Infected Thornwaldt Cyst: Case Report of an Unusual Cause of Pediatric Neck Pain.

BACKGROUND: The differential diagnosis for pediatric neck pain is broad and includes benign and life-threatening entities. The neck is a complex structure with many compartments. Rare disease processes exist that can mimic more serious conditions, such as meningitis. CASE REPORT: We present a case of a teenager with several days of severe pain underneath her left jaw, limiting the motion of her neck. After laboratory and imaging evaluation, the patient was found to have an infected Thornwaldt cyst and was subsequently admitted for IV antibiotic treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Including infected congenital cysts on the differential for pediatric neck pain can help ensure appropriate use of invasive procedures, such as lumbar puncture. Missed cases of infected congenital cysts could lead to patients returning to the emergency department with persistent or worsened symptoms.

Otolaryngology residents' experiences of pregnancy and return to work: A multisite qualitative study.

Objectives: A paucity of literature exists about childbearing during otolaryngology residency. Pregnancy is a common part of many physician life cycles, but the timing of residency and the rigors of surgical training amplify the challenges. This study was designed to understand the experiences of childbearing otolaryngology residents and support them during this major life event. Unique challenges include long training, shortage of role models, combination surgical and clinical work, and higher rates of infertility. Study Design: Qualitative research. IRB exempt. Setting: United States. Methods: To capture modern perspectives, 16 current and former otolaryngology residents that experienced pregnancy and childbirth during residency in all four geographic regions of the United States in the past 10 years were recruited to participate in individual structured qualitative interviews. Results: Although there was significant training program and personal anxiety reported by childbearing otolaryngology residents, many surgeons experienced healthy pregnancies and postpartum recoveries with minimal disruption to clinical productivity and minimal disruption to their training programs. Multiple recurring themes were identified among the participants spanning the entire childbearing process: increased incidence of pregnancy complications and preterm labor, pregnancy stigma from leadership and coresidents, scheduling logistics regarding call and parental leave, and challenging transitions back to clinical work while navigating breastfeeding and childcare. Conclusion: There are actional recommendations that programs can address to make childbearing during residency accessible and acceptable. Understanding these challenges is an important step to encouraging childbearing residents to prosper in academic otolaryngology, increasing the diversity at the highest levels of the field. Level of Evidence: 4.

Ring Finger Protein 11 (RNF11) Modulates Dopamine Release in Drosophila.

Recent work indicates a role for RING finger protein 11 (RNF11) in Parkinson disease (PD) pathology, which involves the loss of dopaminergic neurons. However, the role of RNF11 in regulating dopamine neurotransmission has not been studied. In this work, we tested the effect of RNF11 RNAi knockdown or overexpression on stimulated dopamine release in the larval Drosophila central nervous system. Dopamine release was stimulated using optogenetics and monitored in real-time using fast-scan cyclic voltammetry at an electrode implanted in an isolated ventral nerve cord. RNF11 knockdown doubled dopamine release, but there was no decrease in dopamine from RNF11 overexpression. RNF11 knockdown did not significantly increase stimulated serotonin or octopamine release, indicating the effect is dopamine specific. Dopamine clearance was also changed, as RNF11 RNAi flies had a higher Vmax and RNF11 overexpressing flies had a lower Vmax than control flies. RNF11 RNAi flies had increased mRNA levels of dopamine transporter (DAT) in RNF11, confirming changes in DAT. In RNF11 RNAi flies, release was maintained better for stimulations repeated at short intervals, indicating increases in the recycled releasable pool of dopamine. Nisoxetine, a DAT inhibitor, and flupenthixol, a D2 antagonist, did not affect RNF11 RNAi or overexpressing flies differently than control. Thus, RNF11 knockdown causes early changes in dopamine neurotransmission, and this is the first work to demonstrate that RNF11 affects both dopamine release and uptake. RNF11 expression decreases in human dopaminergic neurons during PD, and that decrease may be protective by increasing dopamine neurotransmission in the surviving dopaminergic neurons.

Long-term Audiometric Outcomes After Atresiaplasty for Congenital Aural Atresia.

OBJECTIVE: Describe long-term trends and stability of hearing outcomes for patients undergoing primary congenital aural atresia (CAA) repair. STUDY DESIGN: Retrospective chart review. SETTING: Single academic, tertiary referral center. PATIENTS: Children and adults who underwent primary CAA repair between 1980 and 2017. INTERVENTION: CAA repair. MAIN OUTCOME MEASURES: Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) air conduction pure-tone average (AC PTA) compared with the immediate (within 90 d of surgery) postoperative audiogram. RESULTS: The mean preoperative AC PTA was 59.6 dB HL. CAA repair improved hearing an average of 30.5 dB, but hearing declined by 8.2 dB over the long-term follow-up period (mean 4.4 yr; range 1-15.7 yr), leaving a final mean improvement of 22.2 dB (final mean AC PTA 37.3 dB HL). Two-thirds (92 of 138 ears) had an AC PTA ≤ 30 dB HL recorded in the first year after surgery. At the last follow-up test, 64% had "stable" hearing defined as no more than a 10 dB decline in AC PTA compared with the immediate postoperative audiogram; 21% had a 10 to 20 dB decline, 8% a 20 to 30 dB decline, and 7% declined > 30 dB. CONCLUSIONS: All patients enjoyed improvement in AC PTA after surgery (preoperative minus the best postoperative PTA, mean = 34 dB, range = 3.3-52 dB). Hearing declined by an average 8.2 dB over the long-term leaving a final average AC PTA of 37.4 dB HL. Sixty-four percent of patients exhibited stable (< 10 dB loss) hearing over time; 36% lost 10 dB or more over the long-term follow-up period. Hearing results typically stabilize over time with most of the change occurring in the first 3 years after CAA repair. Bone conduction thresholds remained stable over the study period.

The impact of learning communities on interpersonal relationships among medical students.

BACKGROUND: Medical students at the University of Virginia (UVA) are mentored and learn within the framework of a four college learning community. Uniquely, these learning communities are used to organize the third-year clerkship rotations. METHODS: Students were surveyed after their first pre-clinical year and after their clerkship year to determine what the effect of the learning community was on their social and educational interpersonal relationships. RESULTS: Students knew a higher percentage of their college mates after completing their third-year clerkships within the framework of the college system. Students chose peers from within the college system for social and educational interpersonal scenarios statistically more often than what would be expected at random. Small group learning environments that were not formed within the framework of the college system at UVA did not have the same effect on interpersonal relationships, indicating that learning communities are uniquely able to provide a context for relationship building. Students felt more positively about the social and educational effects of the college system after the clerkship year, with a corresponding increase in the strength of their interpersonal bonds with their college peers. CONCLUSION: This work is the first to investigate the effects of learning communities on interpersonal relationships among medical students and finds that learning communities positively impact both social and educational medical student bonds.

Fast-Scan Cyclic Voltammetry (FSCV) Detection of Endogenous Octopamine in Drosophila melanogaster Ventral Nerve Cord.

Octopamine is an endogenous biogenic amine neurotransmitter, neurohormone, and neuromodulator in invertebrates and has functional analogy with norepinephrine in vertebrates. Fast-scan cyclic voltammetry (FSCV) can detect rapid changes in neurotransmitters, but FSCV has not been optimized for octopamine detection in situ. The goal of this study was to characterize octopamine release in the ventral nerve cord of Drosophila larvae for the first time. A FSCV waveform was optimized so that the potential for octopamine oxidation would not be near the switching potential where interferences can occur. Endogenous octopamine release was stimulated by genetically inserting either the ATP sensitive channel, P2X2, or the red-light sensitive channelrhodopsin, CsChrimson, into cells expressing tyrosine decarboxylase (TDC), an octopamine synthesis enzyme. To ensure that release is due to octopamine and not the precursor tyramine, the octopamine synthesis inhibitor disulfiram was applied, and the signal decreased by 80%. Stimulated release was vesicular, and a 2 s continuous light stimulation of CsChrimson evoked 0.22 ± 0.03 µM of octopamine release in the larval ventral nerve cord. Repeated stimulations were stable with 2 or 5 min interstimulation times. With pulsed stimulations, the release was dependent on the frequency of applied light pulse. An octopamine transporter has not been identified, and blockers of the dopamine transporter and serotonin transporter had no significant effect on the clearance time of octopamine, suggesting that they do not take up octopamine. This study shows that octopamine can be monitored in Drosophila, facilitating future studies of how octopamine release functions in the insect brain.