Sigmoni: classification of nanopore signal with a compressed pangenome index.

SUMMARY: Improvements in nanopore sequencing necessitate efficient classification methods, including pre-filtering and adaptive sampling algorithms that enrich for reads of interest. Signal-based approaches circumvent the computational bottleneck of basecalling. But past methods for signal-based classification do not scale efficiently to large, repetitive references like pangenomes, limiting their utility to partial references or individual genomes. We introduce Sigmoni: a rapid, multiclass classification method based on the r-index that scales to references of hundreds of Gbps. Sigmoni quantizes nanopore signal into a discrete alphabet of picoamp ranges. It performs rapid, approximate matching using matching statistics, classifying reads based on distributions of picoamp matching statistics and co-linearity statistics, all in linear query time without the need for seed-chain-extend. Sigmoni is 10-100× faster than previous methods for adaptive sampling in host depletion experiments with improved accuracy, and can query reads against large microbial or human pangenomes. Sigmoni is the first signal-based tool to scale to a complete human genome and pangenome while remaining fast enough for adaptive sampling applications. AVAILABILITY AND IMPLEMENTATION: Sigmoni is implemented in Python, and is available open-source at https://github.com/vshiv18/sigmoni.

Comparison of chest radiographs against minimum intensity projection reconstruction computed tomography scans for detection of airway stenosis in children with lymphobronchial tuberculosis.

BACKGROUND: Ideally, suspected airway compression in symptomatic children with lymphobronchial tuberculosis (TB) would be diagnosed using modern computed tomography (CT) assisted by coronal minimum intensity projection (MinIP) reconstructions. However, in TB-endemic regions with limited resources, practitioners rely on conventional radiography for diagnosing TB and its complications. Furthermore, airway compression detected on conventional radiographs would upgrade a patient into the severe category according to the new World Health Organization guidelines, precluding the patient from shorter treatment protocols. The accuracy of conventional radiographs in the context of detecting airway compression in children with TB has not been specifically evaluated against an imaging gold standard. OBJECTIVE: We aimed to compare frontal chest radiographs against thick-slab angled coronal CT MinIP in identifying airway stenosis at ten specific sites and to determine observer agreement between the modalities regarding the degree of stenosis. MATERIALS AND METHODS: This retrospective cross-sectional study compared chest radiographs with standardized angled coronal CT MinIP in children with symptomatic lymphobronchial TB at ten predetermined airway locations. Chest radiographs were evaluated by one pediatric radiologist and CT MinIP reconstructions were independently interpreted by three readers. Sensitivity and specificity were calculated using CT MinIP as the gold standard. Stenosis was graded as 1 for mild (1-50%), 2 for moderate (51-75%), 3a for severe (76-99%), and 3b for total occlusion (100%). Agreement between the two modalities regarding severity of stenosis was calculated using the kappa coefficient for each affected site. RESULTS: A total of 37 patients were included in the study. The median age of patients was 14.3 months (interquartile range 8.0-23.2). Three hundred and seventy individual bronchi (10 from each of the 37 patients) were evaluated for stenosis. Chest radiographs showed that 31 out of 37 (84%) patients had stenosis in at least one of ten evaluated sites, most commonly the left main bronchus and bronchus intermedius, and this was confirmed via CT MinIP. The gold standard (CT MinIP) demonstrated stenosis in at least one of ten sites in all 37 patients (100%). Left main bronchus stenosis was detected by chest radiography with a 92.9% sensitivity and 100% specificity. Sensitivity and specificity for bronchus intermedius stenosis were 80% and 75%, respectively. There was substantial agreement for grade of stenosis between chest radiographs and CT (kappa=0.67) for the left main bronchus and moderate agreement (kappa=0.58) for the bronchus intermedius. Severe stenosis was found in 78 bronchi on CT compared to 32 bronchi (Grade 3a: 9, Grade 3b: 23) on chest radiographs. CONCLUSION: The diagnosis of pulmonary TB in children continues to rely heavily on imaging, and we have shown that in young children, chest radiographs had a high sensitivity and specificity for detecting airway stenosis at certain anatomical sites, when adequately visualized, resulting from tuberculous lymph node compression at left main bronchus and bronchus intermedius. For most sites, the interobserver agreement was poor. Stenosis of the left main bronchus and bronchus intermedius should be the focus of chest radiograph interpretation and can assist both diagnosis and classification of patients for treatment.

Cliffy: robust 16S rRNA classification based on a compressed LCA index.

Taxonomic sequence classification is a computational problem central to the study of metagenomics and evolution. Advances in compressed indexing with the r -index enable full-text pattern matching against large sequence collections. But the data structures that link pattern sequences to their clades of origin still do not scale well to large collections. Previous work proposed the document array profiles, which use 𝒪 ( rd ) words of space where r is the number of maximal-equal letter runs in the Burrows-Wheeler transform and d is the number of distinct genomes. The linear dependence on d is limiting, since real taxonomies can easily contain 10,000s of leaves or more. We propose a method called cliff compression that reduces this size by a large factor, over 250x when indexing the SILVA 16S rRNA gene database. This method uses Θ( r log d ) words of space in expectation under a random model we propose here. We implemented these ideas in an open source tool called Cliffy that performs efficient taxonomic classification of sequencing reads with respect to a compressed taxonomic index. When applied to simulated 16S rRNA reads, Cliffy's read-level accuracy is higher than Kraken2's by 11-18%. Clade abundances are also more accurately predicted by Cliffy compared to Kraken2 and Bracken. Overall, Cliffy is a fast and space-economical extension to compressed full-text indexes, enabling them to perform fast and accurate taxonomic classification queries. 2012 ACM Subject Classification: Applied computing → Computational genomics.

DandD: Efficient measurement of sequence growth and similarity.

Genome assembly databases are growing rapidly. The redundancy of sequence content between a new assembly and previous ones is neither conceptually nor algorithmically easy to measure. We introduce pertinent methods and DandD, a tool addressing how much new sequence is gained when a sequence collection grows. DandD can describe how much structural variation is discovered in each new human genome assembly and when discoveries will level off in the future. DandD uses a measure called δ ("delta"), developed initially for data compression and chiefly dependent on k-mer counts. DandD rapidly estimates δ using genomic sketches. We propose δ as an alternative to k-mer-specific cardinalities when computing the Jaccard coefficient, thereby avoiding the pitfalls of a poor choice of k. We demonstrate the utility of DandD's functions for estimating δ, characterizing the rate of pangenome growth, and computing all-pairs similarities using k-independent Jaccard.

Reliability Risk Mitigation in Advanced Packages by Aging-Induced Precipitation of Bi in Water-Quenched Sn-Ag-Cu-Bi Solder.

Bi-doped Sn-Ag-Cu (SAC) microelectronic solder is gaining attention for its utility as a material for solder joints that connect substrates to printed circuit boards (PCB) in future advanced packages, as Bi-doped SAC is reported to have a lower melting temperature, higher strength, higher wettability on conducting pads, and lower intermetallic compound (IMC) formation at the solder-pad interface. As solder joints are subjected to aging during their service life, an investigation of aging-induced changes in the microstructure and mechanical properties of the solder alloy is needed before its wider acceptance in advanced packages. This study focuses on the effects of 1 to 3 wt.% Bi doping in an Sn-3.0Ag-0.5Cu (SAC305) solder alloy on aging-induced changes in hardness and creep resistance for samples prepared by high cooling rates (>5 °C/s). The specimens were aged at ambient and elevated temperatures for up to 90 days and subjected to quasistatic nanoindentation to determine hardness and nanoscale dynamic nanoindentation to determine creep behavior. The microstructural evolution was investigated with a scanning electron microscope in tandem with energy-dispersive spectroscopy to correlate with aging-induced property changes. The hardness and creep strength of the samples were found to increase as the Bi content increased. Moreover, the hardness and creep strength of the 0-1 wt.% Bi-doped SAC305 was significantly reduced with aging, while that of the 2-3 wt.% Bi-doped SAC305 increased with aging. The changes in these properties with aging were correlated to the interplay of multiple hardening and softening mechanisms. In particular, for 2-3 wt.% Bi, the enhanced performance was attributed to the potential formation of additional Ag3Sn IMCs with aging due to non-equilibrium solidification and the more uniform distribution of Bi precipitates. The observations that 2-3 wt.% Bi enhances the hardness and creep strength of the SAC305 alloy with isothermal aging to mitigate reliability risks is relevant for solder samples prepared using high cooling rates.

Interleukin-10 Gene Polymorphisms Modulate the Risk of Infertility in Chlamydia trachomatis Positive Kurdish Women in Erbil Province.

Background: There is evident inter-individual variability in women's responses to Chlamydial infections and reproductive tract problems. Women's genetic variations within the Interleukin-10 (IL-10) gene have been linked to variances in response to Chlamydia trachomatis infection. This study was aimed to demonstrate the profound association of IL-10 with infertility and demonstrate the role of IL-10 (-592 C/A rs1800872) and (-1082 A>G rs1800896) single nucleotide polymorphism (SNPs) gene in the susceptibility and severity of a C. trachomatis infection. Methods: In this evaluation study, serum IL-10 concentration was measured in 134 women diagnosed with infertility and 50 healthy volunteers by enzyme-linked immunosorbent assay (ELISA). The tetra-amplification refractory mutation system-PCR (T-ARMS-PCR) analysis was performed to detect the genotyping of the rs1800872 and rs1800896 SNPs genes. Results: Both female groups were positive for anti-chlamydial IgM antibody, but the intensity of response differed between cases. At the same time, the incidence of genital C. trachomatis by PCR was 46.2% in infertile women. The serum concentration of IL10 was lower in infertile women than healthy participants and higher in infertile C. trachomatis -positive women compared to infertile C. trachomatis-negative in all groups except endometriosis (Endo) infertility. In rs1800872, the CA genotype and C allele are associated with an increased risk for infertility, except in polycystic ovarian syndrome (PCOS), which is an A allele. In the case of rs1800896, the AG genotype and G allele show a greater risk for infertility. Conclusions: Our results confirmed that rs1800872 and rs1800896 gene polymorphisms were associated with an increased risk of C. trachomatis infection.

A Review on the Effect of Metal Oxide Nanoparticles on Tribological Properties of Biolubricants.

This review provides a comprehensive and accessible literature review on the integration of nanoparticles into biolubricants to enhance wear and friction regulation, thus improving the overall lubricated system performance. Nanotechnology has significantly impacted various industries, particularly in lubrication. Nanobiolubricants offer promising avenues for enhancing tribological properties. This review focuses on oxide nanoparticles, such as zinc oxide (ZnO), aluminum oxide (Al2O3), copper oxide (CuO), titanium dioxide (TiO2), zirconium dioxide (ZrO2), and graphene oxide (GO) nanoparticles, for their ability to enhance lubricant performance. The impact of nanoparticle concentration on biolubricant properties, including viscosity, viscosity index, flash point temperature, and pour point temperature, is analyzed. The review also addresses potential obstacles and limitations in nanoparticle incorporation, aiming to propose effective strategies for maximizing their benefits. The findings underscore the potential of nanobiolubricants to improve operational efficiency and component lifespan. This review aims to provide valuable insights for researchers, engineers, and professionals in exploring and leveraging nanotechnology's potential in the lubrication industry. This review paper explores the basics of tribology along with its significance, green principles, mechanisms, and energy savings because of friction, wear, and lubrication. Condition monitoring techniques are also explored to achieve brief knowledge about maintaining reliability and safety of the industrial components. Recent advances in tribology including superconductivity, biotribology, high-temperature tribology, tribological simulation, hybrid polymer composite's tribology, and cryogenic tribology are investigated, which gives a thorough idea about the subject.

Targeting of Antifungal Metabolites from Grapevine Byproducts by UPLC-HRMS/MS Approaches Using Bioactivity-Based Molecular Networking.

This study focuses on countering Fusarium graminearum, a harmful fungal pathogen impacting cereal crops and human health through mycotoxin production. These mycotoxins, categorized as type B trichothecenes, pose significant health risks. Research explores natural alternatives to synthetic fungicides, particularly investigating phenolics in grapevine byproducts. Thirteen eco-extracts from five French grape varieties (Merlot, Cabernet Sauvignon, Sauvignon blanc, Tannat, and Artaban) exhibited substantial antifungal properties, with ten extracts displaying remarkable effects. Extracts from grapevine stems and roots notably reduced fungal growth by over 91% after five days. Through UHPLC-HRMS/MS analysis and metabolomics, the study identified potent antifungal compounds such as ampelopsin A and cyphostemmin B, among other oligomeric stilbenes. Interestingly, this approach showed that flavan-3-ols have been identified as markers for extracts that induce fungal growth. Root extracts from rootstocks, rich in oligostilbenes, demonstrated the highest antifungal activity. This research underscores grapevine byproducts' potential both as a sustainable approach to control F. graminearum and mycotoxin contamination in cereal crops and the presence of different metabolites from the cultivars of grapevine, suggesting different activities.

Predictors of Facial Pain and Headache Associated With Cryotherapy Ablation of the Posterior Nasal Nerve for the Treatment of Chronic Rhinitis.

OBJECTIVE: Cryotherapy ablation of the posterior nasal nerve (PNN) for treatment of patients with refractory chronic rhinitis (CR) is associated with postoperative facial pain and headache. This study sought to understand factors that may contribute to the development of this adverse effect. METHODS: Patients undergoing PNN cryotherapy ablation for refractory CR at a single institution from January 2018 to August 2023 were included. Demographics and clinical characteristics were collected via chart review and interview. Student's T-test and Chi-square tests were used to assess the significance of quantitative and categorical data, respectively (alpha = 0.05). RESULTS:  Forty-eight patients underwent cryotherapy ablation. Twenty-eight patients (58%) reported having facial pain and headache (adverse effect group) immediately post-procedurally. The average age of the adverse effect group was 54.9 years (SD: 17.8 years) which was significantly lower (p=0.002) than the asymptomatic group (69.7 years, SD: 8.7 years). Female patients were significantly more likely to experience this adverse event than males (p=0.04). Moreover, Caucasian females were significantly more likely to experience this adverse effect when compared to all patients experiencing the adverse effect (n=15, p=0.04). Previous diagnosis of migraine disorder was more common in the adverse effect group (28%) compared to the asymptomatic group (15%) but not statistically significant (p=0.26). Previous migraine, trigeminal neuralgia, or headache disorder diagnoses were not significantly correlated with adverse effect prevalence (p = 0.26, 0.24, 0.15, respectively). CONCLUSION: Given the relative immediacy and severity of this adverse effect, physicians should strongly consider these factors when counseling and selecting certain patient groups for this procedure.

Taxonomic classification with maximal exact matches in KATKA kernels and minimizer digests.

For taxonomic classification, we are asked to index the genomes in a phylogenetic tree such that later, given a DNA read, we can quickly choose a small subtree likely to contain the genome from which that read was drawn. Although popular classifiers such as Kraken use k -mers, recent research indicates that using maximal exact matches (MEMs) can lead to better classifications. For example, we can ■ build an augmented FM-index over the the genomes in the tree concatenated in left-to-right order; ■ for each MEM in a read, find the interval in the suffix array containing the starting positions of that MEM's occurrences in those genomes; ■ find the minimum and maximum values stored in that interval; ■ take the lowest common ancestor (LCA) of the genomes containing the characters at those positions. This solution is practical, however, only when the total size of the genomes in the tree is fairly small. In this paper we consider applying the same solution to three lossily compressed representations of the genomes' concatenation: ■ a KATKA kernel, which discards characters that are not in the first or last occurrence of any k max -tuple, for a parameter k max ; a minimizer digest; ■ a KATKA kernel of a minimizer digest. With a test dataset and these three representations of it, simulated reads and various parameter settings, we checked how many reads' longest MEMs occurred only in the sequences from which those reads were generated ("true positive" reads). For some parameter settings we achieved significant compression while only slightly decreasing the true-positive rate.

Modified technique improves efficacy for in-office posterior nasal nerve ablation.

Objectives: Posterior nasal nerve (PNN) ablation is a minimally invasive treatment option for patients with chronic rhinitis. Recent evidence shows that parasympathetic innervation of the nasal cavity is more extensive and there are many fibers posterior to the lateral attachment of the middle turbinate. We describe a modified ablative technique that targets the extensive innervation of the posterior nasal nerves. Methods: Description of the technique and retrospective cohort analysis. In addition to the traditional radiofrequency and cryoablation targets, three additional treatment sites posterior to the middle turbinate were targeted using radiofrequency ablation, as well as one focused treatment posteroinferior to the middle turbinate attachment using cryotherapy ablation. The primary outcome collected was a 30% improvement in overall rhinitis symptoms. Results: Forty-five patients received treatment and completed 3-month follow-up using the modified technique for radiofrequency and cryotherapy PNN ablation. Previously, our institution documented a 64.5% responder rate at 3 months. After introducing the modified technique, the response rate at 3 months significantly improved (64.5% vs. 91.1%, p = .004). Conclusions: This report suggests improved efficacy with implementation of the modified technique for in-office PNN ablation. Given the extensive nature of the post-ganglionic parasympathetic fibers of the nasal cavity which often emerge posterior to the middle turbinate attachment, a modified technique to target these branches should be considered. Prospective randomized studies comparing this modified technique to the traditional technique are needed. Level of Evidence: III.

The Prevalence and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Before and After the COVID-19 Pandemic in a Tertiary Saudi Hospital.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become a major public health problem all over the world. After the 2019 coronavirus illness (COVID-19), the pandemic may have influenced research priorities and resource allocation, potentially affecting the ability to monitor MRSA trends. AIMS: The study aimed to evaluate the prevalence of S. aureus, including MRSA infections, and their antimicrobial susceptibilities over the years 2019 and 2020 in a tertiary hospital in Makkah City, KSA. METHODOLOGY: A total of 2128 and 1515 laboratory (lab) samples were collected during the years 2019 and 2020, respectively. From these samples, the prevalence of S. aureus, including MRSA, and their antibiotic susceptibility were identified using standard, automated, and molecular microbiological methods. RESULTS: The present study shows that the lab prevalence of all S. aureus during 2019 was found to be 35.5%, of which MRSA was 44.8%. During 2020, the frequency of S. aureus strains was 16%, of which MRSA was 41.2%. The most common MRSA isolated during both years were colonizing pus swabs and urine samples. The results showed that MRSA susceptibility against antimicrobial agents in 2019 was as follows: vancomycin (100%), linezolid (100%), trimethoprim-sulfamethoxazole (88%), and doxycycline (34.2%). The MRSA strains isolated during 2020 were as follows: vancomycin (100%), linezolid (96%), trimethoprim-sulfamethoxazole (100%), and doxycycline (24.3%). There was no significant difference in the incidence and antimicrobial resistance rates of MRSA over the two years. CONCLUSION: It was concluded that the prevalence rates of MRSA have not increased in 2020 when compared to 2019. Vancomycin, linezolid, trimethoprim-sulfamethoxazole, and doxycycline remain susceptible to the positive collected MRSA strains. There was no significant difference between the prevalence and antimicrobial resistance rates of MRSA between 2019 and 2020. Continued research efforts are needed to address this persistent public health threat. Strategies to control the spread of MRSA should include early detection of MRSA and surveillance, even during pandemics.

MEM-based pangenome indexing for k-mer queries.

Pangenomes are growing in number and size, thanks to the prevalence of high-quality long-read assemblies. However, current methods for studying sequence composition and conservation within pangenomes have limitations. Methods based on graph pangenomes require a computationally expensive multiple-alignment step, which can leave out some variation. Indexes based on k-mers and de Bruijn graphs are limited to answering questions at a specific substring length k. We present Maximal Exact Match Ordered (MEMO), a pangenome indexing method based on maximal exact matches (MEMs) between sequences. A single MEMO index can handle arbitrary-length queries over pangenomic windows. MEMO enables both queries that test k-mer presence/absence (membership queries) and that count the number of genomes containing k-mers in a window (conservation queries). MEMO's index for a pangenome of 89 human autosomal haplotypes fits in 2.04 GB, 8.8× smaller than a comparable KMC3 index and 11.4× smaller than a PanKmer index. MEMO indexes can be made smaller by sacrificing some counting resolution, with our decile-resolution HPRC index reaching 0.67 GB. MEMO can conduct a conservation query for 31-mers over the human leukocyte antigen locus in 13.89 seconds, 2.5x faster than other approaches. MEMO's small index size, lack of k-mer length dependence, and efficient queries make it a flexible tool for studying and visualizing substring conservation in pangenomes.

Cell-type-specific cholinergic control of granular retrosplenial cortex with implications for angular velocity coding across brain states.

Cholinergic receptor activation enables the persistent firing of cortical pyramidal neurons, providing a key cellular basis for theories of spatial navigation involving working memory, path integration, and head direction encoding. The granular retrosplenial cortex (RSG) is important for spatially-guided behaviors, but how acetylcholine impacts RSG neurons is unknown. Here, we show that a transcriptomically, morphologically, and biophysically distinct RSG cell-type - the low-rheobase (LR) neuron - has a very distinct expression profile of cholinergic muscarinic receptors compared to all other neighboring excitatory neuronal subtypes. LR neurons do not fire persistently in response to cholinergic agonists, in stark contrast to all other principal neuronal subtypes examined within the RSG and across midline cortex. This lack of persistence allows LR neuron models to rapidly compute angular head velocity (AHV), independent of cholinergic changes seen during navigation. Thus, LR neurons can consistently compute AHV across brain states, highlighting the specialized RSG neural codes supporting navigation.

Posterior Nasal Nerve Ablation as a Viable Treatment Option for the Primary Symptom of Postnasal Drip.

BACKGROUND: Postnasal drip (PND) syndrome is a prevalent complaint encountered in otolaryngology practices. PND may be refractory to medical therapy, and surgical treatments are complicated by side effects. OBJECTIVE: While posterior nasal nerve (PNN) ablation has demonstrated efficacy for chronic rhinitis overall, we sought to examine the effect of PNN ablation for patients with PND as their primary complaint. METHODS: This is a retrospective case series study of 40 chronic rhinitis (CR) patients with a primary complaint of PND. Included patients had to have failed medical therapy such as anti-cholinergic nasal sprays, reflux treatments, and/or nasal steroids. Primary outcome measures included 22 item Sino-Nasal Outcome Test (SNOT-22) PND component and Total Nasal Symptom Score. Secondary outcome measure was subjective improvement, defined as a > 30% improvement in PND symptoms. RESULTS: Median follow-up was 138 days (interquartile range: 72-193). 72.5% (29/40) of patients reported at least a 30% improvement in PND symptoms. Mean PND SNOT-22 scores were 4.2/5 (SD = 0.8) pre-procedure versus 1.9/5 (SD = 1.3) post-procedure (P = .001). PNN ablation response did not correlate to ipratropium bromide nasal spray response, although younger and non-smoker patients had better response rates. CONCLUSION: This exploratory study of PNN ablation for the primary symptom of PND demonstrates efficacy as assessed by the PND component of SNOT-22 and subjective improvement. These results can be useful in guiding physician-patient discussions in determining treatment options for medically refractory PND.

Heat Transfer of Ca (NO3)2-KNO3 Molten Salt Mixtures for Austempering and Martempering Processes of Steels.

Molten salts are highly effective as a quenching medium for austempering and martempering processes, enabling precise control of cooling rates to achieve the desired microstructures and mechanical characteristics in steel components. One such promising molten salt is a multicomponent Ca (NO3)2-KNO3 molten salt. The current work explores the cooling severity of molten Ca (NO3)2-KNO3 mixtures, which are commonly used for such purposes. The said mixture, with varying concentrations and bath temperatures was used for quenching the Inconel probe with thermocouples. The temperature data extracted was used to determine the transient heat flux developed at the metal-quenchant interface. A set of critical points were assessed against the peak heat extraction rates. Additionally, the fluctuation of mean heat flux and surface temperature in relation to these crucial points were plotted, along with changes in composition and bath temperature of the quench media. The cooling intensity of these quench solutions, as measured by Inconel probes, correlated well with the average hardness values observed in steel probes. The level of homogeneity in heat transmission, as measured by the spatial variance of the normalized heat energy, decreased as the percentage of KNO3 in the quench medium increased.

Disparities in seeking care for olfactory and gustatory dysfunction: A population analysis.

INTRODUCTION: Despite effects on quality of life from olfactory and gustatory dysfunction (OD and GD), screening practices are limited, and patients' self-reporting of symptoms remains the only way to understand the burden of chemosensory dysfunction (CSD). Using a large population-based database, we sought to understand factors leading to reduced likelihood of discussing CSD with a provider. METHODS: The 2013‒2014 National Health and Nutrition Examination Survey (NHANES) chemosensory protocol was queried for factors influencing discussion of OD/GD with a healthcare provider. Sociodemographic, comorbidity, and objective OD/GD testing results were assessed with a multivariate analysis. RESULTS: Out of 146.1 million US adults, there were an estimated 41.4 million individuals with self-reported OD/GD in the prior 12 months (28.3%). A total of 86.8% of participants did not discuss their problem with a healthcare provider. Men were about half as likely to speak with a healthcare provider (odds ratio [OR] 0.42; 0.26-0.66; p < 0.001) and those with a college education were about nine times more likely to discuss the problem compared to those with less than a ninth-grade educational achievement (OR 8.83; 1.86-41.98; p = 0.02). Those with objective confirmation of CSD were still unlikely to speak with a provider (OR 0.77; 0.44-1.33; p = 0.36). CONCLUSION: Men and those with less education are less likely to discuss OD/GD with a healthcare provider. These populations tend to be at increased risk for CSD, and there are severe downstream health and quality of life implications related to CSD. Dedicated screening and increased public awareness are critical to ensure more equitable care.

Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis.

Cases of delayed osteoradionecrosis (ORN) of the anterior skull base have unique management considerations. A 59-year-old woman with a history of basaloid squamous cell carcinoma of the sinonasal cavity with intracranial extension through the anterior skull base developed delayed radiation sequelae of anterior skull base ORN. She underwent an initial endoscopic resection in 2011 with persistent disease that required an anterior craniofacial resection with left medial maxillectomy in 2012. She had a radiologic gross total resection with microscopic residual disease at the histologic margins prompting adjuvant chemoradiotherapy to target volume doses of 66 to 70 Gy with concurrent cisplatin chemotherapy. She subsequently developed an intracranial abscess in 2021 along the anterior skull base that required a craniotomy and endoscopic debridement. Despite aggressive surgical and medical therapy, she had persistent intracranial infections and evidence of skull base ORN. She ultimately underwent a combined open bifrontal craniotomy and endoscopic resection of the necrotic frontal bone and dura followed by an anterolateral thigh free flap reconstruction with titanium mesh cranioplasty. The patient recovered well from a microvascular free-tissue reconstruction without concern for cerebrospinal fluid leak. Anterior skull base reconstruction with free tissue transfer is a commonly utilized method for oncologic resections. Here, an anterolateral free flap was effectively used to treat an anterior skull base defect secondary to a rare indication of skull base ORN.

Multi-Institutional Analysis of Insurance Denial Patterns Within Rhinology.

BACKGROUND: Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue. OBJECTIVE: Examine the trends in insurance denials for rhinological procedures. METHODS: A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials. RESULTS: A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid. CONCLUSION: Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.

Therapeutic targets achievement in secondary prevention after myocardial infarction in a North African tertiary center.

INTRODUCTION: Despite the demonstrated efficacy of cardiovascular (CV) preventive measures, data from international literature indicate that control of CV risk factors (RF) remains insufficient in very high-risk patients. AIM: This study aimed to assess prevalence of achievement of recommended therapeutic targets for the major and modifiable CVRF 12 months after myocardial infarction (MI). METHODS: From 1st January to 30th April 2023, we collected consecutive patients with type 1 MI who had completed 12 months follow-up. Primary endpoint was prevalence of achievement of all recommended therapeutic targets of low-density lipoprotein cholesterol (LDL-C), diabetes mellitus (DM), arterial hypertension (HTN), and smoking. Targets and treatment goals were defined according to the 2021 European Society of Cardiology guidelines on CV disease prevention. RESULTS: 107 patients, mean age 58.8 ± 8.8 years, 74.8% male, were included. 42 (39.3%) patients had HTN, 50 (46.7%) were diabetics, 77 (72.0%) were smokers and eight (7.5%) had hypercholesterolemia. At 12 months, primary endpoint was achieved in 20 (18.7%) patients. 55 (71.4%) of 77 smoker patients were weaned. Blood pressure was at target in 26 (61.9%) among hypertensive patients. In DM patients, HbA1c target was achieved in 23 (46.0%) of them. 32 patients (29.9%) achieved the goal of LDL-C < 0.55 g/L. CONCLUSIONS: Secondary prevention of CV disease was suboptimal. Less than a fifth of patients achieved treatment target for most major and modifiable risk factors. Improvement in follow-up care and treatment after MI is needed.