Virtual reality surgical planning for endoscopic endonasal approaches to the craniovertebral junction.

PURPOSE: To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of endoscopic endonasal craniovertebral junction (CVJ) surgery. MATERIALS AND METHODS: Five patients who had undergone endoscopic endonasal surgery of the craniovertebral junction with preoperative virtual reality surgical planning were identified and described. RESULTS: The anterior approach to the CVJ has been traditionally accomplished transorally. However, recently the transnasal endoscopic approach to this location has been described. Multiple anatomical studies have been conducted using the nasopalatine, nasoaxial, and rhinopalatine lines (NPL, NAxL, RPL) in an attempt to preoperatively delineate the inferior limits of endoscopic dissection. The use of advanced surgical simulation using immersive virtual reality is an innovative approach for analyzing CVJ anatomy and developing a surgical plan. VR simulation through the use of interactive and highly accurate patient specific models allows for the creation of three-dimensional (3D) digital reconstructions via the fusion of CT and MRI studies. Incorporation of simulation technology has been shown to increase surgeon proficiency while simultaneously decreasing complication rates. The described case series demonstrates the novel utility of VR planning for designing the endoscopic surgical approach to the CVJ. CONCLUSIONS: VR technology allows for the creation of anatomically accurate 3D models that can be used for preoperative planning of endoscopic endonasal surgery. Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.

The impact of surgeon volume on total thyroidectomy outcomes among otolaryngologists.

PURPOSE: To evaluate the impact of surgeon volume on total thyroidectomy complications and outcomes among otolaryngologists. MATERIALS AND METHODS: This state-wide, multi-hospital retrospective review identified patients who underwent total thyroidectomy (TT) (ICD9-06.4) through the Statewide Planning and Research Cooperative System (SPARCS) between 1995 and 2015. Surgeons were categorized into high (>100), medium (10-99), and low (<10) volume groups and differences in complication rates were analyzed. Statistical analysis employed Spearman's rank correlation, Kruskal-Wallis testing, and chi-squared testing. RESULTS: 32,133 TT performed by 1032 otolaryngologists were identified. Overall complication rate in our cohort was 9.83% (CI: 9.48-10.18). The most common complication identified overall was hypocalcemia occurring in 3.85% of cases. Surgeons in the high volume group had a complication rate of 9.6%, compared to 10.0% and 11.6% in the medium and low volume groups. This represents a moderate, but statistically significant difference (rho: -0.4, p < 0.0001; KW p ≤0.0001). When looking at individual complications, temporary tracheostomy rate was higher in the low volume group (5.1%, p = 0.001). Other variables such as advanced age, sex, non-white race, or thyroid malignancy were not predictors of increased complication rates for TT. CONCLUSIONS: Otolaryngologists who perform a high volume of total thyroidectomy were found to have overall less perioperative complications than those with less volume. In particular, the risk of temporary tracheostomy is higher among low volume surgeons. These findings are consistent with previous studies of the effect of thyroidectomy volume on surgical complications.

Households food consumption pattern in Pakistan: Evidence from recent household integrated economic survey.

The analysis of food consumption pattern is a primary concern of any developing country because it is related with food security. Pakistan is one of the emerging nations of the developing world. Due to the similarities and differences in households' food consumption behavior, income distribution, the effects of alternative tax structures, cost-benefit analyses, and the choice of cost of living index, the study of households' food consumption pattern is crucial for a developing nation like Pakistan. Furthermore, for Pakistan's food security in the present and the future, an analysis of food consumption pattern is crucial. The main objective of this study is to analyze the households' food consumption pattern. Linear Approximation Almost Ideal Demand System (LA/AIDS) is applied using data from Household Integrated Economic Survey (HIES) for the year 2018-19. This study makes a significant contribution by estimating household age composition elasticities, which were absent from earlier studies. Results from the income elasticities reveal that milk, meat, and fruits are luxuries food items. Similarly, on the basis of inelastic income elasticities we declared cereals, pulses, vegetables, sugar, and ghee as necessity food items. Results from the compensated own price elasticities show that the eight food commodity groups have inelastic own-price elasticities. This implies that these food commodities are integral food items of household diet. Results from the compensated cross-price elasticities shows that cereals and pulses, cereals and vegetables, pulses and vegetables, milk and fruits, meat and fruits, and milk and ghee are gross substitutes. On the other hand, pulses and meat, pulses and fruits, and ghee and meat are gross complements. According to the findings of the household age composition elasticities, adding children to a household significantly increases its sugar consumption while significantly reducing its fruit consumption. Any increase in the size of the household by an adolescent, adult, or a person in their middle age results in a significant increase in the consumption of cereals and a significant drop in the consumption of fruits. Finally, any increase in the size of the households brought about by an elder resulted in a significant rise in the consumption of cereals and a significant drop in the consumption of vegetables.

Exploring the Students' Perceived Effectiveness of Online Education during the COVID-19 Pandemic: Empirical Analysis Using Structural Equation Modeling (SEM).

The world faced COVID-19, which was a threat to public health and disturbed the educational system and economic stability. Educational institutes were closed for a longer period, and students faced difficulty to complete their syllabus. The government adopted a policy of "suspending classes without stopping learning" to continue education activities. However, student satisfaction with online education is a growing concern. Satisfaction of students is an important indicator of academic quality. Therefore, this study attempts to investigate the influencing factors behind learning satisfaction using information from 335 students from various institutes in Pakistan. This research examined the impact of computer and internet knowledge, instructor and course material, and Learning Management Systems (LMS) on learning satisfaction. The path coefficients were obtained via Partial Least Square-Structural Equation Modeling (PLS-SEM). The LMS is a tool that facilitates the learning process with the provision of all types of educational material. The path coefficient was more in the case of LMS (0.489), which indicates its positive and significant role to attain learning satisfaction. The instructor and course material ordered second (0.261), which shows that the quality of an instructor and course material also plays a positive role to attain learning satisfaction. The computer and internet are essential ingredients of online education, showing a significant and positive path coefficient (0.123), implying that computer and internet knowledge could enhance learning satisfaction. The universities should develop their LMS to implement online education with quality course materials. It is also vital that the instructor should be up to date with modern learning techniques while ensuring internet connectivity, especially in rural areas. The government should provide an internet connection to students at discounted rates.

Skull Base Anatomy in Patients with Bilateral Choanal Atresia: A Radiographic Study.

Introduction The risk of skull base injury during choanal atresia repair can be mitigated via thorough understanding of skull base anatomy. There is a paucity of data describing differences in skull base anatomy between patients with coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities (CHARGE) syndrome and those without. Objectives The aim of this study was to measure nasal and skull base anatomy in patients with isolated bilateral choanal atresia (BCA), CHARGE syndrome, and other syndromic congenital anomalies. Methods Retrospective chart review of patients with bilateral choanal atresia and computed tomography of the face between 2001 and 2019 were evaluated. Choanal width, height, mid-nasal height, and skull base slope were measured radiographically. Differences in anatomy between healthy patients, those with CHARGE syndrome, and those with other congenital anomalies were compared. Results Twenty-one patients with BCA and relevant imaging were identified: 7 with isolated BCA, 6 with CHARGE syndrome, and 8 with other congenital anomalies. A t -test indicated insignificant difference in skull base slope, choanal height, choanal width, or mid-nasal skull base height between isolate BCA cases and patients with any congenital anomaly. When comparing CHARGE to isolated BCA cases, mid-nasal height was shorter in CHARGE patients ( p = 0.03). There were no differences in measurements between patients with congenital anomalies excluding CHARGE ( p > 0.05). Two patients in the congenital anomaly group were found to have bony skull base defects preoperatively. Conclusion This study represents the largest description of skull base and nasal anatomy in patients with CHARGE syndrome and BCA. Surgeons should be aware of the lower skull base in CHARGE patients to avoid inadvertent skull base injury.

Reversing Coffee-Ring Effect by Laser-Induced Differential Evaporation.

The coffee-ring effect, ubiquitously present in the drying process of aqueous droplets, impedes the performance of a myriad of applications involving precipitation of particle suspensions in evaporating liquids on solid surfaces, such as liquid biopsy combinational analysis, microarray fabrication, and ink-jet printing, to name a few. We invented the methodology of laser-induced differential evaporation to remove the coffee-ring effect. Without any additives to the liquid or any morphology modifications of the solid surface the liquid rests on, we have eliminated the coffee-ring effect by engineering the liquid evaporation profile with a CO2 laser irradiating the apex of the droplets. The method of laser-induced differential evaporation transitions particle deposition patterns from coffee-ring patterns to central-peak patterns, bringing all particles (e.g. fluorescent double strand DNAs) in the droplet to a designated area of 100 µm diameter without leaving any stains outside. The technique also moves the drying process from the constant contact radius (CCR) mode to the constant contact angle (CCA) mode. Physical mechanisms of this method were experimentally studied by internal flow tracking and surface evaporation flux mapping, and theoretically investigated by development of an analytical model.