Search

Report outcomes of rapid implementation of telehealth across an academic otolaryngology‐head and neck surgery department during the COVID‐19 pandemic This is a retrospective, single‐institution study of rapid deployment of telehealth during the COVID‐19 pandemic Characteristics of patients were compared between those who agreed and those who declined telehealth care Reasons for declining telehealth visits were ascertained Characteristics of telehealth visits were collected and patients were asked to complete a post‐visit satisfaction survey There was a 68% acceptance rate for telehealth visits In multivariable analysis, patients were more likely to accept telehealth if they were being seen in the facial plastics subspecialty clinic (odds ratio [OR] 59 55, 95% confidence interval [CI] 2 21‐1607 52;P = 015) compared to the general otolaryngology clinic Patients with Medicare (compared to commercial insurance) as their primary insurance were less likely to accept telehealth visits (OR 0 10, 95% CI 0 01‐0 77;P = 027) Two hundred and thirty one patients underwent telehealth visits;most visits (69%) were for established patients and residents were involved in 38% of visits There was an 85% response rate to the post‐visit survey On a scale of one to ten, the median satisfaction score was 10 and 99% of patients gave a score of 8 or higher Satisfaction scores were higher for new patient visits than established patient visits (P = 020) Rapid implementation of telehealth in an academic otolaryngology‐head and neck surgery department is feasible There was high acceptance of and satisfaction scores with telehealth 3 [ABSTRACT FROM AUTHOR] Copyright of Laryngoscope Investigative Otolaryngology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Gephyrin has long been thought of as a master regulator for inhibitory synapses, acting as a scaffold to organize γ-aminobutyric acid type A receptors (GABAARs) at the post-synaptic density. Accordingly, gephyrin immunostaining has been used as an indicator of inhibitory synapses, despite this, the pan-synaptic localization of gephyrin to specific classes of inhibitory synapses has not been demonstrated. Genetically encoded fibronectin intrabodies generated with mRNA display (FingRs) against gephyrin (Gephyrin.FingR) reliably label endogenous gephyrin, and can be tagged with fluorophores for comprehensive synaptic quantitation and monitoring. Here we investigated input- and target-specific localization of gephyrin at a defined class of inhibitory synapse, using Gephyrin.FingR proteins tagged with EGFP in brain tissue from transgenic mice. Parvalbumin-expressing (PV) neuron presynaptic boutons labeled using Cre- dependent synaptophysin-tdTomato were aligned with postsynaptic Gephyrin.FingR puncta. We discovered that more than one-third of PV boutons adjacent to neocortical pyramidal (Pyr) cell somas lack postsynaptic gephyrin labeling. This finding was confirmed using correlative fluorescence and electron microscopy. Our findings suggest some inhibitory synapses may lack gephyrin. Gephyrin-lacking synapses may play an important role in dynamically regulating cell activity under different physiological conditions.

SummaryThe coordination of activity between brain cells is a key determinant of neural circuit function; nevertheless, approaches that selectively regulate communication between two distinct cellular components of a mammalian circuit remain sparse. To address this gap, we developed a novel class of gap junctions by selectively engineering two connexin proteins found inMorone americana(white perch fish): connexin34.7 (Cx34.7) and connexin35 (Cx35). By iteratively exploiting protein mutagenesis, a novelin vitroassay of connexin docking, and computational modeling of connexin hemichannel interactions, we uncovered a pattern of structural motifs that contribute to hemichannel docking compatibility. Targeting these motifs, we designed Cx34.7 and Cx35 hemichannels that dock with each other, but not with themselves, nor with other major connexins expressed in the mammalian central nervous system. We validated these hemichannelsin vivousingC. elegansand mice, demonstrating that they can facilitate communication across neural circuits composed of pairs of distinct cell types and modify behavior accordingly. Thus, we establish a potentially translational approach, ‘Long-termintegration ofCircuits using connexins’ (LinCx), for context-precise circuit-editing with unprecedented spatiotemporal specificity in mammals.

The novel coronavirus disease 2019 (COVID‐19) pandemic continues to have extensive effects on public health as it spreads rapidly across the globe. Patients with head and neck cancer are a particularly susceptible population to these effects, and we expect there to be a potential surge in patients presenting with head and neck cancers after the surge in COVID‐19. Furthermore, the impact of social distancing measures could result in a shift toward more advanced disease at presentation. With appropriate anticipation, multidisciplinary head and cancer teams could potentially minimize the impact of this surge and plan for strategies to provide optimal care for patients with head and neck cancer.

Breakthroughs in understanding neural circuit activity hold much promise for developing next generation therapeutics for psychiatric disorders. Determination of how dynamic activity is coordinated across brain regions to effect specific behavioral function (or dysfunction) enables the development of therapeutics with increased specificity and fewer side effects. This chapter discusses methodologies for measuring neural circuit activity in humans and in animal models, and describes a bidirectional research pipeline whereby studies in humans are followed by tightly controlled studies in animal models that can then be applied back to humans. Targeted neural circuit manipulations from these studies are already being applied to a wide range of therapeutic strategies.

To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) in patients with previous renal transplantation.We retrospectively identified all patients who had undergone RARP for localized prostate cancer between 2005 and 2008 at a single institution (N=228). Of these, three patients were renal transplant recipients. A four-arm robotic configuration was used in all patients. Port placement was modified in two of the three renal transplant recipients to avoid trauma to the renal allograft. Preoperative demographics, perioperative parameters, and postoperative outcomes were reviewed.RARP was completed successfully in all three renal transplant recipients. As expected, the American Society of Anesthesiologists score (3.3 vs 2.4) and Charlson weighted index of comorbidity (4.7 vs 2.4) were greater in previous transplant patients. There were no major differences in mean age, Gleason score, body mass index, estimated blood loss, operative time, complications, or oncologic outcomes between the two groups. Each of the patients with renal allografts had an undetectable prostate-specific antigen level and was continent (needing no pads) at 13 months of follow-up.RARP is feasible in patients with a previous renal transplant. Although technically more challenging, RARP can be performed in previous transplant patients with acceptable morbidity and oncologic outcomes similar to those of other prostate cancer patients.

Although the long-term effects of radiation exposure are not completely predictable, the principle of keeping radiation exposure "as low as reasonably achievable" should be used. The purpose of this study was to compare fluoroscopy times before and after the implementation of a protocol designed to reduce fluoroscopy usage during ureteroscopy.A retrospective review was conducted of 300 consecutive ureteroscopy patients at a single institution. Patients undergoing simple ureteroscopy without ancillary procedures or balloon dilation were further evaluated to determine the effect of a reduced fluoroscopy protocol. The protocol included several measures, including use of a laser-guided C-arm, use of a designated fluoroscopy technician and substitution of visual for fluoroscopic cues during ureteroscopy. Fluoroscopy times were compared between groups using a paired t test with P.05 considered significant.Ureteroscopy cases before protocol implementation (n = 30) were compared with procedures after implementation (n = 30). Stone size and location were similar between groups. Protocol implementation significantly reduced the mean fluoroscopy exposure from 86.1 seconds (range 30-300) to 15.5 seconds (range 0-54; P.001). There was no difference in mean operative time (74.2 vs 65.1 minutes; P = .14), or complications (2 patients vs 2 patients; P = 1) between groups. No complication in either group could be ascribed to the fluoroscopic technique.The reduced fluoroscopy protocol resulted in an 82% reduction in fluoroscopy time without altering patient outcomes. These simple radiation-reducing techniques add no technical difficulty and improve safety for the patient, surgeon, and operating room staff by lowering radiation exposure.

Laparoendoscopic single-site (LESS) surgery produces virtually no scar but is technically challenging because of the loss of triangulation. The objective of this study is to compare classic transumbilical LESS nephrectomy with needlescopic-assisted laparoscopy (NAL) surgery. In doing so, we evaluated whether the addition of a single 2-mm subcostal port could restore triangulation while not jeopardizing recovery or cosmetic outcome in the porcine model.Ten female farm pigs were randomized to laparoscopic nephrectomy with either LESS or NAL. In LESS, a TriPort was placed through a single 2.5-cm umbilical incision. In NAL, 5- and 10-mm ports were placed in the umbilicus and a 2-mm port was placed in the midclavicular line. Preoperative, perioperative, and postoperative parameters were compared. Variables were analyzed with the Wilcoxon signed-rank test and two-tailed Fisher exact test. Cosmesis was evaluated objectively using the Vancouver Scar Scale and subjectively by a blinded dermatologist. A cost analysis was performed.Estimated blood loss was minimal in both groups (28.8 mL in LESS and 9.4 mL in NAL). Operative time was significantly shorter in NAL (103 vs 150 min; P0.001). There was no difference in complications (2 vs 1; P=0.500), objective cosmesis (3.9 vs 3.8; P0.2), or subjective cosmesis (2 vs 3; P=0.500). The NAL protocol had significantly lower disposable equipment costs ($363 vs $1696).The addition of a 2-mm subcostal port and the restoration of triangulation in the NAL protocol enable shorter operative times, increased surgeon comfort, improved technical ease, and lower costs while maintaining the scarless cosmesis of the traditional LESS protocol.

Aim: Natural orifice approaches for nephrectomy have included access via the stomach, vagina, bladder, and rectum. The use of the ureter as a natural orifice for natural orifice translumenal endoscopic surgery (NOTES) nephrectomy has not previously been reported. The aim of this study was to test the feasibility of transureteral laparoscopic NOTES nephrectomy. Materials and Methods: Three female farm pigs (29.2–30.8 kg) were placed into the lithotomy position. A cystoscopically placed extra-stiff guide wire was used to place a prototype dilating sheath into the left ureter. After dilation of the ureter and urethra, the sheath was exchanged for a 12-mm bariatric laparoscopic trocar. A 10.5-inch-long, 10-mm offset operating laparoscope with an internal 5-mm working port was utilized for the nephrectomy. One 2-mm and one 2/3-mm port were placed transabdominally to facilitate in situ morcellation. The kidney was cut into slices using the bipolar device and extracted via the ureteral port using the ho...

Objectives: To address the significant shortage of kidneys available for transplant, laparoendoscopic single-site surgery (LESS) has been employed to further decrease the morbidity of kidney donation. To circumvent the complexity of LESS, we have developed a bridging hand-assisted LESS (BLESS) technique that allows the surgeon to gain experience with single-incision surgical techniques in the setting of traditional hand-assisted laparoscopy. Methods: A retrospective study of three patients undergoing BLESS donor nephrectomy was performed. Similar to LESS, this bridging technique employs a single periumbilical incision, but enlargement of the incision by a few centimeters facilitates immediate transition to hand-assisted laparoscopy if needed. Statistics on preoperative, perioperative, and postoperative variables was collected for the patients undergoing this procedure. Results: BLESS patients had a mean age of 31. Average postoperative hospital stay was short at 1.34 days, with two of the three p...

Introduction: The altruistic act of kidney donation places the donor at risk for complications with no potential direct benefit. Any significant morbidity in a healthy donor is unacceptabl...

Natural orifice approaches for nephrectomy have included access via the stomach, vagina, bladder, and rectum. The use of the ureter as a natural orifice for natural orifice translumenal endoscopic surgery (NOTES) nephrectomy has not been previously reported. The purpose of this study is to test the feasibility of transureteral laparoscopic NOTES nephrectomy.Three female farm pigs (29.2-30.8 kg) were placed into the lithotomy position. A cystoscopically placed extra-stiff guidewire was used to place a prototype dilating sheath into the left ureter. After dilation of the ureter and urethra, the sheath was exchanged for a 12-mm bariatric laparoscopic trocar. A 10.5-inch long 10-mm offset operating laparoscope with an internal 5-mm working port was used for the nephrectomy. One 2-mm and one 2/3-mm port were placed transabdominally to facilitate in situ morcellation. The kidney was cut into slices using the bipolar device and extracted via the ureteral port using the housing of a 12-mm bariatric stapling device.All three transureteral nephrectomies were successfully completed. The total mean operative time was 220 minutes (range 113-346 min). Component portions of the procedure were: Ureteral access (mean 21 min), nephrectomy (mean 70 min), and kidney morcellation (mean 103 min). Mean estimated blood loss was 20 mL (range 5-50 mL). There were no intraoperative complications.This nonsurvival porcine feasibility study demonstrates the successful performance of transureteral nephrectomy. This approach shows promise as a way to decrease the invasiveness of NOTES nephrectomy by using the ureteral orifice as an access site.

Climate change is one of the major challenges facing society today. More effective education of the public on this topic certainly is necessary and K-12 teachers play an important role in climate change education. It is therefore necessary to find ways of training teachers in the science behind climate change and equipping them with effective strategies for confronting it in their classroom. One method of teacher training is through the use of summer institutes and workshops, in which teachers spend a significant amount of time in professional development and in interactions with scientists.

Although radiation exposure from CT and plain film imaging has been characterized, the radiation received by patients during modern-era fluoroscopy has not been well described. The purposes of this study were to measure absolute organ and tissue-specific radiation doses during ureteroscopy and to determine the influence of body mass index (BMI) and sex on these doses.Eight cadavers underwent a simulated left ureteroscopy. Using a modern C-arm with automatic exposure control settings, thermoluminescent dosimeters were exposed for a fluoroscopy time of 145 seconds (mean time of clinical ureteroscopies from 2006 to 2008). Total tissue exposures were compared by BMI and between sexes using the Wilcoxon signed ranks test and the Mann-Whitney test with p0.05 considered significant.Among all cadavers, radiation doses were significantly lower in all contralateral organs excluding the gonad (p0.012). Doses were similar bilaterally in the gonad in cadavers with BMI30, and in all organs in cadavers with BMI30 (p0.05). There were significantly higher mean bilateral gonadal doses in female cadavers (3.4 mGy left and 1.9 mGy right) compared with male cadavers (0.36 mGy left and 0.39 mGy right). The highest cancer risk increase was seen at the posterior skin equivalent to 104 additional cancers per 100,000 patients.Contralateral doses were lower for all organs except the gonad when the BMI was30. In contrast, when the BMI was30, there was no difference in radiation dose delivered to the ipsilateral and contralateral organs. Gonadal doses were significantly higher in female cadavers. Modern-era fluoroscopy remains a significant source of radiation exposure and steps should be taken to minimize exposure during ureteroscopy.