Trusted Information Sources About the COVID-19 Vaccine Vary in Underserved Communities.

The COVID-19 pandemic was one of the deadliest global public health events. In the United States, over 1.1 million individuals have died, and now COVID-19 is the third leading cause of death (CDC, 2023). Vaccine uptake has stalled among different demographics. Vaccine hesitancy, a delay in accepting or refusing vaccines, poses a significant challenge regardless of the availability of safe and effective COVID-19 vaccines. This study aimed to identify disparate COVID-19 vaccine uptake among individuals in Western New York. The primary objective was to identify the factors contributing to lower rates of COVID-19 vaccination within this population.Data were collected from 585 adults recruited from 20 Niagara and Erie Counties sites using a self-administered survey on vaccine hesitancy, vaccination status, and COVID-19-related characteristics. The survey included the adult Vaccine Hesitancy Scale (aVHS) and acquired information on demographic characteristics and COVID-19 impact, knowledge, and information sources. Data were analyzed using descriptive statistics, a chi-squared test, a Wilcoxon rank-sum test, and a logistic regression model.Findings suggest that unvaccinated participants (n = 35) were concerned about vaccine side effects (48.6%). For vaccinated/unboosted participants (n = 52), they (40.0%) reported clinical concerns. After adjusting for gender and age, healthcare provider guidance and family guidance remained significant predictors of vaccination status, while clinical research studies were significant predictors of booster status. Findings from this study suggest public health interventions that target vaccine education and facilitate well-informed decisions about COVID-19 vaccines lead to less vaccine hesitancy.

Proceedings From the Ice Hockey Summit III: Action on Concussion.

OBJECTIVES: The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these 5 objectives: (1) describe sport related concussion (SRC) epidemiology; (2) classify prevention strategies; (3) define objective, diagnostic tests; (4) identify treatment; and (5) integrate science and clinical care into prioritized action plans and policy. METHODS: Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session. RESULTS: To (1) establish a national and international hockey database for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care; and (6) mandate baseline testing to improve concussion diagnosis for all age groups. CONCLUSIONS: Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.

The Montreal Cognitive Assessment as a Cognitive Screening Tool in Athletes.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool known to accurately measure mild cognitive impairment (MCI) in many different neurological populations. OBJECTIVE: We aimed to determine whether a sport-related concussion (SRC) history and other concussion modifiers influence global cognitive function in high-performance athletes. METHODS: A cross-sectional study of 326 varsity and national team athletes aged 18-36 years was completed at the University of Calgary Sports Medicine Clinic, Calgary, Alberta, Canada. Logistic regression analysis was used to examine the association between the total MoCA score, MoCA subscales, and number of previous SRC, adjusting for age, sex, sport participation (SP), and concussion modifiers. RESULTS: Athletes with a history of three or more SRC were 5.36 times more likely to score less than 26/30 on the MoCA (the cutoff for MCI) compared to athletes with two or less SRC (p = 0.02). Males were 2.23 times more likely to have MCI than females (p = 0.0004). There was a significant relationship between the number of previous concussions and the MoCA subscales of attention (p = 0.05) and abstraction (p = 0.003). Age, SP, and concussion modifiers (migraine, depression, anxiety, and attention deficit and hyperactivity disorder) did not influence the relationship between MoCA and previous concussion history. CONCLUSION: In the appropriate clinical context, cognitive screening with the MoCA may benefit clinical care in athletes with multiple previous SRC, but should not replace a full neuropsychological assessment. Thus, further research is needed to compare the MoCA to full neuropsychological assessments in this population.

Proceedings from the Ice Hockey Summit III: Action on Concussion.

The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these five objectives: 1) describe sport-related concussion (SRC) epidemiology, 2) classify prevention strategies, 3) define objective, diagnostic tests, 4) identify treatment, and 5) integrate science and clinical care into prioritized action plans and policy. Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session. 1) Establish a national and international hockey data base for SRC at all levels, 2) eliminate body checking in Bantam youth hockey games, 3) expand a behavior modification program (Fair Play) to all youth hockey levels, 4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues, 5) establish objective tests to diagnose concussion at point of care (POC), and 6) mandate baseline testing to improve concussion diagnosis for all age groups. Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.

Ice Hockey Summit II: zero tolerance for head hits and fighting.

OBJECTIVE: To present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building on the Ice Hockey Summit I action plan (2011) to reduce SRC. METHODS: The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards; and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. RESULTS: The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. CONCLUSIONS: The highest priority action items identified from the Summit includes the following: (1) eliminate head hits from all levels of ice hockey, (2) change body-checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Alpha-Synuclein Pathology in Sensory Nerve Terminals of the Upper Aerodigestive Tract of Parkinson's Disease Patients.

Dysphagia is common in Parkinson's disease (PD) and causes significant morbidity and mortality. PD dysphagia has usually been explained as dysfunction of central motor control, much like other motor symptoms that are characteristic of the disease. However, PD dysphagia does not correlate with severity of motor symptoms nor does it respond to motor therapies. It is known that PD patients have sensory deficits in the pharynx, and that impaired sensation may contribute to dysphagia. However, the underlying cause of the pharyngeal sensory deficits in PD is not known. We hypothesized that PD dysphagia with sensory deficits may be due to degeneration of the sensory nerve terminals in the upper aerodigestive tract (UAT). We have previously shown that Lewy-type synucleinopathy (LTS) is present in the main pharyngeal sensory nerves of PD patients, but not in controls. In this study, the sensory terminals in UAT mucosa were studied to discern the presence and distribution of LTS. Whole-mount specimens (tongue-pharynx-larynx-upper esophagus) were obtained from 10 deceased human subjects with clinically diagnosed and neuropathologically confirmed PD (five with dysphagia and five without) and four age-matched healthy controls. Samples were taken from six sites and immunostained for phosphorylated α-synuclein (PAS). The results showed the presence of PAS-immunoreactive (PAS-ir) axons in all the PD subjects and in none of the controls. Notably, PD patients with dysphagia had more PAS-ir axons in the regions that are critical for initiating the swallowing reflex. These findings suggest that Lewy pathology affects mucosal sensory axons in specific regions of the UAT and may be related to PD dysphagia.

Test-retest reliability of KINARM robot sensorimotor and cognitive assessment: in pediatric ice hockey players.

BACKGROUND: Better diagnostic and prognostic tools are needed to address issues related to early diagnosis and management of concussion across the continuum of aging but particularly in children and adolescents. The purpose of the current study was to evaluate the reliability of robotic technology (KINARM robot) assessments of reaching, position sense, bimanual motor function, visuospatial skills, attention and decision making in youth ice hockey players (ages 10-14). METHODS: Thirty-four male children attended two testing days, one week apart. On day one, each subject completed five tasks on the robot with two examiners (alternating examiner sequence); the 2(nd) examiner followed the same procedure as the 1(st) immediately afterwards. One consistent examiner tested subjects one week later. This is a test-retest reliability study. The robotic tasks characterize sensorimotor and/or cognitive performance; 63 parameters from 5 tasks are reported. Session 1 was the 1(st) time the subject performed the 5 tasks, session 2 the 2(nd) time on day 1, and session 3 one week following. RESULTS: Intra-class correlation coefficients ranged from 0.06 to 0.91 and 0.09 to 0.90 for session 1 to 2 and 2 to 3, respectively. Bland-Altman plots showed agreement in a majority of the parameters and a learning effect in 25 % and 24 % of parameters in session 1 vs 2 and 1 vs 3, respectively but none for session 2 vs 3. Of those that showed a learning effect, only 8 % of parameters in session 1 vs 2 and 10 % in session 1 vs 3 had a clinical relevance measure ≥ 0.8. CONCLUSIONS: The relative homogeneity of the sample and the effect of learning seen in some of the task parameters appears to have negatively impacted the intra-class correlation coefficients from session 1 to 2, with less impact for 2 to 3. The Bland-Altman analysis supports good absolute reliability in healthy male children with no neurological impairment ranging in age from 10 to 14. The clinically relevant learning effect seen, in a small number of parameters could be addressed by creating a learning effect adjustment factor and/or implementing a practice session, which would eliminate the learning effect.

Ice Hockey Summit II: zero tolerance for head hits and fighting.

This study aimed to present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure for the science and discussion held during Summit II (Mayo Clinic, Rochester, MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward, (2) Acute and Chronic Concussion Care: Making a Difference, (3) Preventing Concussions via Behavior, Rules, Education, and Measuring Effectiveness, (4) Updates in Equipment: Their Relationship to Industry Standards, and (5) Policies and Plans at State, National, and Federal Levels To Reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were voted on subsequently for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. The highest-priority action items identified from the Summit include the following: (1) eliminate head hits from all levels of ice hockey, (2) change body checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Examining computerized software reliability to measure individual exposure time.

OBJECTIVE: Epidemiological sport injury research lacks relevance when all athletes are assumed to have equal time exposed to risk. Because athletes do not play equal minutes in ice hockey games, it is important to control for players' individual exposure times (IETs) when studying risk factors for injury. DESIGN: Cohort study. SETTING: Hockey games. PARTICIPANTS: Twenty-eight Minnesota Junior A hockey players. INTERVENTIONS: Individual exposure times were measured on all players dressed for their home games using both a manual (game clock, paper, and pencil) and a computer-based system [Time on Ice (TOI) software]. A sample of matched records was evaluated to compare the 2 methods of recording exposure. MAIN OUTCOME MEASURES: Values of individual player exposure times obtained by TOI software designed for hockey and the manual recording method were compared. RESULTS: Individual exposure times were measured simultaneously by computer-based and manual methods. For 26 games, it would require 156 hours to determine IET per game by the manual method. Conversely, IET totals on TOI software were computed automatically for each player per game. When IET was compared across periods and games, the computer analysis consistently totaled more IET than the manual method. CONCLUSIONS: Time on Ice software was user friendly, required no postgame processing, and showed a high degree of correlation to manually recorded times, although consistently higher IET per player per period than the manual method was noted.

Assessing and Improving the Effectiveness of Online Patient Education Materials on Essential Vocal Tremor: A Comprehensive Evaluation.

INTRODUCTION: Health literacy, a strong indicator of health outcomes, is an important aspect of good patient care. With an increasing reliance on the Internet for health information, online patient materials should be easily understood by the average reader. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that patient education materials be written at a sixth-grade level. Creating effective digital information requires careful consideration of not only word choice, but also many other factors including actionability, comprehensiveness, evidence, and visual organization. To support the creation of valuable online health content, the Office of Disease Prevention and Health Promotion (ODPHP) published Health Literacy Online, a research-based guide that discusses why and how to design digital health information tools.This study aims to assess the effectiveness of online patient education materials regarding vocal tremor, assess the effectiveness of patient education materials published by the American Laryngological Association, and to evaluate the usefulness of the Health Literacy Online guide in creating effective online patient education materials on laryngological diseases. METHODS: The first 50 unsponsored search results for the terms "vocal tremor" and "essential vocal tremor" were evaluated. Each website was analyzed using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) readability tests, the DISCERN instrument, and the Patient Education Materials Assessment Tool (PEMAT). The resources published by the American Laryngological Association were also evaluated in this manner. RESULTS: Of the 100 websites identified from the initial queries, 14 websites were included in this analysis. The average FRES and FKGL scores were 47.21 ± 10.47 and 10.96 ± 2.46, respectively, indicating that readers need a 11th-grade education to comprehend the materials. The average DISCERN score was 22.50 ± 9.76, indicating "very poor" quality with serious shortcomings and not appropriate sources of information about treatment choices. The average PEMAT understandability score was 68.43% ± 9.80% with an actionability score of 20.00% ± 23.53%, indicating the information was fairly difficult to process and do not help identify next steps. For the materials published by the American Laryngological Association (ALA), the average FRES and FKGL scores were 38.33 ± 12.81 and 12.56 ± 2.15, respectively, indicating a 12th-grade reading level. A DISCERN score of 27 was consistent across each item, indicating "very poor" quality. A PEMAT understandability score was 45% with an actionability score of 0%, indicating they are difficult to process and do not help identify next steps. After writing a revised sample of the information provided by the ALA based on the ODPHP's Health Literacy Online tool, the new FRES and FKGL score was 75.6 and 5.9, respectively. The new DISCERN score was 35. The new PEMAT understandability scores was 79% with actionability scores of 80%. CONCLUSION: This study found that most publicly available online patient education materials on essential vocal tremor and other laryngological diseases do not use plain language and require reading levels too advanced for the average reader to comprehend. In addition, most websites were of very poor quality readability, and were therefore less likely to benefit individuals in their decision-making. In an age where most people seek information on the Internet, the lack of easily understood online patient resources reduces the usefulness of these resources for many individuals. Professional organizations and societies like the American Laryngological Association may consider the use of the Health Literacy Online tool as a resource to provide both accurate and easily understandable patient education resources.

Medical Student Research Activity in Otolaryngology.

OBJECTIVE: To investigate medical student research productivity by institutions associated with otolaryngology residency programs and identify correlates of productivity. STUDY DESIGN: Retrospective review. SETTING: N/A. METHODS: A systematic search for articles indexed on PubMed published by 116 programs from January 1, 2016 to February 28, 2021 was conducted. Primary outcomes were number of faculty publications, first-author medical student publications and medical students from each institution. Secondary outcomes included geographic region, number of otolaryngology faculty members, and program rankings. RESULTS: Nationally, the mean number of faculty per institution was 21.7 at the time of search. Over a 5-year period, there was a mean 98.7 total publications and 15.8 medical student first-author publications per institution consisting of a mean of 10.03 distinct medical students. One-way analysis of variance showed no statistically significant difference in medical student productivity (P = .09) or department size (P = .12) between regions. Number of medical student first-author publications positively correlated to number of faculty (R = .43, P < .05) and number of faculty publications (R = .63, P < .05). The top 30 programs ranked by United States News & World Report or National Institute of Health for funding had a statistically significantly greater mean number of medical student first-author publications and distinct medical student first authors than all other programs (P < .05). CONCLUSION: Greater numbers of faculty members likely provide more mentorship and opportunities that allow medical students to engage in projects that lead to first-author publications. These findings allow institutions to reflect on efforts in medical student engagement and provide data to students for career planning.

Angiotensin converting enzyme inhibitor-induced gastrointestinal angioedema: a case series and literature review.

GOALS: The objective of this study was to better understand the presenting signs and symptoms of angiotensin converting enzyme (ACE) inhibitor-induced gastrointestinal angioedema, review the medical literature related to this condition, and bring this diagnosis to the attention of clinicians. BACKGROUND: Angioedema occurs in 0.1% to 0.7% of patients treated with ACE inhibitors and ACE inhibitors account for 20% to 30% of all angioedema cases presenting to emergency departments. However, only recently have ACE inhibitors been recognized as a cause of angioedema of the gastrointestinal tract. Patients with this disease present with one or more episodes of abdominal pain associated with nausea, vomiting, and/or diarrhea. STUDY: We present four cases of ACE inhibitor-induced gastrointestinal angioedema seen at a single institution and review the literature of other case reports. RESULTS: Review of the medical literature identified 27 case reports of ACE inhibitor-induced angioedema of the gastrointestinal tract. Multiple ACE inhibitors were implicated in these case reports suggesting that this disease is a class effect of ACE inhibitors. In cases where the race of the patient was stated, 50% were identified as being African American. Ascities was described as a radiographic finding in 16 of 27 cases. There were no reported cases of paracentesis or ascitic fluid analysis described in any of the identified case reports. CONCLUSIONS: This series highlights ascites as a key feature that distinguishes ACE inhibitor-induced gastrointestinal angioedema from infectious enteritis. This series also confirms the increased incidence of this condition among African American women, an unpredictable interval between medication initiation and the development of symptoms, and the heightened probability of symptom recurrence if ACE inhibitors are not discontinued. ACE inhibitor-induced gastrointestinal angioedema is a rare cause of acute abdominal complaints, but is likely underdiagnosed and should be considered in the differential diagnosis of all individuals taking ACE inhibitors with such symptoms. Early recognition of ACE inhibitor-induced gastrointestinal angioedema may avoid recurrent episodes or costly, invasive evaluations.

What are the most effective risk-reduction strategies in sport concussion?

AIM: To critically review the evidence to determine the efficacy and effectiveness of protective equipment, rule changes, neck strength and legislation in reducing sport concussion risk. METHODS: Electronic databases, grey literature and bibliographies were used to search the evidence using Medical Subject Headings and text words. Inclusion/exclusion criteria were used to select articles for the clinical equipment studies. The quality of evidence was assessed using epidemiological criteria regarding internal/external validity (eg, strength of design, sample size/power, bias and confounding). RESULTS: No new valid, conclusive evidence was provided to suggest the use of headgear in rugby, or mouth guards in American football, significantly reduced players' risk of concussion. No evidence was provided to suggest an association between neck strength increases and concussion risk reduction. There was evidence in ice hockey to suggest fair-play rules and eliminating body checking among 11-years-olds to 12-years-olds were effective injury prevention strategies. Evidence is lacking on the effects of legislation on concussion prevention. Equipment self-selection bias was a common limitation, as was the lack of measurement and control for potential confounding variables. Lastly, helmets need to be able to protect from impacts resulting in a head change in velocities of up to 10 and 7 m/s in professional American and Australian football, respectively, as well as reduce head resultant linear and angular acceleration to below 50 g and 1500 rad/s(2), respectively, to optimise their effectiveness. CONCLUSIONS: A multifactorial approach is needed for concussion prevention. Future well-designed and sport-specific prospective analytical studies of sufficient power are warranted.

Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes.

INTRODUCTION: Glottic obstruction may arise secondary to bilateral vocal fold immobility (BVFI). Treatment options include a tracheostomy to bypass the site of obstruction as well as unilateral transverse cordotomy to alleviate the obstruction. The objective of this review is to determine the efficacy, adverse event profile, and long-term outcomes, including the need for tracheostomy, in patients undergoing unilateral cordotomy. METHODS: The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for this systematic review. A literature search of unilateral cordotomy was performed by searching PubMed, Cochrane Library, and Embase. Articles presenting cases of BVFI treated with unilateral cordotomy were included. Review articles, animal studies, non-English-language articles, and abstracts were excluded. Articles presenting cases of bilateral cordotomy or cordotomy with arytenoidectomy were excluded. RESULTS: We identified 14 studies and 291 patients undergoing unilateral cordotomy. Sixty-eight patients had a prior tracheostomy in place at the time of cordotomy. The most common post-operative complication was granulation tissue formation (n = 39). Thirty-one patients developed glottic edema with subsequent dyspnea. Three patients developed scarring of the primary cordotomy site with the return to an obstructed airway. Nine patients required a post-cordotomy tracheostomy due to these complications. Five patients required a long-term tracheostomy and were unable to be decannulated. CONCLUSION: Unilateral cordotomy is an effective treatment for glottic obstruction with high post-operative decannulation rates. Adverse events including worsening glottic obstruction are uncommon, although edema and granulation tissue may develop in the post-operative period and necessitate close post-operative monitoring. Laryngoscope, 133:6-14, 2023.

Capacity Limits Lead to Information Bottlenecks in Ongoing Rapid Motor Behaviors.

Studies of ongoing, rapid motor behaviors have often focused on the decision-making implicit in the task. Here, we instead study how decision-making integrates with the perceptual and motor systems and propose a framework of limited-capacity, pipelined processing with flexible resources to understand rapid motor behaviors. Results from three experiments show that human performance is consistent with our framework: participants perform objectively worse as task difficulty increases, and, surprisingly, this drop in performance is largest for the most skilled performers. As well, our analysis shows that the worst-performing participants can perform equally well under increased task demands, which is consistent with flexible neural resources being allocated to reduce bottleneck effects and improve overall performance. We conclude that capacity limits lead to information bottlenecks and that processes like attention help reduce the effects that these bottlenecks have on maximal performance.

Diagnosis and Management of Barosinusitis: A Systematic Review.

OBJECTIVE: To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the medical and surgical treatment options. METHODS: A review of PubMed/MEDLINE, EMBASE, and Cochrane Library for articles published between 1967 and 2020 was conducted with the following search term: aerosinusitis OR "sinus squeeze" OR barosinusitis OR (barotrauma AND sinusitis) OR (barotrauma AND rhinosinusitis). Twenty-seven articles encompassing 232 patients met inclusion criteria and were queried for demographics, etiology, presentation, and medical and surgical treatments. RESULTS: Mean age of patients was 33.3 years, where 21.7% were females and 78.3% were males. Causes of barotrauma include diving (57.3%), airplane descent (26.7%), and general anesthesia (0.4%). The most common presentations were frontal pain (44.0%), epistaxis (25.4%), and maxillary pain (10.3%). Most patients received topical steroids (44.0%), oral steroids (28.4%), decongestants (20.7%), and antibiotics (15.5%). For surgical treatment, most patients received functional endoscopic sinus surgery (FESS) (49.6%). Adjunctive surgeries include middle meatal or maxillary antrostomy (20.7%), septoplasty (15.5%), and turbinate surgery (9.1%). The most efficacious medical treatments are as follows: 63.6% success rate with oral steroids (66 treated), 50.0% success rate with topical steroids (102 treated), and 50.0% success rate analgesics (10 treated). For surgical treatments received by greater than 10% of the sample, the most efficacious was FESS (91.5% success rate, 108 treated). CONCLUSION: Oral and topical steroids should be first line therapies. If refractory, then functional endoscopic sinus surgery is an effective treatment.

Surgical management of facial dog bite trauma: A contemporary perspective and review.

Objective: To perform a review evaluating management of and complications stemming from dog bite trauma sustained to the head and neck over the past decade. Data Sources: PubMed and Cochrane Library. Methods: The authors searched the PubMed and Cochrane Library databases for relevant published literature. A total of 12 peer-reviewed canine-exclusive series inclusive of 1384 patient cases describing facial dog bite trauma met inclusion criteria. Wounds including fractures, lacerations, contusions, and other soft-tissue injuries were evaluated. Demographics related to clinical course and management, operating room requirements, and antibiotic usage were compiled and analyzed. Initial trauma and surgical management complications were also assessed. Results: 75.5% of patients sustaining dog bites required surgical intervention. Of these patients, 7.8% suffered from postsurgical complications, including hypertrophic scarring (4.3%), postoperative infection (0.8%), or nerve deficits and persistent paresthesias (0.8%). Prophylactic antibiotics were administered to 44.3% of patients treated for facial dog bites and the overall infection rate was 5.6%. Concomitant fracture was present in 1.0% of patients. Conclusion: Primary closure, often in the OR may be necessary, with few cases requiring grafts or flaps. Surgeons should be aware that the most common complication is hypertrophic scarring. Further research is needed to elucidate the role of prophylactic antibiotics.

Effect of obesity on outcomes after open laryngeal surgery including total laryngectomy: A NSQIP database analysis.

BACKGROUND: The impact of obesity on outcomes after open laryngeal surgery has not been well-described. METHODS: The NSQIP database was queried for all open laryngeal surgeries including total laryngectomies between 2005 and 2018. Outcomes of patients identified as obese or nonobese by BMI were compared. RESULTS: Of 1865 patients, 20.1% classified as obese. The most common operation performed was total laryngectomy with or without radical neck dissection (73.2%). Operation time and length of hospital stay were significantly less for obese patients. On multivariate analysis, obesity was associated with less bleeding transfusions occurrences (aOR, 0.395, p = 0.0052), surgical complications (aOR, 0.604, p < 0.001), and any complication (aOR, 0.730, p = 0.0019). CONCLUSION: Though there may be an inverse association of obesity with complications and bleeding transfusion occurrences, as well as decreased operation time and length of hospital stay, several confounders and bias may exist; therefore, it is difficult to conclude that the obesity paradox is present.

A tale of two functions: enzymatic activity and translational repression by carboxyltransferase.

Acetyl-CoA Carboxylase catalyzes the first committed step in fatty acid synthesis. Escherichia coli acetyl-CoA carboxylase is composed of biotin carboxylase, carboxyltransferase and biotin carboxyl carrier protein functions. The accA and accD genes that code for the alpha- and beta-subunits, respectively, are not in an operon, yet yield an alpha(2)beta(2) carboxyltransferase. Here, we report that carboxyltransferase regulates its own translation by binding the mRNA encoding its subunits. This interaction is mediated by a zinc finger on the beta-subunit; mutation of the four cysteines to alanine diminished nucleic acid binding and catalytic activity. Carboxyltransferase binds the coding regions of both subunit mRNAs and inhibits translation, an inhibition that is relieved by the substrate acetyl-CoA. mRNA binding reciprocally inhibits catalytic activity. Preferential binding of carboxyltransferase to RNA in situ was shown using fluorescence resonance energy transfer. We propose an unusual regulatory mechanism by which carboxyltransferase acts as a 'dimmer switch' to regulate protein production and catalytic activity, while sensing the metabolic state of the cell through acetyl-CoA concentration.

Morphometric and Immunohistochemical Characteristics of the Adult Human Soft Palate Muscles.

The soft palate is the only structure that reversibly separates the respiratory and gastrointestinal systems. Most species can eat and breathe at the same time. Humans cannot do this and malfunction of the soft palate may allow food to enter the lungs and cause fatal aspiration pneumonia. Speech is the most defining characteristic of humans and the soft palate, along with the larynx and tongue, plays the key roles. In addition, palatal muscles are involved in snoring and obstructive sleep apnea. Considering the significance of the soft palate, its function is insufficiently understood. The objectives of this study were to document morphometric and immunohistochemical characteristics of adult human soft palate muscles, including fiber size, the fiber type, and myosin heavy chain (MyHC) composition for better understanding muscle functions. In this study, 15 soft palates were obtained from human autopsies. The palatal muscles were separated, cryosectioned, and stained using histological and immunohistochemical techniques. The results showed that there was a fast type II predominance in the musculus uvulae and palatopharyngeus and a slow type I predominance in the levator veli palatine. Approximately equal proportions of type I and type II fibers existed in both the palatoglossus and tensor veli palatine. Soft palate muscles also contained hybrid fibers and some specialized myofibers expressing slow-tonic and embryonic MyHC isoforms. These findings would help better understand muscle functions.