Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance.

IMPORTANCE: Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery. OBJECTIVE: To elicit surgeon feedback of a virtual surgery planning tool for NAO and to determine if this tool affects surgeon decision making. DESIGN, SETTING, AND PARTICIPANTS: For this cross-sectional study, 60-minute face-to-face interviews with board-certified otolaryngologists were conducted at a single academic otolaryngology department from September 16, 2016, through October 7, 2016. Virtual surgery methods were introduced, and surgeons were able to interact with the virtual surgery planning tool interface. Surgeons were provided with a patient case of NAO, and open feedback of the platform was obtained, with emphasis on surgical decision making. MAIN OUTCOMES AND MEASURES: Likert scale responses and qualitative feedback were collected for the virtual surgery planning tool and its influence on surgeon decision making. RESULTS: Our 9 study participants were all male, board-certified otolaryngologists with a mean (range) 15 (4-28) number of years in practice and a mean (range) number of nasal surgeries per month at 2.2 (0.0-6.0). When examined on a scale of 1 (not at all) to 5 (completely), surgeon mean (SD) score was 3.4 (0.5) for how realistic the virtual models were compared with actual surgery. On the same scale, when asked how much the virtual surgery planning tool changed surgeon decision making, mean (SD) score was 2.6 (1.6). On a scale of 1 (strongly disagree) to 7 (strongly agree), surgeon scores for perceived usefulness of the technology and attitude toward using it were 5.1 (1.1) and 5.7 (0.9), respectively. CONCLUSIONS AND RELEVANCE: Our study shows positive surgeon experience with a virtual surgery planning tool for NAO based on CFD simulations. Surgeons felt that future applications and areas of study of the virtual surgery planning tool include its potential role for patient counseling, selecting appropriate surgical candidates, and identifying which anatomical structures should be targeted for surgical correction. LEVEL OF EVIDENCE: NA.

Laryngeal abscess formation in an immunosuppressed patient: A case report.

Prior to the onset of the antibiotic era, laryngeal perichondritis and abscess formation were more frequent complications of systemic infections. We report a case of 54-year-old male who was medically immunosuppressed after kidney transplantation and developed multiple pseudomonas abscesses of his larynx. After failing initial treatment and with worsening signs and symptoms, the patient eventually was treated with a prolonged course of intravenous and oral antibiotics, with resolution of his symptoms and clinical findings. Although this pathophysiology remains uncommon, laryngeal abscess formation should remain in the differential for persistent symptoms, especially in cases of patients on immunosuppression. Laryngoscope, 127:2827-2829, 2017.

A Novel ERAP2 Haplotype Structure in a Chilean Population: Implications for ERAP2 Protein Expression and Preeclampsia Risk.

Single nucleotide polymorphisms (SNPs) in the endoplasmic reticulum aminopeptidase 2 (ERAP2) gene are associated with preeclampsia (PE) in different populations. rs2549782, a coding variant (N392K) that significantly affects substrate specificity, is in linkage disequilibrium (LD) with rs2248374, a marker SNP associated with ERAP2 protein expression in previously studied populations. As a result of non-sense mediated RNA decay, ERAP2 protein is not expressed from the rs2248374 G allele. We previously reported that the fetal rs2549782 minor G allele is associated with PE in African-Americans, but not Chileans. In this study, we found that rs2549782 was in LD with rs2248374 in African-Americans, but not in Chileans. The unexpected lack of strong LD in Chileans raised the possibility that rs2248374 could be associated with PE in the absence of an association with rs2549782. However, we found no significant association for this allele with PE in Chileans. Chileans homozygous for the rs2248374 G allele did not express 110 kDa ERAP2 protein, consistent with non-sense mediated RNA decay, and carriers of the rs2248374 A allele did. We conclude that the Chilean ERAP2 haplotype structure allows for the expression of the major T allele of rs2549782 encoding 392N, which could impact peptide trimming and antigen presentation. Our discovery of racial differences in genetic structure and association with PE reveal here-to-fore unrecognized complexity of the ERAP2 locus.

Best practices for use of the HEMOX analyzer in the clinical laboratory: quality control determination and choice of anticoagulant.

The HEMOX Analyzer (TCS Scientific) has been used to measure the full oxygen-dissociation curve (ODC) and to calculate P(50) and the Hill coefficient. The effects of different anticoagulants on sample stability and P(50) values have not been evaluated extensively for this instrument. We characterized an artificial hemoglobin (Equil QC463) for quality control (QC) and compared P(50) values for blood samples drawn into 3 different anticoagulants (acid citrate dextrose [ACD], heparin, and EDTA). P(50) values were not stable in ACD but were stable in heparin and EDTA anticoagulants for up to 4 days. Tests with Equil QC463 showed that P(50) values were quite sensitive to small variations in buffer pH. Use of the correct anticoagulant and strict control of buffer pH are 2 parameters that need to be accounted for in best-practices use of this hemoximeter and before determining P(50).

Sharps exposures among otolaryngology-head and neck surgery residents.

OBJECTIVES/HYPOTHESIS: Examine the incidence of sharps exposures among otolaryngology residents, assess characteristics of exposures, and determine rates of reporting these potentially career- and life-impacting exposures. STUDY DESIGN: Cohort study of otolaryngology-head and neck surgery residents. METHODS: Survey was administered online to otolaryngology residents in the spring of 2008, gathering demographic information, characteristics of sharps exposures, and residents' self-reporting of sharps exposures. RESULTS: Among 1,407 otolaryngology residents nationwide, 231 completed the survey. Of these, 168 (72.7%) had at least one sharps exposure during residency, with most due to solid-bore needles (51.7%) and occurring in the operating room (67%). Fifty percent of residents reported exposures occurring in postgraduate year (PGY)-3 or PGY-4, whereas exposures occurred at slightly lower rates in the other PGYs. There was no difference in incidence of sharps exposures based on gender (Fisher exact test, P = .2742) or history of sharps exposure during medical school (Fisher exact test, P = .7559). Seventy-four participants had an exposure that they did not report to the hospital, with the most common reason for not reporting being the perceived burden of the hospital testing protocol. CONCLUSIONS: Otolaryngology residents report a high rate of sharps exposures during residency training, with a significant number of these exposures going unreported. Better education may be needed to help decrease these often preventable workplace exposures and to improve compliance with reporting and testing procedures.