Validation of Visual Analogue Scale for loss of smell as a quick test in chronic rhinosinusitis with nasal polyps.

BACKGROUND AND OBJECTIVE: Diagnostic criteria of chronic rhinosinusitis with nasal polyps (CRSwNP) include, among others, olfactory dysfunction (OD). We hypothesize that patients suffering with CRSwNP are good at self-assessing their sense of smell through visual analogue scale (VAS) compared to smell tests. METHODS: A controlled cross-sectional study was planned. Adults diagnosed with severe CRSwNP waiting for endoscopic sinus surgery were included. A cohort of healthy controls was also studied. All participants performed Barcelona smell test (BAST-24), sinonasal outcomes test 22 (SNOT-22), and VAS for loss of smell. CRSwNP underwent blood test (eosinophils count, total serum IgE), CT scan (Lund-Mackay Score), and nasal endoscopy. RESULTS: 138 severe CRSwNP and 40 controls subjects were included. The BAST-24 identification score was strongly correlated with the VAS score in the CRSwNP group (rho=-0.79, p<0.001) but not in the control group (rho=-0.14; p=0.39), this difference between groups being statistically significant (p<0.001). A significant correlation of SNOT-22 item 21 (loss of smell) was also found with BAST-24 identification (rho=-0.65, p<0.001), this difference being statistically significant (Z=-2.43; p=0.015). In the ROC curve, the area under the curve (AUC) was 0.85 with 72.5% sensitivity and 93.1% specificity. CONCLUSION: This study demonstrates a potential role of the VAS score for the screening of OD in severe CRSwNP in daily clinical practice.

Septoplasty and/or inferior turbinoplasty produce significant improvements of the sense of smell.

BACKGROUND: Patients with septal deviation and/or turbinal hypertrophy may experience olfactory disfunction (OD). The aim of this study was to analyse the effect of septoplasty and/or turbinoplasty on both lateralized and bilateral olfactory function. METHODOLOGY: Prospective study of 47 patients with nasal obstruction secondary to septal deviation and/or turbinal hypertrophy and 20 healthy controls. The Barcelona Olfactory test (BOT-8), a new supraliminal orthonasal subjective olfactometry, was applied 3 times in a row (in each nostril separately and in both simultaneously). The 8 items were applied randomly to minimize the possible risk of learning. The test has not established the minimal clinically important difference (MCID). Anterior rhinomanometry and acoustic rhinometry were performed. All participants self-assessed smell loss and nasal obstruction using a visual analogue scale (VAS) and completed questionnaires for nasal obstruction (Nasal Obstruction Symptom Evaluation, NOSE) and for quality of life (QoL), using disease-specific (SinoNasal Outcome Test-22, SNOT-22) and generic (Short Form-12 Health Survey, SF-12) questionnaires. Nasal measurements and questionnaires were performed preoperatively and 12 months after surgery. RESULTS: Before surgery, patients reported worse VAS on smell loss and on nasal obstruction compared to controls. Patients scored lower BOT-8 than controls. Lateralized preoperative olfactory function showed that all BOT-8 characteristics were lower at the narrow side than the wider one. Smell function and QoL improved significantly one year after surgery. CONCLUSIONS: Nasal septal deviation and turbinal hypertrophy lead to an olfactory impairment on the obstructed nostril. Nasal surgery provides a positive outcome on olfactory function, as well as on subjective and objective outcomes.

Sinonasal mucosal melanomas: defining profiles for better survival outcomes.

BACKGROUND: Sinonasal mucosal melanoma is an aggressive malignancy with a 5-year survival rate ranging from 20% to 39%. Despite the evolving surgical and radiotherapy techniques, and introduction of immune-checkpoint inhibitor therapy, overall survival rates remain poor. METHODOLOGY: A retrospective cohort study was conducted at the Hospital Clinic de Barcelona and the Hospital de la Santa Creu i Sant Pau between 1984 and 2020; primary outcome measures were 3 and 5-year melanoma-specific survival (MSS). Kaplan-Meier survival analysis and Cox proportional hazards model were performed to identify predictors of survival. RESULTS: Fifty patients were included, the mean age was 70.4, MSS at 3 and 5 years was 51.2%, and 29.5%, respectively. The median follow-up was 39.6 months during which 46% presented locoregional recurrence and 36%, metastasis. The univariate and multivariate analyses found as survival predictors the N category, the treatment received, the surgical margins and the mitotic index. CONCLUSIONS: We found an overall 5-year MSS of 29.5%. Those patients with intention-to-cure (stages III and IVa) treated by surgery that were N0 at diagnosis, with < 10 mitoses per HPF showed a 5-year MSS rate of 74.1%. More studies will be needed to adequately define the patients' profiles that will benefit from a better survival outcome.

Twelve-year long-term postoperative outcomes in patients with chronic rhinosinusitis with nasal polyps.

BACKGROUND: Evidence regarding long-term postoperative follow-up of chronic rhinosinusitis with nasal polyps (CRSwNP) patients is scarce in the literature. The objective of the present study was to report long-term 12-year postoperative outcomes for CRSwNP patients. METHODS: CRSwNP patients were prospectively followed after endoscopic sinus surgery. Sinonasal symptoms, nasal polyp score (NPS), Barcelona Smell Test 24 (BAST-24), Lund-Mackay Score (LMS), and Medical Outcome Study Short Form-36 (SF-36) questionnaire were assessed before and 12 years after surgery. RESULTS: At long-term follow-up (median, 12 years), a strong improvement was noted for all patients (N=76) in nasal symptoms score, NPS, BAST-24, and LMS scores compared with baseline. No long-term improvement in SF-36 was found. CONCLUSION: Patients with CRSwNP have a long-term 12-year postoperative improvement in nasal symptoms, polyp size, computed tomography, and olfaction.

The 8-Odorant Barcelona Olfactory Test (BOT-8): Validation of a New Test in the Spanish Population During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVE: Most smell tests are difficult to implement in daily clinical practice owing to their long duration. The aim of the present study was to develop and validate a short, easy-to-perform, and reusable smell test to be implemented during the COVID-19 pandemic. METHODS: The study population comprised 120 healthy adults and 195 patients with self-reported olfactory dysfunction (OD). The 8-Odorant Barcelona Olfactory Test (BOT-8) was used for detection, memory/recognition, and forced-choice identification. In addition, a rose threshold test was performed, and a visual analog scale was applied. The Smell Diskettes Olfaction Test (SDOT) was used for correlation in healthy volunteers, and the University of Pennsylvania Smell Identification Test (UPSIT) was used for patients with OD to establish cut-offs for anosmia and hyposmia. In order to take account of the COVID-19 pandemic, disposable cotton swabs with odorants were compared with the original test. RESULTS: In healthy persons, the mean (SD) BOT-8 score was 100% for detection, 94.5% (1.07) for memory/recognition, and 89.6% (0.86) for identification. In patients with OD, the equivalent values were 86% (32.8), 73.2% (37.9), and 77.1% (34.2), respectively. BOT-8 demonstrated good test-retest reliability, with agreement of 96.7% and a quadratic k of 0.84 (P<.001). A strong correlation was observed between BOT-8 and SDOT (r=0.67, P<.001) and UPSIT (r=0.86, P<.001). Agreement was excellent for disposable cotton swabs, with a k of 0.79 compared with the original test. The cut-off point for anosmia was ≤3 (area under the curve, 0.83; sensitivity, 0.673; specificity, 0.993). CONCLUSION: BOT-8 offers an efficient and fast method for assessment of smell threshold, detection, memory, and identification in daily clinical practice. Disposable cotton swabs with odorants proved to be useful and safe during the COVID-19 pandemic.

Twelve-year long-term postoperative outcomes in patients with chronic rhinosinusitis with nasal polyps.

BACKGROUND: Evidence regarding long-term postoperative follow-up of chronic rhinosinusitis with nasal polyps (CRSwNP) patients is scarce in the literature. The objective of the present study was to report long-term 12-year postoperative outcomes for CRSwNP patients. METHODS: CRSwNP patients were prospectively followed after endoscopic sinus surgery. Sinonasal symptoms, nasal polyp score (NPS), Barcelona Smell Test 24 (BAST-24), Lund-Mackay Score (LMS), and Medical Outcome Study Short Form-36 (SF-36) questionnaire were assessed before and 12 years after surgery. RESULTS: At long-term follow-up (median, 12 years), a strong improvement was noted for all patients (N=76) in nasal symptoms score, NPS, BAST-24, and LMS scores compared with baseline. No long-term improvement in SF-36 was found. CONCLUSION: Patients with CRSwNP have a long-term 12-year postoperative improvement in nasal symptoms, polyp size, computed tomography, and olfaction.

The 8-Odorant Barcelona Olfactory Test(BOT-8): Validation of a New Test in the Spanish Population During the COVID-19 Pandemic

Background: Most smell tests are difficult to implement in daily clinical practice owing to their long duration. The aim of the present study was to develop and validate a short, easy-to-perform, and reusable smell test to be implemented during the COVID-19 pandemic. Methods: The study population comprised 120 healthy adults and 195 patients with self-reported olfactory dysfunction (OD). The 8-Odorant Barcelona Olfactory Test (BOT-8) was used for detection, memory/recognition, and forced-choice identification. In addition, a rose threshold test was performed, and a visual analog scale was applied. The Smell Diskettes Olfaction Test (SDOT) was used for correlation in healthy volunteers, and the University of Pennsylvania Smell Identification Test (UPSIT) was used for patients with OD to establish cut-offs for anosmia and hyposmia. In order to take account of the COVID-19 pandemic, disposable cotton swabs with odorants were compared with the original test. Results: In healthy persons, the mean (SD) BOT-8 score was 100% for detection, 94.5% (1.07) for memory/recognition, and 89.6% (0.86) for identification. In patients with OD, the equivalent values were 86% (32.8), 73.2% (37.9), and 77.1% (34.2), respectively. BOT-8 demonstrated good test-retest reliability, with agreement of 96.7% and a quadratic k of 0.84 (P<.001). A strong correlation was observed between BOT-8 and SDOT (r=0.67, P<.001) and UPSIT (r=0.86, P<.001). Agreement was excellent for disposable cotton swabs, with a k of 0.79 compared with the original test. The cut-off point for anosmia was ≤3 (area under the curve, 0.83; sensitivity, 0.673; specificity, 0.993). Conclusions: BOT-8 offers an efficient and fast method for assessment of smell threshold, detection, memory, and identification in daily clinical practice. Disposable cotton swabs with odorants proved to be useful and safe during the COVID-19 pandemic (AU)

Introducción: Las olfatometrías son difíciles de implementar en la práctica clínica diaria por su larga duración. El objetivo del presente estudio fue desarrollar y validar una prueba simple, fácil y reutilizable para ser utilizada durante la pandemia de COVID-19. Métodos: Se incluyeron 120 voluntarios sanos ≥18 años y 195 pacientes con disfunción olfatoria (DO) autoreportada. Se utilizó el Barcelona Olfactory Test (BOT-8) con 8 odorantes para la detección, memoria/reconocimiento e identificación. Además, se hizo una prueba de umbral de rosa (alcohol feniletílico) de 6 diluciones, escala visual analógica (EVA). Se compararon los resultados con una prueba validada Smell Diskettes Olfaction Test (SDOT), para definir puntos de corte de hiposmia y anosmia se comparó en pacientes con DO con UPSITTM. Considerando la pandemia de COVID-19, se compararon hisopos de algodón desechables con los odorantes respecto a la prueba original. Resultados: BOT-8 se tarda entre 3 y 7 minutos en realizar. En población sana, la media de detección fue del 100%, memoria 94,5% (DE=1,07) e identificación 89,6% (DE=0,86). En pacientes con DO fue de 86% (DE=32,8), 73,2% (DE=37,9) y 77,1% (DE=34,2), respectivamente. BOT-8 demostró buena fiabilidad test-retest con 96,7% de concordancia observada y una kappa cuadrática de 0,84 (p<0,001). Presentó una fuerte correlación con SDOT (r=0,673, p <0,001) en población sana y con UPSITTM en pacientes con DO (r=0,86, p<0,001). Los hisopos de algodón desechables mostraron una excelente concordancia (kappa de 0,79) en comparación con la prueba original. El punto de corte para anosmia fue ≤ 3 (AUC=0,83, Se= 0,673, Sp=0,993) y de hiposmia ≤ 6 (AUC=0,451, Se= 0,088, Sp= 0,814). Conclusiones: BOT-8 ofrece un método eficiente y rápido para ser utilizado en la práctica clínica diaria para evaluar el sentido del olfato mediante la detección, memoria, identificación y umbral (AU)

Change in olfactory function after septoplasty. A systematic review and meta-analysis.

BACKGROUND: Septoplasty is one of the most frequently performed surgeries. However, there remains a question as to the effect of such intervention on the sense of smell. This study aims to examine the available evidence regarding the effect of septoplasty on the sense of smell. METHODS: A database search was performed using PubMed, ScienceDirect, Google Scholar and The Cochrane Library databases from January 1990 to February 2020. Search terms included smell, olfaction, odor, septum, septoplasty, and septorhinoplasty. A meta-analysis was performed with 12 studies that provided sufficient data on change in olfaction. RESULTS: 14 studies met the inclusion criteria, and 2 additional studies were included manually; comprising a total of 996 patients and 25 controls. Significant improvement in olfactory test scores was observed in all tests. Pre- and postoperative differences in means were 0.63 for BSIT, 0.80 for CCCRC test, 1.16 for odor threshold, 1.43 for odor discrimination, and 1.18 for odor identification. CONCLUSIONS: Septoplasty seems to improve olfactory function. However, the outcome of this intervention is discrete and not equal for all patients, so further randomized trials are needed to confirm current findings.

Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery.

OBJECTIVE: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in five consecutive cases of intrinsic brainstem lesions that were managed via an EEA, as well as the specific anatomy of each case. METHODS: All patients were treated in a single center by a multidisciplinary surgical team between 2015 and 2019. Before surgery, a dedicated anatomical analysis of the brainstem safe entry zone was performed, and proper surgical planning was carried out. Neurophysiological monitoring was used in all cases. Anatomical dissections were performed in three human cadaveric heads using 0° and 30° endoscopes, and specific 3D reconstructions were executed using Amira 3D software. RESULTS: All lesions were located at the level of the ventral brainstem. Specifically, one mesencephalic cavernoma, two pontine ca- vernomas, one pontine gliomas, and one medullary diffuse midline glioma were reported. Cerebrospinal fluid leak was the major complication that occurred in one case (medullary diffuse midline glioma). From an anatomical standpoint, three main safe entry zones were used, namely the anterior mesencephalic zone (AMZ), the peritrigeminal zone (PTZ, used in two cases), and the olivar zone (OZ). Reviewing the literature, 17 cases of various brainstem lesions treated using an EEA were found. CONCLUSIONS: To our knowledge, this was the first preliminary clinical series of intrinsic brainstem lesions treated via an EEA presented in the literature. The EEA can be considered a valid surgical alternative to traditional transcranial approaches to treat selected intra-axial brainstem lesions located at the level of the ventral brainstem. To achieve good results, surgery must involve comprehensive anatomical knowledge, meticulous preoperative surgical planning, and intraoperative neurophysiological moni- toring.

Self-perception of olfactory dysfunction is associated with history of Traumatic Brain Injury: post-hoc analysis from the OLFACAT survey.

BACKGROUND: Traumatic brain injury (TBI) is one of the main causes of smell loss. However, epidemiological studies evaluating the incidence in general population are scarce. The aim of this analysis is to investigate the prevalence of TBI-induced olfactory dysfunction (OD) in a general-based population study. METHODOLOGY: A cross-sectional population-based survey was distributed to general population (260,000 households) through the newspaper. The survey included four microencapsulated odorants (smell test) to assess smell loss and two self-administered questionnaires (odour description and epidemiology/health status). Participants were divided into two groups, with or without a history of TBI. RESULTS: From 10,783 returned surveys, 9,348 were analysed. The survey profile was a 43-year old woman with medium-high educational level, living in a city. The overall prevalence of TBI was 5% (N=464, 44.5±14.1 years old, 57% females). Recorded causes of TBI were traffic, domestic, or work accidents. Subjects with TBI reported a poorer subjective smell self-perception compared to non-TBI participants, and a decreases ability to identify mercaptan (odour added to gas used in cities). Although, using the smell test, both groups showed similar smell capacities. CONCLUSIONS: Subjects with TBI history report a higher frequency of self-perceived OD, and a decrease ability to smell the odour added to domestic gas. Having said that, the prevalence of OD, according to the smell test, was similar in both groups.

Patient Advisory Board for Chronic Rhinosinusitis - A EUFOREA initiative.

Despite the high prevalence of chronic rhinosinusitis (CRS) and its impact on patients' quality of life, no European patient organization that advocates for patients with CRS currently exists. To fill this gap and give a voice to CRS patients, EUFOREA has created a patient advisory board, whose goal is to better understand the real-life needs of patients, to raise awareness at political level and to involve patients in the development of novel integrated solutions to accelerate access to accurate diagnosis and treatments. This report summarizes the key discussion points from the kick-off meeting of the board on the 8th June 2018 and provides an outline of the key objectives for the future.

Free nasal floor mucosal grafting after endoscopic total ethmoidectomy for severe nasal polyposis: a pilot study.

BACKGROUND: We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation. RESULTS: Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty. CONCLUSION: Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.

A Comparative Assessment of the Aquatic Toxicity of Corexit 9500 to Marine Organisms.

The use of chemical dispersants during oil spill responses has long been controversial. During the Deepwater Horizon (DWH) oil spill, 1.8 million gallons of dispersant, mainly Corexit 9500, were applied in offshore waters to mitigate the human health and coastal environmental impact of surface oil contamination. To evaluate the potential impact of the dispersant on marine life, 18 species, representing important ecological and commercial taxa, were tested using low-energy, dispersant-only water accommodated fractions (WAFs) of Corexit 9500 and standard acute toxicity test methods. All prepared WAFs were analytically characterized. Analyses included the two dispersant markers found in the dispersant and evaluated in samples collected during the DWH Response, dioctylsulfosuccinate sodium salt, and dipropylene glycol n-butyl ether (DPnB). The median lethal and effective concentrations (LC/EC50s) were calculated using a nominal exposure concentration (mg/L, based on the experimental loading rate of 50 mg/L) and measured DPnB (µg/L). Results ranged from 5.50 to > 50 mg/L dispersant and 492 to > 304,000 µg/L DPnB. Species sensitivity distributions of the data demonstrated that taxa were evenly distributed; however, algae and oysters were among the more sensitive organisms. The calculated 5% hazard concentration (HC5) for DPnB (1172 µg/L) was slightly higher than the USEPA chronic criteria of 1000 µg/L and substantially higher than all measured concentrations of DPnB measured in the Gulf of Mexico during the DWH oil spill response.

Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits.

BACKGROUND: The nasal floor and inferior meatus (NFIM) flap represents an available option for the reconstruction of a septal perforation (SP). This study explores the feasibility of repairing SPs using a modified simple and extended (including inferior turbinate) NFIM flap. METHODS: An anatomic study was achieved in fresh frozen cadaveric specimens to measure the area and lengths of NFIM flap. The repair of SP with simple and extended NIFM flaps was performed in some of these cadaveric specimens. Preoperative radiological evaluation of CT scans allowed studying the reconstruction limits of the simple or extended NFIM flap. A cohort of patients with SP who underwent reconstruction with an NFIM flap was also included. RESULTS: Complete SP repair with NFIM was achieved in all specimens (n=10). In 38 fresh cadaveric specimens, coronal and sagittal lengths and area of simple NFIM flaps were smaller than in extended NFIM flaps. The radiological analysis of 75 CT scans revealed that the septal height could be reconstructed with a simple and extended NFIM flap. Complete SP repair wasachieved in 5 patients (4 male, mean age 57.4 years) using modified NFIM flaps. CONCLUSION: The simple or expanded NFIM flap represents a feasible option to repair small or medium-sized perforations located at the lower 1/3 or 3/4 of the nasal septum.

EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis.

The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

Visual sign phonology: insights into human reading and language from a natural soundless phonology.

Among the most prevailing assumptions in science and society about the human reading process is that sound and sound-based phonology are critical to young readers. The child's sound-to-letter decoding is viewed as universal and vital to deriving meaning from print. We offer a different view. The crucial link for early reading success is not between segmental sounds and print. Instead the human brain's capacity to segment, categorize, and discern linguistic patterning makes possible the capacity to segment all languages. This biological process includes the segmentation of languages on the hands in signed languages. Exposure to natural sign language in early life equally affords the child's discovery of silent segmental units in visual sign phonology (VSP) that can also facilitate segmental decoding of print. We consider powerful biological evidence about the brain, how it builds sound and sign phonology, and why sound and sign phonology are equally important in language learning and reading. We offer a testable theoretical account, reading model, and predictions about how VSP can facilitate segmentation and mapping between print and meaning. We explain how VSP can be a powerful facilitator of all children's reading success (deaf and hearing)-an account with profound transformative impact on learning to read in deaf children with different language backgrounds. The existence of VSP has important implications for understanding core properties of all human language and reading, challenges assumptions about language and reading as being tied to sound, and provides novel insight into a remarkable biological equivalence in signed and spoken languages. WIREs Cogn Sci 2016, 7:366-381. doi: 10.1002/wcs.1404 For further resources related to this article, please visit the WIREs website.

Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study.

OBJECTIVES: Endoscopic resection has become an established surgical option for most juvenile nasopharyngeal angiofibromas (JNA). However, surgical management of JNA with intracranial extension remains challenging. This retrospective multicenter study reviews a series of patients with advanced stage JNA treated via endonasal/endoscopic approach. METHODS: The experience of five academic tertiary or quaternary care ORL-HNS Departments were included. Medical records of all patients operated for JNA staged as Radkowski stage IIIA or IIIB were reviewed. Main outcome measures included intraoperative blood loss, length of hospital stay, complication rate, and rate of persistence or recurrence. RESULTS: A total of 74 male patients with stages IIIA and IIIB were included. The mean age was 16.4 years and preoperative embolization was performed in 71 patients. The mean blood loss in 45 patients for whom the data was available was 1279.7 ml. The more anatomic subsites were involved, the higher the risk was of intraoperative bleeding. The mean follow-up for 54 out of 73 patients was 37.9 months. Patients with residual disease are significantly linked to involvement of combined (anterior-lateral and posterior) anatomic subsites and to a higher number of affected subsites. At last follow-up, all patients were asymptomatic and those with residual tissue displayed no imaging signs of growth. CONCLUSIONS: This retrospective multicenter study supports the notion that expanded endonasal endoscopic approaches for advance staged JNA are a feasible option associated with good long-term results.

Changes in Ocean Heat, Carbon Content, and Ventilation: A Review of the First Decade of GO-SHIP Global Repeat Hydrography.

Global ship-based programs, with highly accurate, full water column physical and biogeochemical observations repeated decadally since the 1970s, provide a crucial resource for documenting ocean change. The ocean, a central component of Earth's climate system, is taking up most of Earth's excess anthropogenic heat, with about 19% of this excess in the abyssal ocean beneath 2,000 m, dominated by Southern Ocean warming. The ocean also has taken up about 27% of anthropogenic carbon, resulting in acidification of the upper ocean. Increased stratification has resulted in a decline in oxygen and increase in nutrients in the Northern Hemisphere thermocline and an expansion of tropical oxygen minimum zones. Southern Hemisphere thermocline oxygen increased in the 2000s owing to stronger wind forcing and ventilation. The most recent decade of global hydrography has mapped dissolved organic carbon, a large, bioactive reservoir, for the first time and quantified its contribution to export production (∼20%) and deep-ocean oxygen utilization. Ship-based measurements also show that vertical diffusivity increases from a minimum in the thermocline to a maximum within the bottom 1,500 m, shifting our physical paradigm of the ocean's overturning circulation.

Detection of Neorickettsia risticii from various freshwater snail species collected from a district irrigation canal in Nevada County, California.

This study investigated the role of a district irrigation canal in Nevada County, California, USA, as the point source of infection for Neorickettsia risticii, causative agent of equine neorickettsiosis (EN). A total of 568 freshwater snails comprising Juga spp., Planorbella subcrenata (Carpenter, 1857) (Rough Rams-horn), Physella virgata (Gould, 1855) (Protean Physa) and feces from three horses with EN were collected and tested for N. risticii by real-time PCR. A total of four freshwater snails tested PCR positive for N. risticii. Phylogenetic analysis showed 99.8-100% homology between the different snail and horse N. risticii isolates. This study represents the first report of infection with N. risticii in Planorbella subcrenata and suggests that the irrigation canal was the aquatic environment responsible for the spread of N. risticii.