Astrocyte ensheathment of calyx-forming axons of the auditory brainstem precedes accelerated expression of myelin genes and myelination by oligodendrocytes.

Early postnatal brain development involves complex interactions among maturing neurons and glial cells that drive tissue organization. We previously analyzed gene expression in tissue from the mouse medial nucleus of the trapezoid body (MNTB) during the first postnatal week to study changes that surround rapid growth of the large calyx of Held (CH) nerve terminal. Here, we present genes that show significant changes in gene expression level during the second postnatal week, a developmental timeframe that brackets the onset of airborne sound stimulation and the early stages of myelination. Gene Ontology analysis revealed that many of these genes are related to the myelination process. Further investigation of these genes using a previously published cell type-specific bulk RNA-Seq data set in cortex and our own single-cell RNA-Seq data set in the MNTB revealed enrichment of these genes in the oligodendrocyte lineage (OL) cells. Combining the postnatal day (P)6-P14 microarray gene expression data with the previously published P0-P6 data provided fine temporal resolution to investigate the initiation and subsequent waves of gene expression related to OL cell maturation and the process of myelination. Many genes showed increasing expression levels between P2 and P6 in patterns that reflect OL cell maturation. Correspondingly, the first myelin proteins were detected by P4. Using a complementary, developmental series of electron microscopy 3D image volumes, we analyzed the temporal progression of axon wrapping and myelination in the MNTB. By employing a combination of established ultrastructural criteria to classify reconstructed early postnatal glial cells in the 3D volumes, we demonstrated for the first time that astrocytes within the mouse MNTB extensively wrap the axons of the growing CH terminal prior to OL cell wrapping and compaction of myelin. Our data revealed significant expression of several myelin genes and enrichment of multiple genes associated with lipid metabolism in astrocytes, which may subserve axon wrapping in addition to myelin formation. The transition from axon wrapping by astrocytes to OL cells occurs rapidly between P4 and P9 and identifies a potential new role of astrocytes in priming calyceal axons for subsequent myelination.

Psychophysiology, Cognitive Function, and Musculoskeletal Status Holistically Explain Tactical Performance Readiness and Resilience.

ABSTRACT: Thompson, AG, Ramadan, JH, Alexander, JS, and Galster, SM. Psychophysiology, cognitive function, and musculoskeletal status holistically explain tactical performance readiness and resilience. J Strength Cond Res 37(12): 2443-2456, 2023-This study aimed to advance the techniques used in quantifying holistic readiness and resilience within military personnel. Tactical performers, instructors, and applied human performance scientists designed a weeklong competition to reflect realistic operational demands, test specific underlying performance constructs, and elucidate how modernized assessments could drive programmatic action. By placing first in their installation's local preliminary competition, 34 active-duty Marines earned the opportunity to compete in a series of 7 intense events for the title of champion. All inferential statistics were set to a p ≤ 0.05 level of significance. Morning heart rate variability identified top from bottom quartile finishers before a single competition event. By day 3, morning countermovement jump force production (normalized reactive strength index-modified) and cognitive psychomotor vigilance were significant indicators of performance resilience and final competition group rank. Heart rate variability also tracked performer readiness across time, identifying within-group and between-group differences among top, bottom, and field. Collectively, these holistic assessments proved significant markers of acute and chronic tactical performance capabilities. In summary, the incorporation of psychophysiological monitoring, cognitive performance testing, and musculoskeletal force plate evaluations could help inform selection and support needs, drive workload or recovery modulation, and provide critical metrics for evaluating training efficacy and operational readiness. Defense organizations should consider routinely incorporating and actioning similar holistic status monitoring strategies in training and operational settings. Moreover, leveraging other tactical competitions may provide key opportunities for advancing the standard of practice through additional scientific investigation.

Identifying biomarkers of drug use recurrence using wearable device technologies and phone applications.

BACKGROUND: Identifying predictors of drug use recurrence (DUR) is critical to combat the addiction epidemic. Wearable devices and phone-based applications for obtaining self-reported assessments in the patient's natural environment (e.g., ecological momentary assessment; EMA) have been used in various healthcare settings. However, the utility of combining these technologies to predict DUR in substance use disorder (SUD) has not yet been explored. This study investigates the combined use of wearable technologies and EMA as a potential mechanism for identifying physiological/behavioral biomarkers of DUR. METHODS: Participants, recruited from an SUD treatment program, were provided with a commercially available wearable device that continuously monitors biometric signals (e.g., heart rate/variability [HR/HRV], sleep characteristics). They were also prompted daily to complete an EMA via phone-based application (EMA-APP) that included questionnaires regarding mood, pain, and craving. RESULTS: Seventy-seven participants are included in this pilot study (34 participants experienced a DUR during enrollment). Wearable technologies revealed that physiological markers were significantly elevated in the week prior to DUR relative to periods of sustained abstinence (p<0.001). Results from the EMA-APP revealed that those who experienced a DUR reported greater difficulty concentrating, exposure to triggers associated with substance use, and increased isolation the day prior to DUR (p<0.001). Compliance with study procedures during the DUR week was lower than any other period of measurement (p<0.001). CONCLUSIONS: These results suggest that data acquired via wearable technologies and the EMA-APP may serve as a method of predicting near-term DUR, thereby potentially prompting intervention before drug use occurs.

Whole-body photobiomodulation improves post-exercise recovery but does not affect performance or physiological response during maximal anaerobic cycling.

This study aims to examine the effects of acute whole-body photobiomodulation (wbPBM), applied pre-exercise, on bouts of anaerobic cycling (Wingate) performances. Forty-eight healthy, active males and females participated in this single-blind, randomized, crossover study. Participants visited the laboratory three times to complete repeat (4 ×) Wingate testing, with one week between each visit. All participants completed baseline testing during their first visit and randomly received either the wbPBM or placebo condition before testing on the second visit, followed by the opposite condition on the third visit. There were no significant condition × time interactions for any variable (peak power, average power, power decrement, lactate, heart rate, ratings of perceived exertion, heart rate variability (HRV), root-mean square of differences between R-R intervals (rMSSD), power in the high-frequency range (HF) average, power in the low-frequency range (LF) average, total power, LF/HF, or power in the very-low-frequency range average). A main condition effect was only noted for heart rate, where peak heart rate was significantly higher for wbPBM (145, 141-148 bpm) than placebo (143, 139-146 bpm; p = 0.006) and baseline testing (143, 140-146; p = 0.049) throughout the entire testing session (i.e., collapsed across all timepoints). Furthermore, HRV (rMSSD) the following morning after testing was significantly higher for the wbPBM session compared to placebo (p = 0.043). There were no differences in perceived recovery (p = 0.713) or stress (p = 0.978) scores between wbPBM and placebo. Implementing 20 min of wbPBM immediately prior to maximal bouts of anaerobic cycling did not improve performance (i.e., power output) or physiological responses (e.g., lactate). However, wbPBM elicited the ability to work at a higher heart rate throughout testing and seemed to enhance recovery through improved HRV the following morning.

Full-Body Photobiomodulation Therapy Is Associated with Reduced Sleep Durations and Augmented Cardiorespiratory Indicators of Recovery.

Research is emerging on the use of Photobiomodulation therapy (PBMT) and its potential for augmenting human performance, however, relatively little research exists utilizing full-body administration methods. As such, further research supporting the efficacy of whole-body applications of PBMT for behavioral and physiological modifications in applicable, real-world settings are warranted. The purpose of this analysis was to observe cardiorespiratory and sleep patterns surrounding the use of full-body PBMT in an elite cohort of female soccer players. Members of a women's soccer team in a "Power 5 conference" of the National Collegiate Athletic Association (NCAA) were observed across one competitive season while wearing an OURA Ring nightly and a global positioning system (GPS) sensor during training. Within-subject comparisons of cardiorespiratory physiology, sleep duration, and sleep composition were evaluated the night before and after PBMT sessions completed as a standard of care for team recovery. Compared to pre-intervention, mean heart rate (HR) was significantly lower the night after a PBMT session (p = 0.0055). Sleep durations were also reduced following PBMT, with total sleep time (TST) averaging 40 min less the night after a session (p = 0.0006), as well as significant reductions in light sleep (p = 0.0307) and rapid eye movement (REM) sleep durations (p = 0.0019). Sleep durations were still lower following PBMT, even when controlling for daily and accumulated training loads. Enhanced cardiorespiratory indicators of recovery following PBMT, despite significant reductions in sleep duration, suggest that it may be an effective modality for maintaining adequate recovery from the high stress loads experienced by elite athletes.

Transcriptional profiling reveals roles of intercellular Fgf9 signaling in astrocyte maturation and synaptic refinement during brainstem development.

Neural tissue maturation is a coordinated process under tight transcriptional control. We previously analyzed the kinetics of gene expression in the medial nucleus of the trapezoid body (MNTB) in the brainstem during the critical postnatal phase of its development. While this work revealed timed execution of transcriptional programs, it was blind to the specific cells where gene expression changes occurred. Here, we utilized single-cell RNA-Seq to determine transcriptional profiles of each major MNTB cell type. We discerned directional signaling patterns between neuronal, glial, and vascular-associated cells for VEGF, TGFß, and Delta-Notch pathways during a robust period of vascular remodeling in the MNTB. Furthermore, we describe functional outcomes of the disruption of neuron-astrocyte fibroblast growth factor 9 (Fgf9) signaling. We used a conditional KO (cKO) approach to genetically delete Fgf9 from principal neurons in the MNTB, which led to an early onset of glial fibrillary acidic protein (Gfap) expression in astrocytes. In turn, Fgf9 cKO mice show increased levels of astrocyte-enriched brevican (Bcan), a component of the perineuronal net matrix that ensheaths principal neurons in the MNTB and the large calyx of Held terminal, while levels of the neuron-enriched hyaluronan and proteoglycan link protein 1 (Hapln1) were unchanged. Finally, volumetric analysis of vesicular glutamate transporters 1 and 2 (Vglut1/2), which serves as a proxy for terminal size, revealed an increase in calyx of Held volume in the Fgf9 cKO. Overall, we demonstrate a coordinated neuron-astrocyte Fgf9 signaling network that functions to regulate astrocyte maturation, perineuronal net structure, and synaptic refinement.

Simplifying External Load Data in NCAA Division-I Men's Basketball Competitions: A Principal Component Analysis.

The primary purpose was to simplify external load data obtained during Division-I (DI) basketball competitions via principal component analysis (PCA). A secondary purpose was to determine if the PCA results were sensitive to load demands of different positional groups (POS). Data comprised 229 observations obtained from 10 men's basketball athletes participating in NCAA DI competitions. Each athlete donned an inertial measurement unit that was affixed to the same location on their shorts prior to competition. The PCA revealed two factors that possessed eigenvalues >1.0 and explained 81.42% of the total variance. The first factor comprised total decelerations (totDEC, 0.94), average speed (avgSPD, 0.90), total accelerations (totACC, 0.85), total mechanical load (totMECH, 0.84), and total jump load (totJUMP, 0.78). Maximum speed (maxSPD, 0.94) was the lone contributor to the second factor. Based on the PCA, external load variables were included in a multinomial logistic regression that predicted POS (Overall model, p < 0.0001; AUCcenters = 0.93, AUCguards = 0.88, AUCforwards = 0.80), but only maxSPD, totDEC, totJUMP, and totMECH were significant contributors to the model's success (p < 0.0001 for each). Even with the high significance, the model still had some issues differentiating between guards and forwards, as in-game demands often overlap between the two positions. Nevertheless, the PCA was effective at simplifying a large external load dataset collected on NCAA DI men's basketball athletes. These data revealed that maxSPD, totDEC, totJUMP, and totMECH were the most sensitive to positional differences during competitions. To best characterize competition demands, such variables may be used to individualize training and recovery regimens most effectively.

The Nasoseptal Flap for Reconstruction of Lateral Oropharyngectomy Defects: A Clinical Series.

OBJECTIVES/HYPOTHESIS: To study use of the nasoseptal flap (NSF) to reconstruct lateral transoral robotic surgery (TORS) oropharyngectomy defects. STUDY DESIGN: Retrospective case series. METHODS: A clinical series of six patients undergoing NSF reconstruction of lateral TORS oropharyngectomy defects was retrospectively studied. All patients underwent TORS for the treatment of intermediate-risk human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma of the lateral pharyngeal wall between January and June 2017. All patients underwent NSF reconstruction of lateral TORS defects with retrospective analysis of outcomes and complications. RESULTS: Six patients underwent NSF reconstruction of lateral TORS defects. Operative times decreased from 180 minutes to 90 minutes over the study period. There were two cases of partial flap dehiscence and partial necrosis. There were no major donor site complications. All patients had temporary nasal obstruction and crusting. Two experienced temporary aural fullness. In all patients, the lateral wall was mucosalized in 1-3 weeks. Cephalometric analysis of preoperative imaging revealed that patients with high-arched palates (>3 cm) and defect lengths that are longer than NSF flap lengths are poor candidates for this technique. CONCLUSIONS: This NSF is a vascularized, locoregional rotational flap that can reconstruct lateral TORS defects in salvages cases or those where the parapharyngeal carotid or mandibular bone are exposed. Postoperative morbidity is limited to temporary nasal dyspnea, aural fullness, and crusting. Preoperative imaging can determine which patient will have successful defect coverage. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:53-60, 2022.

Using Random Forest Regression to Determine Influential Force-Time Metrics for Countermovement Jump Height: A Technical Report.

ABSTRACT: Merrigan, JJ, Stone, JD, Wagle, JP, Hornsby, WG, Ramadan, J, Joseph, M, and Hagen, JA. Using random forest regression to determine influential force-time metrics for countermovement jump height: a technical report. J Strength Cond Res 36(1): 277-283, 2022-The purpose of this study was to indicate the most influential force-time metrics on countermovement jump (CMJ) height using multiple statistical procedures. Eighty-two National Collegiate Athletic Association Division I American football players performed 2 maximal-effort, no arm-swing, CMJs on force plates. The average absolute and relative (i.e., power/body mass) metrics were included as predictor variables, whereas jump height was the dependent variable within regression models (p < 0.05). Best subsets regression (8 metrics, R2 = 0.95) included less metrics compared with stepwise regression (18 metrics, R2 = 0.96), while explaining similar overall variance in jump height (p = 0.083). Random forest regression (RFR) models included 8 metrics, explained ∼93% of jump height variance, and were not significantly different than best subsets regression models (p > 0.05). Players achieved higher CMJs by attaining a deeper, faster, and more forceful countermovement with lower eccentric-to-concentric force ratios. An additional RFR was conducted on metrics scaled to body mass and revealed relative mean and peak concentric power to be the most influential. For exploratory purposes, additional RFR were run for each positional group and suggested that the most influential variables may differ across positions. Thus, developing power output capabilities and providing coaching to improve technique during the countermovement may maximize jump height capabilities. Scientists and practitioners may use best subsets or RFR analyses to help identify which force-time metrics are of interest to reduce the selectable number of multicollinear force-time metrics to monitor. These results may inform their training programs to maximize individual performance capabilities.

Contextual Variation in External and Internal Workloads across the Competitive Season of a Collegiate Women's Soccer Team.

As sports technology has continued to develop, monitoring athlete workloads, performance, and recovery has demonstrated boundless benefits for athlete and team success. Specifically, technologies such as global positioning systems (GPS) and heart rate (HR) monitors have granted the opportunity to delve deeper into performance contributors, and how variations may exist based upon context. A team of NCAA Division I women's soccer athletes were monitored during games throughout one competitive season. Individual athlete, positional groups, and team external and internal workloads were explored for differences based upon game location, opponent ranking, game result, and the final score differential. Game location and opponent ranking were found to have no effect on team-wide absolute or relative external workloads, whereas game result and score differential did. Internal workloads across the team tended to only vary by game half, independent of game context; however, the HR of defenders was determined to be higher during losses as compared to wins (p = 0.0256). Notably, the games that resulted in losses also represented the games with the fewest number of substitutions. These findings suggest high value in monitoring performance and workloads that are characteristic of varying, often multifaceted, contexts. It is hoped that this information can lead to more informed approaches to vital game-time and coaching decisions.

Assessing the Accuracy of Popular Commercial Technologies That Measure Resting Heart Rate and Heart Rate Variability.

Commercial off-the shelf (COTS) wearable devices continue development at unprecedented rates. An unfortunate consequence of their rapid commercialization is the lack of independent, third-party accuracy verification for reported physiological metrics of interest, such as heart rate (HR) and heart rate variability (HRV). To address these shortcomings, the present study examined the accuracy of seven COTS devices in assessing resting-state HR and root mean square of successive differences (rMSSD). Five healthy young adults generated 148 total trials, each of which compared COTS devices against a validation standard, multi-lead electrocardiogram (mECG). All devices accurately reported mean HR, according to absolute percent error summary statistics, although the highest mean absolute percent error (MAPE) was observed for CameraHRV (17.26%). The next highest MAPE for HR was nearly 15% less (HRV4Training, 2.34%). When measuring rMSSD, MAPE was again the highest for CameraHRV [112.36%, concordance correlation coefficient (CCC): 0.04], while the lowest MAPEs observed were from HRV4Training (4.10%; CCC: 0.98) and OURA (6.84%; CCC: 0.91). Our findings support extant literature that exposes varying degrees of veracity among COTS devices. To thoroughly address questionable claims from manufacturers, elucidate the accuracy of data parameters, and maximize the real-world applicative value of emerging devices, future research must continually evaluate COTS devices.

Thrombocytosis Predicts Surgical Site Infection in Head and Neck Microvascular Surgery- A Pilot Study.

OBJECTIVE/HYPOTHESIS: Early and objective prediction of complications in head and neck reconstructive surgery could decrease morbidity and prolonged hospital stays but unfortunately most complications are not identified until their effect is fully realized. There are limited data regarding the association of platelet levels and post-operative complications. Post-operative thrombocytosis (POTCT) is proposed as a possible indicator for complications following free-flap reconstruction. STUDY DESIGN: Retrospective review. METHODS: A multisite retrospective chart review of patients undergoing free tissue transfer between 2013 and 2018 was undertaken. POTCT was recorded and data normalized between institutions. Data were compared between groups using t-tests and logistic regression (P < .05). A lag-1 difference was used to compare the rate of change in platelet values. RESULTS: A total of 398 patients were included. POTCT and a rate of change of 30 K between POD5 and POD6 was significantly associated with the presence of post-operative complication (P = .007). Additionally, lag-1 difference demonstrated a significant association of change in daily platelet counts and complication rates. CONCLUSIONS: Isolated POTCT may be an early predictor of complications in HNC patients undergoing free-flap reconstruction. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1542-1547, 2021.

Airway foreign bodies in pediatric patients: An analysis of composition and age via HCUP KID.

OBJECTIVE: To compare outcomes for children food and non-food airway foreign body (AFB) diagnoses and to compare outcomes for patients age <2 versus ≥2 years with an AFB diagnosis. METHODS: Data from 2016 HCUP KID was used to compare outcomes for food and non-food AFB diagnoses based on location in the larynx, trachea, bronchus, and whole group (including these three specified locations and location unspecified). Outcomes were also compared for children aged <2 versus ≥2 years. Demographic data included age, race, gender, primary payer, location and teaching status of the hospital. Available co-morbidity data included APR-DRG mortality and APR-DRG severity. Outcomes were length of stay (LOS), total charge, mortality, and performance of a tracheotomy. RESULTS: 2973 patients were included. 49.1% were less than 2 years old, the remainder (50.9%) were between 2 and 20 years old. Food AFBs made up 26.0% and 74.0% were other specified non-food AFBs. Overall mortality was 3.7%, and 3.8% underwent tracheotomy. Children with non-food AFBs were significantly older, had significantly longer median LOS, and higher median total charges, when compared to food AFBs. Non-food AFBs had a significantly higher likelihood of tracheotomy. Patients aged 2 or more years with bronchial AFBs had significantly higher total charges, LOS, and APR-DRG risk mortality and severity than <2 year old patients with bronchial AFBs. CONCLUSION: AFBs remain a serious health concern, especially non-food objects in older children which have elevated risks.

Bleeding Complications After Transoral Robotic Surgery: A Meta-Analysis and Systematic Review.

OBJECTIVE: Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post-TORS hemorrhage. STUDY DESIGN: Systematic Review and Metanlysis. METHODS: A systematic review of the published literature using the Cochrane Handbook for Systematic Reviews of Interventions was performed and examined TORS, postoperative hemorrhage, and the use of prophylactic transcervical arterial ligation (TAL). RESULTS: A total of 13 articles were included in the analysis. To date, there have been 332 cases of hemorrhage following a total of 5748 TORS. The pooled median post-TORS hemorrhage rate was 6.47%. The overall incidence of minor and major hemorrhage was 5.29% and 2.90%. Patients with prior radiation (relative risk [RR] = 1.46, 95% confidence interval [CI] = 1.00-2.12), large tumors (RR = 2.11, 95% CI = 1.48-2.99), and those requiring perioperative coagulation (RR = 2.25, 95% CI = 1.54-3.28) had significantly higher relative risks of hemorrhage. There was no significant difference in the relative risk of overall hemorrhage with TAL. Looking at major hemorrhage, patients undergoing TAL had a large but insignificant relative risk reduction in post-TORS hemorrhage (RR = 0.40, 95% CI = 0.15-1.07). CONCLUSION: The incidence of post-TORS hemorrhage is low (5.78%), and for major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage it is even lower (2.90%). Large tumors, perioperative anticoagulation, and prior radiation were associated with significantly increased risk of post-TORS hemorrhage. TAL does not reduce the overall incidence of post-TORS hemorrhage but may lead to fewer severe hemorrhages. LEVEL OF EVIDENCE: III Laryngoscope, 131:95-105, 2021.

Assessment of Pediatric Middle Ear Effusions With Wideband Tympanometry.

OBJECTIVE: To determine if wideband tympanometry (WBT) can differentiate types of middle ear effusion (MEE): serous, mucoid, and purulent. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care children's hospital. METHODS: Children who met American Academy of Otolaryngology-Head and Neck Surgery's guidelines for ventilation tube insertion had WBT after anesthesia induction but before tympanotomy. MEE was categorized into 1 of 4 comparison groups: serous effusion, mucoid effusion, purulent effusion, or no effusion. WBT measurements were averaged to 16 one-third octave frequency bands, and comparison of the absorbance patterns for each MEE type was performed through a linear mixed effects model. RESULTS: A total of 118 children (211 ears) were included: 47 females (39.8%) and 71 males (60.2%). The mean age was 2.73 years (95% CI, 2.25-3.22); mean weight, 14.35 kg (95% CI, 12.85-15.85); and mean Z score, 1.13 (95% CI, -0.64 to 2.33). Effusions included 61 mucoid (28.9%), 30 purulent (14.2%), and 14 serous (6.6%), with 106 (50.2%) having no effusion. No significant differences were found for sex, race, age, weight, or Z score among the 4 types of effusion (P < .05). WBT showed a significant difference in median absorption among the effusion groups (P < .001), with a medium effect size of 0.35. CONCLUSIONS: WBT has potential use to differentiate types of MEE and should be studied further as a tool for investigating how the natural history and management of serous and mucoid effusions may differ.

Adult Palatopharyngoplasty: Trends in Morbidity and Mortality from the NSQIP Database.

OBJECTIVES: Describe the postop morbidity of adults undergoing palatopharyngoplasty (PPP). METHOD: Adults who underwent PPP were studied using ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database (2016-2017) via CPT code 42145. Analyzed outcomes included length of stay (LOS), readmission, reoperation, and postop complications. Predictive variables were age, gender, BMI, comorbidities. RESULTS: A total of 1081 patients (73.7% male, mean age 42.0 years, range 18-79 years) were included. 95 (8.8%) were diabetic, 183 (16.9%) were smokers, 30 (2.8%) had preoperative dyspnea. 328 (30.3%) took medicine for hypertension. Concurrent procedures occurred in 646 (59.76%), 357 (33.02%) had nasal procedures, 320 (29.60%) had tonsil procedures, 66 (6.11%) had tongue procedures. Within 30 days postop, there were two (0.19%) mortalities. Complications included six wound infections, two dehiscences, four with pneumonia, two pulmonary embolisms, three myocardial infarctions, one DVT, three sepsis, one UTI, one who required CPR, and two who were ventilated for >48 hours. Five required reintubation. A total of 41 (3.79%) returned to OR for a related reason, at least 27 (65.90%) for bleeding. LOS ranged from 0 to 15 days, median 1 day. Overall 38 (3.52%) were readmitted for a related reason, 12 (31.58%) for bleeding and three (7.89%) for pain. Using a significance level of 0.002 (Bonferroni correction), LOS varied with presence of any concurrent procedure, BMI, and estimated probability of mortality and morbidity indices; readmission and reoperation had no significantly associated variables. CONCLUSION: PPP is associated with low frequency but significant morbidity and mortality.

Evaluations of Commercial Sleep Technologies for Objective Monitoring During Routine Sleeping Conditions.

PURPOSE: The commercial market is saturated with technologies that claim to collect proficient, free-living sleep measurements despite a severe lack of independent third-party evaluations. Therefore, the present study evaluated the accuracy of various commercial sleep technologies during in-home sleeping conditions. MATERIALS AND METHODS: Data collection spanned 98 separate nights of ad libitum sleep from five healthy adults. Prior to bedtime, participants utilized nine popular sleep devices while concurrently wearing a previously validated electroencephalography (EEG)-based device. Data collected from the commercial devices were extracted for later comparison against EEG to determine degrees of accuracy. Sleep and wake summary outcomes as well as sleep staging metrics were evaluated, where available, for each device. RESULTS: Total sleep time (TST), total wake time (TWT), and sleep efficiency (SE) were measured with greater accuracy (lower percent errors) and limited bias by Fitbit Ionic [mean absolute percent error, bias (95% confidence interval); TST: 9.90%, 0.25 (-0.11, 0.61); TWT: 25.64%, -0.17 (-0.28, -0.06); SE: 3.49%, 0.65 (-0.82, 2.12)] and Oura smart ring [TST: 7.39%, 0.19 (0.04, 0.35); TWT: 36.29%, -0.18 (-0.31, -0.04); SE: 5.42%, 1.66 (0.17, 3.15)], whereas all other devices demonstrated a propensity to over or underestimate at least one if not all of the aforementioned sleep metrics. No commercial sleep technology appeared to accurately quantify sleep stages. CONCLUSION: Generally speaking, commercial sleep technologies displayed lower error and bias values when quantifying sleep/wake states as compared to sleep staging durations. Still, these findings revealed that there is a remarkably high degree of variability in the accuracy of commercial sleep technologies, which further emphasizes that continuous evaluations of newly developed sleep technologies are vital. End-users may then be able to determine more accurately which sleep device is most suited for their desired application(s).

Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae.

OBJECTIVE: Identify risk factors and determine perioperative morbidity of children undergoing surgery for laryngomalacia (LM). METHODS: A retrospective analysis of the multi-institutional American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was performed to abstract patients aged <18 years with LM (ICD-10 code Q31.5) who underwent laryngeal surgery (CPT code 31541) from 2015 to 2017. Analyzed clinical variables include patient demographics, hospital setting, length of stay, medical comorbidities, postoperative complications, readmission, and reoperation. RESULTS: A total of 491 patients were identified, 283 were male (57.6%) and 208 were female (42.4%). The mean age at time of surgery was 1.07 years (range .01-17 years). Younger patients were more likely to undergo surgery in the inpatient setting compared to their counterparts (P < .001). Infants were more likely to have prolonged duration of days from admission to surgery (P < .001), days from surgery to discharge (P < .001), and total length of stay (P<.0010). Finally, there was no significant difference between age groups with respect to 30-day general surgical complications (P = .189), with an overall low incidence of reintubation (1.2%), readmission (3.1%), and reoperation (1.6%). CONCLUSION: This analysis supports laryngeal surgery as a safe surgical procedure for LM. However, younger children are more likely to undergo operative intervention in the inpatient setting, endure delays from hospital admission to surgical intervention, and experience a prolonged length of stay due to their overall medical complexity. Recognition of key factors may assist in optimizing perioperative risk assessment and promote timely procedural planning in this unique pediatric patient subpopulation.

Endoscopic endonasal CSF rhinorrhea repair in children: Systematic review with meta-analysis.

OBJECTIVES: Cerebrospinal fluid (CSF) rhinorrhea in children is relatively uncommon. Endoscopic repair techniques in adults have become first line for nasal-based CSF leaks, and this meta-analysis looks at the success rates of CSF leak cessation following endoscopic repair in children. METHODS: Three researchers extracted information involving patient population, surgical technique, outcomes of interest, and study design. A computerized search of MEDLINE, EMBASE and the Cochrane library (January 1990-September 2019) looked for several papers on the subject of CSF leak repair in children using endoscopic technique. RESULTS: A total of 15 studies met inclusion criteria. Endoscopic repair of CSF rhinorrhea in children shows a pooled weighted success rate of 94% after first attempt. The most common etiology was traumatic followed by congenital. Iatrogenic defects secondary to tumor resection are becoming more common. The high success rate was irrespective of the techniques using. CONCLUSION: Endoscopic repair techniques have a highly successful closure rate for children presenting with CSF rhinorrhea.

Balloon Catheter Dilation in Pediatric Chronic Rhinosinusitis: A Meta-analysis.

BACKGROUND: Paranasal sinus balloon catheter dilation (BCD) represents a tool that has been shown to be safe in the management of pediatric chronic rhinosinusitis (pCRS); however, its efficacy compared to standard treatment regimens has not been well established. OBJECTIVE: The purpose of this meta-analysis was to evaluate the clinical utility of BCD in pCRS. METHODS: Articles reporting BCD for pCRS in patients under 18 years of age were identified via the following search terms: sinusitis OR rhinosinusitis AND balloon dilatation OR balloon dilation OR balloon sinuplasty OR sinuplasty AND adolescent OR children OR infant OR pediatric OR toddler. The primary outcome analyzed includes quality of life improvement as measured via Sinus and Nasal Quality of Life Survey (SN-5) or Sino-nasal Outcome Test (SNOT-22) scores. RESULTS: Eighty studies were abstracted; 10 studies were included for final qualitative analysis after dual investigator screening. Three studies described BCD with surgical controls, including adenoidectomy, saline irrigation, or maxillary antrostomy. Noninferiority was not demonstrated (ie, BCD is inferior) in 2 of 3 studies. Pooled analysis utilizing a random effects model revealed a decreased effect size yet no statistically significant difference between BCD and standard operative techniques as measured by quality of life measures (g = -0.04, I2 = 41%). CONCLUSION: This work highlights a lack of published evidence regarding the role of BCD in pCRS. Two of the 3 included studies demonstrated the inferiority of BCD when compared to other standard surgical interventions, whereas meta-analysis was unable to detect any statistically significant difference between standard treatment regimens. Future scientific investigations are necessary to assess the comparative effectiveness of BCD in pCRS.