National Trends of Pediatric Aspirated/Ingested Foreign Bodies.

Foreign body (FB) aspiration/ingestion in children represents a major cause of hospital admission and mortality. Evaluating risk factors and identifying trends in specific FB products could improve targeted health literacy and policy changes. A cross-sectional study querying emergency department patients less than 18 years old with a diagnosis of aspirated/ingested FB was conducted using the National Electronic Injury Surveillance System database between 2010 and 2020. Incidence rates per 100 000 people-year were calculated and multivariate analyses were performed to identify risk factors for hospital admission and mortality. There has been a significantly decreasing rate of aspirated (-23.6%; P = .013) but not ingested FB (-9.4%; P = .066) within the study period. Within pediatric aspirated FB, black compared with white patients had decreased odds of same hospital admission (odds ratio [OR]: 0.8), but increased odds of transfer admission (OR: 1.6) and mortality (OR: 9.2) (all, P < .001).

"The Pedagogical Legacy of Dr. Chevalier Jackson: An Archival Visit to the John Q. Adams History Center at the American Academy of Otolaryngology-Head and Neck Surgery".

This article explores the historic records of the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) John Q. Adams Center for the History of Otolaryngology-Head and Neck Surgery, with particular attention paid to the Dr. Chevalier Jackson Collection. The library houses diverse materials that would be of interest to medical historians seeking to understand the early innovations in our specialty. With a repository of over 2200 items chronicling over 200-years of otolaryngological history, the library contains special collections dedicated to Drs. Maurice H. Cottle, Samuel Rosen, Adam Politzer, and Chevalier Jackson. An original aim of this visit sought to understand Dr. Jackson's early contributions to the fields of laryngology, bronchology, and esophagology; yet, an intimate review of his works, including autobiographical material, reveals a fascinating pedagogical legacy.

The Rare Presentation of Multiple Chondroid Syringomas in One Patient: A Case Report.

Chondroid syringomas are rare, benign tumors originating from sweat glands occurring as singular lesions of the head and neck. This case report presents a patient in whom multiple chondroid syringoma lesions were found. Thus illuminating the possibility for such occurrences in the future of which physicians should be aware.

Fulminant Retropharyngeal Edema Associated with SARS-COV-2 (+) Diagnosis in an Adult.

SARS-COV-2 can cause retropharyngeal edema for which literature on optimal management is sparse. Prompt identification and treatment of the condition is vital to successful recovery. This report presents such a case and offers support for conservative management in treatment of retropharyngeal edema.

Evaluation of fluoropyruvate as nucleophile in reactions catalysed by N-acetyl neuraminic acid lyase variants: scope, limitations and stereoselectivity.

The catalysis of reactions involving fluoropyruvate as donor by N-acetyl neuraminic acid lyase (NAL) variants was investigated. Under kinetic control, the wild-type enzyme catalysed the reaction between fluoropyruvate and N-acetyl mannosamine to give a 90 : 10 ratio of the (3R,4R)- and (3S,4R)-configured products; after extended reaction times, equilibration occurred to give a 30 : 70 mixture of these products. The efficiency and stereoselectivity of reactions of a range of substrates catalysed by the E192N, E192N/T167V/S208V and E192N/T167G NAL variants were also studied. Using fluoropyruvate and (2R,3S)- or (2S,3R)-2,3-dihydroxy-4-oxo-N,N-dipropylbutanamide as substrates, it was possible to obtain three of the four possible diastereomeric products; for each product, the ratio of anomeric and pyranose/furanose forms was determined. The crystal structure of S. aureus NAL in complex with fluoropyruvate was determined, assisting rationalisation of the stereochemical outcome of C-C bond formation.

Reaction mechanism of N-acetylneuraminic acid lyase revealed by a combination of crystallography, QM/MM simulation, and mutagenesis.

N-Acetylneuraminic acid lyase (NAL) is a Class I aldolase that catalyzes the reversible condensation of pyruvate with N-acetyl-d-mannosamine (ManNAc) to yield the sialic acid N-acetylneuraminic acid (Neu5Ac). Aldolases are finding increasing use as biocatalysts for the stereospecific synthesis of complex molecules. Incomplete understanding of the mechanism of catalysis in aldolases, however, can hamper development of new enzyme activities and specificities, including control over newly generated stereocenters. In the case of NAL, it is clear that the enzyme catalyzes a Bi-Uni ordered condensation reaction in which pyruvate binds first to the enzyme to form a catalytically important Schiff base. The identity of the residues required for catalysis of the condensation step and the nature of the transition state for this reaction, however, have been a matter of conjecture. In order to address, this we crystallized a Y137A variant of the E. coli NAL in the presence of Neu5Ac. The three-dimensional structure shows a full length sialic acid bound in the active site of subunits A, B, and D, while in subunit C, discontinuous electron density reveals the positions of enzyme-bound pyruvate and ManNAc. These 'snapshot' structures, representative of intermediates in the enzyme catalytic cycle, provided an ideal starting point for QM/MM modeling of the enzymic reaction of carbon-carbon bond formation. This revealed that Tyr137 acts as the proton donor to the aldehyde oxygen of ManNAc during the reaction, the activation barrier is dominated by carbon-carbon bond formation, and proton transfer from Tyr137 is required to obtain a stable Neu5Ac-Lys165 Schiff base complex. The results also suggested that a triad of residues, Tyr137, Ser47, and Tyr110 from a neighboring subunit, are required to correctly position Tyr137 for its function, and this was confirmed by site-directed mutagenesis. This understanding of the mechanism and geometry of the transition states along the C-C bond-forming pathway will allow further development of these enzymes for stereospecific synthesis of new enzyme products.

Orthodontic treatment motivation and cooperation: a cross-sectional analysis of adolescent patients' and parents' responses.

INTRODUCTION: Orthodontic patients' cooperation determines their treatment outcomes. Our objectives were to compare orthodontic treatment motivation of child and adolescent patients and their parents at an initial screening appointment with the responses of patients in treatment and their parents. Furthermore, we explored the association between participants' levels of treatment motivation and treatment cooperation. METHODS: Data were collected from 227 child and adolescent patients (50.2% boys, 49.8% girls; average age, 13 years; age range, 7.11-16.11 years) and their parents. Of the respondents, 144 (63.4%) were in orthodontic treatment (71 boys, 73 girls), and 83 (36.6%) (43 boys, 40 girls) were surveyed at their initial orthodontic screening appointment. RESULTS: Parents reported greater motivation for their children to have orthodontic treatment than did the children. This was especially true among patients who were already in treatment. The higher the patients' treatment motivation, the more they reported that they cooperated with their orthodontists' treatment recommendations. However, the parents' motivation for their child to have orthodontic treatment was not significantly correlated with their children's treatment cooperation. CONCLUSIONS: Although parents reported greater motivation levels than their children, the patients' levels of motivation to receive orthodontic treatment were found to determine their reported cooperation with their orthodontists' treatment recommendations.

Dental students treating patients living with HIV/AIDS: the influence of attitudes and HIV knowledge.

As life expectancy for people living with HIV/AIDS (PLWHA) increases, these individuals will have greater need for competent and compassionate oral health care. Unfortunately, PLWHA face many significant barriers to receiving adequate oral health care, due in part to the fear of being stigmatized or discriminated against by dental care providers (DCPs). Although many studies have documented accounts of prejudice and discrimination toward PLWHA in the dental health care setting, few have developed theoretical explanations as to why these attitudes and behaviors persist or how they can be effectively ameliorated. The goal of the current study was to utilize Weiner's Attribution-Helping model to explain how a patient's perceived responsibility for contracting HIV might impact DCPs' attitudes and behavioral responses toward PLWHA. Existing research has demonstrated that DCPs' level of HIV-related knowledge impacts their treatment attitudes and behaviors toward PLWHA, but it remains unclear whether the effects of HIV-related knowledge may be masked by the personal attitudes (i.e., perceived patient responsibility for contracting HIV) that DCPs maintain. One hundred and eighteen dental students were recruited from a New England dental program. All participants read one of three brief patient vignettes in which the mode by which an individual contracted HIV was manipulated. Dental students then completed a survey assessing 1) perceptions of the patient's responsibility for contracting HIV; 2) knowledge of HIV; and 3) treatment attitudes. Results indicated that both knowledge of HIV and attributions of patient responsibility for illness were predictive of negative attitudes toward treatment.