Achieving Cochlear Therapeutic Hypothermia through Irrigation of the Mastoid and Tympanic Cavities.

INTRODUCTION: Mild therapeutic hypothermia (MTH) is an exciting nonpharmaceutical otoprotection strategy. In this study, we applied simple irrigation of the tympanic and mastoid cavities to understand the timing of both achieving MTH and recovery back to euthermic temperatures for application in the clinical setting. METHODS: Three human temporal bones were used in this study in the temporal bone laboratory. A standard mastoidectomy was performed on each followed by the insertion of temperature probes into the basal turn of the cochlea via a middle cranial fossa approach. The temporal bones were warmed in heated bead baths to 37°C. The tympanic and mastoid cavities were then irrigated with room temperature water, and intracochlear temperature readings were recorded every minute. After 15 min, irrigation was stopped, and temperature readings were collected until temporal bones returned to euthermic levels. RESULTS: Intracochlear MTH was achieved within the first minute of irrigating the tympanic and mastoid cavities. Intracochlear temperatures plateaued after 5 min around 30°C. Discontinuation of irrigation resulted in the temperature rising logarithmically above the MTH levels after 9-10 min. CONCLUSION: Intracochlear MTH can be achieved via irrigation of the tympanic and mastoid cavities with room temperature irrigation within 60 s. After irrigation for 5 min, hypothermic temperatures will remain therapeutic for 10 min following cessation of irrigation.

COVID-19 impact on facial trauma: Insights from Mississippi's only level 1 trauma center.

PURPOSE: Our primary aim was to understand and describe the impact of COVID-19 on the incidence and etiology of facial trauma in the state of Mississippi. METHODS: Retrospective review of facial trauma-related Emergency Department encounters in Mississippi from March 11, 2019 to March 10, 2021, divided into three time periods using the state of Mississippi's Governor's Office Executive Orders. Chi-square tests and segmented linear regressions were used for analysis. RESULTS: Patients presenting with facial trauma were typically male, 18-44 years old, and lived in urban zip codes. Insurance payors significantly differed across time periods. There were no significant differences in self-inflicted assault or accidental injury between the 3 time periods, with pre- and pandemic patients more likely to be self-pay while patients during recovery being more likely to have private insurance. During the pandemic, facial trauma from a family member, partner or spouse, or other person in the household significantly increased. CONCLUSION: Similar accidental facial trauma trends may reflect lower adherence to social distancing guidelines. The increase in facial trauma perpetrated by family members is consistent with reported increases in domestic violence during the pandemic. While overall facial trauma demographic patterns did not change significantly during the COVID-19 pandemic, there were notable changes in the etiology and insurance payor of facial trauma cases. LAY SUMMARY: The COVID-19 pandemic impacted healthcare systems worldwide, and our study seeks to understand how the pandemic affected incidence of facial trauma.

Direct Bluetooth connectivity results in better hearing aid compliance in children.

OBJECTIVE: To determine if hearing aid use in school aged children is impacted when upgraded to direct Bluetooth® enabled technology. We hypothesized that because children are better able to connect to their devices and headphones, they would be more inclined to use their hearing aids throughout the day, resulting in an increase in hearing aid compliance. METHODS: This retrospective analysis examined changes in datalogging of hours of usage per day in 51 school aged children who underwent an upgrade from non-direct Bluetooth® hearing technology to direct Bluetooth®-enabled hearing technology. RESULTS: Hours per day of hearing aid use in all hearing aid users significantly increased after upgrading to DBT enabled technology (6.82 vs 9.82, <0.001). There were no significant differences noted in hours before and after upgrade depending on race (p = 0.147), gender (p = 0.887), developmental delay (p = 0.749), type of hearing loss (p = 0.218), and degree of hearing loss (p = 0.551). However, when comparing private versus Medicaid insurance, there was noted to be a significant difference with the odds of an increase in hours of usage after upgrade being higher for those patients privately insured (OR = 1.247, p < 0.001, 95 % CI 1.093-1.422). CONCLUSION: Direct Bluetooth® enabled hearing technology positively impacts children's hearing aid compliance, which has the potential improve speech and language outcomes.

Management of Hidden Cutaneous Melanoma of the Umbilicus.

Melanoma is currently the fifth most common cancer in the United States (US) and most often develop on areas that have increased sun exposure, such as the arms, legs, back or face. The incidence of primary cutaneous melanoma increases each year and curative treatment improves with earlier detection of disease. Primary cutaneous umbilical melanoma is extremely rare with as few as 46 cases reported worldwide. As a result, limited literature is available regarding the management of tumors originating in the umbilicus. By evaluating uncommon areas such as the umbilicus, earlier detection and possible intervention can be provided. We present a rare case of a 33-year-old female with a primary cutaneous melanoma of the umbilicus successfully treated with wide local excision (WLE) and sentinel lymph node biopsy (SLNB).

The Effects of Acute Exercise on Short- and Long-Term Memory: Considerations for the Timing of Exercise and Phases of Memory.

The specific questions addressed from this research include: (1) Does high-intensity acute exercise improve memory?, (2) If so, do the mechanisms occur via encoding, consolidation, or retrieval? and (3) If acute exercise occurs in multiple phases of memory (e.g., before encoding and during consolidation), does this have an additive effect on memory? Three experimental, within-subject, counterbalanced studies were conducted among young adults. High-intensity exercise involved a 20-minutes bout of exercise at 75% of heart rate reserve. Memory was evaluated from a word-list task, including multiple evaluations out to 24-hours post-encoding. The timing of the exercise and memory assessments were carefully positioned to evaluate whether any improvements in memory were driven by mechanisms related to encoding, consolidation, and/or retrieval. We demonstrated that high-intensity acute exercise enhanced memory. This effect was robust (repeatable) and occurred through encoding, consolidation and retrieval-based mechanisms. Further, incorporating acute exercise into multiple phases of memory additively enhanced memory function.

Cloned, CD117 selected human amniotic fluid stem cells are capable of modulating the immune response.

Amniotic fluid stem (AFS) cells are broadly multipotent, can be expanded extensively in culture, are not tumorigenic and can be readily cryopreserved for cell banking. Mesenchymal stem cells (MSC) show immunomodulatory activity and secrete a wide spectrum of cytokines and chemokines that suppress inflammatory responses, block mixed lymphocyte reactions (MLR) and other immune reactions, and have proven therapeutic against conditions such as graft-versus-host disease. AFS cells resemble MSCs in many respects including surface marker expression and differentiation potential. We therefore hypothesized that AFS cells may exhibit similar immunomodulatory capabilities. We present data to demonstrate that direct contact with AFS cells inhibits lymphocyte activation. In addition, we show that cell-free supernatants derived from AFS cells primed with total blood monocytes or IL-1ß, a cytokine released by monocytes and essential in mediation of the inflammatory response, also inhibited lymphocyte activation. Further investigation of AFS cell-free supernatants by protein array revealed secretion of multiple factors in common with MSCs that are known to be involved in immune regulation including growth related oncogene (GRO) and monocyte chemotactic protein (MCP) family members as well as interleukin-6 (IL-6). AFS cells activated by PBMCs released several additional cytokines as compared to BM-MSCs, including macrophage inflammatory protein-3α (MIP-3α), MIP-1α and Activin. AFS cells also released higher levels of MCP-1 and lower levels of MCP-2 compared to BM-MSCs in response to IL-1ß activation. This suggests that there may be some AFS-specific mechanisms of inhibition of lymphocyte activation. Our results indicate that AFS cells are able to suppress inflammatory responses in vitro and that soluble factors are an essential component in the communication between lymphocytes and AFS cells. Their extensive self-renewal capacity, possibility for banking and absence of tumorigenicity may make AFS cells a superior source of stable, well characterized "off the shelf" immunomodulatory cells for a variety of immunotherapies.

Stress and staff support in hospice: a review of the literature.

An extensive review of the literature was carried out which highlighted the causes and effects of stress, both generally and in palliative care, along with the coping strategies for stress. The literature emphasised the intense nature of palliative care and the importance of having effective support mechanisms in place for staff.

Staff support in hospices.

This article reports on a descriptive study of staff support in 116 hospices in the UK. The study took the form of a postal questionnaire survey. Before the survey an extensive review of the literature was carried out which highlighted the causes and effects of stress, both generally and in palliative care, along with coping strategies. The literature emphasised the intense nature of palliative care and the importance of having effective support mechanisms in place for staff (McKee, 1995). The results of this survey showed that, in general, hospices are attempting to deal with staff stress by offering group and/or individual support.