17 years of age). Methylation sensitive Southern blot (mSB) and Methylation Specific‐Quantitative Melt Aanalysis (MS‐QMA) were used to examine FMR1 methylation. FMR1 mRNA levels in blood showed strong relationships with FMR1 methylation assessed using MS‐QMA in blood (n = 68; R2 = 0.597; p = 1.4 × 10−10) and buccal epithelial cells (BEC) (n = 62; R2 = 0.24; p = 0.003), with these measures also showing relationships with intellectual functioning scores (p < 0.01). However, these relationships were not as strong for mSB, with ~40% of males with only FM alleles that were 100% methylated and non‐mosaic by mSB, showing methylation mosaicism by MS‐QMA. This was confirmed through presence of detectable levels of FMR1 mRNA in blood. In summary, FMR1 methylation levels in blood and BEC examined by MS‐QMA were significantly associated with FMR1 mRNA levels and intellectual functioning in males with FXS. These relationships were not as strong for mSB, which underestimated prevalence of mosaicism. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to quantitatively compare the effectiveness of unilateral and bilateral botulinum toxin A (BTX‐A) injections for mitigating undesirable weak/breathy voice quality and dysphagia for patients with adductor spasmodic dysphonia and/or essential tremor of voice (ETV). Methods: Data were collected from the medical records of 319 patients, yielding three treatment cohorts: patients who received an equal dose bilateral injection regimen (BL=) throughout their course of treatment at VUMC, patients who switched to a unilateral injection regimen (UL), and patients who switched to an unequal dose bilateral injection regimen (BL≠). Changes in length of improvement, duration of weak/breathy voice, and dysphagia severity were compared. Results: The BL = treatment group reported the longest duration of improved voice. Shorter periods of improved voice were reported at baseline by patients who later switched to UL or BL ≠ injection regimens. Patients receiving UL injections reported significantly reduced weak/breathy voice and dysphagia. Patients receiving BL ≠ injections reported increased length of improved voice; however, dysphagia symptoms increased. Ninety‐two percent of patients with ETV switched to a UL regimen, with 61% of patients transitioning within the first three injections. Conclusions: Patients with pronounced dysphagia and extended periods of weak/breathy voice may benefit from a UL injection approach to mitigate side effects from BTX‐A without sacrificing improved voice outcomes. For patients seeking to extend their length of improved voice, a BL ≠ injection regimen may be effective provided the adverse side effects from BTX‐A are minimal. Patients with ETV may benefit from a UL injection approach at the outset of their course of treatment with BTX‐A. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Objective: To identify barriers and facilitators to adoption of a new surgical procedure via an implementation science framework to characterize associated socioemotional, clinical, and decision-making processes. Study Design: Qualitative study with a semistructured interview approach. Setting: Large tertiary care referral center. Methods: Academic otolaryngologists with at least 2 years of practice were identified and interviewed. Transcripts were thematically coded and separated into steps in the clinical pathway. Synthesis of major themes characterized facilitators and barriers to uptake of a new surgical technique. Results: Of 22 otolaryngologists, 19 were interviewed (85% male). They had a median 18 years of practice (interquartile range, 7.8-26.3), and 65% were subspecialty trained. In the decision to implement a new procedure, improving patient outcomes and addressing unmet clinical needs facilitated adoption, whereas costs and adopting profit-driven technologies without improved outcomes were barriers. In patient consults, establishing trust facilitated implementation of new techniques; barriers included participants' hesitation to communicate about the unknowns of a new procedure. Intraoperatively, little change to existing workflow or improved efficiency facilitated adoption, while a substantial learning curve for the new procedure was a barrier. Achieving favorable outcomes and patient satisfaction sustained implementation of new procedures. Too few referrals or indications for the new procedure hindered implementation. Conclusion: Our study demonstrates that innovation in otolaryngology is often an individual iterative process that providers pursue to improve patients' outcomes. Although models for the oversight of surgical innovation emphasize the need for evidence, obtaining sufficient numbers of providers and patients to generate evidence remains a challenge in specialty surgical practice. [ABSTRACT FROM AUTHOR]

The flavour of aquatic animal products is distinct from terrestrial foods, facilitating a competitive marketing advantage. However, the flavour of aquatic animals can also be highly variable. Importantly, differences are reported in the flavour of animals from aquaculture and wild‐capture systems. These differences can erode consumer acceptance of aquaculture products and reduce financial returns to producers. Mild 'fish‐like', 'marine', 'crustacean‐like', 'seafood' and 'sweet' odours are desirable. However, overt 'fish‐like', 'fatty' and 'earthy' odours are quality deficits and cause products to become unpalatable. Odorous volatile compounds are responsible for eliciting these characteristic odours. In this literature review, the odorous volatile compounds of 96 aquatic animal samples are reported, revealing 291 different compounds. Generalist compounds that are integral to the odour of aquatic animals are presented in addition to 86 compounds that elicit key characteristic odours. The influence of these compounds on aquatic animal flavour is explored and the specific factors likely to affect their manipulation in aquaculture products are discussed. The culture environment and diet are critical factors affecting volatile profiles of aquatic animals and are the variables that can be controlled by aquaculture producers. The information presented in this review can underpin the development of innovative aquaculture strategies that prevent environmental exposure of aquatic animals to unpalatable volatile compounds and facilitate the development of aquaculture diets that optimise the volatile profile of edible tissues. [ABSTRACT FROM AUTHOR]

One hypothesis for the origin of endemic species of tomato on the Galápagos islands postulates a hybridization of Solanum pimpinellifolium and Solanum habrochaites. Solanum galapagense accession LA1141 has purple fruit pigmentation, previously described in green‐fruited wild tomatoes such as S. habrochaites or Solanum chilense. Characterization of LA1141 derived purple pigmentation provides a test of the hybridization hypothesis. Purple pigmentation was recovered in progenies derived from LA1141, and the anthocyanins malvidin 3(coumaroyl)rutinoside‐5‐glucoside, petunidin 3‐(coumaroyl) rutinoside‐5‐glucoside, and petunidin 3‐(caffeoyl)rutinoside‐5‐glucoside were abundant. Fruit color was evaluated in an introgression population, and three quantitative trait loci (QTLs) were mapped and validated in subsequent populations. The loci atroviolacium on chromosome 7, Anthocyanin fruit on chromosome 10, and uniform ripening also on chromosome 10 underly these QTLs. Sequence analysis suggested that the LA1141 alleles of Aft and atv are unique relative to those previously described from S. chilense accession LA0458 and Solanum cheesmaniae accession LA0434, respectively. Phylogenetic analysis of the LA1141 Aft genomic sequence did not support a green‐fruited origin, and the locus clustered with members of the red‐fruited tomato clade. The LA1141 allele of Aft is not the result of an ancient introgression from the green‐fruited clade and underlies a gain of anthocyanin pigmentation in the red‐fruited clade. Highlight: Anthocyanin fruit and atroviolacium confer purple pigmentation in Solanum galapagense LA1141, confirming a mechanism described for green‐fruited tomatoes. LA1141 alleles cluster with red‐fruited homologs suggesting an independent gain of pigmentation. [ABSTRACT FROM AUTHOR]

General academic words are those which are typically learned through exposure to school texts and occur across disciplines. We examined academic vocabulary assessment data from a group of English‐speaking middle school students (N = 1,747). We tested how word frequency, complexity, proximity, polysemy, and diversity related to students' knowledge of target words across ability levels. Our results affirm the strong relation between vocabulary and reading at the individual level. Strong readers were more likely to know the meanings of words than struggling readers were, regardless of the features of the academic words tested. Words with more meanings were easier for all students, on average. The relation between word frequency and item difficulty was stronger among better readers, whereas the relation between word complexity and item difficulty was stronger among less proficient readers. Our examination of academic words' characteristics and how these characteristics relate to word difficulty across reading performance has implications for instruction. [ABSTRACT FROM AUTHOR]

Background: Research on academic development has mainly focused on early time periods with less attention on individual differences in development in the later school years. Methods: To improve our knowledge of how students develop academically during later school years, this study used a multivariate growth model to investigate the developmental trajectories of literacy and math skills in a sample of Australian students in fifth through ninth grades (n = 114). Results: Students progressed at greater average rates in math from primary to secondary school than in literacy. Both literacy and math skills showed significant individual differences in growth rate at Grade 9. There was no evidence of an association between change in math and change in literacy. Primary school socioeconomic status was not a statistically significant predictor of inter‐individual differences in the development of either literacy or math. Conclusions: These results, taken together, suggest that both domain‐general and domain‐specific influences act on the development of these academic skills. Highlights: What is already known about this topicWe know that developmental trajectories for literacy and math skills demonstrate considerable inter‐individual variation in the early school years. The Integrated Intelligent Architecture model, a cognitive model that incorporates procedural knowledge and planning behaviour with the construction–integration process, suggests that these inter‐individual differences will persist into later school years.The developmental trajectories of literacy and math skills are inter‐related and are likely influenced by both domain‐general and, to a lesser degree, domain‐specific factors.There is substantial evidence that socioeconomic status acts as a domain‐general predictor of individual differences in school achievement over time. What this paper addsMuch of the research to date has focused on early developmental time periods with less attention devoted to individual differences in development in the later school years. Less is known about developmental trajectories of writing. This study helps to fill these gaps by using a multivariate framework focused on the core academic outcomes of literacy and math to examine individual differences in development during the later school grades.By examining whether development in literacy is associated with development in math, or whether developmental trajectories unfold independently of each other, we can provide evidence for domain‐specific or domain‐general influences on academic development. SES was included as a potential domain‐general predictor in the model. Implications for theory, policy or practiceOur results suggested that continued knowledge‐integration processes may underlie literacy and math ability in ninth grade.Additionally, this study provided evidence for domain‐general and domain‐specific influences on the development of academic skills from primary to secondary school. SES was not a significant domain‐general predictor, suggesting that other domain‐general predictors should be considered. [ABSTRACT FROM AUTHOR]

Objectives: Paradoxical vocal fold movement (PVFM) is often misdiagnosed as asthma and tends to have a prolonged time to diagnosis. Study aims were to estimate the time from dyspnea onset to PVFM diagnosis, to estimate associated pre‐ and postdiagnosis direct and indirect healthcare cost, and to compare the cost of postdiagnosis care among patients who did and did not undergo standard‐of‐care speech therapy. Methods: Patients diagnosed with PVFM were identified retrospectively. Time from dyspnea symptom onset to diagnosis was measured. Direct costs consisting of office visits, procedures, and prescribed pharmaceuticals before and after diagnosis were calculated. Indirect costs associated with lost wages related to healthcare were also estimated. Costs for patients who initiated versus did not initiate speech therapy and who had successful versus unsuccessful therapy were compared. Results: Among 110 patients, median time from dyspnea onset to PVFM diagnosis was 33 months (interquartile range [IQR] 5–60). Direct and indirect prediagnosis median costs were $8,625 (IQR $1,687–$35,812) and $736 (IQR $421–$1,579) while first year following dyspnea symptom onset median direct and indirect costs were $1,706 (IQR $427–$7,118) and $315 (IQR $131–$631). Median direct and indirect costs of care in the postdiagnosis year were $2,062 (IQR $760–$11,496) and $841 (IQR $631–$1,261). Pharmaceuticals were predominant cost drivers in all time periods. Of those who completed speech therapy, 85% had breathing symptom improvement while incurring significant cost savings compared to those whose symptoms persisted. Conclusion: Costs of care leading to diagnosis of PVFM are substantial. More efficient methods of identifying patients with PVFM are essential to reduce prolonged time to diagnosis and associated costs. Level of Evidence: NA Laryngoscope, 132:142–147, 2022 [ABSTRACT FROM AUTHOR]

The FMR1 premutation (PM:55‐199 CGG) is associated with fragile X‐associated tremor/ataxia syndrome (FXTAS) and when maternally transmitted is at risk of expansion to a hypermethylated full mutation (FM: ≥ 200 CGG) that causes fragile X syndrome (FXS). We describe a maternally transmitted PM (77 CGG) that was passed to a son (103 CGG), and to a daughter (220–1822 CGG), who were affected with FXTAS and FXS, respectively. The male with the PM showed low‐level mosaicism for normal size of 30 and 37 CGG. This male had two offspring: one female mosaic for PM and FM (56, 157, >200 CGG) and another with only a 37 CGG allele detected in multiple tissues, neither with a clinical phenotype. The female with the 37 CGG allele showed normal levels of FMR1 methylation and mRNA and passed this 37 CGG allele to one of her daughters, who was also unaffected. These findings show that post‐zygotic paternal retraction can lead to low‐level mosaicism for normal size alleles, with these normal alleles being functional when passed over two generations. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: We sought to establish normative peak expiratory flow (PEF) data for patients with idiopathic subglottic stenosis (iSGS), evaluate whether immediate changes in PEF after a procedure predict long‐term treatment response, and test if a decline in longitudinal PEF is associated with disease recurrence. Study Design: International, prospective, 3‐year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS. Methods: iSGS patients consented and enrolled in the North American Airway Collaborative (NoAAC) iSGS1000 cohort recorded PEF data on a mobile smartphone app. Cox regression tested the associations between the magnitude of postoperative PEF improvement and longitudinal 90‐day PEF decline with the risk of disease recurrence. Results: Within the NoAAC iSGS1000 cohort, 810 patients participated in a 3‐year prospective study comparing surgical treatment efficacy and 385 had appropriate PEF measurements and follow‐up data. Of those patients, 42% (161/385) required at least one operation during study follow‐up. The mean PEF preceding operative intervention was 241 L/min (95% confidence interval [CI]: 120–380) corresponding to a predicted PEF of 52%. The mean increase in PEF following a procedure was 111 L/min (95% CI: 96–125 L/min). Interestingly, the magnitude of immediate PEF improvement was not predictive of disease recurrence (hazard ratio [HR] for 100 L/min increase = 0.90, 95% CI: 0.60–1.00). However, recurrence was associated with the magnitude of PEF decline over 90 days (30% vs. 10% decline, HR = 2.2, 95% CI: 1.5–3.0). Conclusions: We provide normative PEF data on a large iSGS patient cohort. The degree of PEF improvement immediately after surgery was not associated with a longer procedure‐free interval. However, a 30% decline in PEF over 90 days was associated with elevated risk of disease recurrence. Level of Evidence: 2 Laryngoscope, 131:E2841–E2848, 2021 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Adjuvant medications including proton pump inhibitors (PPI), antibiotics (trimethoprim/sulfamethoxazole [TMP‐SMX]), and inhaled corticosteroids (ICS) may be prescribed for patients with idiopathic subglottic stenosis (iSGS). We describe medication use with endoscopic dilation (ED) or endoscopic resection with medical treatment (ERMT) and evaluate impact on outcomes. Study Design: International, prospective, 3‐year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS. Methods: Post hoc secondary analysis of prospectively collected North American Airway Collaborative data on outcomes linked with adjuvant medication utilization. Primary outcome was time to recurrent operation, evaluated using Kaplan–Meier curves and Cox regression analysis. Secondary outcomes of change in peak expiratory flow (PEF) and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score over 12 months were compared. Results: Sixty‐one of 129 patients undergoing ED received PPI (47%), and 10/143 patients undergoing ED received ICS (7%). TMP‐SMX was used by 87/115 patients (76%) undergoing EMRT. PPI use in the ED group did not affect time to recurrence (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.53–1.88; P =.99) or 12‐month change in PEF (L/min) (median [interquartile range], 12.0 [10.7–12.2] vs. 8.7 [−5.1 to 24.9]; P =.59), but was associated with 12‐month change in CCQ (−0.05 [−0.97 to 0.75] vs. −0.50 [−1.60 to 0.20]; P =.04). ICS did not affect outcome measures. TMP‐SMX use in ERMT did not affect time to recurrence (HR = 0.842, 95% CI: 0.2345–3.023; P =.79), PEF at 12 months (75 [68–89] vs. 81 [68–89]; P =.92), or 12‐month change in CCQ (0.20 [−1.05 to 0.47] vs. −0.30 [−1.00 to 0.10]; P =.45). Conclusion: There is no standard practice for prescribing adjuvant medications. These data do not support that adjuvant medications prolong time to recurrence or increase PEF. Patients with iSGS and gastroesophageal reflux disease may experience some symptom benefit with PPI. Level of Evidence: 3 Laryngoscope, 131:E2880–E2886, 2021 [ABSTRACT FROM AUTHOR]

Objectives: To determine the factors that shape utilization of social media‐based online support communities (OSCs) and study the influence of these communities on medical decision‐making in patients with Idiopathic Subglottic Stenosis (iSGS). Study design: Survey study. Methods: A survey investigating OSC use was sent to the 1,056 members of the North American Airway Collaborative (NoAAC) iSGS1000 cohort in January 2018. Responses were merged with the existing NoAAC data set containing extensive demographic data, disease‐specific history, and responses to validated patient‐reported outcome measures. Results: A total of 755 individuals with iSGS and mean age of 51.8 ± 11.6 years were included (99% female, 98% white, 63% college educated) and 58% were OSC users. Younger age, female gender, and college education were each associated with OSC use (P <.05). Users spent 2.5 ± 3.3 hours per week on the platforms. Time spent on OSC was not associated with total number of prior treatments. Higher disease anxiety (FoP‐Q, R = 0.26, P <.001), lower social support (MOS, R = −0.12, P =.037), and lower level of shared‐decision‐making with the treating physician (SDM‐Q9, R = −0.16, P =.007) were weakly associated with more hours spent engaging an OSC. OSC use influenced treatment and physician choice in 35% and 26% of users, respectively. Increased time spent on OSC use was associated with increased influence on patient medical decisions regarding treatment, surgery, and physician choice (P <.05). Conclusion: OSC engagement is common in patients with iSGS. Disease anxiety, social support, and relationship with the physician may influence OSC utilization. More OSC engagement weakly associated with greater OSC influence on patient medical decision‐making. Level of Evidence: NA. Laryngoscope, 131:1821–1827, 2021 [ABSTRACT FROM AUTHOR]

This figure has been digitally altered to improve visibility of the SNP (single nucleotide polymorphism) array probes. gl The proband's clinical diagnosis of APECED was confirmed and he was commenced on intravenous corticosteroids for immunosuppression. Microarray diagnosis of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy caused by a novel homozygous intragenic AIRE deletion The proband is indicated by the arrow. gl The proband presented to our centre at age 15 years with the additional feature of hepatitis with elevated transaminases and decreased synthetic function resulting in coagulopathy. [Extracted from the article]

In this cluster randomized control trial study, the authors explored the efficacy of an intervention designed to improve second‐grade English learners' knowledge of challenging, high‐utility English vocabulary. The authors also examined whether the intervention had a differential effect on content words that differ on two attributes (cognate status and abstractness designation) and whether the effects lasted across time. Within schools, teachers were randomly assigned to treatment or control conditions, resulting in 12 treatment classrooms and 10 control classrooms. Teachers in the treatment condition developed vocabulary using six methods: interactive shared reading, direct instruction of individual words, instruction in cognate use, activities to foster word consciousness and reinforce instructed words, and use of visual and linguistic supports. Teachers in the control condition read the same books with the target vocabulary inserted into the stories. Findings on the curriculum‐based and standardized measure of vocabulary indicated that the intervention implemented for four 50‐minute lessons per week for 18 weeks was effective in helping English learners acquire challenging high‐utility school‐relevant vocabulary (Cohen's d = 1.88 for content words; d = 0.41 for connecting words; d = 0.47 for the Test of Oral Language Development). The effects differed by word characteristics, with higher effect sizes for words that are noncognates (d = 1.57 for both concrete and abstract noncognates; d = 1.02 concrete cognates; d = 0.81 for abstract cognates). Ten months after the intervention, treatment students still outperformed control students on content vocabulary learned during the intervention (d = 1.31). This study helps validate a multifaceted approach to vocabulary intervention and research. [ABSTRACT FROM AUTHOR]

Fragile X syndrome (FXS) is caused by CGG expansions of ≥200 repeats (full mutation: FM). Typically, FM causes abnormal methylation of the FMR1 promoter and silencing of FMR1, leading to reduction of FMRP, a protein essential for normal neurodevelopment. However, if unmethylated, these alleles cause over‐expression of FMR1 mRNA which has been associated with Fragile X Tremor and Ataxia Syndrome (FXTAS), a late onset disorder. This report details the molecular and clinical profile of an asymptomatic male (29 years) identified as a result of cascade testing who was found to have a rare unmethylated FM (UFM) allele, as well as premutation (PM: 55–199 CGG) size alleles in multiple tissues. Full‐scale IQ was within the normal range and minimal features of autism were observed. Southern blot analysis identified FM smears in blood (220–380 CGG) and saliva (212–378 CGG). A PM of 159 CGG was identified in blood and saliva. FMR1 promoter methylation analysis showed all alleles to be unmethylated. FMR1 mRNA levels were greater than fivefold of median levels in typically developing controls and males with FXS mosaic for PM and FM alleles. Issues raised during genetic counseling related to risk for FXTAS associated with UFM and elevated FMR1 mRNA levels, as well as, reproductive options, with implications for future practice. [ABSTRACT FROM AUTHOR]

We highlight a potential major complication from GlideScope intubation—perforation of the soft palate. With increasing use of video laryngoscopy, precautions must be taken to ensure that its continued use does not increase airway complications. [ABSTRACT FROM AUTHOR]

Objective: Cross-frequency coupling has been reported in the STN of patients with PD, but its significance and functional role are still not well understood. This study investigates pharmacological modulations of subthalamic oscillations and their nonlinear cross-frequency interactions across three consecutive cycles over unique 24-hour-long recordings.Background: Identifying neurobiomarkers for PD can drive the development of novel personalized treatments by providing objective assessment of impairment. In particular, distinct frequency bands in LFP recordings and their interaction with one another have been shown to modulate with dopaminergic medication and thus, proposed as such biomarkers.Methods: We recorded local field potentials 3 weeks postoperatively from externalized leads in 9 patients and correlated the neural patterns with improvements in motor signs over three medication intake cycles. We used two modalities to assess symptoms in the unmedicated OFF and the l-dopa-induced motor ON state: a subsection of the UPDRS and a keyboard tapping score measuring bradykinesia.Results: In the OFF state, the amplitude of high-frequency oscillations in the 200- to 300-Hz range was coupled with the phase of low-beta (13-22 Hz) in all patients. After transition to the ON state, three distinct coupling patterns were observed among subjects. Among these, patients showing ON coupling between high-beta (22-30 Hz) and high-frequency oscillations in the 300- to 400-Hz range had significantly greater improvement in bradykinesia, according to the keyboard scores.Conclusion: Observing diminished coupling in the ON state, previous studies have hypothesized that the sole existence of coupling in STN has an "impeding" effect on normal processes, and thus it was considered to be pathological. In contrast, our observation of ON state coupling at distinct frequencies associated with the improvements in motor features suggest that the underlying mechanism of coupling might have impeding or enhancing effects depending on the coupled frequencies. © 2019 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Articles in this issue examine (1) the primary sources of variability in reading and language achievement among Spanish‐speaking English learners (ELs) in the United States, (2) the extent to which poor performance at the end of grade 2 is identifiable in developmental trajectories beginning in kindergarten, (3) the relations among core reading constructs of phonological awareness and decoding in both English and Spanish and the factors that affect their relationship, (4) the performance of different approaches to identification and the factors that influence how well they work, as well as (5) the growing literature focused on intervention for reading problems in this population. This article examines the literature on language minority students and disability identification and analyzes a large‐scale longitudinal dataset (>4,000 ELs; >15,000 observations) to systematically characterize and describe the oral language and reading development of Spanish‐speaking children designated as ELs from kindergarten to second grade, considering a range of factors that may potentially contribute to that characterization and its relation to academic performance. This systematic characterization should facilitate the development of an empirical basis for a theoretically grounded framework of typical development in ELs in order to more precisely identify those children with language and learning disabilities. [ABSTRACT FROM AUTHOR]

This article serves as an introduction to the special issue on Identification, Classification, and Treatment of Reading and Language Disabilities in Spanish‐speaking English Learners. The article explains the driving forces behind the need for the special issue, the global nature of linguistic diversity, and provides an overview of the five papers that comprise the special issue. [ABSTRACT FROM AUTHOR]

This study investigated the dimensionality of bilingual phonological awareness (PA) in English and Spanish by replicating a kindergarten model in Grade 1, and presents alternatives to modeling clustered data. English and Spanish tasks were analyzed from previously collected samples totaling 1,586 first grade Spanish‐speaking English learners. Four distinct approaches to confirmatory factor analysis (CFA) models were examined: (a) uncentered student‐level data, (b) student‐level data centered at the classroom means, (c) classroom‐level data, and (d) multilevel CFA. Results indicated that while the multilevel CFA provided the most comprehensive view of the data, the multi‐level student‐level estimates were not appreciably different from estimates based on student‐level data centered at the classroom means, and multi‐level classroom‐level estimates were comparable to estimates based on the analysis of classroom means. Importantly, English and Spanish PA were statistically separable at the student‐level, but minimally distinct (r = .86) and slightly less correlated than what has been reported for kindergarten (r = .93). At the classroom level, the correlation was moderate (r = .51), and substantially reduced compared to kindergarten (r = .83). The distinction at the classroom‐level between kindergarten and Grade 1 implies that instruction differentiates the abilities across languages at the classroom‐level, but less so at the student‐level. [ABSTRACT FROM AUTHOR]

This article examines the validity of IQ‐achievement discrepancy and low achievement as criteria for the identification of disabilities in Spanish‐speaking English‐language learners (ELs) and the factors that moderate the validity of these approaches as bases for identification. While there has been a long history of examining the validity of different approaches to disability identification in monolinguals, there are no systematic approaches taken for ELs. Data from Grades 1 and 2 of a large longitudinal data set consisting of young Spanish‐speaking students attending schools in the United States were used to empirically examine criteria for disability identification among language minority children—one of the first large‐scale attempts. Findings indicated significant overidentification when the language of assessment was not matched to the language of the instruction, although the effects varied predictably over time and by language of instruction. Validation of classifications using measures external to the classification found that low achieving and discrepant children differ from typically developing children, and from one another in predictable ways based on differences in IQ. The study highlights the importance of taking into account the language of instruction and the severity of the cut‐off to reduce misidentification of typically developing children. [ABSTRACT FROM AUTHOR]

This study investigated early indicators of Spanish‐speaking English learners (ELs) at risk for reading difficulties at the end of Grade 2 by examining their early bilingual oral language development, taking into account language of academic instruction. Standardized measures of reading and narrative samples were collected in English and Spanish from kindergarten to Grade 2 from 1,243 ELs primarily instructed in English or Spanish. Conditional growth curve models yielded four primary findings of reading and oral language development. First, ELs with low reading achievement at the end of Grade 2 demonstrated early reading difficulties during kindergarten. Second, although ELs demonstrated overall higher reading achievement in their instructed language, this difference decreased over time. Third, ELs with low reading achievement at the end of Grade 2 demonstrated lower oral language skills in each language over time. Fourth, ELs demonstrated overall higher oral language skills in their instructed language, yet these differences varied over time. The study provided a detailed description of the longitudinal relations among the bilingual reading and oral language skills of Spanish‐speaking ELs during the early school years. These findings help to inform the processes of early identification and intervention for Spanish‐speaking ELs who are likely to demonstrate reading achievement difficulties. [ABSTRACT FROM AUTHOR]

Objective: To compare presenting characteristics of patients with adductor spasmodic dysphonia (ADSD), ADSD with laryngeal tremor (ADSD + LT), and laryngeal tremor without ADSD (LT).Design: Cross-sectional analysis.Methods: Patients treated for laryngeal movement disorders (1990-2016) were included. Analysis of variance and chi square tests measured differences in patient characteristics across the three disease groups. Using ADSD as the referent, multivariable logistic regression models were used to determine whether potential risk factors including patient demographics, family history, presence of potential inciting events prior to disease onset, and coprevalent movement disorders were associated with ADSD + LT or LT.Results: In all, 652 patients with ADSD (n = 377), ADSD + LT (n = 98), and LT (n = 177) were included. ADSD patients were significantly younger than those with ADSD + LT and LT (52.5 ± 13.4, 63.9 ± 11.3, and 69.3 ± 10.5 years, respectively; P < 0.001). Coprevalent movement disorders were more common in ADSD + LT (38.7%) and LT (57.1%) groups than in the ADSD group (11.5%; P < 0.001). Compared to ADSD, patients with ADSD + LT and LT were more likely to develop an additional movement disorder during follow-up. In multivariable analyses, increasing age, female gender, and having a movement disorder at presentation were associated with significantly greater odds of having ADSD + LT or LT when compared to ADSD.Conclusion: ADSD + LT patients demonstrate intermediate gender composition and age distributions between those with ADSD and LT. These findings suggest that ADSD + LT may be a distinct phenotype in the spectrum of laryngeal movement disorders.Level Of Evidence: 4 Laryngoscope, 129:170-176, 2019. [ABSTRACT FROM AUTHOR]

Objective/hypothesis: This study aimed to determine the clinical and cost-effectiveness of endoscopes during cholesteatoma surgery. More specifically, this study hypothesized that endoscope use would reduce cholesteatoma recurrence rates and cost.Study Design: Case series involving the prospective enrollment of 110 consecutive cholesteatoma patients over a 2-year period.Methods: Patients underwent cholesteatoma surgery with microscopy. During dissection, the location of the cholesteatoma was assessed. At the end of dissection and before reconstruction, the same subunits were visualized with straight and angled endoscopes for residual cholesteatoma. Hearing was analyzed before surgery and at the last possible examination. Costs were analyzed using Medicare reimbursement rates from the Centers for Medicare and Medicaid Services.Results: Intraoperative endoscopic surveillance was able to detect residual cholesteatoma in 18 patients. With a 0° endoscope, residual cholesteatoma was noted in the epitympanum (two patients), sinus tympani (one patient), and the supratubal air cells (one patient). With a 45° endoscope, residual cholesteatoma was noted in the epitympanum (three patients), sinus tympani (nine patients), the supratubal air cells (two patients), and the mesotympanum (two patients). From a cost analysis, endoscopic surveillance ($6110.36 per patient) are less expensive than second look surgeries ($11,829.83 per patient), observation ($7097.20 per patient), and observation with annual magnetic resonance imaging studies ($9891.95 per patient). The patients hearing improved after surgery, consistent with previous studies. No complications were noted from the use of endoscopes.Conclusions: Intraoperative endoscopic surveillance reduced recurrence in our series of 110 patients. Endoscopes are particularly useful in evaluating the epitympanum, mesotympanum, sinus tympani, and supratubal air cells. Moreover, endoscopic surveillance is cost-effective.Level Of Evidence: 4 Laryngoscope, 128:2867-2871, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Intubation is an essential component of intensive care, yet it does have potential complications. Posterior glottic stenosis (PGS) is among the most severe sequela. Risk factors are poorly understood. One hypothesis is that large endotracheal tubes (ETTs) in smaller airways may increase risk. Because tracheal diameter is proportional to height, we designed a case-control study to evaluate the association between intensive care unit (ICU)-patient height (proxy for tracheal diameter) and their risk of postintubation PGS.Study Design: Retrospective case-control study METHODS: Among patients who underwent intubation in an ICU at a single tertiary care medical center between 2001 and 2015, a convenience sample of all patients with confirmed PGS (cases) were enrolled. Cases were matched 1:1 by age, sex, and race with intubated non-PGS controls chosen from the same population of ventilated patients. Data on height, weight, comorbidities, size of ETT, and duration of intubation were abstracted from the medical record. Multivariate models were used to test the association between patient height and risk of PGS development.Results: In all, 106 PGS cases (mean age 48.9 years, 50.7% female, 79.2% Caucasian) were identified; 77 met inclusion criteria. Compared to matched controls, cases were significantly shorter (mean 166 cm vs. 173 cm, P = .001). Height and PGS showed an inverse relationship in multivariate models. Specifically, odds of PGS decreased 9% (95% confidence interval: 0.01%-16%) for each centimeter increase in height.Conclusions: Shorter height is independently associated with increased odds of having PGS. Further work should consider whether height should be incorporated into ETT selection algorithms.Level Of Evidence: 3b Laryngoscope, 128:2811-2814, 2018. [ABSTRACT FROM AUTHOR]

Objective To determine if immediate postoperative uncuffed tracheostomy placement following oral cavity or oropharyngeal head and neck free flap reconstruction is associated with shorter hospital length of stay and higher inpatient decannulation rates without an increase in respiratory complications, as compared with immediate placement of cuffed tracheostomy. Study Design Retrospective cohort. Setting Tertiary referral center. Subjects and Methods Patients were included if they underwent free flap reconstruction for oral cavity or oropharyngeal squamous cell carcinoma and had an intraoperative tracheostomy placed between 2005 and 2016. In 2012, head and neck surgeons changed from routine placement of cuffed to uncuffed tracheostomy tubes immediately after free flap reconstruction. This study compares length of hospital stay, inpatient decannulation rates, and respiratory complications between patients who had cuffed and uncuffed tracheostomies. Analysis of variance and chi-square test were used to examine continuous and categorical variables, respectively. Multivariable regression analyses were performed to determine whether cuff status was independently associated with primary outcomes of length of hospital stay, decannulation, and respiratory complications. Results Of 752 patients who underwent free flap reconstruction, 493 patients met inclusion criteria (cuffed, n = 366; uncuffed, n = 127). Patient variables (ie, age, sex, body mass index, prior chemoradiation) and tumor characteristics (ie, location, stage) did not differ significantly between groups. Adjusted analysis showed that an uncuffed tracheostomy (vs a cuffed tracheostomy) was associated with shorter length of stay (7.7 vs 9.7 days, P < .001) and did not increase the rate of respiratory complications. Conclusion Immediate placement of a uncuffed tracheostomy after oral cavity or oropharyngeal free flap reconstruction is associated with shorter hospital stays without an increase in respiratory complications. [ABSTRACT FROM AUTHOR]

Background and Objective There is convincing evidence that small CGG expansion (41-54 repeats): FMR1 "gray zone" alleles (GZ) contribute to the risk of parkinsonism in males, but there is insufficient corresponding data in females. This study intends to fill this gap. Methods We screened whole-blood-derived DNA from a cohort of 601 females diagnosed with idiopathic PD, and from dry Guthrie blood spots from a local sample of 1,005 female newborns (population controls), for the size of the FMR1 CGG repeat using a PCR technique. Results We found a significant excess (8.2%) of GZ carriers compared with 5.2% in the control sample, with a P value of 0.009 for the difference in proportions. Conclusion FMR1 gray zone alleles are a significant risk factor for parkinsonism in females. These population data and occasional reports of FXTAS-like or parkinsonian manifestations in carriers suggest possible mechanisms whereby the effects of these alleles synergize with the existing pathologies underpinning parkinsonism. © 2018 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Abstract: Ocean warming (OW) and ocean acidification (OA) are threatening coral reef ecosystems, with a bleak future forecast for reef‐building corals, which are already experiencing global declines in abundance. In contrast, many coral reef sponge species are able to tolerate climate change conditions projected for 2100. To increase our understanding of the mechanisms underpinning this tolerance, we explored the lipid and fatty acid (FA) composition of four sponge species with differing sensitivities to climate change, experimentally exposed to OW and OA levels predicted for 2100, under two CO2 Representative Concentration Pathways. Sponges with greater concentrations of storage lipid, phospholipids, sterols and elevated concentrations of n‐3 and n‐6 long‐chain polyunsaturated FA (LC PUFA), were more resistant to OW. Such biochemical constituents likely contribute to the ability of these sponges to maintain membrane function and cell homeostasis in the face of environmental change. Our results suggest that n‐3 and n‐6 LC PUFA are important components of the sponge stress response potentially via chain elongation and the eicosanoid stress‐signalling pathways. The capacity for sponges to compositionally alter their membrane lipids in response to stress was also explored using a number of specific homeoviscous adaptation (HVA) indicators. This revealed a potential mechanism via which additional CO2 could facilitate the resistance of phototrophic sponges to thermal stress through an increased synthesis of membrane‐stabilizing sterols. Finally, OW induced an increase in FA unsaturation in phototrophic sponges but a decrease in heterotrophic species, providing support for a difference in the thermal response pathway between the sponge host and the associated photosymbionts. Here we have shown that sponge lipids and FA are likely to be an important component of the sponge stress response and may play a role in facilitating sponge survival under future climate conditions. [ABSTRACT FROM AUTHOR]

Objective To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Data Sources PubMed, Embase (OVID), and CINAHL (EBSCO). Review Methods English-language, original research (systematic reviews/meta-analyses, randomized control trials, prospective or retrospective cohort studies, case-control studies, or case series) studies that evaluated the role of perioperative antibiotic use in common otolaryngology surgeries were systematically extracted using standardized search criteria by 2 investigators independently. Conclusions Current evidence does not support routine antibiotic prophylaxis for tonsillectomy, simple septorhinoplasty, endoscopic sinus surgery, clean otologic surgery (tympanostomy with tube placement, tympanoplasty, stapedectomy, and mastoidectomy), and clean head and neck surgeries (eg, thyroidectomy, parathyroidectomy, salivary gland excisions). Antibiotic prophylaxis is recommended for complex septorhinoplasty, skull base surgery (anterior and lateral), clean-contaminated otologic surgery (cholesteatoma, purulent otorrhea), and clean-contaminated head and neck surgery (violation of aerodigestive tract, free flaps). In these cases, antibiotic use for 24 to 48 hours postoperatively has shown equal benefit to longer duration of prophylaxis. Despite lack of high-quality evidence, the US Food and Drug Administration suggests antibiotic prophylaxis for cochlear implantation due to the devastating consequence of infection. Data are inconclusive regarding postoperative prophylaxis for nasal packing/splints after sinonasal surgery. Implications for Practice Evidence does not support the use of perioperative antibiotics for most otolaryngologic procedures. Antibiotic overuse and variability among providers may be due to lack of formal practice guidelines. This review can help otolaryngologists understand current evidence so they can make informed decisions about perioperative antibiotic usage. [ABSTRACT FROM AUTHOR]

Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia. [ABSTRACT FROM AUTHOR]

This plain language summary for patients serves as an overview in explaining hoarseness (dysphonia). The summary applies to patients in all age groups and is based on the 2018 "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)." The evidence-based guideline includes research to support more effective identification and management of patients with hoarseness (dysphonia). The primary purpose of the guideline is to improve the quality of care for patients with hoarseness (dysphonia) based on current best evidence. [ABSTRACT FROM AUTHOR]