Publications by authors named "Alexandra Bourdillon"

12 Publications

  • Page 1 of 1

Anesthesia screen use may impact operating room communication practices in otolaryngology.

Am J Otolaryngol 2021 Mar 22;42(5):103000. Epub 2021 Mar 22.

Department of Otolaryngology, Boston University School of Medicine, Boston, MA, United States.

Objectives: Failures in communication are a leading contributor to medical error. There is increasing attention on cultivating robust communication practices in the Operating Room (OR) to mitigate against patient injury and optimize efficient patient care. Few studies have evaluated how surgical equipment may introduce barriers to team dynamics.

Design: We conducted a pilot observational study to examine the relationship between anesthesia screen drapes (which are used inconsistently) and the frequency of verbal exchanges between surgical and anesthesia members. 25 procedures spanning various procedures in Otolaryngology were covertly observed, 12 of which employed a screen. Verbal exchanges were recorded across three stages of the surgery: pre-procedure (before the draping), procedure (drapes placed throughout) and post-procedure (after the removal of the draping). Speaker and content of the exchange was noted as well as various features about the procedure.

Results: Decreases in rates of exchanges were most pronounced during the procedure stage, although they did not reach significance on T-testing (p = 0.0719). After controlling for attending, table orientation and number of professionals, regression analysis did reveal a statistically significant decrease in rates of verbal exchanges during the procedure in the presence of the anesthesia screen (7.17 (± 6.33) versus 2.23 (± 1.00), p = 0.0318). Differences were also significant among surgeon-initiated and patient-care-related exchanges (p = 0.0168 and p = 0.0432, respectively). Decreases in anesthesiologist-initiated and non-clinical exchanges did not reach significance (p = 0.1530 and p = 0.5120, respectively).

Conclusion: This pilot study suggests that anesthesia screens may negatively impact communication practices in the OR.
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http://dx.doi.org/10.1016/j.amjoto.2021.103000DOI Listing
March 2021

Characterizing Epidemiology and Associated-Factors of Adolescent Sports-Related Traumas Using Trauma Quality Improvement Program.

J Craniofac Surg 2021 Jun;32(4):1618-1621

Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT.

Abstract: Sports-related injuries contribute to a considerable proportion of pediatric and adolescent craniofacial trauma, which can have severe and longstanding consequences on physical and mental health. The growing popularity of sports within this at-risk group warrants further characterization of such injuries in order to enhance management and prevention strategies. In this study, the authors summarized key trends in 1452 sports-related injuries among individuals aged 16 to 19 using the American College of Surgeon's Trauma Quality Improvement Program database from 2014 to 2016. The authors observed a preponderance of injuries associated with skateboarding, snowboarding, and skiing, with significantly higher percentages of traumatic brain injuries among skateboarding-related traumas. Notably, we observed that traumatic brain injurie rates were slightly higher among subjects who wore helmets. Intensive care unit durations and hospital stays appeared to vary by sport and craniofacial fracture. Altogether, this study contributes to the adolescent sports-related injuries and craniofacial trauma literature.
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http://dx.doi.org/10.1097/SCS.0000000000007619DOI Listing
June 2021

Review of probiotic use in otolaryngology.

Am J Otolaryngol 2021 Mar-Apr;42(2):102883. Epub 2021 Jan 5.

Department of Otolaryngology, Boston University School of Medicine, Boston, MA, United States of America. Electronic address:

Objective: Probiotics have garnered considerable attention as an intervention for various conditions common to otolaryngology. The purpose of this review is to evaluate the current literature to offer recommendations about the safety and efficacy of probiotic management in otolaryngologic conditions.

Study Design: Narrative review.

Methods: PubMed and Google Scholar were queried using pertinent keywords to retrieve relevant studies with particular focus in the recent 5 years. All abstracts were assessed and studies, reviews and meta-analyses achieving evaluation of probiotic therapies or characterization of microbiome changes were included for further review. Studies were categorized by condition or anatomic region across various subspecialties. Key data parameters were extracted and evaluated across studies and treatment types.

Results: Strong evidence exists for the use probiotic agents to improve symptoms for allergic rhinitis, chronic rhinosinusitis and certain dental conditions. Despite promising results, further investigation is needed to evaluate and optimize probiotic delivery for mitigating otitis media, oropharyngeal inflammation and upper respiratory tract infections. Preclinical studies suggest that probiotics may potentially offer benefit for voice prosthesis maintenance, wound healing and mitigation of oral dysplasia.

Conclusion: Probiotic therapies may offer clinical benefit in a variety of contexts within the field of otolaryngology, especially for short-term relief of certain inflammatory conditions of the oral cavity, auditory and nasal cavities. Further investigation is warranted for evaluation of long-term outcomes and pathogenic deterrence.
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http://dx.doi.org/10.1016/j.amjoto.2020.102883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914206PMC
January 2021

Does alleviate tinnitus? A review of the current literature.

Laryngoscope Investig Otolaryngol 2020 Dec 30;5(6):1147-1155. Epub 2020 Oct 30.

Division of Otolaryngology - Head and Neck Surgery, Department of Surgery Yale University School of Medicine New Haven Connecticut USA.

Objectives: Endocannabinoid pathways have been proposed to affect the underlying pathophysiology of tinnitus. The aim of this study is to evaluate the scope and findings of existing literature on the relationship between and cannabinoid pathways and tinnitus.

Methods: We conducted a review of animal, clinical and survey studies investigating the relationship between the use of -derived agents and tinnitus. Using pertinent keywords and MeSH terms on PubMed, relevant studies were identified, yielding four animal studies, two large cross-sectional survey studies, one clinical cross-over study, and one case report.

Results: Animal studies revealed that cannabinoid receptor expression in the cochlear nucleus varied with tinnitus symptomatology and the use of cannabinoid agents either increased or had no effect on tinnitus-related behavior. Survey studies yielded conflicting results between use and tinnitus in the general population. Clinical data is largely lacking, although a small cohort study showed a dose-dependent relationship between tetrahydrocannabinol consumption and frequency of tinnitus episodes in patients receiving treatment for cancer.

Conclusion: While animal studies have revealed that cannabinoid receptors likely have a role in modulating auditory signaling, there is no compelling data either from animal or human studies for the use of cannabinoids to alleviate tinnitus. Further research is necessary to elucidate their precise role to guide development of therapeutic interventions.

Level Of Evidence: NA.
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http://dx.doi.org/10.1002/lio2.479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752070PMC
December 2020

Biomimetic six-axis robots replicate human cardiac papillary muscle motion: pioneering the next generation of biomechanical heart simulator technology.

J R Soc Interface 2020 12 2;17(173):20200614. Epub 2020 Dec 2.

Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.

Papillary muscles serve as attachment points for chordae tendineae which anchor and position mitral valve leaflets for proper coaptation. As the ventricle contracts, the papillary muscles translate and rotate, impacting chordae and leaflet kinematics; this motion can be significantly affected in a diseased heart. In heart simulation, an explanted valve is subjected to physiologic conditions and can be adapted to mimic a disease state, thus providing a valuable tool to quantitatively analyse biomechanics and optimize surgical valve repair. However, without the inclusion of papillary muscle motion, current simulators are limited in their ability to accurately replicate cardiac biomechanics. We developed and implemented image-guided papillary muscle (IPM) robots to mimic the precise motion of papillary muscles. The IPM robotic system was designed with six degrees of freedom to fully capture the native motion. Mathematical analysis was used to avoid singularity conditions, and a supercomputing cluster enabled the calculation of the system's reachable workspace. The IPM robots were implemented in our heart simulator with motion prescribed by high-resolution human computed tomography images, revealing that papillary muscle motion significantly impacts the chordae force profile. Our IPM robotic system represents a significant advancement for simulation, enabling more reliable cardiac simulations and repair optimizations.
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http://dx.doi.org/10.1098/rsif.2020.0614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811588PMC
December 2020

The Effect of Surgical Timing on 30-Day Outcomes in Cleft Palate Repair.

Plast Reconstr Surg 2021 01;147(1):131-137

From the Department of Surgery, Section of Plastic Surgery, Yale School of Medicine.

Background: The optimal age for cleft palate repair continues to be debated, with little discussion of surgical risk related to operative timing. This study of 3088 cleft palate patients analyzed the impact of surgical timing on perioperative and 30-day postoperative outcomes.

Methods: Primary cleft palate repairs were identified in the National Surgical Quality Improvement Program database from 2012 to 2015. Data were combed for total postoperative complications, rates of readmission and reoperation, operating room time, and length of stay. Bivariate analyses were performed comparing 3-month periods from months 6 to 18, and months 0 to 5, 18 to 23, 24 to 29, and 30 to 59.

Results: Despite a higher proportion of isolated soft palate closure, children operated on before 6 months had a higher complication rate than children at other ages (7.1 percent versus 3.2 percent; OR, 2.4; p = 0.04), and higher rates of both readmission (3.6 percent versus 1.4 percent; OR, 3.6; p = 0.02) and reoperation (2.4 percent versus 0.5 percent; OR, 4.7; p = 0.04). There were no differences in short-term outcomes for any other age group younger than 5 years, and no differences in hospital length of stay among any age groups.

Conclusions: The authors' findings suggest a relative contraindication to operation before 6 months. As there were no differences between any other age groups, long-term speech optimization should continue to be the primary consideration for operative planning. These findings improve the current rationale for palatoplasty timing, and can aid surgeons and parents in the surgical decision-making process.

Clinical Question/level Of Evidence: Therapeutic, III.
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http://dx.doi.org/10.1097/PRS.0000000000007458DOI Listing
January 2021

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous-site tumors.

Head Neck 2020 11 2;42(11):3352-3363. Epub 2020 Aug 2.

Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: The aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous-site tumors.

Methods: Descriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004-2016).

Results: Of 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5-year OS: 53.4% [SE: 2.5%]) compared with cartilage tumors (5-year OS: 84.6% [SE: 1.8%]) (log-rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio [HR] 0.495 [95% CI: 0.366-0.670]). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 [0.697-2.438]).

Conclusion: Treatment that included surgery was associated with an increased OS within our cohort of HN osseous-site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.
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http://dx.doi.org/10.1002/hed.26389DOI Listing
November 2020

Progressive Trigeminal Hypoesthesia.

JAMA Otolaryngol Head Neck Surg 2020 08;146(8):756-757

Division of Head & Neck Surgery, Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamaoto.2020.1100DOI Listing
August 2020

Acellular therapeutic approach for heart failure: in vitro production of extracellular vesicles from human cardiovascular progenitors.

Eur Heart J 2018 05;39(20):1835-1847

Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS-970, Paris Centre de Recherche Cardiovasculaire, 56, rue Leblanc, 75015 Paris, France.

Aims: We have shown that extracellular vesicles (EVs) secreted by embryonic stem cell-derived cardiovascular progenitor cells (Pg) recapitulate the therapeutic effects of their parent cells in a mouse model of chronic heart failure (CHF). Our objectives are to investigate whether EV released by more readily available cell sources are therapeutic, whether their effectiveness is influenced by the differentiation state of the secreting cell, and through which mechanisms they act.

Methods And Results: The total EV secreted by human induced pluripotent stem cell-derived cardiovascular progenitors (iPSC-Pg) and human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) were isolated by ultracentrifugation and characterized by Nanoparticle Tracking Analysis, western blot, and cryo-electron microscopy. In vitro bioactivity assays were used to evaluate their cellular effects. Cell and EV microRNA (miRNA) content were assessed by miRNA array. Myocardial infarction was induced in 199 nude mice. Three weeks later, mice with left ventricular ejection fraction (LVEF) ≤ 45% received transcutaneous echo-guided injections of iPSC-CM (1.4 × 106, n = 19), iPSC-Pg (1.4 × 106, n = 17), total EV secreted by 1.4 × 106 iPSC-Pg (n = 19), or phosphate-buffered saline (control, n = 17) into the peri-infarct myocardium. Seven weeks later, hearts were evaluated by echocardiography, histology, and gene expression profiling, blinded to treatment group. In vitro, EV were internalized by target cells, increased cell survival, cell proliferation, and endothelial cell migration in a dose-dependent manner and stimulated tube formation. Extracellular vesicles were rich in miRNAs and most of the 16 highly abundant, evolutionarily conserved miRNAs are associated with tissue-repair pathways. In vivo, EV outperformed cell injections, significantly improving cardiac function through decreased left ventricular volumes (left ventricular end systolic volume: -11%, P < 0.001; left ventricular end diastolic volume: -4%, P = 0.002), and increased LVEF (+14%, P < 0.0001) relative to baseline values. Gene profiling revealed that EV-treated hearts were enriched for tissue reparative pathways.

Conclusion: Extracellular vesicles secreted by iPSC-Pg are effective in the treatment of CHF, possibly, in part, through their specific miRNA signature and the associated stimulation of distinct cardioprotective pathways. The processing and regulatory advantages of EV could make them effective substitutes for cell transplantation.
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http://dx.doi.org/10.1093/eurheartj/ehy012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251654PMC
May 2018

An innovative biologic system for photon-powered myocardium in the ischemic heart.

Sci Adv 2017 06 14;3(6):e1603078. Epub 2017 Jun 14.

Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.

Coronary artery disease is one of the most common causes of death and disability, afflicting more than 15 million Americans. Although pharmacological advances and revascularization techniques have decreased mortality, many survivors will eventually succumb to heart failure secondary to the residual microvascular perfusion deficit that remains after revascularization. We present a novel system that rescues the myocardium from acute ischemia, using photosynthesis through intramyocardial delivery of the cyanobacterium . By using light rather than blood flow as a source of energy, photosynthetic therapy increases tissue oxygenation, maintains myocardial metabolism, and yields durable improvements in cardiac function during and after induction of ischemia. By circumventing blood flow entirely to provide tissue with oxygen and nutrients, this system has the potential to create a paradigm shift in the way ischemic heart disease is treated.
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http://dx.doi.org/10.1126/sciadv.1603078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470824PMC
June 2017

Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis.

Clin Orthop Relat Res 2017 Feb 7;475(2):522-528. Epub 2016 Nov 7.

Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor, Dept A26 MC 6342, Redwood City, CA, 94063, USA.

Background: Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine manipulation of implements and tools. In the clinical setting, we commonly measure the grip strength of gross grasp with a hand dynamometer in patients with CMC OA. Cylindrical grasp, which requires more thumb contribution than gross grasp, is an alternative method of measuring grip strength and one that may provide insight into thumb-related conditions. Because gross grasp and cylindrical grasp use the thumb in different planes, measurement of gross grasp alone might underestimate impairment. Therefore, it is important to evaluate cylindrical grasp as well. To our knowledge this tool has yet to be examined in a population with early thumb CMC OA.

Questions/purposes: (1) Is cylindrical grasp and gross grasp strength reduced in subjects with early thumb CMC OA compared with asymptomatic control subjects? (2) What is the association of cylindrical and gross grasp to thumb CMC OA after adjusting for age, sex, and hand dominance?

Methods: We recruited 90 subjects with early symptomatic and radiographic thumb CMC OA and 38 asymptomatic healthy control subjects for this multisite controlled study. Demographic information, hand examination, comprehensive histories, plain film radiographs, and cylindrical and gross grasp strength data were collected on all 128 subjects. Mean grasp strength was calculated for cylindrical and gross grasp in the population with early CMC OA and the control population. A t-test was performed on cylindrical and gross grasp to evaluate the difference between the mean in the control and early CMC OA populations. We used separate linear regression models for the two types of grasp to further quantify the association of grasp with a diagnosis of early thumb CMC OA controlling for age, sex, and whether the subject used their dominant or nondominant hand in the study.

Results: Cylindrical grasp was weaker in the population with thumb CMC OA compared with healthy control subjects (6.3 ± 2.7 kg versus 8.4 ± 2.5 kg; mean difference, 2.1; 95% CI, 1.1-3.1; p < 0.001), but there was no difference in gross grasp force (29.6 ± 11.6 kg versus 31.4 ± 10.1 kg; mean difference, 1.7; 95% CI, -2.5 to 6.0; p = 0.425). When adjusting for age, sex, and handedness, cylindrical grasp reduction was related to CMC OA (β = -2.3; standard error [SE], 0.46; p < 0.001) (Y-intercept = 8.2; SE, 1.8; R = 0.29), whereas gross grasp was not reduced in early thumb CMC OA (β = -2.8; SE, 1.6; p = 0.072) (Y-intercept = 34.3; SE, 6.3; R = 0.48).

Conclusions: A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages.

Clinical Relevance: Cylindrical grasp may serve as a more-sensitive measure for detecting early changes in early CMC OA. The associated decline in hand function also might provide an opportunity for measuring the effectiveness of treatment and intervention.
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http://dx.doi.org/10.1007/s11999-016-5151-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5213951PMC
February 2017