Tissue Sealant Impact on Skull Base Reconstruction Outcomes: A Systematic Review and Meta-Analysis.

OBJECTIVE: Despite significant advances in understanding of skull base reconstruction principles, the role of tissue sealants in modifying postoperative cerebrospinal fluid (CSF) leak outcomes remains controversial. We evaluate postoperative CSF leak incidence associated with tissue sealant use in skull base defect repair during endoscopic skull base surgery (ESBS). DATA SOURCES: Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library. REVIEW METHODS: Systematic review and meta-analysis of risk differences (RD). A search strategy identified original studies reporting CSF leakage following ESBS with disaggregation by tissue sealant use and/or type. RESULTS: 27 non-randomized studies (n = 2,403) were included for qualitative and meta-analysis. Reconstruction with a tissue sealant did not significantly reduce postoperative CSF leak risk compared with reconstruction without sealant (RD[95% CI] = 0.02[-0.01, 0.05]). Sub-analyses of dural sealant (-0.02[-0.11, 0.07]) and fibrin glue (0.00[-0.07, 0.07]) compared with no sealant were similarly unremarkable. Postoperative CSF leakage was not significantly modulated in further sub-analyses of DuraSeal (0.02[-0.02, 0.05]), Adherus (-0.03[-0.08, 0.03]), or Bioglue (-0.06[-0.23, 0.12]) versus no dural sealant use, or Tisseel/Tissucol versus fibrin glue nonuse (0.00[-0.05, 0.05]). No significant association was seen comparing dural sealant use versus fibrin glue use on pairwise (0.01[-0.03, 0.05]) or network meta-analysis (-0.01[-0.05, 0.04]). Limitations in source literature prevented sub-analyses stratified by leak characteristics, defect size and location, and accompanying reconstruction materials. CONCLUSION: Tissue sealant use did not appear to impact postoperative CSF leak incidence when compared with nonuse. Higher quality studies are warranted to thoroughly elucidate the clinical value of adjunct sealant use in endoscopic skull base reconstruction. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

Identifying Core Journals in Otolaryngology: A Bibliometric Analysis.

OBJECTIVES: As research in otolaryngology continues to expand rapidly, it is important to identify core journals to keep clinicians updated with the latest advances. This study is the first to characterize core journals in otolaryngology. METHODS: Using h-index and impact factor (IF), the top 15 NLM-indexed otolaryngology journals were selected for analysis. The references from all articles published in these journals in one randomized quarter were compiled into a citation rank list, with the most cited journal ranked the highest. Citation zonal distribution analysis was conducted to identify the zonal distribution of otolaryngology journals. RESULTS: A total of 3150 journals containing 26876 articles were cited in otolaryngology literature in April-June 2019. Laryngoscope was the most cited journal containing 1762 citations. IF is significantly associated with the h-index for the top 10 otolaryngology journals (p = 0.032). Three core journal zones were identified, with Zone 1 containing 8 journals, Zone 2 containing 36 journals, and Zone 3 containing 189 journals. A linear relationship between the log journal rank for Zones 1-3 and a cumulative number of citations was found (R2 = 0.9948). CONCLUSION: Eight core journals for otolaryngology were identified: Laryngoscope, Otolaryngology-Head and Neck Surgery, Otology & Neurotology, JAMA Otolaryngology-Head & Neck Surgery, Head & Neck, European Archives of Oto-Rhino-Laryngology, International Journal of Pediatric Otorhinolaryngology, Annals of Otology, Rhinology & Laryngology. In the face of rapidly evolving research and a multitude of journals, the high citation density within these core journals highlights their utility in updating busy clinicians. LEVEL OF EVIDENCE: NA Laryngoscope, 133:3346-3352, 2023.

Female Representation Among CORE Grant Recipients by Research Subspeciality.

This study evaluates the gender distribution of Centralized Otolaryngology Research Efforts (CORE) grants by research subspeciality over the past decade. Demographic information on CORE grant recipients from 2010 to 2019 was extracted through an Internet search, and research projects were categorized by subspeciality. Of 343 grants awarded during this period, 127 (37%) were awarded to women. Analysis demonstrated lower absolute rates of CORE funding for women in all fields except pediatrics, but women receive a proportional number of grants for most subspecialities based on their representation within the field.

The Impact of Risk Factors on Treatment Outcomes of Nosocomial Pneumonia Due to Gram-Negative Bacteria in the Intensive Care Unit.

INTRODUCTION: Nosocomial pneumonia is a common infection associated with high mortality in hospitalized patients. Nosocomial pneumonia, caused by gram-negative bacteria, often occurs in the elderly and patients with co-morbid diseases. METHODS: Original research using a prospective cross-sectional design was conducted on 281 patients in an intensive care unit setting with nosocomial pneumonia between July 2015 and July 2019. For each nosocomial pneumonia case, data regarding comorbidities, risk factors, patient characteristics, Charlson comorbidity index (CCI), Systemic Inflammatory Response Syndrome (SIRS), and quick Sepsis-Related Organ Failure Assessment (qSOFA) points and treatment outcomes were collected. Data were analyzed by SPSS 22.0. RESULTS: Nosocomial pneumonia due to gram-negative bacteria occurred in patients with neurological disorders (34.87%), heart diseases (16.37%), chronic renal failure (7.12%), and post-surgery (10.68%). Worse outcomes attributed to nosocomial pneumonia were high at 75.8%. Mechanical ventilation, change of antibiotics, and CCI ≥ 3 and qSOFA ≥ 2 were significantly negative prognostic factors (p < 0.05) on outcomes of nosocomial pneumonia. There was no difference in treatment effects between gender, age, time of onset pneumonia, SIRS score (p > 0.05). The pathogens were significant factors that influence treatment effects, but they weren't independent risk factors for poor outcomes (p = 0.823). CONCLUSIONS: Patients with nosocomial pneumonia hospitalized in intensive care units are usually associated with many underlying diseases, including neurological diseases. Mechanical ventilation, a change in antibiotics, CCI ≥ 3, and qSOFA ≥ 2 are also associated with a worse prognosis of nosocomial pneumonia. CCI and qSOFA might be used in predicting the outcome of nosocomial pneumonia.