Publications by authors named "Brandyn Dunn"

16 Publications

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Functional brow lifting.

Authors:
Brandyn Dunn

Facial Plast Surg 2022 Jun 23. Epub 2022 Jun 23.

Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, United States.

Brow ptosis is an abnormal descent of the eyebrow resulting in a displeased appearance and/or functional deficit. While most cases of brow ptosis do not result in a functional impairment, functional brow surgery is generally reserved for individuals with severe brow asymmetry or visual field deficit related to excess soft tissue pushing downwards on the eyelid. A combination of both intrinsic and extrinsic anatomic factors contributes to an unfavorable brow shape, contour, and position. Proper management of brow ptosis requires an understanding of both surgical and non-surgical modalities. Traditionally, individuals with functional brow ptosis are treated by browpexy via blepharoplasty approach, direct browlift, mid-forehead browlift, or less commonly endoscopic browlift.
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http://dx.doi.org/10.1055/a-1883-0483DOI Listing
June 2022

Exploring feedback-controlled versus open-circuit electrochemical lipolysis in ex vivo and in vivo porcine fat: A feasibility study.

Lasers Surg Med 2022 01 19;54(1):157-169. Epub 2021 Aug 19.

Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, California, USA.

Objectives: Minimally invasive fat sculpting techniques are becoming more widespread with the development of office-based devices and therapies. Electrochemical lipolysis (ECLL) is a needle-based technology that uses direct current (DC) to electrolyze tissue water creating acid and base in situ. In turn, fat is saponified and adipocyte cell membrane lysis occurs. The electrolysis of water can be accomplished using a simple open-loop circuit (V-ECLL) or by incorporating a feedback control circuit using a potentiostat (P-ECLL). A potentiostat utilizes an operational amplifier with negative feedback to allow users to precisely control voltage at specific electrodes. To date, the variation between the two approaches has not been studied. The aim of this study was to assess current and charge transfer variation and lipolytic effect created by the two approaches in an in vivo porcine model.

Methods: Charge transfer measurements from ex vivo V-ECLL and P-ECLL treated porcine skin and fat were recorded at -1 V P-ECLL, -2 V P-ECLL, -3 V P-ECLL, and -5 V V-ECLL each for 5 min to guide dosimetry parameters for in vivo studies. In follow-up in vivo studies, a sedated female Yorkshire pig was treated with both V-ECLL and P-ECLL across the dorsal surface over a range of dosimetry parameters, including -1.5 V P-ECLL, -2.5 V P-ECLL, -3.5 V P-ECLL, and 5 V V-ECLL each treated for 5 min. Serial biopsies were performed at baseline before treatment, 1, 2, 7, 14, and 28 days after treatment. Tissue was examined using fluorescence microscopy and histology to compare the effects of the two ECLL approaches.

Results: Both V-ECLL and P-ECLL treatments induced in-vivo fat necrosis evident by adipocyte membrane lysis, adipocyte denuclearization, and an acute inflammatory response across a 28-day longitudinal study. However, -1.5 V P-ECLL produced a smaller spatial necrotic effect compared to 5 V V-ECLL. In addition, 5 V V-ECLL produced a comparable necrotic effect to that of -2.5 V and -3.5 V P-ECLL.

Conclusions: V-ECLL and P-ECLL at the aforementioned dosimetry parameters both achieved fat necrosis by adipocyte membrane lysis and denuclearization. The -2.5 V and -3.5 V P-ECLL treatments created spatially similar fat necrotic effects when compared to the 5 V V-ECLL treatment. Quantitatively, total charge transfer between dosimetry parameters suggests that -2.5 V P-ECLL and 5 V V-ECLL produce comparable electrochemical reactions. Such findings suggest that a low-voltage closed-loop potentiostat-based system is capable of inducing fat necrosis to a similar extent compared to that of a higher voltage direct current system.
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http://dx.doi.org/10.1002/lsm.23466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8770526PMC
January 2022

Ischemic heart injury leads to HIF1-dependent differential splicing of CaMK2γ.

Sci Rep 2021 06 23;11(1):13116. Epub 2021 Jun 23.

Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB 311, Honolulu, HI, 96813, USA.

Ischemic heart disease is a leading cause of heart failure and hypoxia inducible factor 1 (HIF1) is a key transcription factor in the response to hypoxic injury. Our lab has developed a mouse model in which a mutated, oxygen-stable form of HIF1α (HIF-PPN) can be inducibly expressed in cardiomyocytes. We observed rapid cardiac dilation and loss of contractility in these mice due to lower expression of excitation-contraction coupling genes and reduced calcium flux. As alternative splicing plays an underappreciated role in transcriptional regulation, we used RNA sequencing to search for splicing changes in calcium-handling genes of HIF-PPN hearts and compared them to previous sequencing data from a model of myocardial infarction (MI) to select for transcripts that are modified in a pathological setting. We found overlap between genes differentially expressed in HIF-PPN and post-MI mice (54/131 genes upregulated in HIF-PPN hearts at 1 day and/or 3 days post-MI, and 45/78 downregulated), as well as changes in alternative splicing. Interestingly, calcium/calmodulin dependent protein kinase II, gamma (CAMK2G) was alternatively spliced in both settings, with variant 1 (v1) substantially decreased compared to variants 2 (v2) and 3 (v3). These findings were also replicated in vitro when cells were transfected with HIF-PPN or exposed to hypoxia. Further analysis of CAMK2γ protein abundance revealed only v1 was detectable and substantially decreased up to 7 days post-MI. Rbfox1, a splicing factor of CAMK2G, was also decreased in HIF-PPN and post-MI hearts. Subcellular fractionation showed CAMK2γ v1 was found in the nuclear and cytoplasmic fractions, and abundance decreased in both fractions post-MI. Chromatin immunoprecipitation analysis of HIF1 in post-MI hearts also demonstrated direct HIF1 binding to CAMK2G. CaMK2 is a key transducer of calcium signals in both physiological and pathological settings. The predominantly expressed isoform in the heart, CaMK2δ, has been extensively studied in cardiac injury, but the specific role of CaMK2γ is not well defined. Our data suggest that loss of CaMK2γ after MI is HIF1-dependent and may play an important role in the heart's calcium signaling and transcriptional response to hypoxia.
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http://dx.doi.org/10.1038/s41598-021-92426-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8222303PMC
June 2021

Electrochemical treatment of ex vivo human abdominal skin and potential use in scar management: A pilot study.

Scars Burn Heal 2021 Jan-Dec;7:2059513120988532. Epub 2021 Mar 16.

Beckman Laser Institute & Medical Clinic, University of California - Irvine, Irvine, CA, USA.

Introduction: Scar treatments aim to address pathologic collagen deposition; however, they can be expensive or difficult to control. Electrochemical therapy (ECT) offers a simple alternative treatment. The purpose of this study is to examine the acid-base and histological changes in ex vivo human abdominal skin following ECT.

Methods: Forty-two ex vivo human panniculus tissue sections collected from six individuals were tumesced with normal saline. ECT was performed by inserting two platinum needle electrodes connected to a DC power supply into each specimen. Voltage was varied (3-6 V) and applied for 5 minutes. Each specimen was sectioned across both electrode insertion sites and immediately stained with pH sensitive dye. The width of dye color change for each dosimetry pair was calculated. Hematoxylin and eosin staining was used to evaluate samples.

Results And Discussion: ECT caused a spatially localised and dose-dependent increased area of acidic and basic pH around the anode and cathode, respectively. A significantly greater mean width of pH change was generated at the cathode compared to the anode in all treatment groups. Histological evaluation displayed broad condensation and hyalinisation of dermal collagen.

Conclusion: ECT triggered dermal pH alterations and changed the underlying structural framework of the specimen. This technology may serve as a low-cost, minimally invasive local soft-tissue remodeling technique with potential application in scar management.

Level Of Evidence: 5.

Lay Summary: Electrochemical therapy is a novel treatment that causes spatially selective dermal injury in areas of interest. This study measures the effects of electrochemical therapy when applied to abdominal skin. Electrochemical therapy appears to have beneficial effects by causing a highly localised reduction in collagen content or local softening of tissue, which is consistent with other studies on scar therapies, including chemexfoliation, radiofrequency technologies, and lasers. However, electrochemical therapy can be performed at a fraction of the costs of these aforementioned modalities.
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http://dx.doi.org/10.1177/2059513120988532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970177PMC
March 2021

Development of a Cost-Effective Surgical Headlight Using Consumer Light Emitting Diode Lighting and 3D Printing.

Surg Innov 2021 Dec 25;28(6):776-779. Epub 2021 Feb 25.

218537Beckman Laser Institute and Medical Clinic, Irvine, CA, USA.

Battery-powered Light Emitting Diode (LED) surgical headlights are necessary for improved intraoperative illumination but may be costly. The objective of this study was to develop a low-cost surgical headlight using a consumer-grade LED headlight and 3D-printed mount. Eighteen surgical residents performed simulation exercises that mimicked suturing in the oral cavity using both a custom prototype headlight and a commercial surgical headlight. The time required to complete the task with each headlight was recorded along with an exit survey. A second device was created based on the critiques of the first device and was tested by ten additional surgical trainees. Surgical residents completed the simulation task in 27 ± 8.6 seconds and 21 ± 5.6 seconds with the commercially available headlight and first prototype, respectively. In the second experiment, the simulation task was completed in 23 ± 11.1 and 23 ± 12.2 seconds with the commercially available headlight and second device, respectively. Survey results showed an overall positive consensus, with critiques about headband security, suggestions for smaller LED chassis, and a more robust mounting bracket. Some preferred the prototype headlight due to the wider field of illumination compared to the commercially available unit (ie, beam spread/beam angle). Future adjustments are required to optimize the location of the headlight and the battery to modify the weight distribution of the device. These findings demonstrate that our prototype models are viable alternatives to conventional surgical headlights and warrant continued optimization for broader adoption by surgeons and trainees for whom higher-cost alternatives are not an option.
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http://dx.doi.org/10.1177/1553350621997764DOI Listing
December 2021

The Effect of a Consumer Nose Reshaper on Nasal Tip Projection and the Perceived Attractiveness of Asian Females.

Facial Plast Surg Aesthet Med 2021 Jul-Aug;23(4):314-315. Epub 2020 Dec 29.

Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.

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http://dx.doi.org/10.1089/fpsam.2020.0415DOI Listing
August 2021

Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis.

Am J Rhinol Allergy 2021 Sep 10;35(5):587-595. Epub 2020 Dec 10.

Department of Otolaryngology-Head and Neck Surgery, University of California Irvine Medical Center, Orange, California.

Introduction: Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients.

Methods: A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction.

Results: Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45-4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55-3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43-2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61-4.03, p = 0.35).

Conclusion: Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.
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http://dx.doi.org/10.1177/1945892420980673DOI Listing
September 2021

Current Status and Future Trends: Pediatric Intracapsular Tonsillectomy in the United States.

Laryngoscope 2021 01 24;131 Suppl 2:S1-S9. Epub 2020 Sep 24.

Department of Otolaryngology- Head and Neck Surgery, University of California, Irvine School of Medicine, Orange, California, U.S.A.

Objectives: 1) To assess the current status of pediatric intracapsular tonsillectomy in the United States, and 2) To apply lessons from the scientific literature and adoption of surgical innovation to predict future trends in pediatric intracapsular tonsillectomy.

Methods: This was a cross-sectional survey study and literature review. An anonymous survey was sent to all members of the American Society of Pediatric Otolaryngology (ASPO) to determine current practices in pediatric tonsillectomy. Statistical analysis was performed to compare differences in individuals who perform intracapsular tonsillectomy as opposed to extracapsular tonsillectomy. A literature analysis of the adoption of new technological advancements and innovative surgical techniques was then performed.

Results: The survey was sent to 540 pediatric otolaryngologists with a response rate of 42%. Of all respondents, 20% currently perform intracapsular tonsillectomy. The primary reason cited for not performing the procedure was concern for tonsillar regrowth. Time in practice, practice setting, and fellowship status was not associated with an increased incidence of intracapsular tonsillectomy.

Conclusions: Only 20% of pediatric otolaryngologist respondents in the United States perform intracapsular tonsillectomy. Based on the documented advantages of intracapsular tonsillectomy over extracapsular tonsillectomy and an analysis of adoption of novel surgical techniques, we predict a paradigm shift in the specialty toward intracapsular tonsillectomy.

Level Of Evidence: 3 Laryngoscope, 131:S1-S9, 2021.
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http://dx.doi.org/10.1002/lary.29108DOI Listing
January 2021

Telelecture Educational Series in Facial Plastic and Reconstructive Surgery.

Facial Plast Surg 2020 Apr 20;36(2):211-214. Epub 2020 Mar 20.

Department of Otolaryngology, Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, Irvine, California.

We sought to evaluate the usefulness of a monthly telelecture educational series in facial plastic and reconstructive surgery for resident education and to identify potential areas for improvement. A monthly series of facial plastic and reconstructive surgery telelectures were hosted at our institution between 2016 and 2018. A web-based survey was sent to 13 residents and 7 invited faculty presenters. Resident survey questions included rating of presentation topics, interface, networking opportunities, and educational value. Faculty survey questions included satisfaction, temporal convenience, likelihood of future telelecture participation, and likelihood of telelecture series implementation at speaker's home institution. The survey response rate was 100%. All of the residents expressed satisfaction with topics presented, lecture duration, perceived enhancement of education, and overall satisfaction with the telelecture series. 46% of residents indicated that the telelecture format limited networking opportunities. 72% of faculty reported they would participate in a future telelecture, and 86% indicated interest in integrating telelectures into their home institution educational curriculum. Live virtual telelectures effectively allow experienced facial plastic surgeons to share their operative techniques and management pearls in an interactive and practical format. This is a contemporary solution to bridging knowledge gaps between expert facial plastic surgeons from all corners of the world and the next generation of surgeons.
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http://dx.doi.org/10.1055/s-0040-1708840DOI Listing
April 2020

Electrochemolipolysis of Human Adipose Tissue.

Facial Plast Surg Aesthet Med 2020 Mar/Apr;22(2):86-92. Epub 2020 Feb 20.

Beckman Laser Institute & Medical Clinic, University of California, Irvine, Irvine, California.

Body fat contouring procedures have increasingly grown in popularity over the years. As such, there is a need for inexpensive, minimally invasive, and simple fat reduction/contouring technique. To examine the acid-base and histological changes in ex vivo human adipose tissue after electrochemolipolysis (ECL). Panniculus tissue specimens obtained after abdominoplasty procedures were tumesced with normal saline. Two platinum needle electrodes were inserted into each sample and connected to a DC power supply. Voltage (3-6 V) was varied and applied for 5 min. Specimens were sectioned through a sagittal midline across both electrode insertion sites and immediately stained with pH-sensitive dye. A numerical algorithm was used to calculate the area of the dye color change for each dosimetry pair. Samples were also evaluated utilizing light microscopy (hematoxylin and eosin). An ex vivo human adipose tissue model was used for evaluating the effects of ECL. Acidic and basic pH was appreciated surrounding the anode and cathode insertion sites, respectively. The effect was spatially localized and dose dependent. Statistical analysis of these data showed no significant difference between the mean area of the pH disturbance generated at the anode compared with the cathode at 3 V for 5 min (6.04 mm vs. 2.95 mm,  = 0.40, 95% CI -4.8 to 11). A significantly greater area of pH disruption was generated at the cathode versus the anode in groups 4 V for 5 min (14.7 mm vs. 5.00 mm,  = 0.032, 95% CI 0.93-19), 5 V for 5 min (15.5 mm vs. 6.72 mm,  = 0.019, 95% CI 1.6-16), and 6 V for 5 min (22.5 mm vs. 10.0 mm,  = 0.047, 95% CI 0.22-25). Acute structural changes in adipocytes were observed in all specimens. Vascular damage with adjacent adipocyte necrosis was prominent at the cathode site in group 6 V for 5 min. ECL at the studied dosimetry parameters induced acid and base changes in human adipose tissue, suggesting its potential use in nonsurgical fat reduction as an ultralow cost alternative to current lipolytic devices and pharmaceuticals. NA.
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http://dx.doi.org/10.1089/fpsam.2019.29011.hutDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079389PMC
August 2020

In-office ossicular chain reconstruction using hydroxyapatite cement.

Clin Otolaryngol 2019 11 2;44(6):1228-1230. Epub 2019 Oct 2.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.

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http://dx.doi.org/10.1111/coa.13428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034986PMC
November 2019

Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2017 Aug 4;274(8):2981-2990. Epub 2017 Apr 4.

Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94158, USA.

Objectives: To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries.

Methods: Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE.

Results: 351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea-hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of -0.78 (large magnitude of effect) [95% CI -1.06, -0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4-87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports.

Conclusions: Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m and non-syndromic children have had the most improvement in AHI. The specific type of surgery must be tailored to the patient. Patients with co-morbidities should undergo treatment in centers that are equipped to provide appropriate perioperative care.
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http://dx.doi.org/10.1007/s00405-017-4545-4DOI Listing
August 2017

Transpalatal advancement pharyngoplasty for obstructive sleep apnea: a systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2017 Mar 11;274(3):1197-1203. Epub 2016 Jun 11.

Division of Sleep Surgery and Medicine, Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.

The objective is to determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve after transpalatal advancement pharyngoplasty (TPAP) with obstructive sleep apnea (OSA) in adults, using a systematic review and meta-analysis. Nine databases, including PubMed/MEDLINE, were searched through April 1, 2016. All studies that included patients who underwent TPAP alone were included in this analysis. Fifty-six studies were potentially relevant, 37 were downloaded and five studies met criteria with 199 patients (age: 42.5 ± 9.7 years and body mass index: 29.0 ± 4.0 kg/m). The grand mean (M) and standard deviation (SD) for AHI (199 patients) pre and post-TPAP decreased from 54.6 ± 23.0 [95 % CI 51.4, 57.8] to 19.2 ± 16.8 [95 % CI 16.9, 21.5] events/h (relative reduction: 64.8 %). Random effects modeling demonstrated a mean difference (MD) of -36.3 [95 % CI -48.5, -24.1], overall effect Z = 5.8 (p < 0.00001), and I  = 85 % (significant inconsistency). The standardized mean difference (SMD) for TPAP demonstrated a large magnitude of effect for AHI -1.76 [95 % CI -2.4, -1.1]. For LSAT (70 patients), the pre and post-TPAP M ± SD improved from 81.9 ± 8.1 [95 % CI 80.0, 83.8] to 85.4 ± 6.9 [95 % CI 83.8, 87.0], with a MD of 3.55, overall effect Z = 1.79 (p = 0.07). Thus far, few studies have evaluated transpalatal advancement pharyngoplasty; therefore, we recommend additional studies, especially prospective studies. Research comparing TPAP to pharyngoplasty procedures without palatal advancement would help determine the optimal role for this procedure.
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http://dx.doi.org/10.1007/s00405-016-4121-3DOI Listing
March 2017

Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis.

Laryngoscope 2016 05 22;126(5):1246-55. Epub 2015 Dec 22.

Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii.

Objectives/hypothesis: To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children.

Study Design: Systematic review and meta-analysis.

Methods: Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015.

Results: A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data).

Conclusion: Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246-1255, 2016.
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http://dx.doi.org/10.1002/lary.25827DOI Listing
May 2016

Knowledge and perceptions about community-acquired staphylococcal infections among health care workers in Hawai'i.

Hawaii J Med Public Health 2013 Sep;72(9):311-6

Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.

Since the early 1990s, national rates of methicillin-resistant Staphylococcus aureus (MRSA) infections have increased dramatically.1,2 Initially identified in health care settings, community-acquired MRSA is now a major public health concern. With Hawai'i's expanding S. aureus and MRSA epidemic closely approximating the national trend in inpatient and outpatient settings,7,8 a high level of knowledge and awareness among health care workers is essential to successfully control this evolving epidemic. Health care and related workers were surveyed to assess their knowledge and perceptions about staphylococcal and MRSA infections. Knowledge was estimated by demonstrated ability to correctly identify risk factors including diabetes and obesity, as well as to demonstrate awareness of a growing staphylococcal and MRSA epidemic.9,10 Perceptions were estimated by level of concern of antibiotic resistance as well as of the severity of the staphylococcal and MRSA epidemic. Variations in knowledge and perception concerning basic principles associated with S. aureus infections as well as characteristics of the evolving S. aureus and MRSA epidemic were observed among various occupations (advance clinical practitioners, nurses, public health professionals, athletic trainers, and non-medical workers) as well as work locations (hospital, community, and non-clinical community). Overall, health care and related workers in community settings demonstrated disparities in knowledge regarding S. aureus and MRSA infections. They were also more likely to misperceive this growing threat. These findings provide support for focused educational interventions targeting community health care and related workers to improve awareness of staphylococcal infections in order to successfully address and combat this evolving epidemic.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780463PMC
September 2013

Teen Health Camp Hawai'i: inspiring Hawai'i's youth to be healthcare leaders of tomorrow.

Hawaii J Med Public Health 2013 Apr;72(4):140-2

University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689510PMC
April 2013
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