Imaging and Modeling the Optical Emission from CH Radicals in Microwave Activated C/H Plasmas.

We report a combined experimental/modeling study of optical emission from the A2Δ, B2Σ-, and C2Σ+ states of the CH radical in microwave (MW) activated CH4/H2 gas mixtures operating under a range of conditions relevant to the chemical vapor deposition of diamond. The experiment involves spatially and wavelength resolved imaging of the CH(C → X), CH(B → X), and CH(A → X) emissions at different total pressures, MW powers, C/H ratios in the source gas, and substrate diameters. The results are interpreted by extending an existing 2D (r, z) plasma model to include not just electron impact excitation but also chemiluminescent (CL) bimolecular reactions as sources of the observed CH emissions. Three possible CL reactions (of H atoms with CH2(a1A1) and CH2(X3B1) radicals and of C(1D) atoms with H2) are identified as plausible sources of electronically excited CH radicals (particularly of the lowest energy CH(A) state radicals). Each or all of these could contribute to the observed emissions and, collectively, are deduced to be the major source of the CH(A) emissions observed at the high temperatures (Tgas ∼ 3000 K) and pressures (75 ≤ p ≤ 275 Torr) explored in the present study. We suggest that such CL contributions are likely to be commonplace in such high pressure, high temperature plasma environments and highlight some of the risks associated with using relative emission intensities as an indicator of the electron characteristics in such plasmas.

Genetic characterization of Vibrio vulnificus strains isolated from oyster samples in Mexico.

Vibrio vulnificus strains were isolated from oysters that were collected at the main seafood market in Mexico City. Strains were characterized with regard to vvhA, vcg genotype, PFGE, multilocus sequence typing (MLST), and rtxA1. Analyses included a comparison with rtxA1 reference sequences. Environmental (vcgE) and clinical (vcgC) genotypes were isolated at nearly equal percentages. PFGE had high heterogeneity, but the strains clustered by vcgE or vcgC genotype. Select housekeeping genes for MLST and primers that were designed for rtxA1 domains divided the strains into two clusters according to the E or C genotype. Reference rtxA1 sequences and those from this study were also clustered according to genotype. These results confirm that this genetic dimorphism is not limited to vcg genotyping, as other studies have reported. Some environmental C genotype strains had high similarity to reference strains, which have been reported to be virulent, indicating a potential risk for oyster consumers in Mexico City.

A Qualitative Analysis of a Primary Care Medical-Legal Partnership: Impact, Barriers, and Facilitators.

BACKGROUND: Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization. OBJECTIVE: The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics. METHODS: A qualitative design using a semistructured interview assessed the perceived impact, barriers, and facilitators of an MLP, among clinicians, clinic and MLP staff, and clinic patients. Open AI software (otter.ai) was used to transcribe interviews, and NVivo was used to code the data. Braun & Clarke's framework was used to identify themes and subthemes. RESULTS: Sixteen (n = 16) participants were included in this study. Most respondents were women (81%) and white (56%). Four respondents were clinic staff, and 4 were MLP staff while 8 were clinic patients. Several primary themes emerged including: Patients experienced legal issues that were pernicious, pervasive, and complex; through trusting relationships, the MLP was able to improve health and resolve legal issues, for some; mistrust, communication gaps, and inconsistent staffing limited the impact of the MLP; and, the MLP identified coordination and communication strategies to enhance trust and amplify its impact. CONCLUSION: HHLNs can have a significant, negative impact on the physical and mental health of patients. Respondents perceived that MLPs improved health and resolved these needs, for some. Despite perceived successes, integration between the clinical and legal organizations was elusive.

MAVS signaling is required for preventing persistent chikungunya heart infection and chronic vascular tissue inflammation.

Chikungunya virus (CHIKV) infection has been associated with severe cardiac manifestations, yet, how CHIKV infection leads to heart disease remains unknown. Here, we leveraged both mouse models and human primary cardiac cells to define the mechanisms of CHIKV heart infection. Using an immunocompetent mouse model of CHIKV infection as well as human primary cardiac cells, we demonstrate that CHIKV directly infects and actively replicates in cardiac fibroblasts. In immunocompetent mice, CHIKV is cleared from cardiac tissue without significant damage through the induction of a local type I interferon response from both infected and non-infected cardiac cells. Using mice deficient in major innate immunity signaling components, we found that signaling through the mitochondrial antiviral-signaling protein (MAVS) is required for viral clearance from the heart. In the absence of MAVS signaling, persistent infection leads to focal myocarditis and vasculitis of the large vessels attached to the base of the heart. Large vessel vasculitis was observed for up to 60 days post infection, suggesting CHIKV can lead to vascular inflammation and potential long-lasting cardiovascular complications. This study provides a model of CHIKV cardiac infection and mechanistic insight into CHIKV-induced heart disease, underscoring the importance of monitoring cardiac function in patients with CHIKV infections.

High-Quality Amorphous Silicon Carbide for Hybrid Photonic Integration Deposited at a Low Temperature.

Integrated photonic platforms have proliferated in recent years, each demonstrating its unique strengths and shortcomings. Given the processing incompatibilities of different platforms, a formidable challenge in the field of integrated photonics still remains for combining the strengths of different optical materials in one hybrid integrated platform. Silicon carbide is a material of great interest because of its high refractive index, strong second- and third-order nonlinearities, and broad transparency window in the visible and near-infrared range. However, integrating silicon carbide (SiC) has been difficult, and current approaches rely on transfer bonding techniques that are time-consuming, expensive, and lacking precision in layer thickness. Here, we demonstrate high-index amorphous silicon carbide (a-SiC) films deposited at 150 °C and verify the high performance of the platform by fabricating standard photonic waveguides and ring resonators. The intrinsic quality factors of single-mode ring resonators were in the range of Qint = (4.7-5.7) × 105 corresponding to optical losses between 0.78 and 1.06 dB/cm. We then demonstrate the potential of this platform for future heterogeneous integration with ultralow-loss thin SiN and LiNbO3 platforms.

Generation of quality-controlled SARS-CoV-2 variant stocks.

One of the main challenges in the fight against coronavirus disease 2019 (COVID-19) stems from the ongoing evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into multiple variants. To address this hurdle, research groups around the world have independently developed protocols to isolate these variants from clinical samples. These isolates are then used in translational and basic research-for example, in vaccine development, drug screening or characterizing SARS-CoV-2 biology and pathogenesis. However, over the course of the COVID-19 pandemic, we have learned that the introduction of artefacts during both in vitro isolation and subsequent propagation to virus stocks can lessen the validity and reproducibility of data. We propose a rigorous pipeline for the generation of high-quality SARS-CoV-2 variant clonal isolates that minimizes the acquisition of mutations and introduces stringent controls to detect them. Overall, the process includes eight stages: (i) cell maintenance, (ii) isolation of SARS-CoV-2 from clinical specimens, (iii) determination of infectious virus titers by plaque assay, (iv) clonal isolation by plaque purification, (v) whole-virus-genome deep-sequencing, (vi and vii) amplification of selected virus clones to master and working stocks and (viii) sucrose purification. This comprehensive protocol will enable researchers to generate reliable SARS-CoV-2 variant inoculates for in vitro and in vivo experimentation and will facilitate comparisons and collaborative work. Quality-controlled working stocks for most applications can be generated from acquired biorepository virus within 1 month. An additional 5-8 d are required when virus is isolated from clinical swab material, and another 6-7 d is needed for sucrose-purifying the stocks.

A neonatal mouse model characterizes transmissibility of SARS-CoV-2 variants and reveals a role for ORF8.

Small animal models have been a challenge for the study of SARS-CoV-2 transmission, with most investigators using golden hamsters or ferrets 1, 2 . Mice have the advantages of low cost, wide availability, less regulatory and husbandry challenges, and the existence of a versatile reagent and genetic toolbox. However, adult mice do not robustly transmit SARS-CoV-2 3 . Here we establish a model based on neonatal mice that allows for transmission of clinical SARS-CoV-2 isolates. We characterize tropism, respiratory tract replication and transmission of ancestral WA-1 compared to variants Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), Omicron BA.1 and Omicron BQ.1.1. We identify inter-variant differences in timing and magnitude of infectious particle shedding from index mice, both of which shape transmission to contact mice. Furthermore, we characterize two recombinant SARS-CoV-2 lacking either the ORF6 or ORF8 host antagonists. The removal of ORF8 shifts viral replication towards the lower respiratory tract, resulting in significantly delayed and reduced transmission in our model. Our results demonstrate the potential of our neonatal mouse model to characterize viral and host determinants of SARS-CoV-2 transmission, while revealing for the first time a role for an accessory protein in this context.

A neonatal mouse model characterizes transmissibility of SARS-CoV-2 variants and reveals a role for ORF8.

Small animal models have been a challenge for the study of SARS-CoV-2 transmission, with most investigators using golden hamsters or ferrets. Mice have the advantages of low cost, wide availability, less regulatory and husbandry challenges, and the existence of a versatile reagent and genetic toolbox. However, adult mice do not robustly transmit SARS-CoV-2. Here we establish a model based on neonatal mice that allows for transmission of clinical SARS-CoV-2 isolates. We characterize tropism, respiratory tract replication and transmission of ancestral WA-1 compared to variants Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), Omicron BA.1 and Omicron BQ.1.1. We identify inter-variant differences in timing and magnitude of infectious particle shedding from index mice, both of which shape transmission to contact mice. Furthermore, we characterize two recombinant SARS-CoV-2 lacking either the ORF6 or ORF8 host antagonists. The removal of ORF8 shifts viral replication towards the lower respiratory tract, resulting in significantly delayed and reduced transmission in our model. Our results demonstrate the potential of our neonatal mouse model to characterize viral and host determinants of SARS-CoV-2 transmission, while revealing a role for an accessory protein in this context.

Examining a Continuous Glucose Monitoring Plus Online Peer Support Community Intervention to Support Hispanic Adults With Type 2 Diabetes: Protocol for a Mixed Methods Feasibility Study.

BACKGROUND: Type 2 diabetes is twice as likely to affect Hispanic people than their White counterparts. Technology and social support may be an important part of behavior change. In this study, we address gaps in diabetes care for Hispanic Spanish-speaking people with diabetes through an online peer support community (OPSC) pilot intervention using Hispanic Spanish-speaking peer facilitators with diabetes to enhance the use of continuous glucose monitoring (CGM) for diabetes management. OBJECTIVE: This study aims to address gaps in diabetes care for Hispanic Spanish-speaking people with diabetes through an OPSC pilot intervention using Hispanic Spanish-speaking peer facilitators with diabetes to enhance the use of CGM for diabetes management. METHODS: A mixed-methods, pre-post test design will be used in this feasibility study. A total of 50 Hispanic participants with type 2 diabetes willing to wear a continuous glucose monitor for 13 weeks will be recruited. Hispanic Spanish-speaking peer facilitators with diabetes and experience wearing a continuous glucose monitor will be employed and undergo training. Peer facilitators will help participants learn how CGM data can inform behavior changes via an OPSC. Participants will interact with the private OPSC at least three times a week. Weekly questions and prompts derived from the Association of Diabetes Care and Education Specialists, previously American Association of Diabetes Educators, and seven self-care behaviors will be delivered by peer facilitators to engage participants. Measures of feasibility and acceptability will be determined by the percentage of participants who enroll, complete the study, and use CGM (number of scans) and objective metrics from the OPSC. Efficacy potential outcomes include change in time in range of 70 to 180 mg/dL from baseline to 12 weeks, A1c, diabetes online community engagement, self-efficacy, and quality of life. Additionally, semistructured exit interviews will be conducted. RESULTS: Funding for this project was secured in November 2018 and approved by the institutional review board in April 2019. Peer facilitator recruitment and training were undertaken in the second half of 2019, with participant recruitment and data collection conducted in January and April 2020. The study has now concluded. CONCLUSIONS: This study will generate new evidence about the use of an OPSC for Hispanic Spanish-speaking patients with diabetes to make behavior changes incorporating feedback from CGM. TRIAL REGISTRATION: ClinicalTrials.gov NCT03799796; https://clinicaltrials.gov/ct2/show/NCT03799796. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/31595.

Rhytidectomy: principles and practice emphasizing safety.

There is an unprecedented acceptance of rhytidectomy by today's society. No longer limited to the affluent few, middle class citizens are devoting their expendable income to achieve a more youthful appearance that is natural and inconspicuous. Despite recent difficult economic times, the mindset of the working population continues to be welcoming of rhytidectomy as a way to achieve a refreshed look while expecting minimal downtime and morbidity. To achieve these results, the current literature has described an array of techniques; however, there is no consensus on a preferred method, which reflects limitations and advantages inherent to every style of face-lifting. Each individual patient will have specific needs, and it is key for the facial plastic surgeon to select a technique that can address those areas most affected by the aging process. Whichever method used, an emphasis on safety is of the utmost importance. A solid understanding of the relevant anatomy is imperative as is the awareness of how to best avoid complications. Rhytidectomy can be a challenging procedure, and although complications are fortunately rare, they can be cosmetically devastating and poorly accepted by the elective cosmetic patient. This article aims at providing a summary of the history, the anatomy, and the currently accepted methods in rhytidectomy, emphasizing principles and practices of safety.

[Surgical risk scale in pediatric surgery]. / Escala de riesgo quirúrgico en cirugía pediátrica.

INTRODUCTION: The need to measure the level of surgical risk arises from its direct relationship with the development of postoperative complications and the use of hospital resources. The construction of a surgical risk scale (ERQ) for pediatric surgery should be based on a common language, by using a small number of easy to collect and reproduce variables. The objectives of this study were to construct an ERQ for pediatric patients and to analyze the surgical performance. MATERIALS AND METHODS: We retrospectively analyzed 105 primary surgical procedures under general anesthesia performed by liver transplantation service at Hospital Garrahan, between 29/6/08 and 25/3/10. Newborn patients were not considered. The ERQ was built by adding patient risk factors (PRL): weight (< o > 10 kg), co-morbidities (coagulopathy-obesity-diabetes) and life support; and the magnitude level of the surgical procedure (SPL): surgical time and requirement of blood transfusions. The surgical performance was considered as a relation between the level of surgical risk and the post-operative results, measured with the classification of surgical complications proposed by Clavien et al (STROC). The main end point of the study was the STROC > or = 3 (severe complications). The ERQ predictive power for serious complications was compared with the anaesthetic risk (ASA). Descriptive and analytical statistics took place. The predictive value for complications was calculated by means of a ROC curve. The estimation of the risk was calculated by relative risk. RESULTS: The ERQ was constituted on a continuum of 6 risk levels (2 to 7). The ROC's curve predictive power to determine the development of severe post-operative complications (STROC > or = 3) was 0.87 (CI 0,80-0,94) for the ERQ and 0.81 (CI 0,73-0,89) for the ASA. Level of > or = 5 of ERQ was the cut-off point that better predicted the development of STROC > or = 3. CONCLUSION: The ERQ is an easy tool, useful to quantify and compare surgical risks and results. It showed a high predictive power of postoperative complications.

Atovaquone and Berberine Chloride Reduce SARS-CoV-2 Replication In Vitro.

Epidemic RNA viruses seem to arise year after year leading to countless infections and devastating disease. SARS-CoV-2 is the most recent of these viruses, but there will undoubtedly be more to come. While effective SARS-CoV-2 vaccines are being deployed, one approach that is still missing is effective antivirals that can be used at the onset of infections and therefore prevent pandemics. Here, we screened FDA-approved compounds against SARS-CoV-2. We found that atovaquone, a pyrimidine biosynthesis inhibitor, is able to reduce SARS-CoV-2 infection in human lung cells. In addition, we found that berberine chloride, a plant-based compound used in holistic medicine, was able to inhibit SARS-CoV-2 infection in cells through direct interaction with the virion. Taken together, these studies highlight potential avenues of antiviral development to block emerging viruses. Such proactive approaches, conducted well before the next pandemic, will be essential to have drugs ready for when the next emerging virus hits.

Antibody isotype diversity against SARS-CoV-2 is associated with differential serum neutralization capacities.

Understanding antibody responses to SARS-CoV-2 is indispensable for the development of containment measures to overcome the current COVID-19 pandemic. Recent studies showed that serum from convalescent patients can display variable neutralization capacities. Still, it remains unclear whether there are specific signatures that can be used to predict neutralization. Here, we performed a detailed analysis of sera from a cohort of 101 recovered healthcare workers and we addressed their SARS-CoV-2 antibody response by ELISA against SARS-CoV-2 Spike receptor binding domain and nucleoprotein. Both ELISA methods detected sustained levels of serum IgG against both antigens. Yet, the majority of individuals from our cohort generated antibodies with low neutralization capacity and only 6% showed high neutralizing titers against both authentic SARS-CoV-2 virus and the Spike pseudotyped virus. Interestingly, higher neutralizing sera correlate with detection of -IgG, IgM and IgA antibodies against both antigens, while individuals with positive IgG alone showed poor neutralization response. These results suggest that having a broader repertoire of antibodies may contribute to more potent SARS-CoV-2 neutralization. Altogether, our work provides a cross sectional snapshot of the SARS-CoV-2 neutralizing antibody response in recovered healthcare workers and provides preliminary evidence that possessing multiple antibody isotypes can play an important role in predicting SARS-CoV-2 neutralization.

Test-retest reliability of drug-induced sleep endoscopy.

OBJECTIVE: To determine the test-retest reliability of drug-induced sleep endoscopy (DISE). METHODS: Prospective cohort study. Patients with OSA underwent two separate DISE examinations. The following outcomes were measured: a global assessment of obstruction at the palate and/or hypopharynx; the degree of obstruction at the palate and hypopharynx; and the contribution of individual structures (palate, tonsils, tongue, epiglottis, and lateral pharyngeal walls) to obstruction. RESULTS: Thirty-two patients underwent two separate DISE examinations. The preoperative sleep study apnea-hypopnea index was 40.7 +/- 21.1, and the lowest oxygen saturation was 79.8 +/- 17.4 percent. Point estimates for the intraclass correlation coefficient analogs related to palatal obstruction ranged from 0.41 to 0.89; related to the hypopharyngeal airway, the point estimates ranged from 0.57 to 0.84. CONCLUSION: The test-retest reliability of DISE appears good, especially in the evaluation of the hypopharyngeal airway. Larger studies can generate more precise confidence interval estimates and test the generalizability of these findings.

[Alzheimer's disease and the quality of life of the informal caregiver]. / Enfermedad de Alzheimer y calidad de vida del cuidador informal.

BACKGROUND: Along with an ageing population, a higher incidence of chronic diseases leads to increasingly complex health profiles. The relationship between survival, dependence, and social and demographic trends affecting caregiving, has led to an increase in the negative consequences associated with care provision. In this context, an assessment needs to be made on the impact that caregiving has on the well-being of the caregivers. The main aim of this article is to study the factors that determine the Quality of Life (QoL) of those who provide informal care to people suffering from Alzheimer's disease (AD). METHODS: A total of 175 caregivers of people with AD were recruited through the Galician Association for Relatives with Alzheimer. These caregivers completed a questionnaire (EQ-5D) that gathered sociodemographic and health variables, QoL, and care characteristics. Multiple regression models were calculated to explain the QoL of the caregivers. RESULTS: Of the five dimensions that the EQ-5D used to describe health, anxiety/depression was the one that concerned the largest percentage of caregivers who declared the highest levels of severity. The key variables for explaining QoL are those related to caregiver health status, periods of rest during caregiving, and the presence of a second caregiver. CONCLUSIONS: Maintaining a minimal QoL among the caregivers not only has repercussions on the caregivers themselves, but also has an impact on those receiving care and the entire health system, which would have to find replacements for those informal caregivers.

Evolution-Driven Attenuation of Alphaviruses Highlights Key Glycoprotein Determinants Regulating Viral Infectivity and Dissemination.

Understanding the fundamental mechanisms of arbovirus transmission and pathogenesis is essential to develop strategies for treatment and prevention. We previously took an in vivo evolution-based approach and identified the chikungunya virus E1 glycoprotein residue 80 to play a critical role in viral transmission and pathogenesis. In this study, we address the genetic conservation and function of position 80 and demonstrate that this residue is a key determinant in alphavirus infectivity and dissemination through modulation of viral fusion and cholesterol dependence. In addition, in studying the evolution of position 80, we identified a network of glycoprotein residues, including epidemic determinants, that regulate virus dissemination and infectivity. These studies underscore the importance of taking evolution-based approaches to not only identify key viral determinants driving arbovirus transmission and pathogenesis but also to uncover fundamental aspects of arbovirus biology.

Genetic Analysis of Vibrio parahaemolyticus O3:K6 Strains That Have Been Isolated in Mexico Since 1998.

Vibrio parahaemolyticus is an important human pathogen that has been isolated worldwide from clinical cases, most of which have been associated with seafood consumption. Environmental and clinical toxigenic strains of V. parahaemolyticus that were isolated in Mexico from 1998 to 2012, including those from the only outbreak that has been reported in this country, were characterized genetically to assess the presence of the O3:K6 pandemic clone, and their genetic relationship to strains that are related to the pandemic clonal complex (CC3). Pathogenic tdh+ and tdh+/trh+ strains were analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Also, the entire genome of a Mexican O3:K6 strain was sequenced. Most of the strains were tdh/ORF8-positive and corresponded to the O3:K6 serotype. By PFGE and MLST, there was very close genetic relationship between ORF8/O3:K6 strains, and very high genetic diversities from non-pandemic strains. The genetic relationship is very close among O3:K6 strains that were isolated in Mexico and sequences that were available for strains in the CC3, based on the PubMLST database. The whole-genome sequence of CICESE-170 strain had high similarity with that of the reference RIMD 2210633 strain, and harbored 7 pathogenicity islands, including the 4 that denote O3:K6 pandemic strains. These results indicate that pandemic strains that have been isolated in Mexico show very close genetic relationship among them and with those isolated worldwide.

Endocarditis infecciosa secundaria a Streptococcus gordonii, complicada con aneurisma y fístula en válvula mitral: Reporte de caso / Infective endocarditis due to Streptococcus gordonii complicated with an aneurism and mitral valve fistula.: Case report

Entre las bacterias poco comunes que causan Endocarditis infecciosa (EI), se encuentran el Streptococcus gordonii, conocido por su habilidad de colonizar y dañar las válvulas cardiacas. Asimismo, se conoce que el hallazgo de aneurisma complicado con fístula intracardiaca es infrecuente en EI, sólo se presenta en el 1,6% de pacientes. Se reporta el caso de un varón de 58 años con EI por Streptococcus gordonii complicada con aneurisma y fístula en la válvula mitral. (AU)

Streptococcus gordonii is a rare cause of infective endocarditis (IE) known for its ability to colonize and damage cardiac valves. Moreover, it is known that complicated aneurism with intracardiac fistula is an infrequent finding in IE, reported in1.6% of patients. We report the case of a 58 year old male patient with IE infected with Streptococcus gordonii and complicated with an aneurism and mitral valve fistula. (AU)

Role of panendoscopy to identify synchronous second primary malignancies in patients with oral cavity and oropharyngeal squamous cell carcinoma.

BACKGROUND: Tobacco use increases the risk for squamous cell carcinoma (SCC) of the upper aerodigestive tract. The reported incidence of synchronous second primary tumors in head and neck cancer is approximately 10%. Therefore, patients with oral cancer have routinely undergone "panendoscopy" consisting of direct laryngoscopy, bronchoscopy, and esophagoscopy. Recent studies indicate increasing numbers of upper aerodigestive tumors occurring in nonsmoking populations who may have a lesser risk for second primary tumors. The purpose of this study was to evaluate the utility of performing "panendoscopy" to identify second primary tumors in these patient populations. METHODS: A retrospective study of 64 consecutive patients at a university head and neck surgery practice was performed. A cohort of patients with oral cavity or oropharyngeal SCC with no tobacco history who underwent diagnostic panendoscopy were compared with similarly staged patients with a current or past history of tobacco use. Operative reports were examined for synchronous primaries, and epidemiologic data were collected. Subgroup analysis of incidence of synchronous primaries with regard to smoking status, age, sex, T classification, N classification, and location of primary tumor was also carried out. Student's t test statistical analysis was used to ascertain significance. RESULTS: No synchronous second primary malignancies were discovered in the nonsmoking patients. In all, 12.1% of smoking patients were diagnosed with synchronous primary cancers on panendoscopy, and this difference was significant (p = .0392). CONCLUSIONS: Routine panendoscopy of the upper aerodigestive tract in patients who have never smoked is unlikely to result in identification of synchronous second primary tumors.

Functional rhinoplasty.

The complete rhinoplasty surgeon must possess an understanding of functional nasal airway obstruction. An increasingly sophisticated grasp of the pathophysiology of fixed nasal obstruction has led surgeons to develop and refine surgical techniques aimed toward alleviating nasal valve insufficiency. This article reviews an assortment of techniques within nasal valve surgery, highlighting the underlying pathophysiology, anatomy, and technical considerations.