Vocal cord dysfunction/inducible laryngeal obstruction cannot be diagnosed from symptoms.

Vocal cord dysfunction/inducible laryngeal obstruction is highly variable. Standard clinical symptoms and questionnaires cannot predict laryngoscopic diagnosis in a "lung disease" population. https://bit.ly/3QUtsbB.

Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics.

INTRODUCTION: Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is an important medical condition but understanding of the condition is imperfect. It occurs in healthy people but often co-exists with asthma. Models of VCD/ILO pathophysiology highlight predisposing factors rather than specific mechanisms and disease expression varies between people, which is seldom appreciated. Diagnosis is often delayed, and the treatment is not evidence based. AREAS COVERED: A unified pathophysiological model and disease phenotypes have been proposed. Diagnosis is conventionally made by laryngoscopy during inspiration with vocal cord narrowing >50% Recently, dynamic CT larynx was shown to have high specificity (>80%) with potential as a noninvasive, swift, and quantifiable diagnostic modality. Treatment entails laryngeal retraining with speech pathology intervention and experimental therapies such as botulinum toxin injection. Multidisciplinary team (MDT) clinics are a novel innovation with demonstrated benefits including accurate diagnosis, selection of appropriate treatment, and reductions in oral corticosteroid exposure. EXPERT OPINION: Delayed diagnosis of VCD/ILO is pervasive, often leading to detrimental treatments. Phenotypes require validation and CT larynx can reduce the necessity for laryngoscopy, thereby fast-tracking diagnosis. MDT clinics can optimize management. Randomized controlled trials are essential to validate speech pathology intervention and other treatment modalities and to establish international standards of care.

Computed Tomography Imaging of the Larynx for Diagnosis of Vocal Cord Dysfunction.

BACKGROUND: Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is characterized by breathlessness and often mimics or accompanies severe asthma. The disorder occurs intermittently, and the diagnosis is established by using laryngoscopy. Dynamic computed tomography (CT) imaging of the larynx at low-radiation doses has the potential to provide an alternative method to make the diagnosis of VCD/ILO. METHODS: We report two case series: in series A, laryngoscopy (diagnostic standard) and CT imaging of the larynx were each performed within 1 hour of each other (n=31), and in series B, the procedures were performed on separate days 4 to 6 weeks apart (n=72). Diagnosis of VCD/ILO by laryngoscopy used conventional criteria, and diagnosis by CT imaging was based on vocal cord narrowing in excess of a validated normal threshold. In each series, we evaluated the accuracy of CT imaging of the larynx to establish a diagnosis of VCD/ILO compared with laryngoscopy. RESULTS: In series A, the sensitivity of CT imaging of the larynx was 53.8%, and specificity was 88.9%; in series B, the sensitivity of CT imaging of the larynx was 76.2%, and specificity was 93.3%. At a disease prevalence of 30% (which was known to be the case in our clinic), the positive predictive value was 67.5% in series A and 83% in series B. Negative predictive values were 81.8% and 90.1% in series A and B, respectively, and false-positive rates were 11.1% and 6.7%. CONCLUSIONS: When the population prevalence was assumed to be 30%, low-dose CT imaging of the larynx detected VCD/ILO with negative predictive values greater than 80% in both series settings and agreed with each other within 9 percentage points. Positive predictive values for laryngeal CT imaging varied substantially between the settings of the two case series. (Supported by Monash Lung and Sleep Institute and Grant APP ID 1198362 and others.)

Head and neck squamous cell carcinoma survivorship care.

BACKGROUND: Head and neck cancer is the seventh most commonly diagnosed cancer in Australia. More than 90% of these cancers are squamous cell carcinomas (SCCs). With advances in cancer therapies, survivorship care is becoming increasingly topical. In particular, general practitioners (GPs) will play an increasingly central part in the management of this unique cohort of patients. OBJECTIVE: The aim of this article is to provide a succinct overview of long-term follow-up and surveillance for the head and neck SCC survivor. DISCUSSION: Treatment of head and neck SCC, particularly advanced cases, often requires a combination of surgery, radiotherapy and cytotoxic chemotherapy. As a result, the long-term follow-up care of head and neck SCC survivors is complex and has many facets including physical and mental treatment sequelae. GPs play a vital part in follow-up, particularly in disease surveillance and managing treatment complications.

Traumatic nasal injuries in general practice.

BACKGROUND: Traumatic nasal injuries are common in all age groups of the community. Significant nasal trauma can cause nasal fractures and a range of complicating injuries. OBJECTIVE: This article provides general practitioners (GPs) with a succinct overview of pathology arising from nasal trauma, and a framework on the assessment and management of common nasal injuries. DISCUSSION: During assessment of traumatic nasal injuries, it is essential to exclude a septal haematoma, which requires urgent drainage. Undisplaced nasal fractures without functional symptoms can be managed conservatively. Displaced fractures should be referred for reduction. There is a window of two weeks before the displaced nasal bones start uniting. Investigations are rarely indicated for traumatic nasal injuries. Blood tests, including full blood count and coagulation screening, may be indicated in severe epistaxis. X-rays are not helpful for the assessment of traumatic nasal injuries. Computed tomography (CT) scans are only indicated if there is a suspected orbital, maxillary, frontal or zygomatic fractures.

Inverted organic photovoltaic cells using three-dimensionally interconnected TiO2 nanotube arrays.

Here we describe a simple sol-gel method to fabricate inverted organic photovoltaics (OPV) using interconnected TiO2 nanotubes (inter-TiO2 NT) as an efficient electron transport layer. Three-dimensionally inter-TiO2 NT arrays were prepared by spin-coating a TiO2 precursor solution on the ZnO nanorod (NR) template grown via the liquid phase deposition method. Upon etching of ZnO NRs, inter-TiO2 NT arrays were generated, as confirmed by X-ray diffraction (XRD), energy-filtering transmission electron microscopy (EF-TEM) and field-emission scanning electron microscopy (FE-SEM). A blend of poly(3-hexylthiophene) (P3HT) and phenyl-C61-butyric acid methyl ester (PCBM) deeply infiltrated into the pores of inter-TiO2 NT, as revealed by FE-SEM and atomic force microscopy (AFM) images. The power conversion efficiency (PCE) of inter-TiO2 NT-based inverted OPV reached 3.0% at an air mass of 1.5 (100 mW/cm2), which is a 25% performance improvement compared to flat TiO2 films derived from the sol-gel process or commercial paste. The efficiency improvement arises from facilitated charge separation and collection due to the increased TiO2 interface arera and efficient transport pathway.

Fabrication of 3D interconnected porous TiO2 nanotubes templated by poly(vinyl chloride-g-4-vinyl pyridine) for dye-sensitized solar cells.

Porous TiO(2) nanotube arrays with three-dimensional (3D) interconnectivity were prepared using a sol-gel process assisted by poly(vinyl chloride-graft-4-vinyl pyridine), PVC-g-P4VP graft copolymer and a ZnO nanorod template. A 7 µm long ZnO nanorod array was grown from the fluorine-doped tin oxide (FTO) glass via a liquid phase deposition method. The TiO(2) sol-gel solution templated by the PVC-g-P4VP graft copolymer produced a random 3D interconnection between the adjacent ZnO nanorods during spin coating. Upon etching of ZnO, TiO(2) nanotubes consisting of 10-15 nm nanoparticles were generated, as confirmed by wide-angle x-ray scattering (WAXS), energy-filtering transmission electron microscopy (EF-TEM) and field-emission scanning electron microscopy (FE-SEM). The ordered and interconnected nanotube architecture showed an enhanced light scattering effect and increased penetration of polymer electrolytes in dye-sensitized solar cells (DSSC). The energy conversion efficiency reached 1.82% for liquid electrolyte, and 1.46% for low molecular weight (M(w)) and 0.74% for high M(w) polymer electrolytes.

Nanoscale graft copolymer templates decorated by silver bromide nanoparticles arrays.

A novel amphiphilic poly(4-vinyl pyridine)-graft-poly(lauryl methacrylate) (P4VP-g-PLMA) graft copolymer at 29:71 wt% was synthesized via free radical polymerization, as confirmed by nuclear magnetic resonance (1H NMR). This self-assembled copolymer was used to template the in-situ growth of silver bromide (AgBr) nanoparticles, producing a solid-state nanocomposite film. Interestingly enough, AgBr nanoparticles with a bimodal size distribution were selectively grown within the copolymer matrix. Large nanoparticles with diameters of 30-40 nm were formed in the center of the hydrophilic P4VP spherical domains whereas smaller particles with diameters of 8-10 nm were decorated in hydrophobic PLMA domains. To the best of our knowledge, this is the first report on the nanoscale decoration of amphiphilic copolymer by AgBr nanoparticles with a size-selective, bimodal size distribution.

Self-assembled structures of hydrogen-bonded poly(vinyl chloride-g-4-vinyl pyridine) graft copolymers.

An amphiphilic graft copolymer of poly(vinyl chloride-graft-4-vinyl pyridine), i.e., PVC-g-P4VP was synthesized via atom transfer radical polymerization (ATRP) and modified by introducing 1,5-dihydroxynaphthalene (DHN) as a hydrogen bonding donor to form hydrogen-bonded macromolecules. The PVC-g-P4VP graft copolymer prepared from a selective solvent for PVC, i.e., tetrahydrofuran (THF) exhibited a well-organized micellar morphology consisting of a P4VP core and a PVC corona. However, the graft copolymer prepared from a good solvent for both domains, i.e., N, N-dimethylformamide (DMF) showed a less-organized, random microphase-separated morphology. Upon the introduction of DHN, a more spherical morphology and a more-organized 'bicontinuous-like' morphology was observed in THF and DMF, respectively. This results from strong segregation between the two domains due to the enhanced interfacial energy by DHN. When DHN was removed by methanol, nanoporous films with versatile pore sizes and shapes were generated.

Structure control of organized mesoporous TiO2 films templated by graft copolymers for dye-sensitized solar cells.

Randomly microphase-separated graft copolymers have been self-reorganized so as to exhibit a micellar structure with excellent connectivity upon tuning the solvent affinity. These copolymers are used as a structure-directing agent for organized mesoporous TiO(2) films with no grain boundaries, leading to enhanced solar conversion efficiency of dye-sensitized solar cells.

Synthesis and characterization of AgBr nanocomposites by templated amphiphilic comb polymer.

A novel amphiphilic graft copolymer, poly(vinylidene fluoride-co-chlorotrifluoroethylene)-g-poly(4-vinyl pyridine) (P(VDF-co-CTFE)-g-P4VP) at 65:35 wt.%, respectively, was synthesized via atom transfer radical polymerization (ATRP), as confirmed by nuclear magnetic resonance (1H NMR) and transmission electron microscopy (TEM). Silver bromide (AgBr) nanoparticles were in situ generated within the self-assembled P(VDF-co-CTFE)-g-P4VP graft copolymer. TEM, UV-visible spectroscopy and X-ray diffraction (XRD) analyses support the successful formation of P(VDF-co-CTFE)-g-P4VP nanocomposites consisting of stabilized AgBr nanoparticles mostly 20-40 nm in size, which is presumably due to the capping action of the coordinating pyridine groups of the graft copolymer. The wavenumber of pyridine nitrogen in FT-IR spectra and the glass transition temperature (Tg) of the graft polymer measured by DSC shifted upon the formation of AgBr nanoparticles, indicating specific interactions between the nanoparticles and the graft copolymer matrix.

Simultaneous cesarean section and radical nephrectomy for angiomyolipoma with spontaneous bleeding during pregnancy: a case report.

BACKGROUND: Renal angiomyolipoma with spontaneous bleeding during pregnancy is an extremely rare condition and may jeopardize both the mother and fetus. The ethics of reproductive medicine, method of diagnosis, option for management and optimal time for surgical intervention can be arguable in this situation. CASE: A 31-year-old woman presented with dull right flank pain at 12 weeks' gestation. Abdominal sonography and renal magnetic resonance imaging revealed a hypervascular and fat-containing mass with mother and fetus bleeding at the right kidney. Due to stable hemodynamic status, the patient was treated conservatively and underwent elective, simultaneous cesarean section and radical nephrectomy safely at 38 weeks' gestation. Angiomyolipoma of the right kidney was diagnosed on pathologic examination. CONCLUSION: Renal angiomyolipoma with spontaneous bleeding during pregnancy is a dangerous condition that may cause mortality in the mother and fetus, but elective, simultaneous cesarean section and radical nephrectomy can be performed safely if the hemodynamic status is stable.