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Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder that can increase the risk of hypertension, diabetes, obesity, and cardiovascular diseases. Hypoglossal nerve stimulation (HGNS) is an alternative therapy for OSA in patients who cannot tolerate continuous positive airway pressure. Understanding the impact of HGNS on blood pressure, hemoglobin A1C (A1C), and body mass index (BMI) currently remains limited. Methods: A retrospective review study of HGNS outcomes at a single practice from January 2020 to November 2022 was conducted. Inclusion/exclusion criteria were based on HGNS eligibility and postoperative titration study. Statistical analysis and data management were performed using statistical software, R (v.4.2.1; R Core Team). Paired Student's T test, Fisher's exact test, and McNemar's exact test were utilized for statistical analysis. P values less than .05 were considered statistically significant. Results: Sixty-three patients were included in this study. A significant decrease in mean apnea-hypopnea index was noted following HGNS (mean change -28; P  < .0001). Similar significant decreases were also seen in mean arterial pressures (mean change -8.4, P  < .0001). There was a significant change in overall antihypertensive medication requirements and in requirements ≥3 medications ( P  < .0005, P  = .03). There was a trend toward reduction in A1C; however, there was no change in BMI or number of diabetes medications taken. Conclusions: Our results reinforce previous findings that HGNS is an effective treatment option for carefully selected patients with OSA. In addition, our findings suggest that HGNS may improve patients' quality of life while minimizing OSA associated morbidity., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The benefits and challenges of successful breastfeeding for both mother and child have been well-established in the literature. While ankyloglossia, or tongue tie, alone or in combination with upper lip tie has been the focus of several previous studies, very few have directly addressed isolated symptomatic upper lip tie and the role of surgical correction for breastfeeding difficulties., Materials and Methods: Seven infants with isolated upper lip tie and breastfeeding difficulty were taken to the operating room for labial frenotomy. These infants were assessed at their follow-up visits for their degree of weight gain since their procedure. Their mothers were surveyed regarding their experiences with breastfeeding since the frenotomy was performed., Results: In this article, we present seven infants with isolated upper lip tie and breastfeeding difficulty who were treated with labial frenotomy. Subsequently, these infants demonstrated improved weight gain, and all mothers reported increased ease of breastfeeding., Conclusion: These findings implicate lip tie as an underrecognized cause of breastfeeding difficulty and suggest that labial frenotomy is an effective treatment in these patients. Larger-scale randomized controlled studies are necessary to further evaluate this topic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Freeman et al.)

Objectives: We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we instituted multimodal, evidence-based guidelines for postoperative pain management. In the second part of our multiphasic study, we evaluated the effects of these guidelines on (1) quantity of unused opioids, (2) patient satisfaction, and (3) institutional perceptions toward the opioid epidemic and prescribing guidelines., Methods: Standardized, procedure-specific opioid prescription guidelines were created using prospective data from the first phase of our study and evidence from current literature. Again, we examined sialendoscopy, parotidectomy, parathyroidectomy/thyroidectomy, and transoral robotic surgery (TORS). Patients were surveyed at their first postoperative appointment. Groups from Phases I and II were compared. Attending physicians were surveyed before the start of the multiphasic project and after prescribing guidelines were implemented., Results: Prescribing guidelines led to an average reduction in prescribed morphine milligram equivalents (MME) per patient by: 48% (sialendoscopy), 63% (parotidectomy), 60% (para/thyroidectomy), and 42% (TORS). Average used MME per patient for parotidectomy was significantly reduced (64%). The proportion of unused MME per patient and patient satisfaction scores did not significantly change after guidelines were implemented., Conclusion: Implementation of opioid-prescribing guidelines and the use of multimodal analgesia substantially reduced the amount of opioids prescribed across all procedures without impacting patient satisfaction., Level of Evidence: 2., (© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Introduction: Despite the presence of a growing body of literature suggesting cost-ineffectiveness of routine pathologic analysis of tonsillectomy specimens, little is known about common institutional policies and practice patterns of pediatric otolaryngologists. The objectives of this study were to determine the prevalence of routine pathological evaluation of tonsillectomy specimens for uncomplicated pediatric adenotonsillectomy procedures and to evaluate opinions regarding this controversy among board-certified pediatric otolaryngologists., Methods: This was a cross-sectional survey study sent to board-certified pediatric otolaryngologists currently practicing and registered with the American Society of Pediatric Otolaryngology (ASPO) assessing their institutions' or practices' current policies on sending routine tonsillectomy specimens for pathology, their experience with this practice, and their opinions on whether routine pathologic analysis should be employed. Basic statistical analysis was then conducted., Results: Respondents mostly practiced in an academic setting (68.4%), with the next most common being academically affiliated private practice (21.8%), and private practice was the least common (9.8%). Most respondents (85.1%) did not agree with routine pathologic analysis of otherwise uncomplicated pediatric tonsillectomy specimens., Conclusion: Most pediatric otolaryngologists who responded to this survey do not support routine pathological analysis of otherwise uncomplicated pediatric tonsillectomy specimens. However, the results are likely biased and should be interpreted carefully, since only a small percentage of pediatric otolaryngologists responded to the survey. Potential cost savings could be seen by patients, payers, and hospital systems with judicious use of surgical pathology, specifically in cases with concurrent signs or symptoms suspicious for malignancy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: New consumer health devices are being developed to easily monitor multiple physiological parameters on a regular basis. Many of these vital sign measurement devices have yet to be formally studied in a clinical setting but have already spread widely throughout the consumer market., Objective: The aim of this study was to investigate the accuracy and precision of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) measurements of 2 novel all-in-one monitoring devices, the BodiMetrics Performance Monitor and the Everlast smartwatch., Methods: We enrolled 127 patients (>18 years) from the Thomas Jefferson University Hospital Preadmission Testing Center. SBP and HR were measured by both investigational devices. In addition, the Everlast watch was utilized to measure DBP, and the BodiMetrics Performance Monitor was utilized to measure SpO 2 . After 5 min of quiet sitting, four hospital-grade standard and three investigational vital sign measurements were taken, with 60 seconds in between each measurement. The reference vital sign measurements were calculated by determining the average of the two standard measurements that bounded each investigational measurement. Using this method, we determined three comparison pairs for each investigational device in each subject. After excluding data from 42 individuals because of excessive variation in sequential standard measurements per prespecified dropping rules, data from 85 subjects were used for final analysis., Results: Of 85 participants, 36 (42%) were women, and the mean age was 53 (SD 21) years. The accuracy guidelines were only met for the HR measurements in both devices. SBP measurements deviated 16.9 (SD 13.5) mm Hg and 5.3 (SD 4.7) mm Hg from the reference values for the Everlast and BodiMetrics devices, respectively. The mean absolute difference in DBP measurements for the Everlast smartwatch was 8.3 (SD 6.1) mm Hg. The mean absolute difference between BodiMetrics and reference SpO 2 measurements was 3.02%., Conclusions: Both devices we investigated met accuracy guidelines for HR measurements, but they failed to meet the predefined accuracy guidelines for other vital sign measurements. Continued sale of consumer physiological monitors without prior validation and approval procedures is a public health concern., (©Christina Hahnen, Cecilia G Freeman, Nilanjan Haldar, Jacquelyn N Hamati, Dylan M Bard, Vignesh Murali, Geno J Merli, Jeffrey I Joseph, Noud van Helmond. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 12.02.2020.)

The size-weight illusion (SWI) pertains to the experience of perceiving the smaller of two equally weighted objects as heavier. Competing theories to explain the illusion can be generally grouped into cognitive and sensory theories, which place more importance on top-down processing of cognitive expectations and bottom-up processing of sensory information about the size and weight of objects, respectively. The current study examined the relative contribution of these two general explanations. This was done by varying the amounts of cognitive load in a dual-task and the quality of somatosensory feedback by wearing or not wearing gloves. Participants placed their hands through a curtain inside a box so they could not see the test objects. Inside the box, they were presented with either a small or large sphere of varying weights, which they explored manually without vision. Participants provided magnitude estimates about each object's weight in four experimental conditions (no-load with gloves, no-load without gloves, low-load without gloves, and high-load without gloves). The dual-task involved the visual presentation of a cross on a computer monitor that changed in both colour and orientation. With foot pedals, the participants responded to a target colour and / or orientation, which varied across conditions, while they hefted an object. Some conditions were designed to be more cognitively taxing than others (high-load > low-load > no-load conditions). The results revealed that the strength of the SWI diminished when participants wore the gloves but did not change as cognitive load increased on the dual-task. We conclude that the illusion is more influenced by bottom-up sensory than top-down cognitive processes., Competing Interests: The authors have declared that no competing interests exist.

Recent findings on the role of circulating histone proteins in mediating acute lung injury prompted us to investigate whether there is a specific mechanism for accumulation of histones in the lungs. Binding sites for polycations are already known in the vasculature of the lungs, and we postulated that these could also be involved in histone accumulation, since histones have a high content of positively charged amino acids. Using a histone-coated colloid of a radiolabelled nanocomposite to track histone biodistribution with imaging techniques, it was found that histones bind avidly in the lungs of rabbits after intravenous injection. Blocking experiments with competing polycations in vivo characterised histone lung binding as dependent on a charge interaction with microvessel polyanions. Pretreatment of rabbits with a specific heparinase confirmed that the lung binding sites consist of heparan sulphate in the endothelial glycocalyx. A range of heparan sulphate analogues was accordingly shown to prevent histone accumulation in the lungs by neutralising histones in blood. These findings provide a rational basis for the design of polyanions that can prevent accumulation of cytotoxic histones in the lungs and thereby intervene at an early key step in the development of acute lung injury., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

We report the results of a flowing afterglow ion source-selected ion flow tube study (FA-SIFT) of the reactions of the methoxymethyl cation, CH3OCH2+. Rate coefficients and product branching ratios are reported for twenty nine reagent molecules including those that constitute the major ingredients of air, the hydrocarbons CH4, C2H6, C3H8, n-C4H10, C2H2, C2H4, C3H4 (allene and propyne), C6H6, and the S-containing molecules H2S, CH3SH, C2H5SH, (CH3)2SH, and (C2H5)2SH. In addition, we examined the reactions with the N-containing molecules NH3, CH3NH2, (CH3)2NH, (CH3)3N, pyrrole, pyridine as well as CH3COCH3. The results can be summarized under three general reaction types: Reaction at the CH3 carbon, reaction at the CH2 carbon, and association. The results also indicate that the methoxymethyl cation can be used as a chemical ionization source for the detection of trace levels of S-containing compounds in saturated hydrocarbons.

The ion-molecule reactivity of the products formed in the association reactions of HCNH+ with C2H2 (C3H4N+) and C2H4 (C3H6N+) has been investigated to provide information on the structures of the adducts thus formed. The C3H4N+ and C3H6N+ adducts were formed in the reaction flow tube of a flowing afterglow sourced-selected ion flow tube (FA-SIFT) and their reactivity with a neutral molecular "probe" examined. The reactivity of possible known structural isomers for the C3H4N+ and C3H6N+ ions was investigated in both the FA-SIFT and an ion cyclotron resonance spectrometer (ICR). Ab initio investigations of the potential energy surfaces for both structures at the G2(MP2) level have also been performed and structures corresponding to local minima on both surfaces have been identified and evaluated. The results of these experimental and theoretical studies show that at room temperature, the C3H4N+ adduct ion contains two isomers; a less reactive one that is likely to be a four-membered cyclic covalent isomer (approximately 70%) and a faster reacting component that is probably an electrostatic complex (approximately 30%). The C3H6N+ adduct ion formed from HCNH+ + C2H4 at room temperature is a single isomer that is likely to be the four-membered covalently bound cyclic CH2CH2CHNH+ species.

It is contended that the most comprehensive collection of data on the visible and near-ultraviolet spectrum of pure liquid water can still be found [Appl. Opt. 38, 1216 (1999)]. The data produced [Appl. Opt. 36, 8710 (1997)] from the integrated light loss in a light-scattering cavity containing water produces a useful set of data, although the error bars presented are underestimated. Furthermore, an oxidative purification step was not incorporated into the water purification procedure to remove residual traces of light-absorbing organic impurities.

The optical absorption of pure liquid water in the 300-700-nm region has been measured by use of a long (1.5-m) path-length cell. The absorption spectrum coincides well with the edge of previous data in the 200-320-nm region and provides reliable data in the 320-420-nm region that has until now been a region of considerable unreliability. The data obtained for the 420-700-nm region agree quite well with the means of the existing literature in that well-studied region. The absorptions in the 550-700-nm region show evidence for the overtones and combination tones of the well-known OH stretching frequency at 3500 cm(-1).