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Objectives: Implanted vagal nerve stimulators (VNS) are an accepted therapy for refractory seizures. However, VNS have been shown to affect vocal fold function, leading to voice complaints of hoarseness. We present a case of intermittent VNS-related vocal fold paralysis leading to dysphonia and dysphagia with aspiration in a pediatric patient. Methods: This is a case report of a patient at a tertiary hospital evaluated in pediatric swallow and voice clinics. Patient and mother gave verbal consent to be included in this case report. Results: Indirect laryngeal stroboscopy was performed demonstrating full vocal fold mobility with VNS off and left vocal fold paralysis in lateral position and glottic gap with VNS on. Voice measures were performed demonstrating decreased phonation time, lower pitch, and decreased intensity of voice with VNS on. Flexible endoscopic evaluation of swallowing demonstrated deep penetration alone with VNS off and deep penetration with concern for aspiration with VNS on. Conclusions: While the majority of cases of vocal fold movement impairment associated with VNS have been noted to have a medialized vocal fold with VNS activation, we describe a case of intermittent vocal fold lateralization associated with VNS activation with resultant voice changes and aspiration. [ABSTRACT FROM AUTHOR]

Objective: The frequency of metastasis to level VI lymph nodes in advanced pyriform sinus squamous cell carcinoma (PSSCC) is unknown. We intended to analyze the clinical features and pathological presence or absence of level VI lymph node metastasis in patients with PSSCC. Methods: The data of 270 patients with previously untreated hypopharyngeal squamous cell carcinoma from 2006 to 2016 were obtained. Patients who underwent pharyngolaryngectomy for the pyriform sinus subsite with a curative intent with level VI dissection were included. We retrospectively analyzed the clinical Tumor-Node (TN) status (TNM classification of malignant tumors, eighth edition) and the presence or absence of pathological level VI lymph node metastasis. Results: A total of 34 patients were included. Eight patients (24%) had pathological level VI lymph node metastasis. The rate of pathological level VI lymph node metastasis was directly proportional to the clinical N status (P =.0002, Chi-square test for trend). In all, 5 patients with cN2b- 3 were classified as cN3b. Ipsilateral pathological level VI lymph node metastasis was observed in 1 patient, and bilateral metastasis was observed in 3 patients. There was no association between clinical T status or pyriform sinus apex invasion and pathological level VI metastasis (both P >.99, Fisher's exact test). Conclusions: PSSCC with cN3b is prone to bilateral level VI metastasis. We recommend that patients with PSSCC with cN3b should undergo bilateral level VI lymph node dissection. [ABSTRACT FROM AUTHOR]

Objective: Obstructive Sleep Apnea (OSA) in children is treated primarily with adenotonsillectomy (AT). When clinical exam demonstrates small tonsils, the success of AT in resolving OSA is uncertain. The purpose of this study is to determine the utility of Drug induced Sleep Endoscopy (DISE) for children with OSA and small tonsils (Brodsky scale 1+) and to identify what obstructive trends exist in this subset of patients and to determine the utility of DISE-directed surgical intervention in patients with small tonsils. Methods: A retrospective chart review was performed for patients who underwent DISE at a tertiary care center over a 2-year period. Inclusion criteria were 1+ tonsils and a positive sleep study. Data collected included DISE findings, BMI, comorbid conditions, and pre-op PSG data. Results: Forty children were included with a mean age of 5.0 years (range 8 months-16 years). Mean preoperative AHI was 5.46 and mean oxygen saturation nadir was 87.1%. The most common contributor to airway obstruction was the adenoid (29 patients, 72.5%), followed by the tongue base or lingual tonsil (21 patients, 52.5%). The palatine tonsils (10 patients, 25.0%), epiglottis (10.0%), or obstruction intrinsic to the larynx (10.0%) were significantly less frequently identified as contributors to OSA when compared to the adenoid (P <.001). The majority of patients had multilevel obstruction (25 patients, 62.5%). Adenoidectomy (27 patients, 67.5%) was the most commonly performed procedure, followed by tonsillectomy (10 patients, 25.0%, P <.001) and tongue base surgery (9 patient 22.5%, P <.001). Conclusion: In this group, small palatine tonsils were infrequently identified as a contributor to airway obstruction and tonsillectomy was avoided in most cases. This study illustrates the utility of DISE as a tool to personalize the surgical management of pediatric patients with OSA and small tonsils on physical exam. [ABSTRACT FROM AUTHOR]

Objectives: Appropriate management of chronic rhinosinusitis (CRS) among patients with cystic fibrosis (CF) is important in improving quality of life. Otolaryngologists play a critical role in reducing CRS symptom burden. This study seeks to evaluate the role of patient-reported quality-of-life measures in guiding interventions for CF-related sinus disease. Methods: We performed a prospective, cross-sectional study of 105 patients presenting to a CF-accredited clinic between July and September 2018. Demographic data and sinus surgery history were collected, in addition to Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Disorders (QOD-NS) scores. Statistical analysis was conducted using correlation and non-parametric Mann-Whitney U tests. Results: Baseline well-care visits accounted for 71.4% of all clinical evaluations. Prior otolaryngology intervention was noted in 69 (66%) patients, where the majority of these patients (63/69; 91%) underwent endoscopic sinus surgery (ESS). Patients with a history of otolaryngology intervention had an average SNOT-22 score of 33.2 (SD = 20.6) compared to 24.9 (SD = 18.5) for patients without prior intervention (P =.048). The average QOD-NS score was 5.5 (SD = 6.4) among patients referred to otolaryngologists and 3.1 (SD = 5.7) for non-referred patients (P =.012). SNOT-22 and QOD-NS scores were modestly correlated (R of.43). Conclusion: CF patients with symptoms resulting in worse quality-of-life assessments were more likely to have established coordinated care with an otolaryngologist. Further validation of the utility of SNOT-22 and QOD-NS questionnaires as care coordination metrics is necessary in the CF population. [ABSTRACT FROM AUTHOR]

Objectives: Teprotumumab, a novel monoclonal antibody, targets the insulin-like growth factor 1 (IGF-1) receptor. IGF-1 receptors, found in muscle and fat adjacent to the eye and implicated in Graves Ophthalmopathy, are also in the cochlea. In clinical trials, 5 participants reported self-limited audiologic symptoms but there are no objective data in the literature. The aim of this report is to describe one of the first known cases of teprotumumab-induced irreversible sensorineural hearing loss. Methods: Case report at a tertiary referral center Results: A 61 year old female with Graves ophthalmopathy presented with bilateral hearing loss, sound distortion, and tinnitus following treatment with teprotumumab. Audiogram showed mild sloping to moderately-severe sensorineural hearing loss. Repeat audiometry obtained 4 months after cessation of teprotumumab and treatment with oral corticosteroids was unchanged. Conclusions: This is one of the first descriptive cases of ototoxicity resulting in irreversible sensorineural hearing loss in the setting of treatment with teprotumumab. Periodic audiologic evaluations should be recommended to patients on teprotumumab. [ABSTRACT FROM AUTHOR]

In this work, we aim at constraining the age of the young open cluster Melotte 20, known as α  Per, using seismic indices. The method consists of the following steps: (1) Extract the frequency content of a sample of stars in the field of an open cluster. (2) Search for possible regularities in the frequency spectra of δ Sct stars candidates, using different techniques, such as the Fourier transform, the autocorrelation function, the histogram of frequency differences and the échelle diagram. (3) Constrain the age of the selected stars by both the physical parameters and seismic indices by comparing them with a grid of asteroseismic models representative of δ Sct stars. (4) Find possible common ages between these stars to determine the age of the cluster. We performed the pulsation analysis with MultiModes , a rapid, accurate and powerful open-source code, which is presented in this paper. The result is that the age of α  Per could be between 96 and 100 Myr. This is an improvement over different techniques in the past. We therefore show that space astroseismology is capable of taking important steps in the dating of young open clusters. [ABSTRACT FROM AUTHOR]

Objective: To describe the presentation and treatment of patients developing pulmonary embolism following translabyrinthine approach for vestibular schwannoma resection. Methods: This was a retrospective case series of patients at 2 academic tertiary medical centers who developed symptomatic pulmonary embolism post-operatively following translabyrinthine approach for vestibular schwannoma resection and were found to have evidence of sigmoid sinus thrombosis. Results: Three patients were identified to have post-operative pulmonary emboli after translabyrinthine approach for vestibular schwannoma resection with sigmoid sinus or internal jugular vein clots in the absence of lower extremity deep vein thrombosis. Caprini scores for these patients were 5 or lower. All patients underwent CT pulmonary angiography and were confirmed to have pulmonary emboli. Two were promptly anticoagulated with heparin drips and transitioned to long-term oral anticoagulation therapy and 1 had delayed anticoagulation. None of these patients suffered from intracranial hemorrhage post-operatively. Conclusions: Patients undergoing translabyrinthine approach for vestibular schwannoma can develop pulmonary embolism from sigmoid sinus entry or thrombosis. No clear guidelines exist for the management of this complication in the setting of recent craniotomy and the risk of intracranial hemorrhage must be considered prior to initiating anticoagulation. [ABSTRACT FROM AUTHOR]

Aims. The scientific yield of current and future optical surveys is increasingly limited by systematic uncertainties in the flux calibration. This is the case for type Ia supernova (SN Ia) cosmology programs, where an improved calibration directly translates into improved cosmological constraints. Current methodology rests on models of stars. Here we aim to obtain flux calibration that is traceable to state-of-the-art detector-based calibration. Methods. We present the SNIFS Calibration Apparatus (SCALA), a color (relative) flux calibration system developed for the SuperNova integral field spectrograph (SNIFS), operating at the University of Hawaii 2.2 m (UH 88) telescope. Results. By comparing the color trend of the illumination generated by SCALA during two commissioning runs, and to previous laboratory measurements, we show that we can determine the light emitted by SCALA with a long-term repeatability better than 1%. We describe the calibration procedure necessary to control for system aging. We present measurements of the SNIFS throughput as estimated by SCALA observations. Conclusions. The SCALA calibration unit is now fully deployed at the UH 88 telescope, and with it color-calibration between 4000 Å and 9000 Å is stable at the percent level over a one-year baseline.

Objective: To evaluate the cost-effectiveness of open versus endoscopic surgical repair of Zenker's diverticulum. Methods: In this study, an economic decision tree was utilized to compare the cost-effectiveness of open surgery compared to endoscopic surgery. The primary outcome in this analysis was the incremental cost-effectiveness ratio (ICER) that was calculated based on the economic decision tree. The probability of post-operative esophageal perforation complications, revision rates, and effectiveness of each procedure along with associated costs were extracted to construct the decision tree. Univariate sensitivity analysis was then utilized to determine how changes in esophageal perforation rate affect the cost-effectiveness of each surgical approach. Results: The ICER of open surgery for Zenker's diverticulum was $67 877, above most acceptable willingness to pay (WTP) thresholds. Additionally, if the probability of esophageal perforation with endoscopic surgery is above 5%, then open surgery becomes a more cost-effective option. Probabilistic sensitivity analysis using Monte Carlo simulations also showed that at the WTP thresholds of $30 000 and $50 000, endoscopic surgery is the most cost-effective method with 83.9% and 67.6% certainty, respectively. Conclusion: Open surgery and endoscopic surgery are 2 treatment strategies for Zenker's diverticulum that each have their own advantages and disadvantages that can complicate the decision-making process. With no previous cost-effectiveness analysis of open versus endoscopic surgery for Zenker's diverticulum, our results support the endoscopic approach at most common WTP thresholds. Particularly with the current focus on rising healthcare costs, our results can serve as an important adjunct to medical decision-making for patients undergoing treatment for Zenker's diverticulum. [ABSTRACT FROM AUTHOR]

Objective: Report a series of cases in which patients have concomitant superior semicircular canal dehiscence (SSCD) and a dehiscent tegmen tympani with Dural contact to the malleus head (DCMH). Methods: An analysis of radiologic and audiologic data in 4 patients who presented with SSCD and DCMH at a tertiary care institution. A pertinent literature review was performed. Results: Four patients (5 ears) had SSCD and DCMH. In 3 patients with unilateral DCMH, the mean maximum air-bone gap was 15 dB in the ear with DCMH compared to 50 dB in the ear without DCMH. Of the 5 ears with DCMH, the mean air conduction threshold at 250 Hz was 17 dB compared to 42 dB in the 3 ears without DCMH. Conclusions: We report the findings of DCMH in a series of 4 patients with bilateral SSCD. This limited series suggests that ears with SSCD and DCMH have less of an air-bone gap than would be expected, as 1 would expect an additive effect of DCMH and SSCD on the air-bone gap. [ABSTRACT FROM AUTHOR]

Objectives: We explored the auditory and anatomical success of grafting when the cartilage perichondrium (CP) was prepared using two different methods. Methods: Patients with subtotal or total perforation underwent tympanoplasty with a CP graft. A V -shaped groove for the handle of the malleus was prepared for CP grafts in patients in group 1. Patients in group 2 did not have a groove on the graft. The anatomical success of the graft was evaluated as success, partial success, or failure. Results of auditory evaluations were compared between the two groups. Results: A total of 195 patients were included in the study. The total CP graft integration rate was 96% for both groups. Significant changes were detected in all hearing criteria evaluated 12 months after surgery compared to the preoperative period (P <.05). There were no significant differences between the groups in terms of the relationship between graft technique and postoperative hearing results. However, rates of partial success were significantly higher for group 1 than group 2 (P =.033). Conclusion: Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation. Partial failures are rare, but when they occur, they most often involved anterior graft medialization. When a piece of cartilage is removed at the malleus interface there may be a higher rate of partial failure. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Objective: To investigate the prevalence and patterns of social media use among gynecologic oncologists for professional and academic purposes., Methods: A prospective online survey between November and December 2022 targeted gynecologic oncology practitioners (gynecologic oncologists, surgical oncologists, medical oncologists, radiation/clinical oncologists, and onco-pathologists/pathologists). The survey, distributed via various social media platforms, included 40 questions to capture qualitative and quantitative data on social media use., Results: Of 131 respondents from 32 countries, 106 (80.9%) were gynecologic oncologists and affiliated with academic institutions (84.7%). Facebook (n=110, 83.9%), Twitter (n= 108, 82.4%), and Instagram (n=100, 76.3%) were the most used platforms. Respondents used social media to stay updated (n=101, 77.1%), network (n=97, 74%), learn about conferences and webinars (n=97, 74%), and engage in academic discussions (n=84, 64.1%). Following the COVID-19 pandemic, 100/129 (77.5%) reported increased social media use. However, only 32 (24.4%) used it to connect with patients, and concerns were raised about privacy and the need for separate professional and personal accounts. A quarter of respondents hesitated to share their opinions on social media due to the fear of controversy, with 26 (20%) experiencing cyberbullying, yet 120/130 (92.3%) believed it enabled junior professionals to express their views. Concerns about differentiating valid content, information reliability, and the professional perception of sourcing knowledge from social media were noted. Gender, age, specialty, and income level influenced patterns of social media use, with variations in preferences for platforms, content engagement, and purposes, highlighting a complex landscape of social media interaction among gynecologic oncologists., Conclusion: While the use of social media among gynecologic oncologists is prevalent, particularly for academic and professional development, challenges such as cyberbullying, privacy concerns, and the need for formal training in social media navigation persist. Tailored training programs and guidelines could enhance social media's effective and ethical use in this field, promoting a safe environment for professional expression and engagement., Competing Interests: Competing interests: JK-B is vice president of the European Network of Young Gynecologic Oncologists (ENYGO), ASJ is social media editor for IJGC, GN is Social media editor for Gynecologic Oncology Journal and treasure for Enhanced Recovery After Surgery (ERAS) Society., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The light curve period of an asteroid plays an important role in determining the rotation period, the collision evolution and the YORP effect. There are many period extraction algorithms used to find the light curve period of asteroids with long term observation, which are mainly based on the frequency, time and time--frequency domains. This paper presents a comprehensive and unparalleled comparison of the popular algorithms based on the DAMIT (Database of Asteroid Models from Inversion Techniques) data set to show the statistical results. Considering the quoted period, absolute magnitude, diameter, albedo, time span and number of observations, we analyze the accuracy of five popular methods using the light curve data of 2902 asteroids. We find that although the performance of all the algorithms varies little, Phase Dispersion Minimization (PDM) performs better, followed by Lomb-Scargle (LS), while Conditional Entropy (CE) is not better than the others under certain conditions. We also analyze the cases which are more suitable for searching by frequencies or by periods. [ABSTRACT FROM AUTHOR]

The rotational spectra of the singly substituted carbon-13 isotopic species of six sulphur-terminated carbon chains have been detected between 5 and 40 GHz using a supersonic discharge jet source in combination with a cavity Fourier transform microwave spectrometer. These molecules are H C 3 H S , a closed-shell isomer of H 2 C 3 S , and five radicals: H C C S , H C 3 S , H C 4 S , H C 5 S and C 4 S . Experiments were carried out with precursors enriched in 13 C, either high purity H 13 C 2 H , a statistical sample of 13 C/ 12 C acetylene, or 13 C S 2 . From the 13 C hyperfine coupling constants, the unpaired electronic density along the chain can be quantified for the radical species, while precise experimental structures ( r 0 ) can be derived for each chain except H C 5 S by a least-squares fit to the rotational constants. The use of 13 C S 2 is particularly revealing in that it provides important clues as to the major formation pathway for each chain in our discharge nozzle. Somewhat surprisingly, 13 C from this precursor appears to be substituted in one of three distinct ways: statistical, a single C site, or not at all. This propensity is molecule specific, implying that multiple formation pathways are operative. [ABSTRACT FROM AUTHOR]

Objectives: We report obstructing laryngeal manifestations of Crohn's disease in a toddler with very early onset-IBD (VEO-IBD) who required tracheotomy tube placement at 27 months of age for relief of recalcitrant airway obstruction unresponsive to maximal medical therapy. We review the literature for the frequency of extra-intestinal laryngeal manifestations of Crohn's disease in adults and children. Methods: Case report and literature review of laryngeal manifestations of Crohn's disease. Results: Laryngeal involvement of Crohn's disease is very rare with only 14 other cases reported. Most cases appear in adults, with the supraglottis most commonly affected. This case marks the youngest report and only the second report of a patient requiring a tracheotomy for supraglottic obstruction when intensive medical management, including use of steroids and biologics, failed to relieve obstructing laryngeal inflammation. Despite ongoing Crohn's disease, laryngeal manifestations improved permitting decannulation the following year. Conclusions: Laryngeal manifestations of Crohn's disease are rare and usually affect adults. Most cases are managed with medical therapy, however surgical excision of obstructing lesions or tracheotomy placement is sometimes required for temporary relief of airway obstruction. [ABSTRACT FROM AUTHOR]

Objective: An indeterminate thyroid nodule fine-needle aspiration (FNA) presents a unique dilemma. We evaluated our institution's experience with Bethesda III thyroid nodules, including the risk of malignancy (ROM) of these nodules removed for diagnostic lobectomy and radiologic and clinical risk factors for malignancy. Study design: Retrospective chart review. Setting: San Antonio Military Medical Center (SAMMC; 483 bed Military Treatment Facility and Level 1 Trauma Center). Methods: We identified all patients with a Bethesda III thyroid FNA at our institution from 2010 to 2018 and determined which nodules were removed. The final histological diagnosis was recorded. Whether or not age, gender, body mass index (BMI), race, nodule size, margin regularity, rate of nodule growth, vascularity, internal calcifications, family history of thyroid cancer, personal history of radiation, and history of repeated AUS/FLUS on FNA had a significant impact on malignancy risk was evaluated with chi square and rank sum Wilcoxon tests. Results: 492 patients had 1 or more AUS result. 52% (258/492) underwent repeat FNA. This resulted in Bethesda II or III in 90% (232/258). In 10% (26/258), the repeat FNA resulted in a higher Bethesda grade. 183 lobectomies were performed on the side containing an AUS nodule. The malignancy percentage was 38.3% (70/183). Age less than 30 was the only variable showing statistical significance for increased risk of malignancy (P =.04). Conclusion: The ROM of nodules characterized as AUS/FLUS on FNA may be higher than expected. Age may be a better predictor of malignancy than repeat FNA. [ABSTRACT FROM AUTHOR]

Objective: Surgery on the ossicular chain may impact its underlying mechanical properties. This study aims to investigate comparative differences in frequency-specific hearing outcomes for ossiculoplasty versus stapedotomy. Methods: A retrospective chart review was conducted on subjects who underwent ossiculoplasty with partial ossicular replacement prosthesis (PORP) or laser stapedotomy with self-crimping nitinol/fluoroplastic piston, and achieved closure of postoperative pure tone average air-bone gap (PTA-ABG) ≤ 15 dB. 45 PORP and 38 stapedotomy cases were included, with mean length of follow-up of 7.6 months. Results: The mean change in PTA-ABG was similar for the 2 procedures (−17.9 dB vs −18.1 dB, P =.98). Postoperative ABG closure for stapedotomy was superior at 1000 Hz (8.9 dB vs 13.9 dB, P =.0003) and 4000 Hz (11.8 dB vs 18.0 dB, P =.0073). Both procedures also had improved postoperative bone conduction (BC) thresholds at nearly all frequencies, but there was no statistical difference in the change in BC at any particular frequency between the 2 procedures. Conclusion: Both procedures achieved a similar mean change in PTA-ABG. Stapedotomy was superior to PORP at ABG closure at 1000 Hz and at 4000 Hz, with 1000 Hz the most discrepant. The exact mechanism responsible for these changes is unclear, but the specific frequencies affected suggest that differences in each procedure's respective impact on the native resonant frequency and mass load of the system could be implicated. [ABSTRACT FROM AUTHOR]

Am 30.01.2018 wurde der Deutsche Ausschuss für Mauerwerk e. V. – kurz DAfM – in Berlin von 30 Mitgliedern gegründet. Erklärtes Ziel war, den DAfM zum Kompetenzzentrum und Forschungspool für den Mauerwerksbau in Deutschland zu entwickeln. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the incidence of laryngeal pathology found during bedside flexible endoscopic evaluation of swallowing (FEES) in a community hospital. Methods: A retrospective study among patients who underwent a bedside FEES examination from May 2018 to May 2019. Criteria to perform a bedside FEES exam were patients who were identified through nursing screening swallowing evaluation and failed a bedside clinical evaluation of swallowing by a speech language pathologist. Patient demographics, recent intubation, duration of intubation, dysphonia complaints, laryngeal exam findings, consultation to otolaryngology and intervention were reviewed. Results: Seventy-five patients had an inpatient bedside FEES. All (100%) had subjective complaints of swallowing. 29 (38.66%) had laryngeal pathology identified on FEES examination including unilateral vocal fold immobility (9), fungal infections (6), vocal fold lesion (3), edema (3), erythema (3), vocal process granuloma (2), unilateral TVF Hemorrhage (1), unilateral TVF paresis (1), suspected superior laryngeal nerve palsy (1). Seventeen of the twenty-nine (58.6%) examinations with incidental laryngeal finding received an otolaryngology referral. Twenty-three of the twenty-nine patients with laryngeal findings (79.3%) were intubated during the hospitalization. Conclusion: Bedside FEES is a well-established method to evaluate swallowing function in an inpatient population. Even in a community hospital, routine FEES examinations led to a high rate of detection of clinically significant laryngeal pathology. [ABSTRACT FROM AUTHOR]

Background: Extended endoscopic transsphenoidal (EET) approaches can include complete resection of both superior turbinate (ST) for wider exposure. Moreover, ST resection has been associated with postoperative olfactory impairment. Objective: We sought to determine the impact of bilateral ST resection on olfaction during a transsphenoidal approach. Method: A prospective observational study was conducted on 29 patients undergoing endoscopic skull base surgery sparing the olfactory tracts at a tertiary academic center. Olfactory function was measured with Sniffin' Sticks at the preoperative visit, 2-weeks and 6 to 8 weeks postoperatively. All components: odor threshold (OT), odor discrimination (OD), odor identification (OI) and composite scores (TDI = OT+OD+OI) were evaluated. Result: Study was completed in 15 patients with 14 excluded due to a variety of reasons. At 2 weeks, a significant decrease was noted in composite scores (32.3 ± 5.4 vs. 23.8 ± 5.8, P <.05) and OT (7.7 vs. 3.2, P <.05). There was a significant increase in olfactory scores between post-op weeks 2 and 6 to 8 weeks in TDI (23.8 vs. 31.4, P <.05) as well as in OT (3.2 vs. 7.6, P <.05), OD (9.4 vs. 11.1, P <.05), and OI (11.1 vs. 12.7, P <.05). No significant difference was found between TDI (32.3 ± 5.4 vs. 31.4 ± 5.1), OT (7.7 vs. 7.6), OD (11.4 vs. 11.1) and OI (13.2 vs. 12.7) from preoperative and 6-8 weeks postoperative visits. Conclusion: Patients undergoing bilateral ST resection during EET procedures experience transient hyposmia postoperatively. However, the olfactory function normalizes to preoperative levels at 6 to 8 weeks. The resection of the bilateral superior turbinate does not appear to decrease olfactory function. [ABSTRACT FROM AUTHOR]

Introduction: Tracheal agenesis (TA) is rare and usually fatal. Few survivors with concomitant tracheoesophageal fistulae (TEF) who underwent ligation of the distal esophagus with creation of a spit-fistula and neo-trachea from the proximal esophagus exist. We report a novel surgical technique whereby the esophagus is divided longitudinally to preserve a functional alimentation tract and a parallel neo-trachea. We review the literature of reported cases, including survivors beyond 12 months. Methods: Case report and literature review. Results: A female infant with prenatal polyhydramnios was born at 35 weeks gestation with immediate respiratory distress and absent cry. Oxygenation was maintained with a laryngeal mask airway. Despite a normal appearing larynx, she could not be intubated and emergent neck exploration disclosed no cervical trachea. The patient was placed on extra corporeal membranous oxygenation (ECMO), and later diagnosed with TA, Floyd Type I. Parental desire for reconstruction but refusal of a spit-fistula necessitated a novel procedure. The esophagus was divided longitudinally via a microstapler to preserve the original alimentary tract and create a parallel neo-trachea originating from the TEF and terminating as a cervical stoma. The healing process was complicated but the baby was ultimately discharged to home where she developed normally neurologically until succumbing one night to accidental decannulation at 16 months of age. Conclusion: We describe a novel surgical approach to manage TA. This includes avoiding creation of a spit fistula and preserving the native esophagus. We then survey the literature, reporting the survivorship duration and operative management of 174 reported cases of TA. [ABSTRACT FROM AUTHOR]

The Joint Drill Core Method by Helmerich/Heidel or UIC Codex 778‐3 to determine the compressive strength of existing masonry The compressive strength of existing masonry can be determined either by separate extracting and testing of stones and mortar or by compression testing of manageable size samples of brickwork. One possibility of brickwork testing is the extraction of joint drill cores from the masonry and testing the cores in their primary masonry position. This method was invented by Helmerich and Heidel and was later customised and included in Codex 778‐3 of the worldwide association of cooperation for railway companies (Union internationale des chemins de fer, UIC). Presented in this document are the history of method developing, results from national and international research regarding this method and discussion and comparison of research results. From the comparisons novel evaluation approaches can be derived. [ABSTRACT FROM AUTHOR]

While the majority of massive stars have a stellar companion, most pulsars appear to be isolated. Taken at face value, this suggests that most massive binaries break apart due to strong natal kicks received in supernova explosions. However, the observed binary fraction can still be subject to strong selection effects, as monitoring of newly discovered pulsars is rarely carried out for long enough to conclusively rule out multiplicity. Here, we use the second Gaia data release to search for companions to 1534 rotation-powered pulsars with positions known to better than 0.5 arcsec. We find 22 matches to known pulsars, including 1 not reported elsewhere, and 8 new possible companions to young pulsars. We examine the photometric and kinematic properties of these systems and provide empirical relations for identifying Gaia sources with potential millisecond pulsar companions. Our results confirm that the observed multiplicity fraction is small. However, we show that the number of binaries below the sensitivity of Gaia and radio timing in our sample could still be significantly higher. We constrain the binary fraction of young pulsars to be |$f_{\rm young}^{\rm true}\le 5.3(8.3){{\ \rm per\ cent}}$| under realistic (conservative) assumptions for the binary properties and current sensitivity thresholds. For massive stars (≥10 M⊙) in particular, we find |$f_{\rm OB}^{\rm true}\le 3.7{{\ \rm per\ cent}}$|⁠ , which sets a firm independent upper limit on the Galactic neutron star merger rate, ≤7.2 × 10−4 yr−1. Ongoing and future projects, such as the CHIME/pulsar program, MeerTime, HIRAX, and ultimately the SKA, will significantly improve these constraints in the future. [ABSTRACT FROM AUTHOR]

Objective: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. Methods: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t -test. Intraclass correlation coefficients were used to assess inter-rater agreement. Results: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury (P =.28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group (P =.01). Subjects in the control group required significantly more doses of postoperative dexamethasone (P =.02). Inter-rater agreement for between raters was excellent (ICC =.88). Conclusion: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis. [ABSTRACT FROM AUTHOR]

Objectives: Telemedicine allows for the remote delivery of patient care and has been found to have a wide range of uses in otolaryngology. In order to achieve best practices in telemedicine, a platform must be effective and both patients and providers must be satisfied with the use of technology. As telemedicine becomes more widely used in otolaryngology clinics, particularly in the face of the current COVID-19 pandemic, it is important to assess its applicability in this field. The goal of this study was to evaluate existing literature on telemedicine and assess overall image quality, diagnostic concordance, and patient and provider satisfaction with telemedicine technologies. Methods: A systematic review was conducted on PubMed and MEDLINE according to the PRISMA 2009 guidelines for articles from 1982 to 2019 relating to telemedicine in otolaryngology. English language studies with primary or secondary endpoints pertaining to image quality, diagnostic concordance, or patient or provider satisfaction were included. Descriptive studies, editorials, and literature reviews were excluded. Results: A total of 32 studies were included in our review. Studies assessing imaging quality and diagnostic concordance reported adequate results but with some heterogeneity. Patient and provider satisfaction were consistently high. Conclusions: The literature supports telemedicine delivery of otorhinolaryngologic care as having achieved high rates of patient and provider satisfaction with adequate image quality and heterogeneity in diagnostic concordance. Variability in diagnostic accuracy was reported, but appears improved given proper clinical context. More standardized studies are needed specific to telemedicine in the field of otolaryngology. [ABSTRACT FROM AUTHOR]

Background: For young children, existing measures of children's health‐related quality of life must be parent‐reported or interviewer‐administered for those who cannot read or complete measures independently. Parents' and childrens' reports about the child's health have been shown to disagree. Aims: (a) To test the reliability and validity of an animated, computer‐administered Child Health Rating Inventories (CHRIS2.0) among children aged 4‐12 undergoing surgery; and (b) to develop and test two CHRIS measures of preoperative anxiety and postoperative pain management. Methods: We conducted a longitudinal cohort study of a diverse group of 542 children aged 4‐12 undergoing surgery. We compared the CHRIS measures to Pediatric Quality of Life Inventory (PedsQL), the Functional Disabilities Inventory (FDI), State‐Trait Anxiety Inventory for children (STAI‐CH), and the Parent Postoperative Pain Measure (PPPM). Results: Factor analyses supported the construct validity of the 12‐item general physical health and the 8‐item mental health CHRIS scales, as well as a composite 20‐item scale, and the CHRIS preoperative anxiety and postoperative pain scales. Internal consistency reliability for all CHRIS scales exceeded the standard for group comparisons (Cronbach's α ≥0.70). The CHRIS general health composite was significantly correlated with composite PedsQL and FDI (r = 0.28, P <.001 and r = 0.43, P <.001, respectively). The CHRIS peri‐operative anxiety measure was significantly correlated with the STAI‐CH (r = 0.44, P <.001), as was the CHRIS postoperative pain scale with the PPPM (r = 0.52, P <.001). Conclusions: The CHRIS measures were reliable and valid in this diverse sample of young children (4‐12). Because CHRIS measures are self‐administered, scored in real time, and run on multiple different platforms, this approach provides a feasible method for the collection of health‐related quality of life in young children and those with limited literacy. Our data indicate that this approach is psychometrically sound and has the potential for adding the child's voice to pediatric outcomes. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of full thickness nasal defects usually requires different donor sites for the external skin envelope, structural elements, and internal nasal lining. In this paper we present a novel single site method for dual inner lining and skeleton repair for full thickness nasal defects with a composite nasoseptal flap and extended pedicle dissection. Methods: A 72-year-old male presented with a T4b melanoma involving the nasal dorsum and left upper lateral cartilage. Following full thickness resection, reconstruction was performed with a nasoseptal flap (NSF) with attached septal cartilage and vomer in conjunction with a paramedian forehead flap. Extended pedicle dissection into the pterygopalatine fossa allowed the NSF to fully cover the defect. Results: The nasal defect was fully corrected. There was no evidence of flap compromise or nasal valve stenosis at 1 month, 2 month, and 1 year follow-up visits. Conclusions: We present here the first successful application of a composite cartilage-osseous-mucosal NSF for multilayered nasal reconstruction. In appropriate patients, this technique may obviate the need for flaps or grafts from extranasal sources, limiting donor site morbidity. [ABSTRACT FROM AUTHOR]

Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology.In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally.Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine the utility of Second-look endoscopy with debridement (SLED) after functional endoscopic sinus surgery (ESS) in pediatric cystic fibrosis (CF) patients. To compare outcomes in pediatric CF patients undergoing sinus surgery for chronic sinusitis with or without SLED. To describe findings present at the time of SLED. Methods: Retrospective chart review of 61 ESS procedures performed at a tertiary care pediatric center from 2013 to 2016. Data collected included demographics, SLED findings, and 6-month pre-/postoperative disease specific outcomes including incidence of sinonasal and pulmonary exacerbations and revisions. Results: Sixty-one cases were reviewed. SLED was performed in 38 cases on average 22.4 days postoperatively. Average preoperative Lund-Mackay score was 14.9 and 14.8 among patients undergoing ESS with and without SLED, respectively. Pre-/postoperative intranasal steroid use and extent of surgery performed was similar among all patients. At the time of SLED, rates of synechiae, polyps and maxillary antrostomy obstruction were 26.3%, 23.7%, and 7.9%, respectively. The incidence and number of days to onset of postoperative sinonasal exacerbations requiring antibiotic therapy within 6 months of ESS were 1.0 (SD 1.0) and 85 days (SD 45.7); and 1.3 (SD 1.0) and 80.4 days (SD 40.5) for patients undergoing ESS with and without SLED, respectively (P value.33). The number of days to first pulmonary exacerbation was 113.9 (SD 45.5) and 47.4 (SD 34.1) among SLED and non-SLED patients, respectively (P value.01). No significant difference was observed in revision rates and time to revision ESS (30% and overall average 1.4 years, respectively). Conclusion: The utility of SLED among pediatric CF patients remains unclear. While debridement did not have a significant impact on sinonasal exacerbations or revision rates, pulmonary exacerbations for patients undergoing SLED were delayed. Further studies are needed to clarify the impact of SLED. [ABSTRACT FROM AUTHOR]

Im Dortmunder Vorort Hörde ist auf dem ehemaligen Gelände des Hochofenwerks Phoenix West das PhoenixWERK, der erste Baukörper eines zukunftsweisenden Büroensembles, entstanden. Mit seiner Architektursprache und der Mauerwerksfassade fügt er sich hervorragend in die zum Teil unter Denkmalschutz stehende Umgebung ein und nimmt damit die Ursprünglichkeit des Ortes auf. [ABSTRACT FROM AUTHOR]

Am Hannoveraner Welfenplatz ist ein Ensemble aus Schule, Kindertagesstätte und Sporthalle entstanden, das sich harmonisch in die Umgebung integriert, den Kindern einen freundlich gestalteten und geschützten Raum zum Lernen und Toben zur Verfügung stellt und sich zudem durch eine nachhaltige Bauweise auszeichnet. Im Rahmen einer öffentlich‐privaten Partnerschaft mit der Landeshauptstadt Hannover als Auftraggeber hat das Architektur‐ und Ingenieurbüro pbr Planungsbüro Rohling AG die Architekturplanung erbracht. [ABSTRACT FROM AUTHOR]

Das neue Bürogebäude der Wirtschaftsprüfungsgesellschaft Emde & Partner mbB steht stellvertretend für einen Generationenwechsel im Technologiepark Bremen. Es bietet im Innenraum moderne Arbeitswelten für kommunikatives und konzentriertes Arbeiten. Die Vielseitigkeit und Flexibilität der Räumlichkeiten findet sich in der äußeren Erscheinung als anthrazitfarbene Klinkerfassade mit variierender Wechsellaibung wieder. [ABSTRACT FROM AUTHOR]

Aims. We present a database of 43 340 atmospheric models (∼80 000 models at the conclusion of the project) for stars with stellar masses between 9 and 120 M⊙, covering the region of the OB main-sequence and Wolf-Rayet stars in the Hertzsprung-Russell diagram. Methods. The models were calculated using the ABACUS I supercomputer and the stellar atmosphere code CMFGEN. Results. The parameter space has six dimensions: the effective temperature Teff, the luminosity L, the metallicity Z, and three stellar wind parameters: the exponent β, the terminal velocity V∞, and the volume filling factor Fcl. For each model, we also calculate synthetic spectra in the UV (900−2000 Å), optical (3500−7000 Å), and near-IR (10 000−40 000 Å) regions. To facilitate comparison with observations, the synthetic spectra can be rotationally broadened using ROTIN3, by covering v sin i velocities between 10 and 350 km s−1 with steps of 10 km s−1. Conclusions. We also present the results of the reanalysis of ϵ Ori using our grid to demonstrate the benefits of databases of precalculated models. Our analysis succeeded in reproducing the best-fit parameter ranges of the original study, although our results favor the higher end of the mass-loss range and a lower level of clumping. Our results indirectly suggest that the resonance lines in the UV range are strongly affected by the velocity-space porosity, as has been suggested by recent theoretical calculations and numerical simulations. [ABSTRACT FROM AUTHOR]

Background: Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures. Methods: A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann–Whitney U testing. Results: During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this cohort was 47.6 ± 20.2 years with the majority identifying as African–American (53.7%) and male (67.2%). Otolaryngologists were significantly more likely to assess pre-operative nasal obstruction (100%) compared to plastic surgeons (24.1%) (P <.001). Otolaryngology elected operative management (53.3%) at a significantly higher rate than plastic surgery (24.1%) (P =.005). Additionally, otolaryngology was significantly more likely to manage patients in an outpatient setting (91.2%), whereas plastic surgery more commonly performed inpatient management (57.1%) (P =.006). Plastic surgery averaged a significantly shorter amount of time from presentation to operative management (7.3 ± 10.7 days) compared to otolaryngology (20 ± 27.7) (P =.019). Consulting service was not associated with a need for revision surgery. Conclusions: Consultants across subspecialties differ in the management of nasal bone trauma. A more standardized approach is warranted by all individuals involved in the care of maxillofacial trauma patients. [ABSTRACT FROM AUTHOR]

Objectives: To elucidate the frequency and types of pre- and post-interview communication that applicants engage with programs, to garner the perceptions of both applicants and program directors (PDs), and determine if communication influences outcomes. Subjects and Methods: Electronic surveys were distributed to otolaryngology residency applicants, and to PDs of ACGME-accredited otolaryngology programs after the 2018 to 2019 application cycle. Results: 93 of 324 applicants (28.7%) and 33 of 106 PDs (31.3%) responded. In the pre-interview period, 58.1% of applicants sent emails of interest, and 41.9% had a mentor initiate communication. In the post-interview period, the majority of applicants (82.8%) sent notes of intent to their number one choice, and 32.3% had a faculty mentor communicate this on their behalf. The majority of PDs (84.8%) were undecided or did not believe that emails of interest influence decisions to offer an interview, whereas 81.8% believed that communication initiated by an applicant's mentor has an impact on interview offers. No PD agreed that declarations of intent from applicants have an impact on their rank lists, while only 33.3% of PDs believed that a mentor communicating this for an applicant has some impact. Our statistical findings are in agreement with these perceptions as neither applicant-initiated pre-interview (P =.54), mentor-initiated pre-interview (P =.62), applicant-initiated post-interview (P =.11) nor mentor-initiated post-interview (P =.78) communications influenced the number of interviews received or ultimate match outcome. Conclusion: Pre- and post-interview communication practices vary widely among otolaryngology applicants. Applicant-initiated communication has no impact on outcomes, while mentor-initiated communication is perceived to have more benefit, despite not impacting interview or match outcomes in this study. [ABSTRACT FROM AUTHOR]

Am 30. Januar 2018 wurde der Deutsche Ausschuss für Mauerwerk e.V. (DAfM) gegründet. Stahlbeton und Mauerwerk sind die Massenbaustoffe, aus denen Deutschland seine Gebäude errichtet. Im Jahr 2019 wurden im gesamten Wohnungs‐ und Nichtwohnungsbau Deutschlands rund 130 Mio. Kubikmeter umbauter Raum (m3 u.R.) überwiegend aus Stahlbeton und rund 122 Mio. m3 u.R. aus Mauerwerk errichtet. Mit einem Marktanteil von etwa 72 % ist Mauerwerk der Wandbaustoff Nummer 1 im deutschen Wohnungsbau. In der DAfM geht es darum, das Bauen mit Ziegeln, Kalksandsteinen, Porenbeton‐ und Leichtbetonsteinen weiter zu optimieren. Bauherren, Bauwirtschaft, Baustoffindustrie, Bauaufsicht, Wissenschaft sowie Beratende Ingenieure und Prüfingenieure ziehen dabei an einem Strang. Der „Deutsche Ausschuss für Mauerwerk e.V." vereint somit die Kompetenzen im Bereich des Mauerwerksbaus in Deutschland. Die Mitglieder des Vereins haben sich zum Ziel gesetzt, Wissenschaft und Forschung auf dem Gebiet des Mauerwerksbaus zu fördern. Mit der Erarbeitung von entsprechenden Regelungen – ergänzend zu Gesetzen und Verordnungen, DIN‐Normen und Zulassungen des DIBt – hat der DAfM Richtlinienkompetenz für die Anwendung von Mauerwerkskonstruktionen am Bau erworben. Wenn man bedenkt, dass der Deutsche Ausschuss für Stahlbeton (DAfStb) schon seit über 100 Jahren diese Funktion für den Stahlbetonbau wahrnimmt, war die Gründung des DAfM überfällig. Das im DAfM gebündelte Know‐how bildet das Fundament für den Mauerwerksbau von morgen. Wer Lust hat, den Mauerwerksbau weiter voranzubringen, ist als Mitglied jederzeit herzlich willkommen. [ABSTRACT FROM AUTHOR]

Objectives: Acupuncture is a form of Traditional Chinese Medicine that has minimal side effects, is cost-effective, can be easily administered, and may serve as a useful non-pharmaceutical therapy for certain conditions. However, studies and clinical practice guidelines are inconsistent in conclusions and recommendations about acupuncture. This qualitative review addresses the evidence available for acupuncture use in otolaryngology. Methods: A literature review was completed using EMBASE, PubMed, and The Cochrane Collection for conditions within otolaryngology that have used and studied the comparative effects of acupuncture. Thirty studies ultimately fit the inclusion criteria and were used for this qualitative review. Results: Studies included in this review contained a variety of conditions within otolaryngology, including allergic rhinitis, chronic rhinitis, tinnitus, sudden sensorineural hearing loss, post-viral olfactory dysfunction, dysphonia, and tonsillectomies. Conclusion: Given its safety profile, cost, and perceived benefit, recommendations and guidelines supporting acupuncture as an alternative or adjunctive therapy are surfacing for certain conditions such as allergic rhinitis. However, stronger conclusions with specific recommendations are limited by varied methodology between majority of the studies. Additional high-quality randomized control studies with low risk of bias are required to continue to assess the effects of acupuncture in the field of otolaryngology before stronger recommendations can be made on other conditions. [ABSTRACT FROM AUTHOR]

Robust measurements of cosmological parameters from galaxy surveys rely on our understanding of systematic effects that impact the observed galaxy density field. In this paper, we present, validate, and implement the idea of adopting the systematics mitigation method of artificial neural networks for modelling the relationship between the target galaxy density field and various observational realities including but not limited to Galactic extinction, seeing, and stellar density. Our method by construction allows a wide class of models and alleviates overtraining by performing k-fold cross-validation and dimensionality reduction via backward feature elimination. By permuting the choice of the training, validation, and test sets, we construct a selection mask for the entire footprint. We apply our method on the extended Baryon Oscillation Spectroscopic Survey (eBOSS) Emission Line Galaxies (ELGs) selection from the Dark Energy Camera Legacy Survey (DECaLS) Data Release 7 and show that the spurious large-scale contamination due to imaging systematics can be significantly reduced by up-weighting the observed galaxy density using the selection mask from the neural network and that our method is more effective than the conventional linear and quadratic polynomial functions. We perform extensive analyses on simulated mock data sets with and without systematic effects. Our analyses indicate that our methodology is more robust to overfitting compared to the conventional methods. This method can be utilized in the catalogue generation of future spectroscopic galaxy surveys such as eBOSS and Dark Energy Spectroscopic Instrument (DESI) to better mitigate observational systematics. [ABSTRACT FROM AUTHOR]

Objective: Thyroglossal duct cysts are the most common congenital neck mass. They typically present as a painless midline neck mass in a child or young adult, but may also present later in adulthood when the cyst becomes symptomatic. Thyroglossal duct cysts are most commonly located inferior to the hyoid bone in close relation with the thyrohyoid membrane. Very rarely, they may extend intralaryngeal, occupy the posterior hyoid space, and present with dysphonia and/or dysphagia. To our knowledge, this is the 24th reported case in the literature. Methods: Case report with a comprehensive review of the literature. Results: The patient was a 43-year-old male experiencing dysphonia and dysphagia following a motor vehicle accident. He was subsequently found to have a large thyroglossal duct cyst with endolaryngeal extension that was previously asymptomatic and undiagnosed. He underwent successful surgical excision which resulted in resolution of symptoms. Conclusion: This is the first reported case of a thyroglossal duct cyst in the posterior hyoid space with endolaryngeal extension being diagnosed following a traumatic event. This case illustrates the need to consider thyroglossal duct cyst in the differential diagnosis when working up a post-traumatic intralaryngeal neck mass. A secondary educational objective in this case is to be diligent to consider and rule out laryngeal fracture in the case of a neck mass presenting after trauma as they can easily be missed and present with many overlapping symptoms. [ABSTRACT FROM AUTHOR]

Load‐bearing capacity tables for unreinforced masonry according to DIN EN 1996‐3/NA:2019‐12 Practical design aids are important tools in the day‐to‐day business of structural design. The design of primarily vertically loaded masonry walls in usual building construction can be carried out with the help of so‐called load‐bearing capacity tables. A table value is read off exclusively as a function of the geometric conditions, which – multiplied by the masonry compressive strength – results in the load‐bearing capacity of the wall for cold design and in case of fire. By comparing the acting and resisting force, the verification of structural design can be provided in a simple and yet economical form. The bearing capacity tables based on the simplified calculation methods according to DIN EN 1996‐3/NA:2019‐12 [1], [2] and DIN EN 1996‐1‐2/NA:2013‐06 [3], [4] are presented in this paper. Compared to the previous edition of Part 3 of Eurocode 6, the extended scope of application is taken into account, as well as the normative changes to the construction method with partially supported slabs. [ABSTRACT FROM AUTHOR]

Design of masonry window parapets considering flexural tensile strength Parapet masonry is often neglected in design. However, if verification is explicitly necessary, this is often economically feasible only on the basis of flexural tensile strength. For this application, two design methods are presented with which parapet masonry can be designed as a freestanding wall considering the flexural tensile strength. In addition to a general method based on linear‐elastic stress‐strain relationship of the masonry, which is applicable to both fully and partially supported slabs, a second approach is presented, which takes into account an existing slab edge shell and thus applies especially for parapet masonry with reduced bearing length. Both methods can also be used to design freestanding walls with minor adjustments. Finally, the permissible height of a parapet made of brickwork is determined exemplarily for various applications and indicated in tabular form depending on the acting wind load. [ABSTRACT FROM AUTHOR]

Aim: Endoscopic endonasal nasopharyngectomy (EEN) for recurrent nasopharyngeal carcinoma (rNPC) is being increasingly used due to the added high magnification, reduced morbidities associated with open procedures and good survival outcomes. Most studies looked at usage of EEN in patients with lower recurrent staging (rT1 and rT2) although more and more surgeons are studying the outcome of EEN in advanced rNPC (rT3 and rT4). The aims of this study were to report the long-term 5-year survival outcome of EEN performed in patients with advanced rNPC, and to determine any prognostic factors for patients' survival. Methods: All patients who underwent EEN for advanced rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. We reported the 5-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors. Results: Twelve patients with rNPC (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). The 5-year OS was 50.0% (mean 44.75 months), DFS was 25.0% (mean 35.25 months) and the DSS was 58.3% (mean 43.33 months). No severe operative complications were encountered and no independent prognostic factors for survival outcome were identified. Conclusion: This is the first report in English that exclusively described the long-term 5-year survival data in patients with both rT3 and rT4 recurrent NPC after EEN. The data suggest that EEN is a feasible treatment to improve survival with minimal morbidities in patients with rT3 and rT4 recurrent NPC. However, more studies with larger patient size is recommended. [ABSTRACT FROM AUTHOR]

Objectives: Vocal fold injection augmentations are increasingly being performed in the office setting on awake patients, as opposed to the operating room. These procedures thus require patient cooperation and education. As the Internet is a widely-used resource for patients, our aim was to assess the quality and readability of online resources on in-office awake vocal fold injections. Methods: An online Google search using the terms "office vocal fold injection medialization" and "awake vocal fold injection" was conducted. The first 50 English-language websites were categorized into professional- and patient-targeted, and major and minor sources. They were analyzed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) test, and DISCERN quality score. Results: Fifty websites were evaluated, and the overall DISCERN score was 2.60 ± 1.01, the mean FRES was 32.16 ± 19.10, and the mean FKGL was 13.76 ± 4.12. Between the 25 professional-targeted and 25 patient-targeted websites, professional-targeted sites had significantly higher DISCERN (P <.05) and FKGL (P <.05) scores, and lower FRES (P <.05) scores. Between the 30 major and 20 minor websites, major websites had significantly lower FRES (P <.05) and higher FKGL (P <.05) scores, and there was a trend toward significance for higher DISCERN scores (P =.052). Conclusions: Our study shows that half of the top Google results for our topic were not written for patient education, but rather for health care professionals. The reading level of this information exceeds the recommended grade level for patient education materials, and may be less comprehensible than intended. While patient-targeted materials are easier to read than professional-targeted sites, they are of lower quality. The quality of the available online information on this topic is suboptimal for both patients and health care providers. This research highlights the need for more appropriate patient education materials given low health literacy rates. [ABSTRACT FROM AUTHOR]

The Rank construction company and the introduction of brick vaults in Munich after 1945 The construction of vaults without scaffolding with thin bricks has a centuries‐old tradition, particularly in Spain and Italy. Since the beginning of the 19th century, it has been successfully spread mainly on the American double continent. The Rank Brothers construction company in Munich is known to date as one of those construction companies that began building with concrete in its home city very early on. New investigations, which were made possible above all by the provision of archive material by Paul Basiner, now point to an additional focus of this company's work. The architects and engineers of the company had been also able to familiarise themselves with this traditional Spanish brick‐vaulted construction method via the branch office in Spain, which was established from 1911 on. This knowledge was particularly in demand in the years following World War II, when the destroyed vaults had to be rebuilt with simple means and low material consumption. Together with Carl Sattler, who had become acquainted with similar construction methods in Italy, brick vaults were initially used to complete the construction of the Landeszentralbank in Munich. In the following years, Rank was able to provide many buildings in and around Munich with brick vaults. It was not until the 1960s that this construction technique went out of fashion and was thus somewhat forgotten. [ABSTRACT FROM AUTHOR]

Investigation of robot systems in masonry construction The relevance of robot systems in building construction will increase in the future. This can be seen, among other things, in the number of press releases about successful construction projects and the increasing number of presented systems. This article examines the specific strengths and weaknesses of different robot systems. The University of Duisburg‐Essen is researching the use of cable robots in brickwork construction. This article presents the first results of a series of tests on this cable robot. It is based on the obtained knowledge, the review of existing literature and the analysis of video material. One result is that each robot system has specific strengths and weaknesses and the cable robot can be applied in masonry construction. It has been shown that the combination and parallel production with different robot systems can compensate for the weaknesses of other systems in the long term. [ABSTRACT FROM AUTHOR]

Objectives: The topic of prescription opioid overuse remains a growing concern in the United States. Our objective is to provide insight into pain perception and opioid use based on a patient cohort undergoing common otologic and neurotologic surgeries. Study Design: Prospective observational study with patient questionnaire. Setting: Single academic medical center. Subjects and Methods: Adult patients undergoing otologic and neurotologic procedures by two fellowship trained neurotologists between June and November of 2018 were included in this study. During first postoperative follow-up, participants completed a questionnaire assessing perceived postoperative pain and its impact on quality of life, pain management techniques, and extent of prescription opioid use. Results: A total of 47 patients met inclusion and exclusion criteria. The median pain score was 3 out of 10 (Interquartile Range [IQR] = 2-6) with no significant gender differences (P =.92). Patients were prescribed a median of 15.0 (IQR = 10.0-15.0) tablets of opioid pain medication postoperatively, but only used a median of 4.0 (IQR = 1.0-11.5) tablets at the time of first follow-up. Measured quality of life areas included sleep, physical activity, work, and mood. Sleep was most commonly affected, with 69.4% of patients noting disturbances. Conclusions: This study suggests that practitioners may over-estimate the need for opioid pain medication following otologic and neurotologic surgery. It also demonstrates the need for ongoing patient education regarding opioid risks, alternatives, and measures to prevent diversion. [ABSTRACT FROM AUTHOR]