The Cousa objective: a long-working distance air objective for multiphoton imaging in vivo.

Multiphoton microscopy can resolve fluorescent structures and dynamics deep in scattering tissue and has transformed neural imaging, but applying this technique in vivo can be limited by the mechanical and optical constraints of conventional objectives. Short working distance objectives can collide with compact surgical windows or other instrumentation and preclude imaging. Here we present an ultra-long working distance (20 mm) air objective called the Cousa objective. It is optimized for performance across multiphoton imaging wavelengths, offers a more than 4 mm2 field of view with submicrometer lateral resolution and is compatible with commonly used multiphoton imaging systems. A novel mechanical design, wider than typical microscope objectives, enabled this combination of specifications. We share the full optical prescription, and report performance including in vivo two-photon and three-photon imaging in an array of species and preparations, including nonhuman primates. The Cousa objective can enable a range of experiments in neuroscience and beyond.

Modern Trends in Surgical Site Infection Rates for Colorectal Surgery: A National Surgical Quality Improvement Project Study 2013-2020.

BACKGROUND: There are few studies investigating trends in global surgical site infection rates in colorectal surgery in the last decade. OBJECTIVE: This study seeks to describe changes in rates of different surgical site infections from 2013-2020, identify risk factors for SSI occurrence and evaluate the association of minimally invasive surgery and infection rates in colorectal resections. DESIGN: A retrospective analysis of the National Surgical Quality Improvement Program database 2013-2020 identifying patients undergoing open or laparoscopic colorectal resections by procedure codes was performed. Patient demographic information, comorbidities, procedures, and complications data were obtained. Univariable and multivariable logistic regression were performed. SETTING: This was a retrospective study. PATIENTS: A total of 279,730 patients received colorectal resection from 2013 - 2020. MAIN OUTCOME MEASURES: Primary outcome measure was rate of surgical site infection, divided into superficial, deep incisional and organ space infections. RESULTS: There was a significant decrease in rates of superficial infections (p < 0.01) and deep incisional infections (p < 0.01) from 5.9% in 2013 to 3.3% in 2020 and from 1.4% in 2013 to 0.6% in 2020, respectively, but a rise in organ space infections (p < 0.01) from 5.2% in 2013 to 7.1% in 2020. Use of minimally invasive techniques was associated with decreased odds of all surgical site infections compared to open techniques (p < 0.01) in multivariate analysis and adoption of minimally invasive techniques increased from 59% in 2013 to 66% in 2020. LIMITATIONS: Study is limited by retrospective nature and variables available for analysis. CONCLUSIONS: Superficial and deep infection rates have significantly decreased, likely secondary to improved adoption of minimally invasive techniques and infection prevention bundles. Organ space infection rates continue to increase. Additional research is warranted to clarify current recommendations for mechanical bowel prep and oral antibiotic use as well as to study novel interventions to decrease postoperative infection occurrence. See Video Abstract.

Performance of ChatGPT on American Board of Surgery In-Training Examination Preparation Questions.

INTRODUCTION: Chat Generative Pretrained Transformer (ChatGPT) is a large language model capable of generating human-like text. This study sought to evaluate ChatGPT's performance on Surgical Council on Resident Education (SCORE) self-assessment questions. METHODS: General surgery multiple choice questions were randomly selected from the SCORE question bank. ChatGPT (GPT-3.5, April-May 2023) evaluated questions and responses were recorded. RESULTS: ChatGPT correctly answered 123 of 200 questions (62%). ChatGPT scored lowest on biliary (2/8 questions correct, 25%), surgical critical care (3/10, 30%), general abdomen (1/3, 33%), and pancreas (1/3, 33%) topics. ChatGPT scored higher on biostatistics (4/4 correct, 100%), fluid/electrolytes/acid-base (4/4, 100%), and small intestine (8/9, 89%) questions. ChatGPT answered questions with thorough and structured support for its answers. It scored 56% on ethics questions and provided coherent explanations regarding end-of-life discussions, communication with coworkers and patients, and informed consent. For many questions answered incorrectly, ChatGPT provided cogent, yet factually incorrect descriptions, including anatomy and steps of operations. In two instances, it gave a correct explanation but chose the wrong answer. It did not answer two questions, stating it needed additional information to determine the next best step in treatment. CONCLUSIONS: ChatGPT answered 62% of SCORE questions correctly. It performed better at questions requiring standard recall but struggled with higher-level questions that required complex clinical decision making, despite providing detailed responses behind its rationale. Due to its mediocre performance on this question set and sometimes confidently-worded, yet factually inaccurate responses, caution should be used when interpreting ChatGPT's answers to general surgery questions.

Role of Diagnostic Laparoscopy During Pancreatic Cancer Surgery in the Modern Era.

INTRODUCTION: Despite improvements in preoperative image resolution, approximately 10% of curative-intent resection attempts for pancreatic ductal adenocarcinoma are aborted at the time of operation. To avoid nontherapeutic laparotomy, many surgeons perform intraoperative diagnostic laparoscopy (DL) to identify radiographically occult metastatic disease. There are no consensus guidelines regarding DL in pancreatic cancer. The goal of this study is to investigate the efficacy of same-procedure DL at avoiding nontherapeutic laparotomy. METHODS: A single-institution retrospective review was performed from 2016 to 2022, identifying 196 patients with pancreatic ductal adenocarcinoma who were taken to the operating room for open curative-intent resection. Patient demographic, tumor characteristic, treatment, and outcome data were abstracted. Univariate and multivariate Cox hazard ratio analysis was performed to investigate risk factors for overall survival and recurrence-free survival. Number needed to treat (NNT) was calculated to identify number of DLs necessary to avoid one nontherapeutic laparotomy. RESULTS: Curative-intent resection was achieved in 161 (82.1%) patients. One hundred twenty six (64.0%) patients received DL prior to resection and DL identified metastatic disease in three (2.4%) patients with an NNT of 42. NNT of DL in a subgroup analysis performed on clinically high-risk patients (defined by preoperative or preneoadjuvant therapy carbohydrate antigen 19-9 > 500 U/mL) is 11. Receipt of DL did not prolong operative times in patients receiving pancreaticoduodenectomy when accounting for completed versus aborted resection. CONCLUSIONS: Although intraoperative DL is a short procedure with minimal morbidity, these data demonstrate that same-procedure DL has potential efficacy in avoiding nontherapeutic laparotomy only in a subgroup of clinically high-risk patients. Focus should remain on optimizing preoperative patient selection and further investigating novel diagnostic markers predictive of occult metastatic disease.

Effectiveness of interventions on sedentary behaviors in office workers: a systematic review and meta-analysis.

OBJECTIVES: Various interventions have sought to break sedentariness among office workers, but their pooled effect on sitting time reduction remains unknown. Also, it is essential to compare the effectiveness of different intervention types. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A literature search was conducted in the PubMed, EMBASE, Scopus, Web of Science, MEDLINE (via EBSCO), PsycINFO, and Cochrane Library databases from inception to May 2, 2023. Two independent reviewers screened eligibility, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Randomized controlled trials aiming to reduce sitting at work were included. The primary outcome was sitting time at work per day. The secondary outcomes included cardiometabolic risk factors, psychological well-being, and work engagement. A random effects model was performed to synthesize continuous data as mean differences with 95% confidence intervals (95% CIs). RESULTS: Twenty-four studies with 3169 participants were included. All intervention types in combination significantly reduced workplace sitting by 38 min per workday (95% CI: -47.32 to -28.72; P < 0.001; I2 = 49.78%). Interventions using environmental support (ES), motivational strategies (MS), or multiple components (multi) had all shown a significant reduction in work-time sedentary behavior (SB) relative to control groups. Regarding secondary outcomes, no significant effects were observed in physical or psychological outcomes besides high-density lipoprotein. CONCLUSIONS: Findings suggest that SB reduction interventions are generally effective for reducing workplace sitting. Multi interventions with both ES and MS are recommended for future clinical applications. Future studies should aim not only to reduce SB but also to attain the benefits of SB reduction interventions on physical and psychological well-being.

Imaging to Predict Prognosis in Hepatocellular Carcinoma: Current and Future Perspectives.

The focus of hepatocellular carcinoma (HCC) research for many years has been on noninvasive diagnosis. Standardized systematic algorithms composed of combinations of precise features now serve as diagnostic imaging markers of HCC and constitute a major innovation for liver imaging. In clinical practice, the diagnosis of HCC is based primarily on imaging and secondarily on pathologic analysis if the imaging features are not specific. Whereas accurate diagnosis is essential, the next phase of innovation for HCC will likely encompass predictive and prognostic markers. HCC is a biologically heterogeneous malignancy because of complex molecular, pathologic, and patient-level factors that impact the outcomes of treatment. In recent years, there have been many advances in systemic therapy to augment and extend the existing large cache of local and regional options. However, the guideposts for treatment decisions are neither sophisticated nor individualized. This review provides an overview of prognosis in HCC from the patient to the imaging feature level with a focus on future directions toward more individualized treatment guidance.

Peritoneal Metastases After Intraductal Papillary Mucinous Neoplasm Resection: How Common are They?

INTRODUCTION: Peritoneal metastases (PMs) following resection of pancreatic intraductal papillary mucinous neoplasms (IPMNs) are rare. Consequently, prevalence, risk factors, and prognosis are not well known. We reviewed our institution's experience and published literature to further characterize the scope of this phenomenon. METHODS: All pancreatectomy cases (556 patients) performed at a tertiary care center between 2010 and 2020 were reviewed to identify IPMN diagnoses. Patients with adenocarcinoma not arising from IPMN, or a history of other malignancies were excluded. RESULTS: Seventy-eight patients underwent pancreatectomy with IPMN on final pathology at our institution; 51 met inclusion criteria. Of these, there were five cases of PMs (4:1 females:males). Four had invasive carcinoma arising from IPMN and one had high-grade dysplasia at the index operation. Female sex and invasive histology were significantly associated with PM (P < 0.05). PM rates by sex were 3% (95% confidence interval [CI]: 0.5-15) in males and 22% (95% CI: 9-45) in females. Rates by histology were 2.9% (95% CI: 0.5-15) for noninvasive IPMN, and 23.5% (95% CI: 9.5-47) for invasive carcinoma arising from IPMN. Median interval from surgery to PMs was 7 mo (range: 3-13). CONCLUSIONS: PMs following IPMN resection are rare but may be more common in patients with invasive histology. Although rare, PMs can arise in patients with noninvasive IPMNs. Further studies on pathophysiology and risk factors of PM following IPMN resection are needed and may reinforce adherence to guidelines recommending long-term surveillance.

Profile and Predictors of Blood Tumor Mutational Burden in Advanced Hepatocellular Carcinoma.

Advanced hepatocellular carcinoma (HCC) is responsive to immune checkpoint inhibitors, but there are currently no known biomarkers to predict treatment benefit. Blood TMB (bTMB) estimation via circulating tumor DNA (ctDNA) profiling can provide a convenient means to estimate HCC TMB. Here we provide the first landscape of bTMB in advanced HCC using a commercially available next-generation sequencing assay, show that it is approximately three times as high as matched tissue TMB, and show that bTMB correlates with NAFLD cirrhosis etiology and the presence of genomic alterations in HTERT and TP53. These results lay the foundation for subsequent studies evaluating bTMB as an immune therapy predictive biomarker in HCC.

Pediatric Dog Bites: A Review of 1422 Cases Treated at a Level One Regional Pediatric Trauma Center.

BACKGROUND: Children under the age of 14 account for over 40% of the almost 900,000 annual hospital visits associated with dog bites. Care for dog bites ranges from simple wound irrigation to complex surgical reconstruction. Due to a number of factors, children frequently sustain dog bites to highly vulnerable regions, often necessitating intervention by plastic surgeons. METHODS: This retrospective study analyzed data from the 1422 pediatric patients who sustained dog bites and presented to the Le Bonheur Children's Hospital Emergency Room from January 2011 to May 2017. RESULTS: The typical pediatric dog bite case was male (63.5%), African-American (57.4%), and less than 10 years old (69.4%). The head and neck were the most commonly affected areas (64.7%). Of the head and neck regions, the cheeks and lips were the most frequently injured structures (34.5%). Hospital admission was required for 188 patients (13.2%) and operative repair was deemed necessary in 16.9% of all cases. Of the patients requiring inpatient operative repair, most (78.3%) were discharged in less than 24 hours. Operative complications occurred in 5.8% of all cases, with infections accounting for the majority (92.9%). No fatal dog bites occurred in this study. CONCLUSIONS: Age, bite location, and number of bites sustained are several factors of significance, which may aid the novice plastic surgeon in identifying, which pediatric dog bite cases will require surgical intervention.

iMIRAGE: an R package to impute microRNA expression using protein-coding genes.

SUMMARY: MicroRNAs (miRNAs) are critical post-transcriptional regulators of gene expression. Due to challenges in accurate profiling of small RNAs, a vast majority of public transcriptome datasets lack reliable miRNA profiles. However, the biological consequence of miRNA activity in the form of altered protein-coding gene (PCG) expression can be captured using machine-learning algorithms. Here, we present iMIRAGE (imputed miRNA activity from gene expression), a convenient tool to predict miRNA expression using PCG expression of the test datasets. The iMIRAGE package provides an integrated workflow for normalization and transformation of miRNA and PCG expression data, along with the option to utilize predicted miRNA targets to impute miRNA activity from independent test PCG datasets. AVAILABILITY AND IMPLEMENTATION: The iMIRAGE package for R, along with package documentation and vignette, is available at https://aritronath.github.io/iMIRAGE/index.html. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Cadaver Nerve Grafts: Past, Present and Future.

Nerve grafts represent an invaluable tool, when reconstructing nerve defects of more than 1 cm. Historically, the criterion standard use of autografts has relied on the premise of using nonessential sensory nerves to fulfill the principle of replacing "like with like," while simultaneously minimizing the infliction of undue morbidity on the patient. The reconstructive surgeon thus faces a dilemma when extensive nerve damage requires reconstruction, or when donor nerves are not available or limited such as in the pediatric population. Cadaver nerve grafts (CNG) uniquely allow for reconstruction of large nerve lesions without the presence of host morbidity. The following article reviews the use of CNG, its indications, advantages, and disadvantages, as well as provides some case studies of real-world application. In addition, an insight into the future perspectives of CNG is provided.

Pronator quadratus muscle flap: a preliminary cadaveric study.

There are very few studies regarding the neurovascular anatomy of pronator quadratus (PQ) or the technique of harvesting it as free functional muscle transfer. The aim of the study was to describe the neurovascular anatomy of PQ, to provide the harvesting technique and review the reported clinical applications. Dissections were performed on four fresh cadaver upper extremities. Measurements of PQ's dimensions, its neurovascular pedicle length, diameter and branching pattern were taken, and photographs were taken. The relation of the neurovascular pedicle to important anatomic landmarks of the forearm was also documented. Identification and raising of the PQ was performed within 30 min on all cases. The neurovascular pedicle was lying over the flexor surface of the interosseous membrane and entered the PQ on its dorsal surface. In all cases, PQ was received its blood supply from the anterior interosseous artery (AIA) with an average length of 12 cm and average diameter of 2.25 mm and it was accompanied by two veins. There were interconnections between the AIA and the ulnar and radial arteries. PQ was innervated by the anterior interosseous nerve with an average length of 12.25 cm. PQ can be easily harvested either as a free or as a pedicled muscle. The learning curve is short. The accompanying vessels and nerve are of adequate length/diameter for microvascular anastomoses and/or neurorrhaphy, respectively. There is no donor site morbidity except the scar. Although there have been sporadic reports on PQ clinical applications, more studies are needed in order to identify the indications/applications in reconstructive surgery.

Correlation Between Altmetric Score and Citations in Pediatric Surgery Core Journals.

BACKGROUND: The impact of a scientific article has traditionally been measured by the impact factor (IF) of the journal it is published in and the number of times it is cited. However, citations have a lag period before the true impact of an article can be determined. The Altmetric score has emerged as a measure of the digital dissemination of a scientific article across multiple platforms, including Tweets, Facebook likes, and other social and popular media mentions. We hypothesized that Altmetric score would correlate with citations and journal IF in pediatric surgery. METHODS: Using the previously identified 14 core journals of pediatric surgery, the top ten most-cited articles from each of these journals were identified for the year 2012, allowing for 5+ y of follow-up. For each article, we determined the number of times cited and the Altmetric score. For each journal, the 2012 IF and year in which the journal's Twitter account was established were determined. Bibliometric data were collected for the year 2015 to allow comparison of Altmetric scores across years. Descriptive statistics and Pearson's correlation coefficients were determined using the GraphPad PRISM software. RESULTS: Citation information for n = 140 articles from 2012 to 2015 was obtained. In 2012, articles were cited 56,159 times (median 192, range 21-5029), and the median Altmetric score was 8 (range 0-4261). Citations correlated strongly with journal IF (r = 0.82, P < 0.0001). Altmetric scores in 2012 showed weak positive correlation with citations (r = 0.1895, P = 0.0125) but did not correlate with IF (r = 0.0841, P = 0.1617). Altmetric scores in 2015 also showed weak positive correlation with citations (r = 0.238, P = 0.0023) but additionally weakly correlated with IF (r = 0.2027, P = 0.0082). Increasing age of a journal's Twitter account resulted in increasing correlation between Altmetric score and citations in both 2012 (r = 0.299, P = 0.169) and 2015 (r = 0.512, P = 0.037). Twitter was the primary social media contributor to Altmetric score in 2012 and 2015, with decreasing contribution from Facebook. CONCLUSIONS: This study is the first to link traditional bibliometric measures with newer measures of digital dissemination for publications in pediatric surgery. Although the Altmetric score of the top cited articles did not correlate with journal IF, it did weakly correlate with citations. Interestingly, this correlation was strongest for journals with well-established Twitter accounts, indicating that, over time, the Altmetric score may emerge as a tool to predict future citations. Currently, Altmetric and traditional bibliometric measures appear to have distinct but complementary roles in measuring dissemination and impact of scientific articles in pediatric surgery.

Mitotic trigger waves and the spatial coordination of the Xenopus cell cycle.

Despite the large size of the Xenopus laevis egg (approximately 1.2 mm diameter), a fertilized egg rapidly proceeds through mitosis in a spatially coordinated fashion. Mitosis is initiated by a bistable system of regulatory proteins centred on Cdk1 (refs 1, 2), raising the possibility that this spatial coordination could be achieved through trigger waves of Cdk1 activity. Using an extract system that performs cell cycles in vitro, here we show that mitosis does spread through Xenopus cytoplasm via trigger waves, propagating at a linear speed of approximately 60 µm min(-1). Perturbing the feedback loops that give rise to the bistability of Cdk1 changes the speed and dynamics of the waves. Time-lapse imaging of intact eggs argues that trigger waves of Cdk1 activation are responsible for surface contraction waves, ripples in the cell cortex that precede cytokinesis. These findings indicate that Cdk1 trigger waves help ensure the spatiotemporal coordination of mitosis in large eggs. Trigger waves may be an important general mechanism for coordinating biochemical events over large distances.

Keystone Flaps: Physiology, Types, and Clinical Applications.

The keystone perforator flap (KPF) was first introduced in 2003 by Behan et al for use in reconstruction after skin cancer excision. Since its initial description, KPF use has been expanded to complex defects of various etiologies and disorders throughout the body. At its most basic, the KPF is a perforator-type flap designed with a 1:1 flap-to-defect width ratio. Keystone perforator flaps are specifically raised on pedicles arising from musculocutaneous or fasciocutaneous perforator vessels. Major advantages of the KPF derive from the maintenance of perforator vascular territories, perforosomes, permitting increased flap viability. In turn, this allows for more aggressive undermining in sites away from perforators when greater skin mobilization is necessary. Furthermore, the KPF is relatively easy to perform leading to shorter operative times and no postoperative monitoring period. There are basically 4 different types of keystone flaps in order of increasing undermining and disturbance of underlying fascia. These different classifications of KPFs may be used in different anatomical locations over the entire body based on skin laxity and defect size/depth. Numerous advancements and modifications have been documented adapting the KPF to specific conditions, including myelomeningoceles, and scrotal and lower eyelid defects. The purpose of this article is to provide an organized review of the KPF with emphasis on different classifications, applications, and limitations as well as an overview of the surgical technique. We have additionally included a discussion on KPF physiology and review of current literature.

Low Referral Rate for Genetic Testing in Racially and Ethnically Diverse Patients Despite Universal Colorectal Cancer Screening.

BACKGROUND & AIMS: Guidelines recommend that all colorectal tumors be assessed for mismatch repair deficiency, which could increase identification of patients with Lynch syndrome. This is of particular importance for minority populations, in whom hereditary syndromes are under diagnosed. We compared rates and outcomes of testing all tumor samples (universal testing) collected from a racially and ethnically diverse population for features of Lynch syndrome. METHODS: We performed a retrospective analysis of colorectal tumors tested from 2012 through 2016 at 4 academic centers. Tumor samples were collected from 767 patients with colorectal cancer (52% non-Hispanic white [NHW], 26% African American, and 17% Hispanic patients). We assessed rates of tumor testing, recommendations for genetic evaluation, rates of attending a genetic evaluation, and performance of germline testing overall and by race/ethnicity. We performed univariate and multivariate regression analyses. RESULTS: Overall, 92% of colorectal tumors were analyzed for mismatch repair deficiency without significant differences among races/ethnicities. However, minority patients were significantly less likely to be referred for genetic evaluation (21.2% for NHW patients vs 16.9% for African American patients and 10.9% for Hispanic patients; P = .02). Rates of genetic testing were also lower among minority patients (10.7% for NHW patients vs 6.0% for AA patients and 3.1% for Hispanic patients; P < .01). On multivariate analysis, African American race, older age, and medical center were independently associated with lack of referral for genetic evaluation and genetic testing. CONCLUSION: In a retrospective analysis, we found that despite similar rates of colorectal tumor analysis, minority patients are less likely to be recommended for genetic evaluation or to undergo germline testing for Lynch syndrome. Improvements in institutional practices in follow up after tumor testing could reduce barriers to diagnosis of Lynch diagnosis in minorities.

Wind alters landing dynamics in bumblebees.

Landing is an important but understudied behavior that flying animals must perform constantly. In still air, insects decelerate smoothly prior to landing by employing the relatively simple strategy of maintaining a constant rate of image expansion during their approach. However, it is unclear whether insects employ this strategy when faced with challenging flight environments. Here, we tested the effects of wind on bumblebees (Bombus impatiens) landing on flowers. We find that bees' approach paths to flowers shift from multidirectional in still air to unidirectional in wind, regardless of flower orientation. In addition, bees landing in a 3.5 m s-1 headwind do not decelerate smoothly, but rather maintain a high flight speed until contact, resulting in higher peak decelerations upon impact. These findings suggest that wind has a strong influence on insect landing behavior and performance, with important implications for the design of micro aerial vehicles and the ecomechanics of insect flight.

Parental and youth understanding of the informed consent process for pediatric endoscopy.

OBJECTIVES: Informed consent (IC) is an essential communication between patient/representative and physician that acknowledges patient autonomy; assent is the equivalent process performed between youth and physician. For clinical procedures involving youth, only the IC process between guardian/parent and physician is required to be performed. Nevertheless, experts recommend that youth undergo assent whenever possible. In the present study, we explored both parental and youth understanding of required IC elements in IC discussions before pediatric endoscopy. METHODS: Following signing of IC documents on the day of endoscopy at a tertiary care academic medical center, youth and their parents underwent structured interviews to assess comprehension of key elements of the IC process. RESULTS: A total of 88 children and adolescents and their parents were evaluated. Two youth and 12 parents demonstrated comprehensive understanding of key IC elements for pediatric endoscopy. Suboptimal youth understanding was demonstrated for nature of the procedure (25% with adequate understanding) and related risks (17%), and alternatives (14%) to the procedure. Suboptimal parental understanding was demonstrated for procedure alternatives (24%). Youth overall understanding of IC varied by age, whereas parental global understanding of IC varied by physician. CONCLUSIONS: Understanding of IC performed for pediatric endoscopy could be improved in both parents and youth. Our findings suggest that interventions targeting parents, youth, and physicians may be helpful. Further study is needed to determine whether our findings are representative of IC understanding at other pediatric endoscopy centers.

Utilizing Histopathology to Predict Success with Macrolide Therapy in CRS Patients.

There is currently interest regarding CRSsNP patients with refractory symptomatology following functional endoscopic sinus surgery, and which of these patients can derive benefit from low-dose macrolide therapy. In the present study, we analyze a cohort of over fifty CRSsNP patients on macrolide therapy; structured histopathological findings at the time of surgery were analyzed against the success of macrolide treatment. Independently, fibrosis, absence of squamous metaplasia, absence of eosinophilia, presence of neutrophilic infiltrate, and lymphoplasmocytic predominance were all associated with objective success of macrolide treatment; these findings may allow clinicians to more appropriately select patients for this therapy.