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The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction.
Prospective survey of rhinology patients.
Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent). Obstruction duration (more than one year) (χ2 = 13.5, p = 0.00024), but not obstruction severity, affected willingness to spend more time being assessed. Questionnaires (48 per cent) and nasal inspiratory peak flow measurement (53 per cent) are the most commonly used assessment techniques. Forty-nine per cent of participants found their assessment unhelpful in understanding their obstruction. Eighty-two per cent agreed or strongly agreed that a visual and numerical aid would help them understand their blockage.
Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.
Multidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.
From July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)–producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.
The overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).
The direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.
Background: To introduce the “uniform cortex sign” (UCS) and evaluate its performance as a diagnostic test for the presence of diffuse cortical injury (DCI). Methods: The study was approved by our institutional review board. Three experienced neuroradiologists were given a tutorial on the UCS. They were subsequently presented with 14 cases (7 control patients and 7 DCI patients with the UCS) in random order and asked to determine whether the UCS was present. Each case consisted of selected DWI, T2-weighted, and FLAIR images from unenhanced 1.5T MRI examinations. A consensus result for each case was determined by unanimity or majority rule. Results: All control patients were correctly identified as normal by all neuroradiologists (7/7). The UCS was correctly identified in 86% of DCI patients (6/7). UCS interrater agreement was high (multirater κ=0.81). Conclusions: This small study shows that the UCS can identify DCI, especially in patients with hypoxic-ischemic encephalopathy. The UCS can be subtle, hence the reader must be vigilant for this finding. The accuracy of the UCS may depend on the extent of cortical injury and time between injury and MRI. Also, a UCS may be reversible, as in our case of viral meningoencephalitis.
Nasal obstruction is a common ENT complaint; however, decisions on its management are challenging, with high rates of dissatisfaction following surgery. This study investigated the practice of UK clinicians in the evaluation of nasal patency.
Seventy-eight UK-based rhinologists were surveyed at the 2015 British Academic Conference in Otolaryngology.
Clinical history and examination are almost universally used to evaluate nasal blockage. The most commonly used test was the nasal misting pattern (73 per cent), followed by peak nasal inspiratory flow (19 per cent). The Sino-Nasal Outcome Test 22 or 23 was utilised by 29 per cent of respondents. Sixty-three per cent of respondents reported that a lack of equipment was the principle reason for not using objective measures, followed by time constraints and a lack of correlation with symptom scores.
British clinicians rely on clinical skills to evaluate nasal blockage. There is a desire for a simple, non-invasive device that objectively measures airflow for nasal breathing during physiological resting and correlates with subjective symptom scores.
Introduction: The Circle of Willis (CoW) is the most effective collateral circulation to the brain during internal carotid artery (ICA) occlusion. Carotid stump pressure (CSP) is an established surrogate measure of the cerebral collateral circulation. This study aims to use hemodynamic and computed tomography angiography measurements to determine the strongest influences upon the dependent variable, CSP. These findings could help clinicians noninvasively assess the adequacy of the collateral circulation and facilitate surgical risk assessment in an outpatient setting. Methods: CSP and mean arterial pressure were measured during carotid endarterectomy or during carotid balloon test occlusion in 92 patients. Intracranial arterial diameters were measured on computed tomography angiography at 16 different locations. Univariate and multivariate analyses were used to determine the key factors associated with CSP. In a subgroup of individuals (n=27) with severe (>70% North American Symptomatic Carotid Endarterectomy Trial) contralateral stenosis or occlusion, the same analysis was performed. Results: The contralateral anterior cerebral artery proximal to anterior communicating artery (A1) of the CoW had the strongest influence upon CSP, followed by the mean arterial pressure, the contralateral ICA diameter, and the anterior communicating artery diameter (R2=0.364). In the subgroup with high-grade contralateral ICA stenosis, the ipsilateral posterior communicating artery exerted the strongest influence (R2=0.620). Conclusions: During ICA occlusion, the anterior CoW dominates in preserving collateral flow, especially the contralateral A1 segment. In individuals with high-grade contralateral carotid stenosis, the posterior communicating artery calibre becomes a dominant influence. The most favourable anatomy consists of large contralateral A1 and anterior communicating arteries, and no contralateral carotid stenosis.
Although peri-conceptional folic acid (FA) supplementation can prevent a proportion of neural tube defects (NTD), there is increasing evidence that many NTD are FA non-responsive. The vitamin-like molecule inositol may offer a novel approach to preventing FA-non-responsive NTD. Inositol prevented NTD in a genetic mouse model, and was well tolerated by women in a small study of NTD recurrence. In the present study, we report the Prevention of Neural Tube Defects by Inositol (PONTI) pilot study designed to gain further experience of inositol usage in human pregnancy as a preliminary trial to a future large-scale controlled trial to evaluate efficacy of inositol in NTD prevention. Study subjects were UK women with a previous NTD pregnancy who planned to become pregnant again. Of 117 women who made contact, ninety-nine proved eligible and forty-seven agreed to be randomised (double-blind) to peri-conceptional supplementation with inositol plus FA or placebo plus FA. In total, thirty-three randomised pregnancies produced one NTD recurrence in the placebo plus FA group (n 19) and no recurrences in the inositol plus FA group (n 14). Of fifty-two women who declined randomisation, the peri-conceptional supplementation regimen and outcomes of twenty-two further pregnancies were documented. Two NTD recurred, both in women who took only FA in their next pregnancy. No adverse pregnancy events were associated with inositol supplementation. The findings of the PONTI pilot study encourage a large-scale controlled trial of inositol for NTD prevention, but indicate the need for a careful study design in view of the unwillingness of many high-risk women to be randomised.
We discuss different methods to separate high- from low-redshift galaxies based on a combination of spectroscopic and photometric observations. Our baseline scenario is the Hobby-Eberly Telescope Dark Energy eXperiment (HETDEX) survey, which will observe several hundred thousand Lyman Alpha Emitting (LAE) galaxies at 1.9 < z < 3.5, and for which the main source of contamination is [OII]-emitting galaxies at z < 0.5. Additional information useful for the separation comes from empirical knowledge of LAE and [OII] luminosity functions and equivalent width distributions as a function of redshift. We consider three separation techniques: a simple cut in equivalent width, a Bayesian separation method, and machine learning algorithms, including support vector machines. These methods can be easily applied to other surveys and used on simulated data in the framework of survey planning.
Cerebral air embolism associated with central venous catheter insertion and removal is a rare but serious complication. There are many hypotheses on how air bubbles might be transported from the venous system to intracranial vessels. The literature has described how intra-cardiac defects transpulmonary passage and even retrograde flow of gas bubbles can explain this phenomenon. We present a case that illustrates the devastating effects of cerebral air embolism after a patient selfextracted his central venous catheter.
High-quality InGaN/GaN multiple quantum wells (MQWs) were fabricated on nano-scale epitaxial lateral overgrown (NELO) GaN layers which was prepared using nanometer-scale SiO2 islands, with an average diameter and interdistance of 300nm and 200nm respectively, as the growth mask. The active region of the device consists of five periods of GaN/InGaN MQWs were grown on top of the NELO layer using MOCVD technique. It is observed that some of the dislocations from the undoped GaN were blocked by the SiO2 growth mask and typical threading dislocation (TD) density found in the NELO samples is ~7.5×107cm-2. Significant improvement in the electroluminescence (EL) is observed which is believed to partly arise from the improvement in the internal quantum efficiency (ηi). The experimental data on the temperature dependence of the photoluminescence (PL) were fitted to a proposed model using Levenberg-Marquardt approximation. Based on our analyses it is found that the relative improvement in ηi at 300K over a control device grown in the same growth condition but without the NELO layer to a NELO device is only 0.59. It is generally accepted that TD is the non-radiative recombination center which affects the IQE. Therefore, room-temperature IQE values also support that NELO device exhibits lower TD density.
Radiosensitive neurogenic stem cells reside in the hippocampi, suggesting that avoidance of the hippocampi may be an important strategy to reduce potential radiation-related cognitive effects. Six patients treated for base of skull tumours were re-planned using co-planar helical fan beam arc therapy (tomotherapy) and co-planar and non-coplanar volumetric arc techniques (RapidArc). The hippocampi were contoured as avoidance structures with the specific goal of minimising the dose. Two gross target volume (GTV) to planning target volume (PTV) expansions (10 and 2 mm) were considered to evaluate the impact of margin selection on organ at risk (OAR) sparing. The dose prescription was 50 Gy to >95% of the PTV. Comparison of the hippocampus avoidance plans demonstrated the importance of non-coplanar delivery when the 10 mm margin was used. With the 2 mm margin, both co-planar and non-coplanar delivery provided similar degrees of sparing. A mean dose of 3–4 Gy and a V6Gy <5% to the hippocampi was realised with the hippocampus sparing techniques. Our comparisons suggest interventions to minimise GTV to PTV margins will have a more profound influence on multiple OAR sparing than the choice of intensity modulated arc delivery technique.
Two cases of Rosai-Dorfman disease with polypoid nasal infiltration mimicking nasal tuberculosis and malignant lymphoma are reported. This rare benign disease was first described by Rosai and Dorfman in 1969 and is characterized by histiocytic proliferation. It is seldom considered in the differential diagnosis of granulomatous diseases due to its rarity and histological similarity to other diseases. Extranodal manifestations of this disease are uncommon. Although no specific treatment can guarantee a sustained remission of this disease, surgery for loco-regional lesions can result in long-term symptomatic control and restoration of function. Both patients underwent endoscopic resection of the nasal polypoid lesions and have subsequently been free of recurrence. Loco-regional infiltration of the nasal cavity by Rosai-Dorfman disease is effectively managed by endoscopic resection.
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