Utility of video fluoroscopic swallow study in advancing oral diet post TORS for oropharyngeal malignancies.

OBJECTIVE: TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to TORS, this study explores both subjective and objective swallowing outcomes. STUDY DESIGN: Retrospective and prospective review of the patients who underwent TORS for oropharyngeal malignancy from 2018 to 2023. SETTING: Single tertiary referral center. METHODS: Postoperative transnasal feeding tubes were administered to 142 patients undergoing TORS. Data on oncological, clinical, surgical, and pathological parameters, including VFSS records, pain with swallow, and feeding tube removal timing, were collected. Clinical swallow exam (CSE) was conducted on POD-1, with a formal swallow study pursued if inconclusive. Once a safe swallow was confirmed, oral diets were initiated, and the feeding tube removed, with most patients discharged on POD-2. RESULTS: At an average age of 59.3 years on the day of operation, the palatine tonsil (N = 101) was the predominant subsite. A dobhoff feeding tube was intraoperatively placed in 98 % of patients (N = 139). On POD-1, CSE was conducted in 119 patients, with 26 % (37/119) cleared for total oral diet (NOMS ≥ 4). Additionally, 30 out of 73 VFSS patients were cleared for total oral diet. A total of 54.9 % (78/142) had the feeding tube removed before discharge on POD-2, with a mean time of 6.5 ± 6.6 days. Overall, 71.1 % (101/142) achieved a total oral diet within one week after TORS. CONCLUSION: Early post-TORS swallowing is vital for oropharyngeal malignancies. VFSS assesses post-operative swallowing safety, allowing most patients to resume total oral nutrition shortly after TORS.

Dysphagia in the Aging Population.

Older adults are projected to outnumber children aged under 18 years for the first time in United States history by 2034, according to Census Bureau projections. This will lead to significant increase in age-related disorders. One of the most important disorders that will increase in prevalence is dysphagia, as it leads to malnutrition, dehydration, aspiration pneumonia, and death. In this article, the physiology of dysphagia in the elderly, as well as the management options is discussed.

Effects of Isoflurane Anesthesia on C57BL/6J Pups after Cervical Dislocation of Dams.

Inhalant anesthesia is routinely used for cesarian section in many animal species, allowing the safe delivery of neonates and smooth recovery of dams. However, in mice, inhalant anesthesia in cesarean section may be avoided due to fear of negative health effects on retrieved pups. This study compared the effects of isoflurane anesthesia on pups after cervical dislocation of conscious and anesthetized dams. Time-mated C57BL/6J dams were either anesthetized with 5% isoflurane or were conscious during cervical dislocation. Rederived pups were fostered to Swiss Webster dams and weaned at 21 d. Weights of litters were recorded at birth, and individual pup weights were recorded at weaning. We found no significant difference between the two treatment groups in pup survival until weaning. We also found no significant difference when comparing the average weaning weights of all the male pups to that of all the female. Female pups from isoflurane-treated dams had significantly higher weaning weights than did those from unanesthetized dams; however, the weights of male pups from the two groups were not different at weaning. This study found no immediate negative effects of using isoflurane anesthesia prior to cervical dislocation of C57BL/6J pregnant dams for the purpose of rederivation. Isoflurane can be used for cervical dislocation of pregnant C57BL/6J dams without affecting pup survival.

Retrospective Examination of the GILLS Algorithm Applied to Mandibular Distraction.

Background: The GILLS (gastroesophageal reflux, preoperative intubation, late intervention (>14 days), low birth weight (<2500 g), and syndromic diagnosis) score is a validated predictor of success for tongue-lip adhesion (TLA) in patients with Robin sequence (RS). Objective: To evaluate the application of the GILLS score to mandibular distraction osteogenesis (MDO) for airway management in patients with RS and the associated syndromes. Methods: A retrospective chart review of 21 patients diagnosed with RS and treated with MDO surgery between the years 2006 and 2016 was performed. Success was defined by tracheostomy status outcome measures. Statistical analysis of the success was completed. Results: A GILLS score limit of ≤3 had a positive predictive value of 100%, a negative predictive value of 50%, 83% sensitivity, and 100% specificity. Conclusions: These data imply that the GILLS scoring algorithm is applicable to aiding in the selection of patients with RS for MDO, including patients with known syndromes.

Perioperative Indicators of Prognosis in Acute Invasive Fungal Sinusitis.

OBJECTIVE: The purpose of this study is to identify perioperative independent prognostic factors that are available to the consulting team to aid in determining prognosis in patients with acute invasive fungal sinusitis. STUDY DESIGN: Retrospective chart review of patients with biopsy-proven acute invasive fungal sinusitis from 2015 to 2018. SETTING: Academic tertiary care center. METHODS: Twenty-one patients were included from our single-center retrospective review. Kaplan-Meier graphs were created, and the Breslow test used to compare the curves to obtain P values. A univariate Cox regression analysis was performed on the data that were significant at 3 months from diagnosis. RESULTS: Twenty-one patients were included, and 17 (76%) had an underlying hematologic malignancy. Overall survival was 71% and 52% at 1 and 3 months, respectively, and 94% of patients with hematologic malignancy had an absolute neutrophil count ≤1 at diagnosis. Absolute neutrophil count values and fungal species were not associated with a difference in prognosis. Factors associated with decreased survival included current smoking and the absence of a rhinologist on the treatment team at the initial or subsequent debridement (hazard ratio, 3.03). Laboratory values such as beta-D-glucan and galactomannan were assessed in addition to disease extension at diagnosis. CONCLUSION: This study presents a retrospective review of a single institution's experience with acute invasive fungal sinusitis. Subspecialty level of care likely improves overall survival in these patients, whereas current smoking may imply a worse prognosis.

Redox-Magnetohydrodynamically Controlled Fluid Flow with Poly(3,4-ethylenedioxythiophene) Coupled to an Epitaxial Light Sheet Confocal Microscope for Image Cytometry Applications.

We present the merging of two technologies to perform continuous high-resolution fluorescence imaging of cellular suspensions in a deep microfluidics chamber with no moving parts. An epitaxial light sheet confocal microscope (e-LSCM) was used to image suspensions enabled by fluid transport via redox-magnetohydrodynamics (R-MHD). The e-LSCM features a linear solid state sensor, oriented perpendicular to the direction of flow, that can bin the emission across different numbers of pixels, yielding electronically adjustable optical sectioning. This, in addition to intensity thresholding, defines the axial resolution, which was validated with an optical phantom of polystyrene microspheres suspended in agarose. The linear fluid speed within the microfluidics chamber was uniform (0.16-2.9%) across the 0.5-1.0 mm lateral field of view (dependent upon the chosen magnification) with continuous acquisition. Also, the camera's linear exposure periods were controlled to ensure an accurate image aspect ratio across this span. Poly(3,4-ethylenedioxythiophene) (PEDOT) was electrodeposited as an immobilized redox film on electrodes of a chip for R-MHD, and the fluid flow was calibrated to specific linear speeds as a function of applied current. Images of leukocytes stained with acridine orange, a fluorescent, amphipathic vital dye that intercalates DNA, were acquired in the R-MHD microfluidics chamber with the e-LSCM to demonstrate imaging of biological samples. The combination of these technologies provides a miniaturizable platform for large sample volumes and high-throughput, image-based analysis without the requirement of moving parts, enabling development of robust, point-of-care image cytometry.

Rural Family Medicine Outcomes at the University of Minnesota Medical School Duluth.

BACKGROUND AND OBJECTIVES: The University of Minnesota Medical School Duluth (MSD) opened in 1972 with a mission to train physicians serving rural Minnesota, emphasizing family medicine and American Indian (AI) communities. Nationwide there are shortages in family medicine and AI physicians, and MSD is a leader in these outcomes. METHODS: This is a longitudinal, retrospective cohort analysis of 1972-2009 MSD graduates using descriptive statistics and multivariate regression to determine relationships between gender, race, age, and hometown and outcomes of family medicine specialty, rural practice, and rural family medicine practice. RESULTS: MSD graduate outcomes are significantly higher than other US medical schools but declining, 47% chose family medicine and 37% chose a rural first practice location. Selection of rural and family medicine declined more rapidly for men than women, but there was no overall gender difference. AI graduates had rates of rural family medicine similar to their white classmates and older AI students were more likely to select rural family medicine. Graduates from rural hometowns were more likely to select rural practice but not to practice family medicine. CONCLUSIONS: MSD culture and curricula produce AI, family medicine, and rural physicians, but the school is experiencing a downward trend. Understanding the relationship between demographics and outcomes over time will assist policy makers and educators in optimizing strategies to develop the rural family medicine workforce.