Objective Improvement After Frenotomy for Posterior Tongue-Tie: A Prospective Randomized Trial.

OBJECTIVE: Infants with posterior tongue-tie (PTT) can have substantial difficulty with breastfeeding and bottle-feeding. This study aimed to address the dearth in investigational objective data surrounding PTT release to better quantify the postoperative impacts of frenotomy for ankyloglossia. STUDY DESIGN: Prospective randomized, controlled trial. SETTING: Private practice clinic. METHODS: In a prospective, randomized controlled trial, infants 3 to 16 weeks of age with PTT undergoing frenotomy were examined using a bottle-feeding system capable of objectively measuring tongue function. Validated patient-reported outcome measures were also obtained simultaneously. RESULTS: Forty-seven infants with PTT were enrolled into an observational/control arm (n = 23) or interventional/surgical treatment arm (n = 24). The total cohort consisted of 29 (61.7%) male infants with a median age of 39 days. At the day 10 time point, the interventional arm demonstrated statistically significant improvement in 11 objectively obtained feeding metrics, indicating faster tongue speed, more rhythmic and coordinated sucking motions, and a tongue more capable of adapting to varying feeding demands. Significant improvement in breastfeeding self-efficacy was reported in the interventional group while poor self-confidence persisted in the observational group. Infant reflux symptoms improved in the interventional group while not in the control group. Nipple pain also persisted in the control group but improved in the surgical cohort. CONCLUSIONS: When measured 10 days after frenotomy for PTT, infants improve feeding parameters using an objective bottle-feeding system. Similar improvements are seen with patient-reported outcomes when PTT is released. Posterior tongue-tie is a valid clinical concern, and surgical release can improve infant and maternal symptoms.

Phase diagram of the J_{1}-J_{2} frustrated anisotropic antiferromagnet with spin S=1 on the quadratic lattice.

In the paper the phase diagram of J_{1}-J_{2} frustrated antiferromagnet with spin S=1 and single-ion anisotropy is studied on the planar quadratic lattice in the cluster approximation. The Bogolyubov inequality is adopted for the Gibbs energy calculation for the case of 2×2 and 4×4 clusters. On this basis, the ranges of existence of the antiferromagnetic, superantiferromagnetic, and paramagnetic phases are investigated for the antiferromagnetic nearest-neighbor (J_{1}<0) and next-nearest-neighbor (J_{2}<0) interactions. In particular, the occurrence of tricritical and triple points is discussed and a comparison between the results for 2×2 and 4×4 clusters is made. The results are also compared with the classical MFA method, adopted here for the model in question, as well as with selected literature results for particular choices of interaction parameters.

Revision Lingual Frenotomy Improves Patient-Reported Breastfeeding Outcomes: A Prospective Cohort Study.

BACKGROUND: Lingual frenotomy improves patient-reported outcome measures, including infant reflux and maternal nipple pain, and prolongs the nursing relationship; however, many mother-infant dyads continue to experience breastfeeding difficulty despite having had a frenotomy. Research aim: The aim of this study was to determine how incomplete release of the tethered lingual frenulum may result in persistent breastfeeding difficulties. METHODS: A one-group, observational, prospective cohort study was conducted. The sample consisted of breastfeeding mother-infant (0-9 months of age) dyads ( N = 54) after the mothers self-elected completion lingual frenotomy and/or maxillary labial frenectomy following prior lingual frenotomy performed elsewhere. Participants completed surveys preoperatively, 1-week postoperatively, and 1-month postoperatively consisting of the Breastfeeding Self-Efficacy Scale-Short-Form (BSES-SF), Visual Analog Scale (VAS) for nipple pain severity, and the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). RESULTS: Significant postoperative improvements were reported between mean preoperative scores compared with 1-week and 1-month scores of the BSES-SF, F(2) = 41.2, p < .001; the I-GERQ-R, F(2) = 22.7, p < .001; and VAS pain scale, F(2) = 46.1, p < .001. CONCLUSION: We demonstrated that besides nipple pain, measures of infant reflux symptoms and maternal breastfeeding self-confidence can improve following full release of the lingual frenulum. Additionally, a patient population was identified that could benefit from increased scrutiny of infant tongue function when initial frenotomy fails to improve breastfeeding symptoms.

Frustrated spin-1/2 Ising antiferromagnet on a square lattice in a transverse field.

We investigate the phase transitions and tricritical behaviors of the frustrated Ising antiferromagnet with first- (J_{1}<0) and second- (J_{2}<0) nearest-neighbor interactions in a transverse field Ω on the square lattice using an effective-field theory with correlations based on a single-spin approximation. We have proposed a functional for the free energy to obtain the phase diagram in the T-R (R=J_{2}/|J_{1}|) or T-Ω planes. It is shown that due to the transverse field the phase transition between ordered and disordered phases changes in the tricritical point (TCP) from the second order to the first order. The longitudinal and transverse magnetizations are also studied for selected values of R and Ω. In particular, the variation of TCP at the ground state in the three-dimensional space is constructed. For some special cases, values of the critical temperature and the critical transverse field have been determined analytically.

Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study.

OBJECTIVES/HYPOTHESIS: Numerous symptoms may arise that prevent mother-infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue-tie/lip-tie release on breastfeeding impairment. STUDY DESIGN: Prospective, cohort study from June 2014 to April 2015 in a private practice setting. METHODS: Study participants consisted of breastfeeding mother-infant (0-12 weeks of age) dyads with untreated ankyloglossia and/or tethered maxillary labial frenula who completed preoperative, 1 week, and 1 month postoperative surveys consisting of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), visual analog scale (VAS) for nipple pain severity, and the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). Breastmilk intake was measured preoperatively and 1 week postoperatively. RESULTS: A total of 237 dyads were enrolled after self-electing laser lingual frenotomy and/or maxillary labial frenectomy. Isolated posterior tongue-tie was identified in 78% of infants. Significant postoperative improvements were reported between mean preoperative scores compared to 1 week and 1 month scores of the BSES-SF (F(2) = 212.3; P < .001), the I-GERQ-R (F(2) = 85.3; P < .001), and VAS pain scale (F(2) = 259.8; P < .001). Average breastmilk intake improved 155% from 3.0 (2.9) to 4.9 (4.5) mL/min (P < .001). CONCLUSIONS: Surgical release of tongue-tie/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie. This study identifies a previously under-recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist. LEVEL OF EVIDENCE: 2c Laryngoscope, 127:1217-1223, 2017.

Frustrated mixed spin-1/2 and spin-1 Ising ferrimagnets on a triangular lattice.

Mixed spin-1/2 and spin-1 Ising ferrimagnets on a triangular lattice with sublattices A, B, and C are studied for two spin-value distributions (S(A),S(B),S(C))=(1/2,1/2,1) and (1/2,1,1) by Monte Carlo simulations. The nonbipartite character of the lattice induces geometrical frustration in both systems, which leads to the critical behavior rather different from their ferromagnetic counterparts. We confirm second-order phase transitions belonging to the standard Ising universality class occurring at higher temperatures, however, in both models these change at tricritical points (TCP) to first-order transitions at lower temperatures. In the model (1/2,1/2,1), TCP occurs on the boundary between paramagnetic and ferrimagnetic (±1/2,±1/2,∓1) phases. The boundary between two ferrimagnetic phases (±1/2,±1/2,∓1) and (±1/2,∓1/2,0) at lower temperatures is always first order and it is joined by a line of second-order phase transitions between the paramagnetic and the ferrimagnetic (±1/2,∓1/2,0) phases at a critical endpoint. The tricritical behavior is also confirmed in the model (1/2,1,1) on the boundary between the paramagnetic and ferrimagnetic (0,±1,∓1) phases.

Phase transitions in a frustrated Ising antiferromagnet on a square lattice.

The phase transitions occurring in the frustrated Ising square antiferromagnet with first- (J1<0) and second-nearest-neighbor (J2<0) interactions are studied within the framework of the effective-field theory with correlations based on the different cluster sizes and for a wide range of R=J2/|J1|. Despite the simplicity of the model, it has proved difficult to precisely determine the order of the phase transitions. In contrast to the previous effective-field study, we have found a first-order transition line in the region close to R=-0.5 not only between the superantiferromagnetic and paramagnetic (R<-0.5) but also between antiferromagnetic and paramagnetic (R>-0.5) phases.

Thermodynamic description of the Ising antiferromagnet on a triangular lattice with selective dilution by a modified pair-approximation method.

The pair-approximation method is modified in order to describe systems with geometrical frustration. The Ising antiferromagnet on a triangular lattice with selective dilution (Kaya-Berker model) is considered and a self-consistent thermodynamic description of this model is obtained. For this purpose, the Gibbs free energy as a function of temperature, concentration of magnetic atoms on the selected sublattice, and external magnetic field is derived. In particular, the phase diagram is constructed and a comparison of different methods is presented. The thermodynamic quantities are discussed in the context of their physical validity, and the improvement in the description introduced by the modified method is emphasized.

Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial.

BACKGROUND: Varenicline, a new treatment for smoking cessation, has demonstrated significantly greater efficacy over placebo and sustained release bupropion (bupropion SR). A study was undertaken to compare a 12-week standard regimen of varenicline with a 10-week standard regimen of transdermal nicotine replacement therapy (NRT) for smoking cessation. METHODS: In this 52-week, open-label, randomised, multicentre, phase 3 trial conducted in Belgium, France, The Netherlands, UK and USA, participants were randomly assigned (1:1) to receive varenicline uptitrated to 1 mg twice daily for 12 weeks or transdermal NRT (21 mg/day reducing to 7 mg/day) for 10 weeks. Non-treatment follow-up continued to week 52. The primary outcome was the biochemically confirmed (exhaled carbon monoxide < or = 10 ppm) self-reported continuous abstinence rate (CAR) for the last 4 weeks of the treatment period in participants who had taken at least one dose of treatment. Secondary outcomes included CAR from the last 4 weeks of treatment through weeks 24 and 52, and measures of craving, withdrawal and smoking satisfaction. RESULTS: A total of 376 and 370 participants assigned to varenicline and NRT, respectively, were eligible for analysis. The CAR for the last 4 weeks of treatment was significantly greater for varenicline (55.9%) than NRT (43.2%; OR 1.70, 95% CI 1.26 to 2.28, p<0.001). The week 52 CAR (NRT, weeks 8-52; varenicline, weeks 9-52) was 26.1% for varenicline and 20.3% for NRT (OR 1.40, 95% CI 0.99 to 1.99, p = 0.056). Varenicline significantly reduced craving (p<0.001), withdrawal symptoms (p<0.001) and smoking satisfaction (p<0.001) compared with NRT. The most frequent adverse event was nausea (varenicline, 37.2%; NRT, 9.7%). CONCLUSIONS: The outcomes of this trial established that abstinence from smoking was greater and craving, withdrawal symptoms and smoking satisfaction were less at the end of treatment with varenicline than with transdermal NRT. TRIAL REGISTRATION NUMBER: NCT00143325.

Cochlear cytokine gene expression in murine chronic otitis media.

OBJECTIVE: To investigate chronic otitis media (COM) induction of cochlear cytokine genes. STUDY DESIGN: RNA from cochleas of five C3H/HeJ mice with and without COM was isolated for cytokine expression in gene arrays. Immunohistochemistry was performed for the protein products of up-regulated genes to confirm their expression in cochlear tissues. RESULTS: Cochleas from COM mice showed increased expression of 29 genes (>2x normal) and decreased expression of 19 genes (<0.5x normal). Cytokines expressed were largely those related to inflammation and tissue remodeling. Cochlear immunohistochemistry confirmed the presence of numerous cytokines, as well as NF-kB, a major inflammatory transcription factor that drives cytokine expression. CONCLUSION: COM causes elevated levels of cochlear cytokine mRNA, which demonstrates that inner ear tissues are capable of NF-kB activation and cytokine production. This may be another mechanism of otitis media-induced cochlear cytotoxicity in addition to that caused by migration of inflammatory cytokines from the middle ear. SIGNIFICANCE: Cochlear tissues are capable of mounting an immunological response to middle ear inflammatory stimuli.

Cochlear cytokine gene expression in murine acute otitis media.

OBJECTIVE: Recurrent acute otitis media (AOM) causes sensorineural hearing loss by unknown mechanisms. It is widely accepted that inflammatory cytokines diffuse across the round window membrane to exert cytotoxic effects. This study addresses whether inner ear cells are capable of expressing genes for inflammatory cytokines. STUDY DESIGN: The authors conducted a prospective animal study. METHODS: BALB/C mice underwent transtympanic injection of heat-killed Haemophilus influenzae to create an acute inflammatory response. These mice were compared with a control group in addition to a group of uninjected mice found to have otomicroscopic changes consistent with persistent or chronic otitis media. The cochleas of these mice were obtained, their RNA harvested, and cytokine gene expression analyzed using prefabricated cDNA arrays. RESULTS: Four groups of mice (control, 3-day postinjection, 7-day postinjection, and mice with chronic otitis media) with five mice in each group were analyzed. Numerous classes of genes were found to be upregulated or downregulated by more than twofold. Some genes differed from control mice by more than 10-fold. These genes included numerous fibroblast growth factors, interleukins, tumor necrosis factors, and colony-stimulating factors. CONCLUSION: The genes of numerous inflammatory cytokines are either up- or downregulated by murine inner ear cells in response to either acute or chronic inflammation of the middle ear. This study provides a novel site of production of cytokines that may be responsible for the damage seen in sensorineural hearing loss.

The utility of bipolar electrocautery in hereditary hemorrhagic telangiectasia.

OBJECTIVE: The surgical treatment of epistaxis associated with hereditary hemorrhagic telangiectasia (HHT) is varied. Laser therapy is often inadequate for larger complex lesions. This study sought to determine if bipolar cautery can be effectively and safely used in treating HHT-associated epistaxis. STUDY DESIGN AND SETTING: Records from all patients with HHT treated surgically over 8 years were reviewed retrospectively. Outcomes or complications were noted in the clinic on follow-up evaluation. RESULTS: Twenty-seven patients with HHT who underwent surgical treatment of epistaxis were evaluated; 18 were treated with bipolar cautery. Forty-two separate bipolar treatments were performed. No new septal perforations or synechiae were noted. Twenty-two of 42 treatments were coupled with ancillary laser treatments. The bipolar was also used as the sole technique in 20 procedures. CONCLUSION: Bipolar electrocautery is a safe and effective tool for the intraoperative control of HHT-related epistaxis. SIGNIFICANCE: Bipolar electrocautery may be used as an adjunct to laser techniques or as a stand-alone technique. EBM RATING: C-4.

Perioperative parathyroid hormone levels in thyroid surgery.

OBJECTIVE: Perioperative hypocalcemia from temporary parathyroid gland dysfunction is common after thyroid surgery. No reliable cutoff values for parathyroid hormone (PTH) and the subsequent possibility of developing hypocalcemia exist. The purpose of this study is to determine a criterion for predicting hypocalcemia based on different PTH levels as cutoff values. STUDY DESIGN: Retrospective chart review. METHODS: A centralized database of intraoperative PTH levels was analyzed. PTH values approximately 10 minutes after excision of the thyroid gland and in the recovery room were obtained; serial ionized calcium levels were also analyzed. PTH values were then compared using chi-square analysis with significance defined as P < .05. A receiver operator characteristic (ROC) curve was also constructed to define sensitivities and specificities of different PTH levels as potential cutoff values. RESULTS: Eighty patients were identified meeting the study criteria between January 1999 and February 2005. Fourteen of the 80 (17.5%) patients became hypocalcemic during the hospital stay; none experienced permanent hypocalcemia. Patients who became hypocalcemic during their hospitalization were more likely to have a PTH level below 15 pg/mL (P < .01). Patients with a PTH level less than 15 pg/mL were more likely to develop hypocalcemia (P < .01). Finally, an ROC curve was constructed, allowing the surgeon to determine acceptable sensitivities and specificities and various PTH cutoff values. CONCLUSION: Low perioperative PTH levels significantly correlate with the presence of postoperative hypocalcemia but cannot be used to predict it. Using the ROC curve allows different chosen cutoff values to predict hypocalcemia with varying sensitivity and specificity.

Second osteocutaneous fibular free flaps for head and neck defects.

OBJECTIVE: To analyze the morbidity of a second fibular free tissue transfer when necessary in rare instances when the initial fibular flap fails. CASE DESIGN: Retrospective analysis of a case series. METHODS: A database of patients who underwent resection of head and neck malignancies with resultant free flap reconstruction was analyzed retrospectively. All patients undergoing fibular free flaps were studied, and those needing a second fibular osteocutaneous flap were identified. The morbidity from the second flap was evaluated by a standard questionnaire. RESULTS: Seven patients underwent a second fibular osteocutaneous flaps for reconstruction; data were available from six. The indications for the second flap were perioperative flap loss (5 patients), osteoradionecrosis (1), and recurrent tumor (1). Follow-up began at 3 months; mean follow-up was 44 (range 9-67) months. The morbidity of harvesting a second fibular flap was similar to that of a unilateral harvest. Four of six patients rated their overall morbidity as low; one patient indicated an intermediate morbidity, and one patient rated their morbidity from the procedure as major. The only donor site morbidities were episodes of mild cellulitis that resolved with outpatient antibiotics. CONCLUSION: Harvest of a second fibular osteocutaneous is a reasonable option for reconstruction when a second flap becomes needed. The morbidities are comparable with those encountered with a unilateral fibular flap harvest.

Preoperative ultrasound is worthwhile for reoperative parathyroid surgery.

OBJECTIVES/HYPOTHESIS: High-resolution ultrasound and sestamibi scanning are regarded as the first-line methods for preoperative localization of parathyroid adenomas. The utility of ultrasound in reoperative cases has been questioned because of concern that scarring will obscure normal tissue planes and vascularity that are critical to identification of an adenoma using this imaging modality. The purposes of the study were to evaluate the ability of high-resolution ultrasound to accurately localize parathyroid adenomas in the reoperative exploration and to identify any factors that influence its accuracy STUDY DESIGN: Retrospective chart review at a tertiary care academic medical center. METHODS: All patients seen in referral for parathyroid surgery between May 1994 and September 2002 underwent high-resolution ultrasound as their initial diagnostic test. Patients who subsequently underwent exploration were included in the study. Intraoperative and ultrasound findings were compared. RESULTS: One hundred forty-two patients were included, 116 without and 26 with prior exploration. The sensitivity and positive predictive value of ultrasound were 86.9% and 89.1%, respectively. These data were not significantly different in patients without (88.2% and 90%) and in patients with (80% and 84.2%) prior thyroid or parathyroid surgery. The overall accuracy was 79% with a false-negative rate of 11.3%. Thyroid nodularity was significantly more common (81.8%) in patients who had a false-positive or false-negative finding on ultrasound than in the total population (61.3%). CONCLUSION: High-resolution ultrasound is an accurate method for localizing parathyroid adenomas even in patients who have previously undergone parathyroid exploration. However, the presence of thyroid nodules can interfere with its accuracy.

Disease control, survival, and functional outcome after multimodal treatment for advanced-stage tongue base cancer.

BACKGROUND: Surgical resection and postoperative radiation for advanced-stage malignancies of the oral cavity, oropharynx, and hypopharynx result in a dismal overall survival of 38%. Patients with carcinoma of the tongue base frequently have advanced disease at the time of presentation, and combined-modality therapy is usually required to achieve cure. Because of the poor survival rates with advanced malignancies with standard therapy, new and innovative approaches continue to be developed in an attempt to have a greater impact on disease control, patient survival, and functional outcome after therapy. This study examines functional outcome, survival, and disease control in patients receiving an intensified treatment regimen with concomitant chemoradiotherapy, surgery, and intraoperative radiotherapy for previously untreated, resectable, stage III and IV squamous cell carcinoma (SCC) of the tongue base. METHODS: Forty patients with previously untreated, resectable, stage III and IV squamous cell carcinoma of the tongue base were treated in one of three sequential phase II intensification regimens (IRs). Treatment consisted of perioperative, hyperfractionated radiotherapy (9.1 Gy) with concurrent cisplatin followed by surgical resection with intraoperative radiotherapy boost (7.5 Gy). Postoperative treatment involved concurrent chemoradiotherapy (40 Gy to the primary site and upper neck and 45 Gy to the supraclavicular areas) with cisplatin with or without paclitaxel. Locoregional and distant disease control, 2-year overall, and disease-specific survival rates were calculated. The Performance Status Scale (PSS) for Head and Neck Cancer Patients was administered to 25 of the surviving patients. The effects of the method of surgical reconstruction, surgery involving the mandible and/or larynx, and early versus advanced T stage on PSS score were evaluated with the Wilcoxon rank-sum test. RESULTS: Median follow-up in months for IR1, IR2, and IR3 were 83.6, 75.2, and 26.8. The locoregional control rate was 100%, and the rate of distant metastases was 7.5% for all patients. Two-year overall and disease-specific survival rates for the entire study population were 74.7% and 93.6%, respectively. Mean PSS scores by subscales Eating in Public, Understandability of Speech, and Normalcy of Diet were 55 (range, 0-100), 73 (range, 25-100), and 49 (range, 0-100), respectively. PSS scores were significantly higher in patients with primary closure of the surgical defect, no mandibular surgery, and early T-stage lesions. CONCLUSIONS: Although functional outcome may be decreased by certain surgical interventions and advanced T stage, the high rate of locoregional and distant disease control and excellent 2-year disease-specific survival supports an aggressive treatment regimen for advanced tongue base cancer.