Nasal Sesamoid Cartilages: Fact or Fiction? An Anatomical Study of the Lateral Nasal Ala.

OBJECTIVES: To evaluate the presence of cartilage in the lateral nasal ala (LNA) via histological analysis of alar Mohs surgical specimens. An accurate understanding of nasal anatomy is essential to optimize esthetic and reconstructive surgical outcomes. LNA anatomy is typically pictured to include discreet accessory and sesamoid cartilages; however, the authors debate the actual presence of these structures. METHODS: A blinded reviewer analyzed 101 lateral nasal alar histologic specimens from 362 tissue blocks using a Hematoxylin and Eosin (H&E) stain to assess for the presence of cartilage. RESULTS: Out of the 362 tissue blocks histologically analyzed, only 1 included cartilaginous components. CONCLUSIONS: We conclude that the presence of sesamoid and accessory cartilages in the LNA within our sample set is exceedingly rare.

Association of SARC-F Score and Rockwood Clinical Frailty Scale with CT-Derived Muscle Mass in Patients with Aortic Aneurysms.

OBJECTIVES: Patients with aortic aneurysms (AA) are often co-morbid and susceptible to frailty. Low core muscle mass has been used as a surrogate marker of sarcopenia and indicator of frailty. This study aimed to assess association between core muscle mass with sarcopenia screening tool SARC-F and Clinical Frailty Scale (CFS) in patients with AA. METHODS: Prospective audit of patients in pre-operative aortic clinic between 01/07/2019-31/01/2020 including frailty assessment using Rockwood CFS and sarcopenia screening using SARC-F questionnaire. Psoas and sartorius muscle area were measured on pre-operative CT scans and adjusted for height. Association was assessed using Spearman's rank correlation coefficient. RESULTS: Of 84 patients assessed, median age was 75 years [72,82], 84.5% were men, 65.5% were multimorbid and 63.1% had polypharmacy. Nineteen percent were identified as frail (CFS score >3) and 6.1% positively screened for sarcopenia (SARC-F score 4 or more). Median psoas area (PMA) at L3 was 5.6cm2/m2 [4.8,6.6] and L4 was 7.4cm2/m2 [6.3,8.6]. Median sartorius area (SMA) was 1.8 cm2/m2 [1.5,2.2]. CFS demonstrated weak but statistically significant negative correlation with height-adjusted PMA at L3 (r=-0.25, p=0.034) but not at L4 (r=-0.23, p=0.051) or with SMA (r=-0.22, p=0.065). No association was observed between SARC-F score and PMA or SMA (L3 PMA r=-0.015, p=0.9; L4 PMA r=-0.0014, p= 0.99; SMA r=-0.051, p=0.67). CONCLUSION: CFS showed higher association with CT-derived muscle mass than SARC-F. Comprehensive pre-operative risk-stratification tools which incorporate frailty assessment and body composition analysis may assist in decision making for surgery and allow opportunity for pre-habilitation.

Disparities in Index of Care for Otolaryngologic Procedures Performed in Ambulatory and Inpatient Settings.

OBJECTIVE: To compare the same surgical procedure performed in ambulatory and inpatient settings to determine the demographics associated with this selection, the differences in 30-day revisit rates, and the total 30-day cost of care. STUDY DESIGN: Retrospective cohort analysis. SETTING: Ambulatory and inpatient centers in Florida, New York, and Maryland. METHODS: The Healthcare Cost and Utilization Project, the State Ambulatory Surgery and Services Database, and the State Inpatient Database were used to identify patients undergoing commonly performed otolaryngologic procedures in 2016. The State Emergency Department Database and State Inpatient Database were used to identify 30-day revisits. RESULTS: A total of 55,311 patients underwent an otolaryngologic procedure: 51,136 (92.4%) ambulatory and 4175 (7.6%) inpatient. Adjusted odds of receiving care in the ambulatory setting was significantly lower for Black patients (odds ratio, 0.69 [95% CI, 0.55-0.85]; P = .001) and nonspecified other races (odds ratio, 0.71 [95% CI, 0.52-0.95]; P = .001) as compared with White patients. Women had 1.16-higher adjusted odds of undergoing a procedure in the ambulatory setting (95% CI, 1.05-1.29; P = .005). Insurance status and income were associated with location of care in the subcategorization of head and neck surgery. Adjusted inpatient procedure costs were significantly more than ambulatory (median, $59,112 vs $14,899); 30-day adjusted costs were $71,333.07 (95% CI, $56,223.99-$86,42.15; P < .001) more expensive for inpatient procedures vs ambulatory; and the adjusted 30-day odds of revisit were 2.23 times greater (95% CI, 1.44-3.44; P < .001) for ambulatory surgery across all procedures. CONCLUSIONS: Disparities exist in the use of ambulatory settings to provide otolaryngologic surgery. Additional research is required to ensure equitable triaging of surgical care setting.

Anti-Tumor and Anti-Inflammatory Activity In Vivo of Apodanthera congestiflora Cogn. (Cucurbitaceae).

This work aimed to carry out a study of Apodanthera congestiflora by investigating its chemical composition and pharmacological potential. From the dichloromethane phase (Dic-Ac) of the A. congestiflora stems, three compounds were identified: cayaponoside C5b (Ac-1), cabenoside C (Ac-2) and fevicordin C2 glucoside (Ac-3), being last identified for the first time as a natural product. These compounds were obtained by chromatographic methods and their structures were elucidated by means of spectroscopic analysis of IR, MS and NMR. In the quantification of Dic-Ac, it was possible to observe the presence of 7% of cayaponoside C5b. Dic-Ac showed significant toxicity for in vivo tests, with macroscopic and biochemical changes. The anti-inflammatory activity of Dic-Ac was investigated using the paw edema model. A decrease in inflammatory signs was observed in the first 5 h and the most effective dose in reducing edema with was 7.5 mg kg-1 (66.6%). Anti-tumor activity of Dic-Ac was evaluated by Ehrlich's carcinoma model, which showed inhibition rate of 78.46% at 15 mg kg-1 dosage. The phytochemical investigation, together with the biological tests carried out in this study, demonstrated that A. congestiflora is a promising species in the search for therapeutics, since it contains substances with high pharmacological potential in its composition.

Cereus jamacaru D.C. (Mandacaru): a Promising Native Brazilian Fruit as a Source of Nutrients and Bioactives Derived from its Pulp and Skin.

Aiming the valorisation of the fruit of Cereus jamacaru D.C. (mandacaru), from the Caatinga biome, the physicochemical and nutritional parameters, total phenolic content and antioxidant capacity of its raw pulp and skin were evaluated. Extracts of the lyophilised pulp (PE) and skin (SE) of this fruit were also characterised for their antioxidant capacity parameters, phenolic compounds and for the semi-quantitative elemental analysis of minerals. From the total carbohydrates of the pulp (13.43 g/100 g, in the fresh basis), 79% was composed by total dietary fibre and, from this fraction, 89% was insoluble dietary fibre. The total antioxidant capacity of the raw skin was about 1.5-fold higher than that of the raw pulp, while the improvement of phenolic content in the lyophilised PE and SE was by 5- and 36-folds, respectively, compared with their respective raw samples (fresh basis). The lyophilised SE had the higher antioxidant capacity, requiring only 3.79 g to scavenge 1 g of DPPH radicals. Frequencies of functional groups assessed through the FT-IR spectrum corroborates with the presence of phenolic compounds in the samples. Potassium was the predominant mineral in both PE and SE. These results indicate that mandacaru, currently consumed only locally, can be an important source of nutrients and antioxidants for the general population and also for industrial use.

Development and validation of the disease-specific QOL-CD quality of life questionnaire for patients with Cushing's disease.

OBJECTIVE: Cushing's disease (CD) patients experience a range of debilitating symptoms that impair quality of life (QOL) as assessed using generic measures. These generic measures are inadequate to capture the disease-specific burden of illness. The development of the CD-specific QOL-CD measure of QOL using items generated by CD patients and healthcare professionals will provide a holistic assessment of patient outcomes and efficacy of novel therapies. METHODS: A total of 96 CD patients participated. A list of 177 items (version 1.0) was generated by treated CD patients (n = 9), caregivers (n = 2), healthcare providers (n = 7), and results of a MEDLINE search. Item reduction was performed through content analysis and dual scaling. Patients' rating of importance was incorporated to reduce to a final version of 56 items (version 3.0). Evidence for test-retest reliability was sought through administering the QOL-CD 1 week apart and Cronbach's α of each subscale. Construct validity was assessed through extreme group analysis and comparison with the normal Canadian population. Concurrent validity was sought through comparison with the SF-36, Functional Assessment of Cancer Therapy-Brain (FACT-Br), and Karnofsky Performance Status (KPS). Perioperative testing was conducted on CD patients (n = 25) against nonfunctioning pituitary adenoma controls (n = 25) through pre- and postoperative testing. RESULTS: A total of 96 CD patients (86 females and 10 males; mean age 45.23 ± 14.16 years) participated. The QOL-CD was feasible (mean completion time 15 minutes, with 70% believing accurate capture of QOL), reliable (CD 1 week apart: r = 0.86; control 1 week apart: r = 0.83; Cronbach's α: general health = 0.73, emotional health = 0.85, physical health = 0.78, mental status = 0.82, social well-being = 0.63, medical treatment = 0.54), and valid (extreme group testing p < 0.001; SF-36 and QOL-CD general health: r = 0.56, social well-being: r = 0.21, emotional health: r = 0.61, total score: r = 0.58; FACT-Br and QOL-CD physical health: r = 0.47, social well-being: r = 0.21, emotional health: r = 0.34, total score: r = 0.68; KPS and QOL-CD general health: r = 0.32, total score: r = 0.14). Perioperative testing of CD patients (n = 25) demonstrated improvement in all subscales postoperatively, with a significant difference in emotional health (p < 0.001) and physical health (p < 0.001). CONCLUSIONS: The QOL-CD questionnaire has been developed for patients with CD and has demonstrated evidence for validity and reliability.

Monitoring long-term evolution of engineered barrier systems using magnets: Magnetic response.

Remote and non-destructive monitoring of the stability and performance of Engineered Barrier Systems for Geological Disposal Facility of is gaining considerable importance in establishing the safety cases for Higher Activity Wastes disposal. This study offers an innovative use of mineral magnetism for monitoring groundwater saturation of the barrier. Four mixtures of permanent magnets (Nd-Fe-B, coated and uncoated; SmCo and AlNiCo) and bentonite were reacted for 4, 8 and 12 months with mildly-saline, high-pH leachates, representing the fluids saturating a time-evolved engineered barrier. Coupled hysteresis and thermomagnetic analyses demonstrate how Nd-Fe-B feature a time-dependent transition from square-like ferromagnetic to superparamagnetic loop via pot-bellied and wasp-waist loops, whereas SmCo and AlNiCo do not show so extensive corrosion-related variations of the intrinsic and extrinsic magnetic properties. This study allowed to identify magnetic materials suitable for shorter- (Nd-Fe-B) and longer-term (SmCo and AlNiCo) monitoring purposes.

Intraoperative Imaging Changes Management in Orbital Fracture Repair.

PURPOSE: Intraoperative imaging is gaining widespread use in the management of facial fracture repair. The aim of this study was to determine whether intraoperative imaging changes the management of orbital fracture repair. MATERIALS AND METHODS: A retrospective case series was performed of all cases of orbital fracture repair from 2008 to 2015 in which the intraoperative O-arm was used at Regions Hospital (St Paul, MN), a level I trauma center. The primary outcome variable was a change in management, ranging from orbital plate repositioning to proceeding with orbital floor exploration. RESULTS: The study sample was composed of 101 patients with a mean age of 40 ± 15 years. Approximately 75% (76 of 101) of patients were male and 25% (25 of 101) were female. All cases were secondary to assault, motor vehicle accident, fall, or gunshot wounds. Use of the O-arm resulted in a change in management in 44% (44 of 101) of cases. In 48% (21 of 44) of these cases in which intraoperative imaging resulted in a change in management, the orbital plate was repositioned to optimize repair. In 16% (7 of 44) of these cases, the orbital plate was exchanged for a different size or type of plate. In 7% (3 of 44) of these cases, the orbital plate was reshaped by bending to improve contour for the repair. In another 7% (3 of 44) of these cases, the orbital plate was reshaped by trimming the plate to optimize the length or width of the plate for repair. In 7% of these cases, the orbital floor required exploration based on intraoperative imaging. In 5% of these cases, the orbital floor was found to be adequately reduced after zygoma reduction based on intraoperative imaging and did not require exploration. CONCLUSIONS: Use of intraoperative imaging allows the surgeon to make real-time changes in operative management ranging from orbital plate repositioning to deciding whether to proceed with orbital floor exploration. This not only allows for immediate optimization of repair but also could decrease the need for revision procedures, thus decreasing patient morbidity and improving patient outcomes.

Antimicrobial Potential of Plant Extracts and Chemical Fractions of Sideroxylon obtusifolium (Roem. & Schult.) T.D. Penn on Oral Microorganisms.

AIM: The aim of this study is to evaluate the in vitro antimicrobial activity of plant extracts and chemical fractions of Sideroxylon obtusifolium T.D. Penn on Streptococcus mutans, Streptococcus oralis, Streptococcus salivarius, Streptococcus parasanguinis, and Candida albicans as well as to identify the chemical classes found in the bioactive extracts possessing better activity. MATERIALS AND METHODS: Freeze-dried hydroalcoholic extracts of the bark and leaves (LC and LF respectively) and ethanol extracts of bark and leaves (EC and EF respectively) of S. obtusifolium were assessed for antimicrobial potential by determining the minimum inhibitory concentration (MIC), minimum bactericidal concentration, and minimum fungicidal concentration (MFC). The tests were performed by microdilu-tion method (in triplicate) in three independent experiments. Phytochemical characterization was performed by quantification of total polyphenols, total flavonoids, and condensed tannins. RESULTS: The EC extract presented weak antimicrobial potential on the growth of S. mutans (MIC = 1000 µg/mL); all extracts showed moderate inhibitory activity on the growth of C. albicans (MIC = 500 µg/mL). The dichloromethane and n-butanol fractions of LF extracts showed moderate growth inhibitory activity (MIC = 250 µg/mL) on C. albicans and fungicide potential (MFC/MIC = 2). The phytochemical characterization revealed a predominance of total polyphenols (EC = 29.23%; LC = 25.98%) and condensed tannins (LC = 38.84%; LF = 17.78%). CONCLUSION: The dichloromethane and n-butanol fractions of S. obtusifolium LF extract showed antifungal activity against C. albicans, with the potential for bioprospection of phytocom-pounds for the treatment of periodontal fungal diseases caused by this microorganism. The effect may be related to phyto-chemical compounds from the polyphenol and condensed tannin classes. CLINICAL SIGNIFICANCE: Research for new oral microbial disease treatment alternatives in bioactive compounds from medicinal plants is of clinical relevance and scientific interest since many therapeutic antifungal agents do not obtain the effectiveness expected due to microbial resistance, or to adverse effects on human tissues.

Cushing Disease Presenting as Primary Psychiatric Illness: A Case Report and Literature Review.

We report the case of a woman with long-standing refractory depression and psychotic features who was eventually diagnosed with Cushing disease. After surgical treatment of a pituitary adenoma, she experienced gradual psychiatric recovery and was eventually able to discontinue all psychotropic medication. We review the psychiatric components of Cushing disease, implications of psychiatric illnesses for the treatment and prognosis of Cushing disease, and potential pathophysiological mechanisms linking glucocorticoid excess to psychiatric illness.

Impact of technique on cushing disease outcome using strict remission criteria.

BACKGROUND: Cushing disease (CD) constitutes a challenging condition for the pituitary surgeon. Given the variety of factors affecting outcomes in CD, it is uncertain whether the newer endoscopic technique improves the results of surgery. METHODS: A review was conducted of CD cases at our institution between 2000 and 2010. Analysis was done to: determine if surgical technique had an effect on outcome, identify the predictors of outcome and provide details of failed cases. Remission was defined as normal postoperative 24-hour urinary free cortisol (24-h UFC), suppression of morning serum cortisol to <50 nmol/L after 1mg of dexamethasone or being dependent on steroid replacement. RESULTS: Forty-two patients met our inclusion criteria. Average follow-up period was 33 months. There were 15 macroadenomas and 27 microadenomas. Seventeen patients had an endoscopic transsphenoidal surgery and twenty-five patients had a microscopic transsphenoidal procedure. Long-term overall remission was achieved in 26 (62%) patients. There was no significant difference in remission rates between the two techniques (p value 0.757). Patient's subjective symptomatic improvement and drop of morning serum cortisol in the postoperative period to less than 100 nmol/L correlated with long-term remission (p value 0.0031 and 0.0101, respectively) while repeat surgery was the only predictor of the lack of postoperative remission (p value 0.0008). CONCLUSIONS: Revision surgery predicted poor remission rate for CD. Within the power of our study size, there was no difference in outcome between the endoscopic and microscopic approaches. Surgical outcomes should be reviewed in association with remission criteria used in a study.

Evaluating the prevalence of tail biting and carcase condemnations in slaughter pigs in the Republic and Northern Ireland, and the potential of abattoir meat inspection as a welfare surveillance tool.

Despite extensive utilisation in epidemiological investigations of animal health, to date there has been little consideration of the value of abattoir meat inspection as a pig welfare surveillance tool. This study measured the prevalence of tail-docking, tail biting, carcase condemnations and associated financial losses of the latter (Northern Ireland only) in 36,963 pigs slaughtered in six abattoirs from the Republic of Ireland and Northern Ireland in July and August 2010. Over 99 per cent of inspected pigs had been tail-docked, while 58.1 per cent and 1.03 per cent had detectable and severe tail lesions, respectively. Producer losses resulting from carcase condemnation were estimated to be €0.37 per pig slaughtered. Enhanced capture and utilisation of meat inspection data for use in animal welfare surveillance schemes has the potential to drive improvements in production efficiency and animal welfare. However, significant differences were detected in the prevalence of carcase condemnation conditions between abattoirs and judiciaries (Republic and Northern Ireland). This reflects variation in the criteria and methods of data capture used in meat inspection in different abattoirs. Thus, the meat inspection process needs to be standardised and reformed before it can be reliably utilised in large-scale pig welfare surveillance schemes.

Outcomes of surgically treated giant pituitary tumours.

OBJECTIVE: To evaluate the outcomes of patients with giant pituitary tumours (GPTs) who underwent a purely binasal endoscopic transsphenoidal surgery (BETS) and compare their outcomes with those achieved through craniotomy and microscopic transsphenoidal surgery (MTS). METHODS: Seventy-two consecutive patients with GPTs (greater than 10 cm3 in volume) who were treated surgically with BETS, craniotomy, or MTS from October 1994 to July 2009 were reviewed for clinical outcomes, degree of tumor resection, recurrence rates, and surgical complications. RESULTS: The BETS group had significantly better mean reduction of tumor volume (91%) than the craniotomy (63%, p = 0.001), and the MTS (63%, p = 0.010) groups. Gross total resection rates were also higher for BETS patients than for craniotomy patients (p = 0.010). Improvements in vision and headaches were noted in 96% and 100% of patients in the BETS group, respectively; these rates were similar to those in the craniotomy and MTS groups. Of the four patients with hormone-secreting tumours in the BETS group, three remained in remission. The median length-of-stay (four days) for the BETS group was shorter (p = 0.010), and surgical complications were less frequent (p = 0.037) and less severe compared to the craniotomy group. There were no differences in the recurrence rates: 79% percent of patients in the BETS group, 69% in the craniotomy group, and 79% in the MTS group were recurrence free at last follow-up (p = 0.829). CONCLUSIONS: Treatment of GPT with BETS offers excellent oncologic and clinical outcomes and can frequently obviate the need for craniotomy in these patients.

Bronchial carcinoid tumors metastatic to the sella turcica and review of the literature.

We review here the literature on neuroendocrine neoplasms metastatic to the pituitary and present an example of the disease. Metastasis of bronchial carcinoid tumors to the sellar region are rare. Herein, we describe the case of a 63-year-old woman who presented with constant cough and headaches. She had previously been operated for carcinoid tumor of the lung. During the preoperative investigation, a CT scan of the head revealed a sellar mass. Six months after a left lower lobectomy, the sellar lesion was removed by transsphenoidal surgery. The two tumors were evaluated by histology, immunohistochemistry and electron microscopy. Both showed identical morphologic features, those of carcinoid tumor. Immunohistochemistry revealed immunoreactivity for the endocrine markers, synaptophysin and chromogranin, as well as CD-56, serotonin, bombesin and vascular endothelial growth factor. The sellar neoplasm showed nuclear immunopositivity for thyroid transcription factor-1, supporting the diagnosis of a metastatic bronchial carcinoid tumor. In conclusion, this is the first report of a serotonin- and bombesin-immunopositive atypical bronchial carcinoid tumor metastatic to the sella.

Identification of factors influencing shark catch and mortality in the Marshall Islands tuna longline fishery and management implications.

Recent average annual catches of sharks by tuna longline vessels fishing in the Republic of the Marshall Islands (RMI) are estimated to be between 1583 and 2274 t. Although 22 shark species have been recorded by the observer programme for this fishery, 80% of the annual catch comprises only five species: blue shark Prionace glauca, silky shark Carcharhinus falciformis, bigeye thresher shark Alopias superciliosus, pelagic thresher shark Alopias pelagicus and oceanic whitetip shark Carcharhinus longimanus. Wire leaders (i.e. branch lines or traces) were also used by nearly all observed vessels. Generalized additive model (GAM)-based analyses of catch rates indicated that P. glauca and A. superciliosus are caught in higher numbers when vessels fish in relatively cooler waters, at night, close to the full moon, when the 27° C thermocline is close to the surface and during El Niño conditions. In contrast, C. falciformis, A. pelagicus and C. longimanus are caught in higher numbers when shark lines are used (all three species) or hooks are set at a shallow depth (A. pelagicus and C. longimanus and, also, P. glauca). These findings are generally consistent with current knowledge of these species' habitat preferences, movement and distribution. The results of these analyses were combined with information pertaining to shark condition and fate upon capture to compare the likely effectiveness of a range of potential measures for reducing shark mortality in the longline fishery. Of the options considered, the most effective would be to combine measures that reduce the catch rate (e.g. restrictions on the use of wire leaders, shark baits and shark lines) with measures that increase survival rates after post-capture release (e.g. finning bans).

Orthodromic temporalis tendon transfer: anatomical considerations.

OBJECTIVES: To define (1) at-risk structures during the orthodromic temporalis tendon transfer and (2) achievable tendon length without temporal releasing incisions or perioral lengthening materials. METHODS: Ten fresh cadavers provided 20 hemifaces for dissection. Measurements and photographic documentation were used to examine the parotid duct, masseteric artery, inferior alveolar nerve, internal maxillary artery, and mobilized tendon relative to adjacent landmarks. RESULTS: The parotid duct was found in a reproducible region posterior to the melolabial crease and inferior to a parotid duct reference line. The masseteric artery was found posterior to the posterior-most attachment of the tendon at its exit from the sigmoid notch (mean, 14.5 mm). The inferior alveolar nerve was found posterior to the anterior edge of the ascending ramus (mean, 18.3 mm). The internal maxillary artery coursed superiorly from posterior to anterior along the medial mandible near the coronoidectomy site. The tendon reached beyond the melolabial crease in 17 of 20 hemifaces (85%). CONCLUSIONS: The parotid duct reference line and the melolabial crease allow estimation of the parotid duct location. Anatomical relationships between the tendon, parotid duct, neurovasculature, and anatomical landmarks underscore the importance of deliberate soft-tissue retraction and subperiostial elevation to minimize injury. The tendon alone usually provides adequate length for orthodromic suspension.

Application of bivariate statistics to full wine bottle diamagnetic screening data.

A bivariate correlated Student distribution is applied to full wine bottle diamagnetic screening measurements. Previous work involving a limited number of rare wines indicated that like wines cluster in a plot of the first two principal component scores derived from a covariance matrix of the diamagnetic screening measurements. This study extends the approach to a much larger, statistically meaningful sixty bottle wine library where bivariate statistics are used to comment on the measured data. The full bottle diamagnetic screening of thirty-six identically labeled, sealed bottles of wine obtained from four different sources combined with principal component analysis data reduction followed by treatment with a bivariate distribution permit the effect of wine transport and storage to be observed. The usefulness and future success of the method towards the identification of counterfeit wines is mentioned.

Using low frequency full bottle diamagnetic screening to study collectible wine.

A low frequency ν < 30 MHz spectrometer capable of noninvasively and nondestructively screening the diamagnetic properties of full intact bottles of wine is described, and along with principal component analysis, used to compare and contrast sealed bottles of wine. The sensitivity of this approach to various ionic and molecular wine solutes is established by analyzing standard solutions. The successful application of this full bottle method to a library of collectible wine is discussed and suggests that the method can be used to identify counterfeit wine without violating the bottle.

Using low frequency dielectric absorption to screen full intact wine bottles.

A ν<25 MHz low frequency spectrometer capable of noninvasively and nondestructively screening the dielectric properties of full intact bottles of wine is described, and along with principal component analysis, used to screen rare wine. The sensitivity of this full bottle method to various ionic and molecular wine solutes was established by analyzing standard solutions. Application of the approach to a library of collectible wine and the identification of counterfeit wine are discussed.

Assessing fundamental 2-dimensional understanding of basic soft tissue techniques.

OBJECTIVE: To develop a written practical examination and scoring system for assessing trainee skills in basic soft-tissue techniques. DESIGN: A brief written practical examination was developed to assess the ability of trainees to sketch preoperative plans and postoperative results for common soft-tissue techniques: simple-excision, M-plasty, geometric broken line closure, Z-plasty, V-to-Y flap, and rhombic flap. A scoring system was developed to assign 0 to 5 points to each of 10 items on the examination for a total score of 0-50. The 15-minute examination was administered as a pretest, posttest, and 3-month posttest assessment as part of a soft-tissue course at our institution. SETTING: University of Minnesota, Otolaryngology Department. RESULTS: Three raters reviewed all examination answer sheets independently. The pretest scores of examinees correlated strongly with their level of training; the average pretest for junior residents (PGY 1-2) compared with senior residents (PGY 4-5) was 17.3 (of 50) versus 26.0 (p < 0.01). The scoring system showed a high intrarater reliability and high interrater reliability with correlation coefficients of r = 0.99 and r = 0.95, respectively and agreement coefficients of κ = 0.82 and κ = 0.77, respectively. CONCLUSION: This written practical examination and scoring system may be used to assess the skills of trainees accurately in basic soft tissue techniques and to expose areas of deficiency that can be addressed in future training sessions.