Masks and air rage: a qualitative content analysis using an interaction ritual framework.

During the pandemic, there was an alarming escalation in reports of air rage in the United States. Prior to the pandemic, the yearly average of unruly airline passenger behaviors was around 100 incidents per year. However, after mask mandates were issued, 5981 unruly passenger incidents in the United States were reported by the Federal Aviation Administration (FAA) in 2021 alone. Therefore, we conducted a qualitative content analysis pertaining to mask-related incidents of air rage, to learn more about this recent social problem. We also applied an interaction ritual (IR) framework to the results of our analysis, to provide sociological insight concerning this issue. The goal of our exploratory research is to understand what it is about masks that cause certain groups of people to lash out violently while on airplanes. To date, little or no scholarly efforts have researched incidents of air rage in relation to masks. Therefore, our research provides a contribution by updating the literature on this topic.

The Auditory Processing Domains Questionnaire (APDQ): Brazilian-Portuguese version.

OBJECTIVE: The present study aimed to determine the fidelity, reliability, and internal validity of the APDQ when translated from English to Brazilian-Portuguese language. METHODS: The first phase included the APDQ translation into Brazilian-Portuguese including forward translation, translation assessment and back-translation in a group of 10 students. The second phase involved establishing the internal consistency and reliability of the APDQ Brazilian-Portuguese version. Data was collected from 66 students without any risk factor for auditory processing disorder. Subjects were divided into a younger group (7-10 yrs) and an older group (11-17 yrs). RESULTS: All items showed appropriate quality in terms of translation. In determining internal consistency, Cronbach's alpha in subscales of auditory processing, attention and language was found to be 0.93, 0.85 and 0.74, respectively. Intraclass Correlation Coefficient for total score was 0.95, ensuring a strong test-retest reliability. CONCLUSION: The Brazilian-Portuguese version of the APDQ has favorable translation quality, internal validity and reliability. It is now ready for continued study as a differential screening tool for 7- to 17-year-old Brazilian children with listening difficulties who are at risk for auditory processing disorder, attention deficits and language learning challenges.

A Case of Ulcerated Gastric Mass and Anemia due to Strongyloidiasis.

Strongyloidiasis is an intestinal infection caused by the nematode Strongyloides, and it is rarely seen in our clinical practice in the United States. Although it remains localized to the gastrointestinal tract most of the time, it can disseminate to other organs when it causes autoinfection in the setting of immunosuppression. The clinical manifestations vary depending on the involved organ. A case of disseminated strongyloidiasis presenting as a case of ulcerated gastric mass and anemia is described here along with a review of the literature on this condition.

Tendinosis develops from age- and oxygen tension-dependent modulation of Rac1 activity.

Age-related tendon degeneration (tendinosis) is characterized by a phenotypic change in which tenocytes display characteristics of fibrochondrocytes and mineralized fibrochondrocytes. As tendon degeneration has been noted in vivo in areas of decreased tendon vascularity, we hypothesized that hypoxia is responsible for the development of the tendinosis phenotype, and that these effects are more pronounced in aged tenocytes. Hypoxic (1% O2 ) culture of aged, tendinotic, and young human tenocytes resulted in a mineralized fibrochondrocyte phenotype in aged tenocytes, and a fibrochondrocyte phenotype in young and tendinotic tenocytes. Investigation of the molecular mechanism responsible for this phenotype change revealed that the fibrochondrocyte phenotype in aged tenocytes occurs with decreased Rac1 activity in response to hypoxia. In young hypoxic tenocytes, however, the fibrochondrocyte phenotype occurs with concomitant decreased Rac1 activity coupled with increased RhoA activity. Using pharmacologic and adenoviral manipulation, we confirmed that these hypoxic effects on the tenocyte phenotype are linked directly to the activity of RhoA/Rac1 GTPase in in vitro human cell culture and tendon explants. These results demonstrate that hypoxia drives tenocyte phenotypic changes, and provide a molecular insight into the development of human tendinosis that occurs with aging.

Developing the auditory processing domains questionnaire (APDQ): a differential screening tool for auditory processing disorder.

OBJECTIVE: The aim of this study was to develop a screening questionnaire for auditory processing disorder (APD). DESIGN: Fifty-two questions were created to enable parent/teacher proxies to rate students listening skills in terms of auditory processing, attention and language factors. STUDY SAMPLE: Parents rated their child's frequency of competent performance (regularly, often, sometimes or rarely) on 52 questions. Scores were calculated for three scales: auditory processing, attention and language. Data was collected from 198 normal controls, 20 students with auditory processing disorder, 40 students with attention deficit hyperactivity disorder and 10 students with a learning disability. Subjects were split into a younger group (7-10 y) and an older group (11-17 y). RESULTS: Factor analysis revealed substantial internal validity. Analysis of external validity using a regression model revealed significant differences between normal and clinical groups for all scales (p < 0.001) and also significantly separated the three clinical groups. A group differential analysis of scale score results clearly demonstrated inter-group differences at 89% (on average) sensitivity and specificity levels. CONCLUSION: The auditory processing domains questionnaire appears to be an effective screening questionnaire for APD with scale score patterns likely to be helpful in making appropriate clinical referrals.

Benign fibrous pseudotumor resulting in orchiectomy despite intraoperative frozen section.

Fibrous pseudotumors are rare benign lesions that originate within the paratesticular tissues. Local excision is the preferred method of treatment of these tumors over radical orchiectomy, however a definitive diagnosis must be made beforehand given the similarity of these tumors to malignant entities. We present a case of fibrous pseudotumor of the tunica vaginalis and cauda epididymis. A diagnosis of fibrous pseudotumor could not be established despite the use of intraoperative frozen section, therefore necessitating radical orchiectomy.

Outcomes of Patients Implanted Using a Left Thoracotomy Technique for a Miniaturized Centrifugal Continuous-Flow Pump.

As ventricular-assist devices (VADs) are increasingly employed in heart failure management, a leading cause of mortality, new literature is consistently published on less-invasive implantation techniques. Although early perioperative outcomes have been shown to be favorable with minimally invasive left thoracotomy (LT) approaches compared with conventional sternotomy (CS), studies comparing long-term outcomes are lacking. We set out to evaluate long-term follow up between LT and CS approach. In a single center, retrospective review, data on patients with similar demographic profiles were collected. HeartWare (HVAD) implantation was performed by either CS or LT. Analysis was performed on perioperative adverse outcomes, and 6 month postoperative adverse events. Primary objectives of the study included comparative outcomes of morbidity and mortality between both groups at 180 days postimplantation. Eighty-one (n = 81) bridge to transplant (BTT) patients underwent CS or LT HVAD implantation. Perioperative transfusion (p = 0.04) favored the LT cohort compared with CS, with a median of 6 units and 8 units transfused for each group, respectively. No survival difference was observed between both groups at 6 months postimplantation (p = 0.52). Clinical outcomes at an average of 6 month follow up showed no difference in adverse events, including common postoperative VAD complications such as infection and right heart failure. Miniaturization of LVAD size and improvement in technology has allowed expansion of interest in alternative surgical approaches for HVAD implantation. For BTT patients, no difference in early outcome was observed 6 months after implantation using a left LT versus CS technique.

The Efficacy of a Brief Nature Sound Intervention on Muscle Tension, Pulse Rate, and Self-Reported Stress: Nature Contact Micro-Break in an Office or Waiting Room.

BACKGROUND: There is a growing recognition that environmental design impacts health and well-being. Nature contact is a design feature or exposure that is especially important in public health and healthcare. To date, there are limited findings on the impact of nature sounds. OBJECTIVE: This experimental study was designed to examine the effect of nature sounds on physiological and psychological stress. METHODS: Participants were randomized into one of three groups-silence (n = 9), nature sound (n = 17), and classical music (n = 14)-and listened to the assigned sound for 15 min in an office or waiting room-like environment. Pre- and postdata were collected including muscle tension (electromyogram), pulse rate, and self-reported stress. RESULTS: With the exception of pulse rate, there were no statistical differences in baseline or demographics among groups. A paired t-test by group showed a decrease in muscle tension, pulse rate, and self-reported stress in the nature group and no significant differences in the control or the classical music groups. The significant reduction in muscle tension occurred at least by 7 min of listening to the nature sound. CONCLUSION: This study highlights the potential benefit of even very brief (less than 7 min) exposure to nature sounds. Brief nature sound "booster breaks" are a promising area for future research with important practical implications.

A preliminary report of percutaneous craniofacial osteoplasty in a rat calvarium.

OBJECTIVES/HYPOTHESIS: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatability and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model. STUDY DESIGN: Randomized controlled animal model. METHODS: Fourteen adult Sprague Dawley rats were injected in the parietal skull with 0.2 ml of hydroxylapatite (10 animals) or 0.2 ml of a carrier gel control (4 animals), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, three rats (1 negative control, 2 variables) were sacrificed and the calvaria were harvested. At 12 months, the remaining five rats were sacrificed. After each harvest, the specimens were processed and then examined under both light and polarized microscopy for new bone growth at the injection sites. RESULTS: The inflammatory response was limited with both hydroxylapatite and carrier injections. Injectables were still present 12 months after the injection. New bone formation was only observed when the injection was located deep to a disrupted periosteum The odds of new bone formation was 48.949 times higher (95% confidence intervals CI [2.637, 3759.961]; P=0.002) with subperiosteal hydroxylapatite injections compared to all other combinations of injection plane and injectable. CONCLUSIONS: This preliminary report of subperiosteal hydroxylapatite (Radiesse) injection in a rat model has verified the biocompatibility of injectable hydroxylapatite at the bony interface and suggests the potential for new bone formation. LEVEL OF EVIDENCE: N/A.

Distal fibula metastasis of cholangiocarcinoma.

Cholangiocarcinoma is a rare disease with a reported incidence in the United States of 1 to 2 cases per 100,000 population. These cancers have a high mortality rate because most are locally advanced at presentation. Cholangiocarcinoma most commonly advances locally and regionally by invading the lymph nodes. In rare cases, it has been noted that cholangiocarcinoma can metastasize to bone, with a preponderance for the axial skeleton. Herein, we describe what we believe to be the first clinical report of an acral bone metastasis from metastatic cholangiocarcinoma.

Value-based analysis of routine pathologic septal and inferior turbinate specimens.

OBJECTIVE: To determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery and evaluate the necessity for histologic processing of nasal septal cartilage, bone, and inferior turbinate specimens. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care academic medical center. SUBJECTS AND METHODS: A retrospective review of surgical pathology reports on adult patients undergoing sinonasal surgery during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, or directed septal biopsies were excluded from review. RESULTS: A total of 1194 pathology reports were reviewed from 1172 individual patients. This included histopathologic evaluation of 1194 septal cartilage and bone specimens and 714 inferior turbinate specimens. None of the patients had unanticipated histopathologic findings that were clinically significant. CONCLUSION: Many surgeons obtain histopathologic diagnoses on all tissue removed from a patient. Based on our institutional case series, histopathology of the septum and inferior turbinates in routine sinonasal cases may not be necessary. A value-based approach to processing grossly unremarkable septal and turbinate tissue by waiving histologic processing and subsequent microscopic evaluation could provide significant cost savings.

The minimally-invasive thyroidectomy incision: a histological analysis.

BACKGROUND: Minimally invasive thyroidectomy (MIT) has gained popularity in the surgical management of benign and malignant pathology of the thyroid. One of the main benefits of utilizing this technique is the use of smaller incisions resulting in increased cosmetic satisfaction. Unfortunately, the retraction required for adequate exposure during MIT may lead to skin damage, impaired wound healing and poor cosmetic outcomes. Some have proposed that excising incision edges prior to closure may improve cosmesis. A review of the literature does not reveal any histologic evidence to support this technique. MATERIAL/METHODS: In this prospective observational study, nine subjects undergoing MIT were identified. Both the superior and inferior skin edges were excised and labeled for orientation. Specimens were sent for hematoxylin and eosin staining and histologic analysis by a staff pathologist. RESULTS: All specimens showed no significant findings such as damage to the architecture of the dermis, acute inflammation, edema or evidence of hemorrhage. Focal blood vessel ectasia within the dermis was identified in three of nine subjects. CONCLUSIONS: Our findings do not yield a histological basis supporting the routine trimming of incisions during MIT. Although no significant findings were noted histologically, further studies are warranted to investigate the long-term cosmetic outcome of MIT incisions.

Parathyroid carcinoma: a rare cause of primary hyperparathyroidism.

Most cases of primary hyperparathyroidism (80 to 90%) are caused by a parathyroid adenoma; most of the rest are caused by either parathyroid gland hyperplasia or multiple adenomas. Parathyroid carcinoma can be the cause of primary hyperparathyroidism in 1 to 5% of patients. When the appropriate clinical scenario is presented, it must be considered in the differential diagnosis. We describe the case of a 72-year-old woman with a long history of hypercalcemia and arthritic shoulder and neck pain who was admitted with an elevated calcium level and acute renal failure secondary to bilateral obstructing ureteral calculi. A sestamibi scan and magnetic resonance imaging detected the presence of what appeared to be a right inferior parathyroid adenoma. Her intact parathyroid hormone (PTH) level was 2,257 pg/ml. Following placement of bilateral ureteral stents and adequate hydration, the patient was taken to the operating room for a neck exploration and removal of a parathyroid adenoma with rapid intraoperative PTH monitoring. A 4 x 2.5-cm, 10-g mass was removed from the right inferior pole of the thyroid gland. Following excision, her intraoperative PTH level dropped from 1,103 to 110 pg/ml. Her ionized calcium levels fell from a high of 8.4 mg/dl preoperatively to 4.7 mg/dl. On final pathologic examination, the mass was confirmed to be a parathyroid carcinoma.

MicroRNA expression profiling of human metastatic cancers identifies cancer gene targets.

Small non-coding microRNAs (miRNAs) contribute to cancer development and progression, and are differentially expressed in normal tissues and cancers. However, the specific role of miRNAs in the metastatic process is still unknown. To seek a specific miRNA expression signature characterizing the metastatic phenotype of solid tumours, we performed a miRNA microarray analysis on 43 paired primary tumours (ten colon, ten bladder, 13 breast, and ten lung cancers) and one of their related metastatic lymph nodes. We identified a metastatic cancer miRNA signature comprising 15 overexpressed and 17 underexpressed miRNAs. Our results were confirmed by qRT-PCR analysis. Among the miRNAs identified, some have a well-characterized association with cancer progression, eg miR-10b, miR-21, miR-30a, miR-30e, miR-125b, miR-141, miR-200b, miR-200c, and miR-205. To further support our data, we performed an immunohistochemical analysis for three well-defined miRNA gene targets (PDCD4, DHFR, and HOXD10 genes) on a small series of paired colon, breast, and bladder cancers, and one of their metastatic lymph nodes. We found that the immunohistochemical expression of these targets significantly follows the corresponding miRNA deregulation. Our results suggest that specific miRNAs may be directly involved in cancer metastasis and that they may represent a novel diagnostic tool in the characterization of metastatic cancer gene targets.

Orbital floor reconstruction using porcine small intestinal submucosa.

BACKGROUND: We conducted a prospective, controlled, blinded pilot study to demonstrate that repair of induced rabbit orbital floor fractures with Surgisis ES (Cook Biotech Inc, West Lafayette, Ind) provides adequate orbital content support while promoting mucosal and bone regeneration of the fracture site. MATERIAL/METHODS: Ten New Zealand white rabbits underwent induced bilateral controlled (5mm) orbital floor fractures under anesthesia. In each rabbit, Surgisis ES, an acellular, freeze-dried soft tissue matrix derived from porcine small intestinal submucosa, was implanted subperiosteally to repair one orbital floor fracture through a transconjuntival approach. The contralateral orbital floor fracture served as a control. Histological assessment was performed at 1, 3, and 12 months post-operatively. RESULTS: All ten rabbits survived the surgery without infection, globe entrapment or implant rejection. Grossly, the orbits appeared similar in the ten rabbits. Subtle histological differences were noted between the fractures repaired with Surgisis ES and those left to heal without treatment. Eosinophilic infiltrates and connective tissue fibrosis found to varying degrees in the Surgisis ES sites were not found in the control sites. Previous Surgisis studies found a foreign body giant cell reaction that was absent in this study. Both sites were healed at all intervals. CONCLUSIONS: Surgisis ES can successfully serve as a graft in the repair of orbital floor fractures in rabbits. However, its ability to promote central bone regeneration has not been clearly established. Additional studies investigating its application in human orbital trauma are needed.

Idiopathic granulomatous mastitis masquerading as carcinoma of the breast: a case report and review of the literature.

BACKGROUND: Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. CASE PRESENTATION: We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. CONCLUSION: There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options include expectant management with spontaneous remission, corticosteroid therapy, immunosuppressive agents and extensive surgery for refractory cases.

Rabbit ear cartilage regeneration with a small intestinal submucosa graft.

OBJECTIVES/HYPOTHESIS: The objective was to demonstrate that interpositional grafting with porcine small intestinal submucosa promotes cartilage regeneration following excision of rabbit auricular cartilage. STUDY DESIGN: Blinded, controlled study. METHODS: Eight New Zealand white rabbits underwent excision of auricular cartilage on two sites with and two sites without preservation of perichondrium. Porcine small intestinal submucosa was implanted into one site with and one site without intact perichondrium. Remaining sites served as control sites. Histological assessment was performed at 3 (n = 4) and 6 (n = 3) months and at 1 year (n = 1) after grafting. RESULTS: Histological evaluation showed cartilage regeneration accompanied by chronic inflammation in areas in which porcine small intestinal submucosa was implanted between layers of intact perichondrium. Other sites failed to show significant cartilage regeneration. CONCLUSION: The results of the study using porcine small intestinal submucosa as a bioscaffold for cartilage regeneration are promising and justify further animal and human studies.