Thursday, May 12, 2022

Olfactory Impairment and Mortality

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The COVID-19 pandemic has elevated the world's attention to olfactory impairment (OI). As a cardinal symptom of the many early variants of the SARS-CoV-2 virus, we have never seen such global attention toward one of our most important senses. Although the prevalence of OI has increased dramatically with COVID-19, OIs have long been a significant health concern. Prior to the COVID-19 pandemic, the median length of time from onset of OI to evaluation by a clinician was 13 months, with many individuals waiting up to 3 years before seeking evaluation. During that time, patients did not receive treatment or counseling, compounding the potential associations of OI with patient health.
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Mid-infrared-scanning cavity ring-down CH2F2 detection using electronically tuned Cr:ZnSe laser

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Otoprotective Effects of Stephania tetrandra S. Moore Herb Isolate against Acoustic Trauma

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AbstractNoise is the most common occupational and environmental hazard, and noise-induced hearing loss (NIHL) is the second most common form of sensorineural hearing deficit. Although therapeutics that target the free-radical pathway have shown promise, none of these compounds is currently approved against NIHL by the United States Food and Drug Administration. The present study has demonstrated that tetrandrine (TET), a traditional Chinese medicinal alkaloid and the main chemical isolate of theStephania tetrandra S. Moore herb, significantly attenuated NIHL in CBA/CaJ mice. TET is known to exert antihypertensive and antiarrhythmic effects through the blocking of calcium channels. Whole-cell patch-clamp recording from adult spiral ganglion neurons showed that TET blocked the transient Ca2+...
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Effects of Masker Envelope Fluctuations on the Temporal Effect

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This study tests the hypothesis that small or absent temporal effects for narrowband maskers are due to the inherent temporal envelope fluctuations of Gaussian noise. Temporal effects were measured for narrowband noise maskers with fluctuating ( "fluctuating maskers") and flattened ("flattened maskers") temporal envelopes as a function of masker level (Exp. I) and in the presence of fluctuating and flattened precursors (Exp. II). The temporal effect was absent for fluctuating narrowband maskers and as large as ~ 7 dB for flattene d narrowband maskers. The AC-coupled power of the temporal envelopes of precursors and maskers accounted for 94 % of the variance in probe detection thresholds measured with fluctuating and flattened precursors and maskers. These results suggest that m...
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Effects of 3,3 ′-Iminodipropionitrile on Hair Cell Numbers in Cristae of CBA/CaJ and C57BL/6J Mice

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This study examines absolute hair cell numbers in the cristae of C57BL/6J mice and CBA/CaJ mice from weaning to adulthood as well as the dose required for 3,3 ′-iminodiproprionitrile (IDPN)-injury of the cristae in C57BL/6J mice and CBA/CaJ mice, the two mouse strains most commonly used by inner ear researchers. In cristae of CBA/CaJ and C57BL/6J mice, no loss of hair cells was observed up to 24 weeks. In both strains, dose-dependent loss of hair cells was observed 7 days after IDPN treatment of 2-month-old mice (IC50 = 16.1 mmol/kg in C57BL/6J mice vs. 25.21 mmol/kg in CBA/CaJ mice). Four-month-old C57BL/6J mice exposed to IDPN developed dose-dependent vestibular dysfunction as indicated by increased activity and circling behavior in open field tests and by failure to swim 7 da...
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Association of APACHE‐II Scores With 30‐Day Mortality After Tracheostomy: A Retrospective Study

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Association of APACHE-II Scores With 30-Day Mortality After Tracheostomy: A Retrospective Study

An APACHE-II score of 30 and above is a potentially useful clinical indicator of increased risk of mortality within 30 days of tracheostomy in patients with ventilator-dependent respiratory failure (VDRF). This tool may prove a valuable resource for ICU physicians, surgeons, and families who are considering tracheostomy for patients with VDRF.


Objective

The objective of this study was to assess whether the Acute Physiology, Age, Chronic Health Evaluation II (APACHE-II) score is a reliable predictor of 30-day mortality in the setting of adult patients with ventilator-dependent respiratory failure (VDRF) who undergo tracheostomy.

Methods

This is a retrospective, single-institution study. Potential subjects were identified using the current procedural terminology codes for the tracheostomy procedure and International Classification of Diseases, 10th Revision, codes for VDRF. APACHE-II scores were retrospectively calculated. Tracheostomies were performed in our population over an 18-month period (November 2018 through April 2020). Our study population did not include patients with novel coronavirus. The primary outcome was mortality at 30 days after tracheostomy.

Results

A total of 238 patients with VDRF who had a tracheostomy were included in this study. Twenty-eight (11.8%) patients died within 30 days of tracheostomy. The mean (standard deviation) APACHE-II score was 22.5 (10.2) for patients who died within 30 days of tracheostomy and 19.8 (7.4) for patients living within 30 days of tracheostomy (p = 0.30). Patients with APACHE-II scores greater than or equal to 30 showed higher odds of death within 30 days of tracheostomy (odds ratio, 3.0; 95% CI, 1.14–7.89, p = 0.03).

Conclusion

An APACHE-II score of 30 and above is associated with mortality within 30 days of tracheostomy in patients with VDRF. APACHE-II scores may be a promising tool for assessing risk of mortality in patients with VDRF after tracheostomy.

Level of Evidence

3 Laryngoscope, 2022

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Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation

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Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation

Two-thirds of children will develop a persistent tracheocutaneous fistula (TCF) after tracheostomy decannulation. Persistent TCF is correlated with longer duration of tracheostomy and congenital malformations.


Objectives

To determine the incidence of tracheocutaneous fistula (TCF) and identify characteristics associated with persistence.

Study Design

Prospective cohort.

Methods

All successfully decannulated children (<18 years) between 2014 and 2020 at a tertiary children's hospital were included. Revision tracheostomies, concomitant major neck surgery, or single-stage laryngotracheal reconstructions were excluded. A persistent TCF was defined as a patent fistula at 6 weeks after decannulation.

Results

A total of 77 children met inclusion criteria with a persistent TCF incidence of 65% (50/77). Children with a persistent TCF were younger at placement (1.4 years (SD: 3.3) vs. 8.5 years (SD: 6.5), p < 0.001) and tracheostomy-dependent longer (2.8 years (SD: 1.3) vs. 0.9 years (SD: 0.7), p < 0.001). On univariate analysis, placement under 12 months of age (86% vs. 26% p < 0.001), duration of tracheostomy more than 2 years (76% vs. 11% p < 0.001), short gestation (64% vs. 26%, p = 0.002), congenital malformations (64% vs. 33%, p = 0.02), newborn complications (58% vs. 26%, p = 0.009), maternal complications (40% vs. 11%, p = 0.009) and chronic respiratory failure (72% vs. 41%, p = 0.01) were associated with persistent TCF. Logistic regression analysis associated duration of tracheostomy (OR: 0.14, 95% CI: 0.05–0.35, p < ; 0.001) and congenital malformations (OR: 0.25, 95% CI: 0.06–0.99, p = 0.049) with failure to spontaneously close.

Conclusions

Two-thirds of children will develop a persistent TCF after tracheostomy decannulation. Persistent TCF is correlated with a longer duration of tracheostomy and congenital malformations. Anticipation of this event in higher-risk children is necessary when caring for pediatric tracheostomy patients.

Level of Evidence

3 Laryngoscope, 2022

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