Citations

AbstractINTRODUCTIONDementia with Lewy bodies (DLB) is typically characterized by parietal, temporal, and occipital atrophy, but less is known about the newly defined prodromal phases. The objective of this study was to evaluate structural brain alterations in prodromal DLB (p‐DLB) as compared to healthy controls (HC) and full‐blown dementia (DLB‐DEM).METHODSThe study included 42 DLB patients (n = 20 p‐DLB; n = 22 DLB‐DEM) and 27 HC with a standardized neurological assessment and 3‐tesla magnetic resonance imaging. Voxel‐wise analyses on gray‐matter and cortical thickness were implemented to evaluate differences between p‐DLB, DLB‐DEM, and HC.RESULTSp‐DLB and DLB‐DEM exhibited reduced occipital and posterior parieto‐temporal volume and thickness, extending from prodromal to dementia stages. Occipital atrophy was more sensitive than insular atrophy in differentiating p‐DLB and HC. Occipital atrophy correlated to frontotemporal structural damage increasing from p‐DLB to DLB‐DEM.DISCUSSIONOccipital and posterior‐temporal structural alterations are an early signature of the DLB continuum and correlate with a long‐distance pattern of atrophy.

AimDebridement, antibiotics, and implant retention (DAIR) is a viable treatment option for acute periprosthetic joint infections (PJI). The landmark DATIPO trial of Bernard et al. concluded that six weeks is not non-inferior to 12-week antibiotic therapy for DAIR. However, it is unknown if suppressive antibiotic treatment (SAT) would improve patient outcomes. Therefore, our study aims to evaluate the utility of SAT after 12 weeks of therapy.MethodWe performed a retrospective study of patients with acute hip or knee PJI managed with DAIR at five institutions; in the U.S. (n=1), Netherlands (n=3), and Spain (n=1) from 2005–2020. We analyzed the effect of SAT using a Cox model among patients after 12 weeks of antibiotic treatment. The primary covariate of interest was whether the patient was on antibiotics after week 12, which was coded as a time-varying covariate. We decided a-priori to control for the clinically important risk factors such as age, sex, type of infection, modular exchange, joint, and presence of bacteremia and Staphylococcus aureus. We excluded patients who died, had treatment failure, or were lost to follow-up before 12 weeks. We defined treatment failure as infection recurrence (same or different organism), unexpected reoperation, or death due to infection.ResultsThere were 504 patients included in the study. The majority were female (58%, n=292), with a mean age of 70 years ago (SD 11). Hips and knees were equally proportioned. Primary arthroplasties represented 69% of the total cohort (n=349). Treatment failure was 11.9% in the total cohort (n=60). There was no statistically significant association between SAT after 12 weeks and treatment failure (HR 1.25, p=0.45, 95% CI 0.70–2.24). This finding was consistent across different subgroups, including hip or knee joints, early or late acute infections, cohort, and a subgroup of knee joints after 180 days.ConclusionsSAT after 12 weeks of antibiotic treatment for acute PJI managed with DAIR does not appear to improve patient outcomes.

Importance: Phenol kits cleared by the Food and Drug Administration (FDA) are indicated as a topical anesthetic for the tympanic membrane (TM) in adults. However, there is no existing literature that reports outcomes to support the safety and use of phenol on the TM of awake children. Objective: Determine if topical phenol is safe and at low risk for complications and therefore be used effectively in awake children to facilitate office otologic procedures as in adults. Design, Setting, and Participants: Children under 21 years of age whose parents agreed to participate in an awake office setting for tympanostomy tube (TT) placement. All children had TT placement after phenol placement on the TM prior to insertion. Main Outcomes and Measures: TM perforation or other signs of TM complications through a minimum of 6-month clinical follow-up, along with assessment of the tolerability of the procedure by the child. Results: A total of 228 children with an age range of 6 months to 15.9 years and 435 TMs completed TT placement using phenol as a local anesthetic while awake in the office. There were no complications reported in the 204 children at the first follow-up visit post TM placement within 3 to 10 weeks. Of the 93 children followed up at least 6 months, there were no TM complications reported. Conclusions: This is the first study to report the outcomes on the use of phenol in an office setting in children. In this large experience, phenol appears to be tolerable and safe for use in young children in the office and is a potential safe choice of topical anesthesia for surgeons if they choose to perform office procedures such as myringotomies or TT placement on children.

AbstractObjectiveDoctors can influence the development of sound healthcare policy through financial contributions to political campaigns and candidates. Our objective was to characterize the political contributions of otolaryngologists in the United States, both individually and through the ENT Political Action Committee (ENTPAC) between the years 2003 and 2020.Study DesignRetrospective observational study.SettingPublicly available information on the internet: fec.gov.MethodsThe Federal Election Commission's website, fec.gov, was used to identify the political contributions of individual otolaryngologists and the ENTPAC between 2003 and 2020. Each contribution is associated with a political group or candidate, designated as a Republican, Democratic, or Independent entity.ResultsA total of 1407 distinct political contributions were made by individuals identifying as otolaryngologists between 2003 and 2020, totaling $432,201. Overall, Republicans received more individual donations than Democrats (711 vs 540), while Democrats received more money ($231,139 vs $183,427). Donations peaked during election years, with the total amount overall increasing each election year ($9664 in 2004 vs $75,102 in 2020). The predominant political party receiving donations between 2003 and 2020 in each US state matched each state's predominant party of the governors and senators 48.6% of the time. The ENTPAC donated $3,027,383 between 2003 and 2020 to a variety of political candidates and entities.ConclusionOtolaryngologists are making increased political contributions over time and interest in political advocacy may be at an all‐time high. Increased time and attention should be devoted to educating otolaryngologists to best politically advocate for interests which are of the most importance to themselves and the profession.

Diffusion measurements in the kidney are affected not only by renal microstructure but also by physiological processes (i.e., glomerular filtration, water reabsorption, and urine formation). Because of the superposition of passive tissue diffusion, blood perfusion, and tubular pre‐urine flow, the limitations of the monoexponential apparent diffusion coefficient (ADC) model in assessing pathophysiological changes in renal tissue are becoming apparent and motivate the development of more advanced diffusion‐weighted imaging (DWI) variants. These approaches take advantage of the fact that the length scale probed in DWI measurements can be adjusted by experimental parameters, including diffusion‐weighting, diffusion gradient directions and diffusion time. This forms the basis by which advanced DWI models can be used to capture not only passive diffusion effects, but also microcirculation, compartmentalization, tissue anisotropy. In this review, we provide a comprehensive overview of the recent advancements in the field of renal DWI. Following a short introduction on renal structure and physiology, we present the key methodological approaches for the acquisition and analysis of renal DWI data, including intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), non‐Gaussian diffusion, and hybrid IVIM‐DTI. We then briefly summarize the applications of these methods in chronic kidney disease and renal allograft dysfunction. Finally, we discuss the challenges and potential avenues for further development of renal DWI.Level of Evidence5Technical EfficacyStage 2

AbstractBackgroundDonor‐derived endemic mycoses are infrequently reported. We summarized the clinical characteristics and outcomes of these infections to provide guidance to transplant clinicians.MethodsMultiple databases were reviewed from inception through May 31, 2023 using endemic fungi as key words (e.g., Coccidioides, histoplasma, blastomyces, talaromyces, paracoccidioides). Only donor‐derived infections (DDI) were included.ResultsTwenty‐four cases of DDI were identified from 18 published reports; these included 16 coccidioidomycosis, seven histoplasmosis, and one talaromycosis. No cases of blastomycosis and paracoccidiodomycosis were published. The majority were male (17/24,70.8%). Half of the cases were probable (12/24, 50%), seven were possible (29.2%), and only five were proven DDI (20.8%). Donor‐derived coccidioidomycosis were observed in kidney (n = 11), lung (n = 6), liver (n = 3), heart (n = 2) and combined SOT recipients (1 KP, 1 KL) at a median time of .9 (range .2–35) months after transplantation. For histoplasmosis, the majority were kidney recipients (6 of 7 cases) at a median onset of 8 (range .4–48) months after transplantation. The single reported possible donor‐derived talaromycosis occurred in a man whose organ donor had at‐risk travel to Southeast Asia. Collectively, the majority of donors had high‐risk exposure to Coccidioides (9/11) or Histoplasma sp. (6/6). Most donor‐derived endemic mycoses were disseminated (18/24, 75%), and mortality was reported in almost half of recipients (11/24, 45.8%).ConclusionDonor‐derived endemic mycoses are often disseminated and are associated with high mortality. A detailed evaluation of donors for the potential of an undiagnosed fungal infection prior to organ donation is essential to mitigate the risk of these devastating infections.

Background Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long‐term efficacy of septoplasty is unclear, and no literature reviews have examined long‐term outcomes of septoplasty with or without turbinate modification. This systematic review aimed to evaluate the long‐term efficacy of septoplasty with or without turbinate modification in improving nasal obstruction. Data Sources PubMed, EMBASE, Cochrane CENTRAL. Methods A systematic review of the literature was conducted using the aforementioned databases. Studies reporting outcomes 12+ months after functional septoplasty with or without turbinate surgery for nasal obstruction were included. Septorhinoplasties, concurrent sinus surgery, pediatric studies, and studies where septoplasty was performed for indications other than nasal obstruction were excluded. Results After screening, 35 studies with 4,432 patients were included. Mean weighted post‐operative follow‐up time was 29.1 months (range 12–120 months). All studies reported significant improvement in subjective and objective outcomes at long‐term follow‐up compared to baseline. When comparing short‐term (<12 months) to long‐term (≥12 months) outcomes, four studies noticed that subjective outcomes worsened slightly over time, but no study found a significant change in objective outcomes over time. In addition, 23 studies reported patient satisfaction and/or improvement rates, with 75.4% (2,348/3,113) of patients expressing satisfaction/improvement at an average of 27.0 months after surgery. Conclusions Overall, septoplasty with or without turbinate modification shows significant improvement in obstructive symptoms at long‐term follow‐up per both objective and subjective measures. Whether outcomes may worsen slightly over time remains indeterminate based on mixed results in the literature. Level of Evidence N/A Laryngoscope , 134:2525–2537, 2024

Abstract Background Caesarean sections (CSs) constitute a large proportion of fetal deliveries, yet no consensus exists on optimal surgical method. Objectives To investigate the safety and efficacy of the Pfannenstiel‐Kerr method (PKM) in comparison to Misgav‐Ladach method (MLM) and Modified Misgav‐Ladach method (MMLM) for CS. Search Strategy Cochrane, Embase, PubMed, CiNAHL, Scopus, and Web of Science were searched from database inception to March 2023. Selection Criteria Prospective studies comparing MLM with PKM or MMLM with PKM. Data Collection and Analysis Three authors independently conducted data extraction and assessed quality. Pooled means and proportions were analyzed using inverse variance and Mantel‐Haenszel methods. Main Results Twenty‐seven studies with 15 251 patients, met the selection criteria. Both MLM (mean difference [MD]: −12.09 min, 95% confidence interval [CI]: −14.40, −9.77, Tau 2 = 16.79, I 2 = 97%), (MD: −125.98 mL, 95% CI: −172.13, −79.83, Tau 2 = 3458.59, I 2 = 87%) and MMLM (MD: −11.38 min, 95% CI: −14.72, −8.04, Tau 2 = 30.56, I 2 = 100%), (MD: −62.61 mL, 95% CI: −103.13, −22.09, Tau 2 = 1451.35, I 2 = 92%) demonstrated shorter operative time and decreased blood loss, respectively, compared to PKM. Similarly, both MLM (MD: −1.70 min, 95% CI: −2.26, −1.14, Tau 2 = 0.51, I 2 = 97%), (MD: −0.77 d, 95% CI: −1.35, −0.19, Tau 2 = 0.60, I 2 = 98%) and MMLM (MD: −2.80 min, 95% CI: −3.89, −1.70, Tau 2 = 1.74, I 2 = 100%), (MD: −0.58 d, 95% CI: −1.00, −0.17, Tau 2 = 0.29, I 2 = 100%) demonstrated shorter fetal extraction time and length of hospital stay, respectively, compared to PKM. Conclusions MLM and MMLM should be considered safe and effective alternative approaches to CSs.

Abstract Aims Obesity is causally related to the development of heart failure with preserved ejection fraction (HFpEF) but complicates the diagnosis and treatment of this disorder. We aimed to determine the relationship between severity of obesity and clinical, echocardiographic and haemodynamic parameters in a large cohort of patients with documented HFpEF. Methods and results The REDUCE LAP-HF II trial randomized 626 patients with ejection fraction ≥40% and exercise pulmonary capillary wedge pressure (PCWP) ≥25 mmHg to atrial shunt or sham procedure. We tested for associations between body mass index (BMI), clinical characteristics, cardiac structural and functional abnormalities, physical limitations, quality of life and outcomes with atrial shunt therapy. Overall, 60.9% of patients had BMI ≥30 kg/m2. As the severity of obesity increased, symptoms (Kansas City Cardiomyopathy Questionnaire score) and 6-min walk distance worsened. More severe obesity was associated with lower natriuretic peptide levels despite more cardiac remodelling, higher cardiac filling pressures, and higher cardiac output. Lower cut points for E/e′ were needed to identify elevated PCWP in more obese patients. Strain measurements in all four chambers were maintained as BMI increased. Pulmonary vascular resistance at rest and exercise decreased with higher BMI. Obesity was associated with more first and recurrent heart failure events. However, there was no significant interaction between obesity and treatment effects of the atrial shunt. Conclusions Increasing severity of obesity was associated with greater cardiac remodelling, higher right and left ventricular filling pressures, higher cardiac output and increased subsequent heart failure events. Despite significant obesity, many HFpEF patients have preserved right heart and pulmonary vascular function and thus, may be appropriate candidates for atrial shunt therapy.

Purpose: This study investigates how Obstructive sleep apnea (OSA) affects the outcomes of ptosis repair. We hypothesized that patients with OSA have an increased rate of reoperation after ptosis repair. Methods: This retrospective cohort study included patients age >18 from the Mayo Clinic who underwent ptosis repair by levator advancement or Müller muscle-conjunctiva resection between 2018 and 2021. Outcomes were measured at 1 to 3 months of follow-up with surgical failure defined as asymmetry or unsatisfactory eyelid height requiring revision surgery within 1 year. Results: A total of 577 patients met the inclusion criteria. There was a statistically significant difference in surgical failure between patients with OSA and those without (20.5% vs. 13.1%, p = 0.02). Patients with OSA showed a statistically significant difference in risk of revision by a factor of 1.70 (95% CI: 1.06–2.07). Revisions were attributed to unsatisfactory eyelid height in 72.6% of patients and eyelid asymmetry in 21.1%. All patients who had revision surgery had satisfactory outcomes. On logistic regression analysis, when adjusting for age and sex, OSA was significantly associated with ptosis revision (p = 0.007). Conclusions: OSA increases risk of surgical failure and need for revision surgery in patients undergoing blepharoptosis repair but is not a sole risk factor.