Characterizing Pediatric Bilateral Vocal Fold Dysfunction: Analysis with the Pediatric Health Information System Database.

OBJECTIVES: The purpose of this study was to characterize pediatric bilateral vocal fold dysfunction and to examine the overall inpatient mortality. METHODS: Retrospective cohort analysis. Data from the Pediatric Health Information System was gathered for all pediatric patients with a diagnosis of bilateral vocal fold dysfunction between January 2008 and September 2020. Univariate and multivariate analyses were performed using Cox proportional hazard models. RESULTS: 2395 patients accounted for 4799 hospitalizations with bilateral vocal fold dysfunction. Inpatient mortality occurred in 2.9% of the study sample. Chiari 2 was found in 2.8% of patients. The most common associated diagnoses were related to comorbid respiratory conditions (61.1%). The median adjusted ratio of cost to charges was $76,569. Aspiration was noted in 28 patients (1.2%). Gastrostomy was performed in 607 patients (25.3%). Tracheostomy was performed in 27% of patients. The overall 90-day readmission rate was 61%. On multivariate analysis, prognostic factors associated with increased hospital survival include gastrointestinal comorbidities (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.18-0.49) and tracheostomy (HR: 0.21; 95% CI: 0.12-0.37). CONCLUSION: This database study represents the largest cohort analysis to date characterizing bilateral vocal fold dysfunction. Favorable prognostic indicators of overall hospital survival include gastrointestinal comorbidities and the presence of tracheostomy. Tracheostomy is associated with an increase in hospital costs, comorbidities, gastrostomy tube placement, and Chiari diagnosis. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1228-1233, 2023.

Level of Evidence in Facial Plastic Surgery Research: A Procedure-Level Analysis.

BACKGROUND: As evidence-based medicine has taken hold across medical specialties, the level of evidence within the facial plastic surgery literature has risen, but remains weak in comparison. There has not yet been a systematic, critical appraisal of the relative strength of evidence among subsets of the practice of facial plastic surgery. METHODS: The current study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature. Five journals were queried using facial plastic surgery terms for four selected years over a 10-year period. Following screening, articles were assigned to a category regarding subject matter, assessed for the presence of various methodological traits, and evaluated for overall level of evidence. Comparisons were made in regard to level of evidence across the breadth of facial plastic surgery subject matter. RESULTS: A total of 826 articles were included for final review. Studies on operative facial rejuvenation and rhinoplasty had significantly fewer authors on average than studies on cancer reconstruction or craniofacial topics. Craniofacial studies demonstrated higher levels of evidence relative to all other categories, with the exception of facial paralysis and facial trauma studies, from which there was no significant difference. In general, reconstructive studies had significantly more authors and higher levels of evidence than did articles with an aesthetic focus. CONCLUSION: Level of evidence in facial plastic surgery remains relatively weak overall. Reconstructive and particularly craniofacial studies demonstrate higher mean level of evidence, relative to other subsets of facial plastic surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

An Update on Level of Evidence Trends in Facial Plastic Surgery Research.

Background: Knowledge of the quality of evidence in facial plastic surgery research is essential for the implementation of evidence-based practices. The purpose of this study is to provide an update over the past decade as to whether the level of evidence in leading journals featuring topics in facial plastic surgery has changed in comparison with prior reports. Materials and Methods: This study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature over time. Five journals were queried using facial plastic surgery keywords for four selected years for a 10-year period. After screening, articles were assessed for the presence of various methodological traits and were evaluated for overall level of evidence. These variables were compared across the years studied to evaluate trends in level of evidence. Results: A total of 826 articles were included for final review. For all selected years, level IV or level V evidence was the most prevalent level of evidence. Over time, significantly less level IV (p = 0.009) and significantly more level II (p = 0.007) evidence was published. The proportion of studies reporting confidence intervals (p < 0.001) and p-values (p = 0.02) were significantly greater in later years. Conclusions: The level of evidence of facial plastic surgery literature has increased over time, as demonstrated by an increased proportion of level II evidence, decreased proportion of level IV evidence, and increased use of p-values and confidence intervals. The absolute number of randomized controlled trials continues to remain low.

Histopathologic analysis in the diagnosis and management of chronic rhinosinusitis.

PURPOSE OF REVIEW: New research in the pathogenesis of chronic rhinosinusitis has shed light on an emerging classification system based on endotypes, which help to explain the individualized mechanism of disease in patients suffering from chronic rhinosinusitis with and without nasal polyps. The purpose of this review is to advocate the use of structured histopathologic analysis in the diagnosis and management of patients affected by chronic rhinosinusitis with and without polyps. RECENT FINDINGS: Numerous studies have demonstrated the role of inflammation in chronic rhinosinusitis and the ensuing histopatholgic changes. Few studies have implemented structured histopathologic analysis to guide diagnosis and treatment. Individualized therapy including biotherapeutics and comprehensive surgery has shown to improve outcomes in patients with refractory disease. SUMMARY: Structured histopathologic analysis can provide helpful information on the endotype of chronic rhinosinusitis. Routine use in clinical practice should be standardized especially in cases of chronic rhinosinusitis refractory to medical therapy and/or surgery.

CT perfusion imaging of lung cancer: benefit of motion correction for blood flow estimates.

PURPOSE: CT perfusion (CTP) imaging assessment of treatment response in advanced lung cancer can be compromised by respiratory motion. Our purpose was to determine whether an original motion correction method could improve the reproducibility of such measurements. MATERIALS AND METHODS: The institutional review board approved this prospective study. Twenty-one adult patients with non-resectable non-small-cell lung cancer provided written informed consent to undergo CTP imaging. A motion correction method that consisted of manually outlining the tumor margins and then applying a rigid manual landmark registration algorithm followed by the non-rigid diffeomorphic demons algorithm was applied. The non-motion-corrected and motion-corrected images were analyzed with dual blood supply perfusion analysis software. Two observers performed the analysis twice, and the intra- and inter-observer variability of each method was assessed with Bland-Altman statistics. RESULTS: The 95% limits of agreement of intra-observer reproducibility for observer 1 improved from -84.4%, 65.3% before motion correction to -33.8%, 30.3% after motion correction (r = 0.86 and 0.97, before and after motion correction, p < 0.0001 for both) and for observer 2 from -151%, 96% to -49 %, 36 % (r = 0.87 and 0.95, p < 0.0001 for both). The 95% limits of agreement of inter-observer reproducibility improved from -168%, 154% to -17%, 25%. CONCLUSION: The use of a motion correction method significantly improves the reproducibility of CTP estimates of tumor blood flow in lung cancer. KEY POINTS: • Tumor blood flow estimates in advanced lung cancer show significant variability. • Motion correction improves the reproducibility of CT blood flow estimates in advanced lung cancer. • Reproducibility of blood flow measurements is critical to characterize lung tumor biology and the success of treatment in lung cancer.