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Growth and extensive urbanisation of the human population has been accompanied by increased manufacture and use of chemical compounds. To classify the fate and behaviour of these compounds in the environment, a series of international standardised biodegradation screening tests (BSTs) were developed over 30 years ago. In recent years, regulatory emphasis (e.g. REACH) has shifted from measuring biodegradation towards prioritisations based on chemical persistence. In their current guise, BSTs are ineffective as screens for persistence. The marine BST OECD 306 in particular is prone to high levels of variation and produces a large number of fails, many of which can be considered false negatives. An ECETOC funded two-day workshop of academia, industry and regulatory bodies was held in 2015 to discuss improvements to the marine BSTs based on previous research findings from the Cefic LRI ECO11 project and other foregoing studies. During this workshop, methodological improvements to the OECD 306 test were discussed, in addition to clarifying guidance on testing and interpretation of results obtained from marine BSTs (such as pass criteria, lag phases, freshwater read across and complex substances). Methodologically: (i) increasing bacterial cell concentrations to better represent the bacterial diversity inherent in the sampled environments; and (ii) increasing test durations to investigate extended lag phases observed in marine assessments, were recommended to be validated in a multi-institutional ring test.

Purpose The primary purpose of this study was to report the prevalence of femoral head articular damage in patients with a central acetabular osteophyte (CAO) that was identified during hip arthroscopy and compare it with that in a matched control group without a CAO. A secondary purpose was to identify rates of coexisting intra-articular pathology in both patient groups. Methods Intraoperative data were collected prospectively on all hip arthroscopy patients at our institution between 2008 and 2015. The inclusion criteria for this study were CAOs identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement. The exclusion criteria were Tonnis grade greater than 0, previous hip conditions, and prior surgical interventions. The matched control group was selected based on sex, age ± 5 years, body mass index, and Workers' Compensation claim at a 3:1 ratio and comprised patients who underwent hip arthroscopy for a labral tear and/or femoroacetabular impingement without a CAO. The size and location of labral tears and chondral lesions were recorded in square millimeters with a 5-mm probe and by the clock-face method. Results The CAO group consisted of 126 patients, who were matched to 378 patients in the control group. Femoral and acetabular chondral damage grades were significantly different between the 2 groups ( P 2 in the CAO group and 1.7 cm 2 in the control group. The mean size of acetabular chondral damage was 1.7 cm 2 in the CAO group and 1.2 cm 2 in the control group. Both femoral and acetabular chondral damage sizes were significantly larger in the CAO group ( P ≤ .007). The prevalence of ligamentum teres tears was significantly different between the 2 groups ( P P = .625). Conclusions This study showed that patients with CAOs had a significantly higher prevalence of femoral chondral damage and ligamentum teres tears than matched controls. Level of Evidence Level III, comparative study.

Introduction Herbal medicine and other forms of complementary and alternative medicine (CAM) are used to treat symptoms of psychiatric disorders in the United States, including anxiety and mood problems. In Traditional Tibetan Medicine anxiety and depression are commonly treated with an herbal compound known as Agar-35. Objective The objective of this pilot study was to explore whether Agar-35 tea would improve anxiety, affect, stress, and rumination. Methods Undergraduate psychology students ( N =14) were randomized to drink either Agar-35 tea ( n =6) or placebo tea ( n =8) for 7 nights. Results The results indicated that Agar-35 significantly reduced participants' negative affect compared to placebo, U = 6.0, p = .019, effect size, r = .63. Further, Agar-35 also reduced anxiety (trending toward significance), U = 10.0, p = .071, effect size, r = .48. Conclusion In accordance with its use in Tibetan Medicine, these preliminary findings suggest that Agar-35 may benefit aspects of psychological health.

Background Long segment tracheobronchial stenosis is a rare congenital anomaly that can also occur in combination with abnormal bronchial arborization. Long segment tracheal reconstruction in the setting of a supernumerary bridging bronchus has been reported; however, these repairs can be particularly complex. We present our experience using the bridging bronchus to augment long segment tracheal stenosis with a side-to-side tracheobronchoplasty. Methods Four patients with complex long segment tracheobronchial stenosis involving a bronchus suis (right upper lobe bronchus) and a bridging bronchus presented with refractory respiratory distress requiring urgent tracheal reconstruction. Patient 1 was initially managed with modified slide tracheoplasty and tracheostomy. Patients 2, 3, and 4 were managed with single-stage procedures. All patients underwent definitive long segment tracheobronchoplasty consisting of a side-to-side anastomosis between the bridging bronchus and the right upper lobe bronchus. Results Age at surgery was 569, 69, 24, and 142 days, respectively. Weight at surgery was 9.3, 4.3, 2.7, and 5.9 kg. All patients were weaned from mechanical ventilation at 84, 13, 47, and 8 days after side-to-side tracheobronchoplasty. All patients were alive and free from tracheostomy at follow-up of 6.7, 3.8, 2.7, and 0.5 years. Conclusions Side-to-side tracheal reconstruction is feasible in severe cases of long segment tracheal stenosis with a right upper lobe bronchus and a bridging bronchus. This technique can be successfully applied in high-risk patients and in the neonatal period and can provide excellent midterm results.

Purpose To report clinical outcomes in patients with borderline dysplasia undergoing an arthroscopic technique of labral seal restoration with minimal acetabular rim resection and capsular plication. Methods Patients younger than 40 years with a lateral center-edge angle of 18° greater and 25° or less and 2-year follow-up after undergoing an arthroscopic technique of labral seal restoration with minimal rim resection (≤2 mm) and capsular plication (3-5 sutures placed in an oblique orientation to create an imbrication and inferior shift) were included. Patients underwent arthroscopy for symptoms that had marginal improvement with a minimum 6-week structured physical therapy program. Patients with a Tonnis grade of 1 or greater, a center-edge angle of 17° or less, and Legg-Calve-Perthes disease were excluded. The following patient-reported outcomes (PROs) were recorded prospectively but retrospectively reviewed: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score–Sports-Specific Subscale, and Hip Outcome Score–Activities of Daily Living. The visual analog scale score, patient satisfaction score, complications, and revision procedures were also recorded. A 2-tailed paired t test was used to analyze change in preoperative to postoperative PRO scores. Significance was defined as P Results During the study period, 232 hip arthroscopies were performed in patients with a lateral center-edge angle between 18° and 25°. The inclusion criteria were met by 59 procedures. Of these procedures, 55 (93.2%) were available for follow-up. The labrum was repaired, debrided, and reconstructed in 37 procedures, 17 procedures, and 1 procedure, respectively. The iliopsoas was released in 34 procedures, the ligamentum teres was debrided in 29, and femoral osteoplasty was performed in 32. At 2-year follow-up, there was significant improvement in the mean scores of all PROs compared with baseline. Mean improvements for the modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, and Non-Arthritic Hip Score were 20.7, 17.5, 27.6, and 20.0, respectively. There was significant improvement in the visual analog scale score at 2 years, decreasing by 3.16 compared with baseline, and the mean patient satisfaction score was 8.09, with 83.6% of patients achieving a good to excellent result (patient satisfaction score ≥7). No complications were related to the procedure, and 6 patients (11%) required revision procedures (4 for labral retear, 1 for painful iliopsoas internal snapping, and 1 for removal of a symptomatic loose body). Conclusions Arthroscopic intervention that encompasses minimal rim resection, restoration of labral function, and capsular plication significantly improves outcomes in patients with borderline dysplasia who do not warrant a periacetabular osteotomy. Level of Evidence Level IV, therapeutic case series.

Currently available OECD biodegradation screening tests (BSTs) are not particularly suited for persistence screening. Their duration can be much less than international half-life thresholds for persistence and they are variable and stringent, therefore prone to false negatives. The present study extended test durations beyond 28 days and increased biomass concentrations for marine BSTs to better represent the microbial diversity inherent in the sampled environment. For this so-called environmentally relevant BST (erBST) marine cell concentrations were nominally increased 100-fold by tangential flow filtration. The marine erBST was validated against a standard BST using five 14C labeled reference compounds with a range of biodegradation potentials (aniline, 4-fluorophenol, 4-nitrophenol, 4-chloroaniline and pentachlorophenol) in a modified OECD 301B test. A full mass balance was collated to follow chemical fate in the tests. The erBST was more accurate and less variable than the comparator BST in assigning the reference compounds to their expected biodegradation classifications (non-persistent or potentially persistent). According to the REACH non-persistence criterion of ≥60% biodegradation over 60 days, the erBST correctly classified 60% of chemical replicates according to their expected biodegradation classification and had a coefficient of variation of 21% between replicates. In contrast, the BST correctly assessed 40% of reference chemicals in regards to their expected biodegradation classification with a coefficient of variation of 36%. All non-persistent chemicals showed increased degradation in the erBST, except for 4-chloroaniline, which did not degrade in either BST or erBST. Both tests showed no false positive results, correctly classifying the negative control pentachlorophenol as potentially persistent. Next, it is recommended to further validate the marine erBST in an inter-laboratory study incorporating different seawater sources to fully assess its variability and reliability.

Lateral hip pain along with tenderness of the greater trochanter has been associated with greater trochanteric pain syndrome. Radiographically, this has been associated with gluteus medius pathology on magnetic resonance imaging. This has led some surgeons to conclude that abductor pathology is a primary cause of lateral hip pain. Failure of conservative treatment in the setting of gluteus medius pathology may lead to surgical intervention. In some patients a focal tear of the gluteus medius cannot be visualized and likely represents more diffuse tendinopathy. In these patients we propose micropuncture of the greater trochanter. Similar procedures have shown effectiveness in the elbow and shoulder by eliciting a healing response. Our experience suggests that trochanteric micropuncture at the insertion of the gluteus medius tendon can be effectively performed endoscopically for gluteus medius tendinopathy.

Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS).Twenty-one children, median age 5 months (35 days to 11 years) and weight 5.0 (2.3 to 28.0) kg have undergone anterior tracheal suspension for severe tracheobronchomalacia through median sternotomy; 15 for inability to ventilate despite mechanical respiratory support, 3 for intermittent ALTEs without mechanical respiratory support, and 3 for recurrent respiratory admissions. Nine procedures were performed as isolated ATS and 12 procedures were combined with at least 1 of the following: repair of ventricular septal defect; vascular ring; atrioventricular canal; tracheal reconstruction or arterial-pexy. Level of respiratory support was graded at preoperative (preop), discharge, and follow-up, and respiratory clinical status was graded at preop and follow-up. Median follow-up was 30.0 months (2.0 to 57.0 months).There was no mortality. Both level of respiratory support and the clinical status improved at all time points studied compared with preoperative score (p0.001) after ATS. Whether ATS was performed in isolation or combined with other procedures did not impact these findings.Anterior tracheal suspension is feasible and appears effective in dramatically improving respiratory clinical status. Tracheal suspension is applicable to a wide range of anatomic variants. Additional study is needed to characterize long-term functional outcomes.

Objective Identify laryngoscopic and functional outcomes of infants with vocal fold immobility (VFI) following patent ductus arteriosus (PDA) ligation and identify predictors of recovery. Methods Retrospective review of patients with VFI following PDA ligation from 2001 to 2012 at a single institution. Inclusion criteria were: (1) PDA ligation as only cardiac surgical procedure; (2) left VFI documented by laryngoscopy; (3) minimum follow up 120 days, with at least 2 laryngoscopies performed. Resolution of VFI was determined at follow-up laryngoscopy. Univariate logistic regression models were used to identify variables associated with VFI recovery. Results 66 subjects were included with median follow up of 3.0 (±2.1) years. The mean gestational age was 24.5 ± 1.4 weeks, mean birth weight 673 ± 167 g, and mean age at procedure was 18.6 ± 14.3 days. Patients presented with respiratory symptoms (39%), dysphonia (78%) and dysphagia (55%). Resolution of VFI was observed in 2/66 (3%) patients. Recovery was documented at 20 days and 11 months respectively. Respiratory symptoms, dysphagia, and dysphonia persisted at last follow up in 11%, 47%, and 20% of patients. Conclusions VFI associated with ligation of the ductus arteriosus has a low rate of recovery. Clinical symptoms frequently persist, and as such regular follow-up by otolaryngologists to mitigate morbidity is indicated.

Objectives Office-based lower airway endoscopy (OLAE) is not a widespread practice in children due to concerns about its safety and efficacy. In 2003, we reported on OLAE in 105 children presenting with airway symptoms and found it both safe and effective as a diagnostic tool. The current study is a follow-up to the 2003 study that reports on an additional 122 pediatric patients who received OLAE with special attention to the safety and efficacy of the procedure. Methods A retrospective review at a tertiary–quaternary pediatric institution of 122 consecutive pediatric patients in which an airway lesion, by history and initial physical exam, was determined to be present at the level of the supraglottic larynx to the carina. In all patients, airway endoscopy was performed in the office using flexible fiberoptic laryngoscopy (FFL) and the endoscope was passed beyond the glottis to assess the lower airway, including the subglottis, trachea, and carina. The diagnoses were recorded and the number of times each diagnosis was encountered as well as the percent of patients who had each diagnosis was calculated. All cases requiring operating room procedures for further diagnosis or therapy were assessed for office-based and operating room diagnostic agreement. The ease of performing the lower airway assessment and the ease with which the subglottis, trachea, and carina were visualized were graded. An assessment for complications was also performed. Results There were no complications with OLAE in any of the 122 patients. The percent of patients rated as having good visualization of anatomic structures were: 97% for visualization of the subglottis, 98% for visualization of the trachea, and 92% for visualization of the carina. In 93% of the cases the procedure was easily performed. There was excellent correlation between OLAE and operative endoscopy. Conclusion OLAE continues to be a safe, efficacious, and cost-effective tool for the diagnosis of lower airway pathology in pediatric patients.

Two-hundred seventy consecutive patients with "unexplained cerebral ischemia" were studied with transesophageal echocardiography to determine the value of this test in identifying potential cardiac sources of cerebral embolism. The findings of this group were compared with those of 772 consecutive patients undergoing transesophageal echocardiographic evaluation for indications other than cerebral ischemia. This study also examined this group of patients with unexplained cerebral ischemia to determine differences in relation to underlying cardiac rhythm and patient age. Intracardiac thrombus, atrial septal aneurysm, patent foramen ovale, spontaneous left atrial contrast and protruding debris in the thoracic aorta were found more often in patients with unexplained cerebral ischemia. Wall motion abnormalities of the left ventricle, as well as mild to moderate valvular lesions including mitral valve prolapse, were found to be similar in both groups. Spontaneous left atrial contrast, as well as mild to moderate valvular abnormalities, were found more often in patients with atrial fibrillation (22% of the group with unexplained cerebral ischemia). However, the presence of intracardiac thrombus was no more frequent in patients with atrial fibrillation than in those with normal sinus rhythm. Patients aged > 50 years were found to have atrial fibrillation and larger left atrial size more often than their younger cohorts, as well as a greater incidence of valvular abnormalities and left ventricular wall motion abnormalities. Mitral valve prolapse was seen more frequently in the younger cohort of patients.

Purpose: To report a case of a respiratory epithelial-lined, air-filled orbital cyst as a late complication of orbital fracture repair. Method: Case report. Results: Recurrent episodes of diplopia and hyperophthalmia developed secondary to pneumatic inflation of a respiratory epithelial-lined orbital cyst 6 months after orbital fracture repair. This cyst remained in communication with an ethmoidal air cell and became inflated during pressurization of the ethmoid sinus. Removal of the cyst and orbital implant was curative. Conclusion: Air-filled, respiratory epithelial-lined orbital cyst is a rare cause of episodic diplopia and globe displacement after orbital trauma.