How We Do It: Otolaryngology Applicant Impressions of Virtual Meet and Greets at a Single Institution.

BACKGROUND: The COVID-19 pandemic altered residency recruitment in the 2021 application cycle. As a result, many programs adapted by creating virtual opportunities to connect with applicants such as clerkships, open houses, meet and greets, and interviews. Recent research has explored applicant impressions on virtual interviews and open houses, but none have assessed the utility of meet and greets, optimal structure, or desired topics to be addressed. METHODS: We hosted two virtual meet and greets for otolaryngology applicants and subsequently conducted a structured survey to assess the benefit, gather insight into desired topics, and determine how future sessions could be optimized. RESULTS: Twenty of 65 participants responded to the survey (31% response rate). The majority of participants learned about the event through social media (n = 15) or online resources such as OtoMatch or HeadMirror (n = 12). Desired topics to be addressed included faculty-resident relationships (85%), research (80%), the city of Madison (75%), breadth and depth of faculty (75%), and ability to train residents for future positions and fellowships (75%), among others. Overall, participants found the events helpful in conveying the culture and environment, exposure to faculty and residents, addressing questions, and providing insight into intangible aspects of the program. The main area of improvement identified was related to having breakout rooms, longer sessions, and varying the topics for breakout rooms. CONCLUSION: Virtual meet and greets facilitate outreach and provide opportunities for applicants to engage with residency programs and demonstrate interest. While initially implemented due to the COVID-19 pandemic, they will likely remain helpful in generating interest, reaching broader audiences, and possibly facilitating a successful match. It is critical to understand and incorporate the content that applicants wish to learn about at virtual meet and greets to best address questions, highlight key features, and demonstrate the intangible aspects of a residency program.

Rhinovirus C targets ciliated airway epithelial cells.

BACKGROUND: The Rhinovirus C (RV-C), first identified in 2006, produce high symptom burdens in children and asthmatics, however, their primary target host cell in the airways remains unknown. Our primary hypotheses were that RV-C target ciliated airway epithelial cells (AECs), and that cell specificity is determined by restricted and high expression of the only known RV-C cell-entry factor, cadherin related family member 3 (CDHR3). METHODS: RV-C15 (C15) infection in differentiated human bronchial epithelial cell (HBEC) cultures was assessed using immunofluorescent and time-lapse epifluorescent imaging. Morphology of C15-infected differentiated AECs was assessed by immunohistochemistry. RESULTS: C15 produced a scattered pattern of infection, and infected cells were shed from the epithelium. The percentage of cells infected with C15 varied from 1.4 to 14.7% depending on cell culture conditions. Infected cells had increased staining for markers of ciliated cells (acetylated-alpha-tubulin [aat], p < 0.001) but not markers of goblet cells (wheat germ agglutinin or Muc5AC, p = ns). CDHR3 expression was increased on ciliated epithelial cells, but not other epithelial cells (p < 0.01). C15 infection caused a 27.4% reduction of ciliated cells expressing CDHR3 (p < 0.01). During differentiation of AECs, CDHR3 expression progressively increased and correlated with both RV-C binding and replication. CONCLUSIONS: The RV-C only replicate in ciliated AECs in vitro, leading to infected cell shedding. CDHR3 expression positively correlates with RV-C binding and replication, and is largely confined to ciliated AECs. Our data imply that factors regulating differentiation and CDHR3 production may be important determinants of RV-C illness severity.

Effects of rhinovirus species on viral replication and cytokine production.

BACKGROUND: Epidemiologic studies provide evidence of differential virulence of rhinovirus species (RV). We recently reported that RV-A and RV-C induced more severe illnesses than RV-B, which suggests that the biology of RV-B might be different from RV-A or RV-C. OBJECTIVE: To test the hypothesis that RV-B has lower replication and induces lesser cytokine responses than RV-A or RV-C. METHODS: We cloned full-length cDNA of RV-A16, A36, B52, B72, C2, C15, and C41 from clinical samples and grew clinical isolates of RV-A7 and RV-B6 in cultured cells. Sinus epithelial cells were differentiated at the air-liquid interface. We tested for differences in viral replication in epithelial cells after infection with purified viruses (10(8) RNA copies) and measured virus load by quantitative RT-PCR. We measured lactate dehydrogenase (LDH) concentration as a marker of cellular cytotoxicity, and cytokine and/or chemokine secretion by multiplex ELISA. RESULTS: At 24 hours after infection, the virus load of RV-B (RV-B52, RV-B72, or RV-B6) in adherent cells was lower than that of RV-A or RV-C. The growth kinetics of infection indicated that RV-B types replicate more slowly. Furthermore, RV-B released less LDH than RV-A or RV-C, and induced lower levels of cytokines and chemokines such as CXCL10, even after correction for viral replication. RV-B replicates to lower levels also in primary bronchial epithelial cells. CONCLUSIONS: Our results indicate that RV-B types have lower and slower replication, and lower cellular cytotoxicity and cytokine and/or chemokine production compared with RV-A or RV-C. These characteristics may contribute to reduced severity of illnesses that has been observed with RV-B infections.

Biological characteristics and propagation of human rhinovirus-C in differentiated sinus epithelial cells.

Information about the basic biological properties of human rhinovirus-C (HRV-C) viruses is lacking due to difficulties with culturing these viruses. Our objective was to develop a cell culture system to grow HRV-C. Epithelial cells from human sinuses (HSEC) were differentiated at air-liquid interface (ALI). Differentiated cultures supported 1-2 logs growth of HRV-C15 as detected by quantitative RT-PCR. Two distinguishing features of HRVs are acid lability and optimal growth at 33-34 °C. We used this system to show that HRV-C15 is neutralized by low pH (4.5). In contrast to most HRV types, replication of HRV-C15 and HRV-C41 was similar at 34 and 37°C. The HSEC ALI provides a useful tool for quantitative studies of HRV-C replication. The ability of HRV-C to grow equally well at 34°C and 37°C may contribute to the propensity for HRV-C to cause lower airway illnesses in infants and children with asthma.

Molecular modeling, organ culture and reverse genetics for a newly identified human rhinovirus C.

A recently recognized human rhinovirus species C (HRV-C) is associated with up to half of HRV infections in young children. Here we propagated two HRV-C isolates ex vivo in organ culture of nasal epithelial cells, sequenced a new C15 isolate and developed the first, to our knowledge, reverse genetics system for HRV-C. Using contact points for the known HRV receptors, intercellular adhesion molecule-1 (ICAM-1) and low-density lipoprotein receptor (LDLR), inter- and intraspecies footprint analyses predicted a unique cell attachment site for HRV-Cs. Antibodies directed to binding sites for HRV-A and -B failed to inhibit HRV-C attachment, consistent with the alternative receptor footprint. HRV-A and HRV-B infected HeLa and WisL cells but HRV-C did not. However, HRV-C RNA synthesized in vitro and transfected into both cell types resulted in cytopathic effect and recovery of functional virus, indicating that the viral attachment mechanism is a primary distinguishing feature of HRV-C.

Endoscopic surgical treatment of neurogenic tumor in pterygopalatine and infratemporal fossae via extended medial maxillectomy.

CONCLUSION: The endoscopic extended medial maxillectomy approach for the management of lesions of the pterygopalatine and infratemporal fossa provides excellent exposure and results with good hemostasis and low morbidity. This approach is a viable alternative to the open approaches to these areas. OBJECTIVES: To describe an endoscopic extended medial maxillectomy approach for the treatment of nonmalignant tumors in the pterygopalatine and infratemporal fossa. METHODS: From January 2004 to June 2007, five patients who had tumors in the pterygopalatine fossa and/or infratemporal fossa, and underwent surgical resection of the tumors with the endoscopic extended medial maxillectomy approach, were reviewed regarding demographics, preoperative images, tumor cell type, surgical techniques, and outcomes. RESULTS: Five patients underwent the procedure mentioned above; three females and two males with a mean age of 38 and a range of 21-58 years. All patients had adequate exposure and total tumor resection with the endoscopic extended medial maxillectomy approach. None of the patients required an external approach for tumor extirpation. There were no major postoperative complications. No evidence of tumor recurrence was noted after follow-up for 12-78 months.

Chronic rhinosinusitis with nasal polyps: a proteomic analysis.

OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a severe subtype of chronic rhinosinusitis that can affect patients despite medical and surgical interventions. The purpose of this study was to utilize the techniques of proteomics to investigate differences in protein abundance within the sinonasal mucosa of patients with CRSwNP compared to healthy controls. METHODS: In a case-control study at a tertiary-care academic medical center, sinonasal mucosa was harvested from 3 patients with CRSwNP and 3 control patients undergoing transsphenoidal excision of pituitary tumors. Two-dimensional gel electrophoresis was used to identify proteins with elevated or reduced abundance in CRSwNP patients compared to controls. The proteins showing the greatest abundance differences were characterized by mass spectrometry. RESULTS: More than 300 differentially abundant proteins (p < or = 0.05) were identified. Many of these protein species were involved in the host inflammatory response. Proteins up-regulated in CRSwNP patients included eosinophil lysophospholipase by a ratio (R) of 18.13, RHO-GDP dissociation inhibitor 2 (R = 2.80), and apolipoprotein A-1 (R = 1.73). Down-regulated proteins in CRSwNP patients included catalase (R = -5.87), annexin A1 (R = -6.27), and keratin II-8 (R = -6.73). A detailed analysis of additional protein species is outlined. CONCLUSIONS: The proteomic approach allows detection of significant differences in protein abundance in CRSwNP and provides unique insight into the pathophysiology of this common disease.

Association of extraesophageal reflux disease and sinonasal symptoms: prevalence and impact on quality of life.

OBJECTIVES: The purpose of this study was to investigate the prevalence of extraesophageal reflux disease symptoms and their association with sinonasal disorders within a general sample of adults in our community and to determine how these conditions affect perception of general health, sinus-related quality of life (QOL), and perception of reflux and digestive function. STUDY DESIGN/METHODS: A community-dwelling sample of 1,878 adults completed symptom and QOL surveys in a two-stage prospective design: an initial screening questionnaire (n = 1,878) and disease-specific (sinus and reflux/digestion) and general health-related QOL instruments (n = 1,073). Demographic and response data were summarized and analyzed for prevalence and correlations among data sets. RESULTS: Sinonasal symptoms were reported in 71% of subjects who completed the initial screening questionnaire, and reflux-related symptoms were reported by 59% of respondents. The co-occurrence of sinonasal and reflux symptoms was reported by 45% of respondents. Subjects with both sinonasal and reflux symptoms scored significantly worse on the disease-specific and general physical and mental QOL scales than subjects with only reflux or sinonasal symptoms or no symptoms. CONCLUSIONS: Symptoms associated with inflammatory sinonasal disorders and gastroesophageal reflux disease are common in the general U.S. adult population and co-occur in the same individuals to a greater degree than can be attributed to chance alone. Co-occurrence was found to be associated with significant declines in both disease-specific and general physical and mental QOL. This finding has implications with regard to pathogenesis and treatment of these disorders.

Radiographic evaluation of aspirated metallic foil foreign bodies.

OBJECTIVES: Aspirated objects generally represent items accessible to children. When metallic candy wrapper aspiration is questioned, radiographic studies may aid diagnosis. An infant with repeated chest radiographs negative for a metallic foreign body was found to have a multi-layer metallic candy wrapper in the left main bronchus. The purpose of this study was to determine whether conventional and dual-energy radiographic techniques exclude the presence of aspirated metallic foil wrappers. METHODS: Single-layer and multi-layer metallic candy wrappers were radiographically studied with conventional and dual-energy radiographic techniques in 3 tissue models. RESULTS: No single-layer metallic samples were detectable with conventional or dual-energy radiography. The multilayer samples were not detectable at less than 8 layers (pulmonary tissue model) or 16 layers (mediastinal model) by either conventional or dual-energy radiography. CONCLUSIONS: Conventional and dual-energy chest radiographic techniques do not reliably exclude the presence of aspirated metallic foil wrappers.