Publications by authors named "Christopher Sullivan"

198 Publications

Human Trafficking Cases Presenting within Child Advocacy Centers.

J Child Sex Abus 2021 Aug-Sep;30(6):637-652. Epub 2021 Jul 27.

School of Criminal Justice, University of Cincinnati, Cincinnati, USA.

Although human trafficking of minors is an increasing concern within the United States, very little information is known about how trafficking cases are processed within child advocacy centers (CACs). The current study addresses this gap in the literature by providing descriptive information about victims, service referrals, and prosecutorial outcomes for human trafficking cases presenting at CACs across a Midwestern state. The data originates from a state-wide study focused on understanding the scope of human trafficking cases. Specifically, the dataset includes 210 youth presenting at CACs over a three-year period of time. In this sample, the typical human trafficking case involved sex trafficking of a self-identified white female victim, with an offender known to the victim. Most child survivors passing through CACs were referred to medical and mental health services, although these service referrals did not greatly differ across at-risk versus substantiated trafficking cases. Overall, the findings suggest that CACs are uniquely positioned to encounter human trafficking cases and provide needed services to trafficking survivors. Finally, recommendations are provided for CACs regarding the intake and identification of trafficking cases more broadly.
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http://dx.doi.org/10.1080/10538712.2021.1955791DOI Listing
July 2021

Juvenile granulosa cell tumor diagnosed in 6-month-old infant with precocious puberty.

Radiol Case Rep 2021 Sep 10;16(9):2609-2613. Epub 2021 Jul 10.

Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.

Juvenile granulosa cell tumor is a rare tumor diagnosed in children, which can present with precocious puberty. We have reported a case of a 6-month-old female patient who presented with precocious puberty. Abdominopelvic imaging revealed a large mixed cystic and solid mass, with internal solid enhancement, and restricted diffusion. At surgery, mass was confirmed to arise from the left ovary, and histopathology confirmed juvenile granulosa cell tumor. We provide a literature review of juvenile granulosa cell tumor and discuss imaging characteristics of this diagnosis.
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http://dx.doi.org/10.1016/j.radcr.2021.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278142PMC
September 2021

Presentation and outcomes of patients with undifferentiated thyroid carcinoma: a national perspective.

Gland Surg 2021 Jun;10(6):1971-1979

Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.

Background: Undifferentiated thyroid cancer (UTC) accounts for only 1-2% of all thyroid cancers. UTC is one of the most aggressive solid tumors with high metastatic rates and mortality. The objectives of this study are to examine the characteristics of patients with UTC and their overall survival.

Methods: Retrospective analysis utilizing the National Cancer Database, 2004-2014 is performed. The study population included adults (≥18 years) patients with UTC or differentiated thyroid carcinoma (DTC), which served as a reference group.

Results: A total of 1,870 UTC and 209,707 DTC patients were identified. The median follow-up time of UTC patients was 3.9 months (interquartile range: 1.6-9.0 months). When compared to DTC patients, patients with UTC were more likely to be ≥45-year-old [OR: 48.62, 95% CI: (35.75, 66.14), P<0.001], male [OR: 2.02, 95% CI: (1.84, 2.22), P<0.001], and/or black [OR: 1.27, 95% CI: (1.08, 1.49), P=0.004]. UTC patients were more likely to have Medicaid/Medicare or no insurance and treated in low-volume hospitals (P<0.001). Overall survival in patients with UTC was lower in patients older than 65 years [OR: 1.63, 95% CI: (1.12, 2.38), P=0.011], with multiple comorbidities [OR: 1.65, 95% CI: (1.02, 2.67), P=0.040] and/or presented with metastatic disease [OR: 1.93, 95% CI: (1.71, 2.17), P<0.001]. Compared to thyroidectomy alone, patients without metastasis who received adjuvant radiotherapy and/or chemotherapy had a better overall survival (P<0.001 each). In patients with metastatic disease, any intervention or combination of interventions other than thyroidectomy alone improved survival (P<0.05).

Conclusions: Older age, male, and/or black are associated with a higher prevalence of UTC compared to DTC. Although overall survival is poor in UTC, utilization of multi-modal treatment may improve survival.
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http://dx.doi.org/10.21037/gs-20-927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258884PMC
June 2021

Oropharyngeal Carcinoma Treated with Surgery Alone: Outcomes and Predictors of Failure.

Ann Otol Rhinol Laryngol 2021 May 30:34894211021287. Epub 2021 May 30.

Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Objective: To analyze the oncologic outcomes and risk factors for recurrence in patients who underwent surgery for oropharyngeal squamous cell carcinoma (OPSCC), and in whom adjuvant therapy was not recommended or was declined.

Methods: Retrospective cohort study of patients with OPSCC who were treated with transoral surgery only at a tertiary care academic medical center from April 2010 to March 2019.

Results: Seventy-four patients met inclusion criteria. In 16, adjuvant therapy was recommended but declined. There were 8 recurrences, of which 6 had been given recommendations for adjuvant therapy. Of the 8 recurrences, 2 died, 2 are alive with disease, and 4 were successfully salvaged. Five patients died of unrelated causes. Lymphovascular invasion (LVI,  = .016) had a significant impact on recurrence, while other pathologic features of the primary tumor such as size, location, human papillomavirus (HPV) status, and margin status did not. Margins were classified as "positive" in 4 patients, "close" in 54, and "negative" in 16. There were 3 local recurrences (4.1%), each of whom had declined adjuvant therapy. Lymph node features such as N-stage ( = .0004), number of positive nodes ( = .0005), and presence of extra-nodal extension (ENE,  = .0042) had a statistically significant impact on relapse. Smoking history and surgical approach showed no significant impact on recurrence.

Conclusion: Patients who undergo surgery for HPV-positive OPSCC with negative margins, no PNI, no LVI, and ≤1 positive lymph node without ENE have low risk for recurrence. These patients can likely be safely treated with surgery alone. Patients with these risk factors who decline adjuvant therapy are at risk for recurrence, and should be monitored.
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http://dx.doi.org/10.1177/00034894211021287DOI Listing
May 2021

Characterization of ALTO-encoding circular RNAs expressed by Merkel cell polyomavirus and trichodysplasia spinulosa polyomavirus.

PLoS Pathog 2021 05 17;17(5):e1009582. Epub 2021 May 17.

Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, United States of America.

Circular RNAs (circRNAs) are a conserved class of RNAs with diverse functions, including serving as messenger RNAs that are translated into peptides. Here we describe circular RNAs generated by human polyomaviruses (HPyVs), some of which encode variants of the previously described alternative large T antigen open reading frame (ALTO) protein. Circular ALTO RNAs (circALTOs) can be detected in virus positive Merkel cell carcinoma (VP-MCC) cell lines and tumor samples. CircALTOs are stable, predominantly located in the cytoplasm, and N6-methyladenosine (m6A) modified. The translation of MCPyV circALTOs into ALTO protein is negatively regulated by MCPyV-generated miRNAs in cultured cells. MCPyV ALTO expression increases transcription from some recombinant promoters in vitro and upregulates the expression of multiple genes previously implicated in MCPyV pathogenesis. MCPyV circALTOs are enriched in exosomes derived from VP-MCC lines and circALTO-transfected 293T cells, and purified exosomes can mediate ALTO expression and transcriptional activation in MCPyV-negative cells. The related trichodysplasia spinulosa polyomavirus (TSPyV) also expresses a circALTO that can be detected in infected tissues and produces ALTO protein in cultured cells. Thus, human polyomavirus circRNAs are expressed in human tumors and infected tissues and express proteins that have the potential to modulate the infectious and tumorigenic properties of these viruses.
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http://dx.doi.org/10.1371/journal.ppat.1009582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158866PMC
May 2021

Phenotypically Anchored mRNA and miRNA Expression Profiling in Zebrafish Reveals Flame Retardant Chemical Toxicity Networks.

Front Cell Dev Biol 2021 9;9:663032. Epub 2021 Apr 9.

The Sinnhuber Aquatic Research Laboratory, Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, United States.

The ubiquitous use of flame retardant chemicals (FRCs) in the manufacture of many consumer products leads to inevitable environmental releases and human exposures. Studying toxic effects of FRCs as a group is challenging since they widely differ in physicochemical properties. We previously used zebrafish as a model to screen 61 representative FRCs and showed that many induced behavioral and teratogenic effects, with aryl phosphates identified as the most active. In this study, we selected 10 FRCs belonging to diverse physicochemical classes and zebrafish toxicity profiles to identify the gene expression responses following exposures. For each FRC, we executed paired mRNA-micro-RNA (miR) sequencing, which enabled us to study mRNA expression patterns and investigate the role of miRs as posttranscriptional regulators of gene expression. We found widespread disruption of mRNA and miR expression across several FRCs. Neurodevelopment was a key disrupted biological process across multiple FRCs and was corroborated by behavioral deficits. Several mRNAs (e.g., ) and miRs (e.g., mir-125b-5p), showed differential expression common to multiple FRCs (10 and 7 respectively). These common miRs were also predicted to regulate a network of differentially expressed genes with diverse functions, including apoptosis, neurodevelopment, lipid regulation and inflammation. Commonly disrupted transcription factors (TFs) such as retinoic acid receptor, retinoid X receptor, and vitamin D regulator were predicted to regulate a wide network of differentially expressed mRNAs across a majority of the FRCs. Many of the differential mRNA-TF and mRNA-miR pairs were predicted to play important roles in development as well as cancer signaling. Specific comparisons between TBBPA and its derivative TBBPA-DBPE showed contrasting gene expression patterns that corroborated with their phenotypic profiles. The newer generation FRCs such as IPP and TCEP produced distinct gene expression changes compared to the legacy FRC BDE-47. Our study is the first to establish a mRNA-miR-TF regulatory network across a large group of structurally diverse FRCs and diverse phenotypic responses. The purpose was to discover common and unique biological targets that will help us understand mechanisms of action for these important chemicals and establish this approach as an important tool for better understanding toxic effects of environmental contaminants.
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http://dx.doi.org/10.3389/fcell.2021.663032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063052PMC
April 2021

More Specialties, Less Problems: Using collaborative competency between Infectious Disease, Podiatry, and Pathology to improve the care of patients with diabetic foot osteomyelitis.

J Am Podiatr Med Assoc 2021 Feb 24. Epub 2021 Feb 24.

Background: Diabetic Foot Osteomyelitis (DFO) is a common infection where treatment involves multiple services including Infectious Disease (ID), Podiatry, and Pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking.

Methods: Representatives from ID, Podiatry, and Pathology interested in quality improvement (QI) developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to DFO. Knowledge acquisition was assessed by pre- and post-intervention surveys. Inpatients with forefoot DFO were retrospectively reviewed pre- and post- intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses.

Results: A post-intervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the pre-intervention cohort (4/1/2018-4/1/2019) and 32 patients in the post-intervention cohort (11/5/2019-03/01/2020), the latter truncated by changes in hospital practice during the COVID-19 pandemic. Non-categorizable or equivocal pathology reports decreased from pre-intervention to post-intervention (27.0% vs 3.3%, respectively, P=0.006). We observed non-significant improvement in correct bone margin definition (74.0% vs 87.5%, p=0.11), unnecessary PICC line placement (18.3% vs 9.4%, p=0.23), and unnecessary prolonged antibiotics (21.9% vs 5.0%, p=0.10). Additionally, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients.

Conclusions: This QI initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and non-significant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.
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http://dx.doi.org/10.7547/20-178DOI Listing
February 2021

A cost-effective maize ear phenotyping platform enables rapid categorization and quantification of kernels.

Plant J 2021 04 19;106(2):566-579. Epub 2021 Mar 19.

Department of Botany & Plant Pathology, Oregon State University, Corvallis, Oregon, USA.

High-throughput phenotyping systems are powerful, dramatically changing our ability to document, measure, and detect biological phenomena. Here, we describe a cost-effective combination of a custom-built imaging platform and deep-learning-based computer vision pipeline. A minimal version of the maize (Zea mays) ear scanner was built with low-cost and readily available parts. The scanner rotates a maize ear while a digital camera captures a video of the surface of the ear, which is then digitally flattened into a two-dimensional projection. Segregating GFP and anthocyanin kernel phenotypes are clearly distinguishable in ear projections and can be manually annotated and analyzed using image analysis software. Increased throughput was attained by designing and implementing an automated kernel counting system using transfer learning and a deep learning object detection model. The computer vision model was able to rapidly assess over 390 000 kernels, identifying male-specific transmission defects across a wide range of GFP-marked mutant alleles. This includes a previously undescribed defect putatively associated with mutation of Zm00001d002824, a gene predicted to encode a vacuolar processing enzyme. Thus, by using this system, the quantification of transmission data and other ear and kernel phenotypes can be accelerated and scaled to generate large datasets for robust analyses.
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http://dx.doi.org/10.1111/tpj.15166DOI Listing
April 2021

Prevalence of major structures injury in thyroid and neck surgeries: a national perspective.

Gland Surg 2020 Dec;9(6):1924-1932

Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.

Background: The objectives of the study is to examine the prevalence and burden of major structures injury (pharynx, esophagus, trachea, larynx, lymphatic, vessels & nerves) in patients who underwent thyroid, parathyroid, and neck dissection surgeries in the United States.

Methods: The study is a retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010-2015. The study population included adults (≥18 years) patients who underwent thyroid, parathyroid, and neck dissection surgeries.

Results: A total of 54,443 patients were included. Major structures injury was reported in 221 (0.48%) patients. The injured structures were vascular (0.22%), lymphatic (0.18%), pharynx/esophagus (0.06%), neural (0.03%), and trachea/larynx (0.002%). The risk of injury increased annually during the study period (OR: 1.29, 95% CI: 1.16, 1.44, P<0.001). The risk of injury was highest in patients who underwent thyroidectomy with neck dissection (1.01%) or neck dissection alone (1.81%) (P<0.001 each). The risk was also highest for patients with a head and neck cancer diagnosis (OR: 1.80, 95% CI: 1.24, 2.61, P=0.002). Patients with those injuries had a higher prevalence of blood transfusion (2.82% 0.17%), postoperative fistula (3.10% 0.03%), readmission (28.90% 3.59%), and postoperative mortality (0.87% 0.06%) (P<0.05 each). Management of patients with those injuries was associated with a longer hospital stay by 4.86±0.48 days (P<0.001), and a higher cost by $16,151.00±173.36 (P<0.001).

Conclusions: Injuries of major structures in thyroid and neck surgeries are more prevalent in cancer patients. There has been a recent increase in the risk of such injuries in the United States. Those injuries are associated with significant clinical and economic burden.
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http://dx.doi.org/10.21037/gs-20-369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804541PMC
December 2020

DUSP11 and triphosphate RNA balance during virus infection.

PLoS Pathog 2021 01 14;17(1):e1009145. Epub 2021 Jan 14.

Department of Molecular Biosciences, LaMontagne Center for Infectious Disease, The University of Texas at Austin, Austin, Texas, United States of America.

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http://dx.doi.org/10.1371/journal.ppat.1009145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808613PMC
January 2021

Considering the rates of growth in two taxa of coral across Pacific islands.

Adv Mar Biol 2020 27;87(1):167-191. Epub 2020 Oct 27.

Scripps Institution of Oceanography, UC San Diego, La Jolla, CA, United States.

Reef-building coral taxa demonstrate considerable flexibility and diversity in reproduction and growth mechanisms. Corals take advantage of this flexibility to increase or decrease size through clonal expansion and loss of live tissue area (i.e. via reproduction and mortality of constituent polyps). The biological lability of reef-building corals may be expected to map onto varying patterns of demography across environmental contexts which can contribute to geographic variation in population dynamics. Here we explore the patterns of growth of two common coral taxa, corymbose Pocillopora and massive Porites, across seven islands in the central and south Pacific. The islands span a natural gradient of environmental conditions, including a range of pelagic primary production, a metric linked to the relative availability of inorganic nutrients and heterotrophic resources for mixotrophic corals, and sea surface temperature and thermal histories. Over a multi-year sampling interval, most coral colonies experienced positive growth (greater planar area of live tissue in second relative to first time point), though the distributions of growth varied across islands. Island-level median growth did not relate simply to estimated pelagic primary productivity or temperature. However, at locations that experienced an extreme warm-water event during the sampling interval, most Porites colonies experienced net losses of live tissue and nearly all Pocillopora colonies experienced complete mortality. While descriptive statistics of demographics offer valuable insights into trends and variability in colony change through time, simplified models predicting growth patterns based on summarized oceanographic metrics appear inadequate for robust demographic prediction. We propose that the complexity of life history strategies among colonial reef-building corals introduces unique demographic flexibility for colonies to respond to a wide breadth of environmental conditions.
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http://dx.doi.org/10.1016/bs.amb.2020.08.006DOI Listing
December 2020

DUSP11-mediated control of 5'-triphosphate RNA regulates RIG-I sensitivity.

Genes Dev 2020 12 12;34(23-24):1697-1712. Epub 2020 Nov 12.

Department of Molecular Biosciences, LaMontagne Center for Infectious Disease, The University of Texas at Austin, Austin Texas 78712, USA.

Deciphering the mechanisms that regulate the sensitivity of pathogen recognition receptors is imperative to understanding infection and inflammation. Here we demonstrate that the RNA triphosphatase dual-specificity phosphatase 11 (DUSP11) acts on both host and virus-derived 5'-triphosphate RNAs rendering them less active in inducing a RIG-I-mediated immune response. Reducing DUSP11 levels alters host triphosphate RNA packaged in extracellular vesicles and induces enhanced RIG-I activation in cells exposed to extracellular vesicles. Virus infection of cells lacking DUSP11 results in a higher proportion of triphosphorylated viral transcripts and attenuated virus replication, which is rescued by reducing RIG-I expression. Consistent with the activity of DUSP11 in the cellular RIG-I response, mice lacking DUSP11 display lower viral loads, greater sensitivity to triphosphorylated RNA, and a signature of enhanced interferon activity in select tissues. Our results reveal the importance of controlling 5'-triphosphate RNA levels to prevent aberrant RIG-I signaling and demonstrate DUSP11 as a key effector of this mechanism.
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http://dx.doi.org/10.1101/gad.340604.120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706711PMC
December 2020

Microsurgical vascular bypass in the setting of pediatric limb length discrepancy.

J Vasc Surg Cases Innov Tech 2020 Dec 2;6(4):641-645. Epub 2020 Sep 2.

Section of Vascular Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill.

Management of pediatric iatrogenic arterial occlusions can be challenging clinically, leading to chronic complications such as claudication and limb length discrepancy. We report the case of a 6-month-old female patient who had experienced iatrogenic right external iliac and common femoral arterial occlusion. At the age of 8 years, she had developed claudication and a limb length discrepancy of 3.2 cm. She underwent common iliac artery to superficial femoral artery and profunda artery bypass via a branched autologous reverse great saphenous vein using microsurgical techniques for the distal anastomoses. In the present report, we have focused on the musculoskeletal improvements, benefits of microsurgery in pediatric vessels, and maximization of epiphyseal perfusion.
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http://dx.doi.org/10.1016/j.jvscit.2020.08.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607203PMC
December 2020

Analysis of palliative care treatment among head and neck patients with cancer: National perspective.

Head Neck 2021 03 5;43(3):805-815. Epub 2020 Nov 5.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Background: To analyze the characteristics and survival patterns of patients with head and neck squamous cell carcinoma (SCC) who received palliative treatment during their first course of treatment.

Methods: Cohort analysis utilizing the National Cancer Data Base (NCDB) of patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal SCC. Statistical analysis included multivariate logistic regression and Cox Hazard ratio modeling, and Kaplan-Meier survival analysis.

Results: 165 081 patients were included, of which 2747 patients received palliative treatment. Patients who received palliative treatment tended to be ≥65 years old, black, Charlson/Deyo score ≥3, hypopharyngeal cancer, stage (III-IV), with Medicaid insurance (P < .05). Patients were more likely to be treated with palliative intent if they underwent chemotherapy/radiotherapy and declined surgery (P < .001) compared to patients who underwent surgery and declined chemotherapy/radiotherapy (P = .006).

Conclusions: Palliative care use in head and neck oncology is associated with older patients, non-whites, Medicaid patients, and nonsurgically treated patients.
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http://dx.doi.org/10.1002/hed.26532DOI Listing
March 2021

Polymicrobial Interactions Facilitate Biofilm Formation, Antibiotic Recalcitrance, and Persistent Colonization of the Catheterized Urinary Tract.

Pathogens 2020 Oct 13;9(10). Epub 2020 Oct 13.

Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, NY 14203, USA.

Indwelling urinary catheters are common in health care settings and can lead to catheter-associated urinary tract infection (CAUTI). Long-term catheterization causes polymicrobial colonization of the catheter and urine, for which the clinical significance is poorly understood. Through prospective assessment of catheter urine colonization, we identified and as the most prevalent and persistent co-colonizers. Clinical isolates of both species successfully co-colonized in a murine model of CAUTI, and they were observed to co-localize on catheter biofilms during infection. We further demonstrate that preferentially adheres to during biofilm formation, and that contact-dependent interactions between and facilitate establishment of a robust biofilm architecture that enhances antimicrobial resistance for both species. may therefore act as a pioneer species on urinary catheters, establishing an ideal surface for persistent colonization by more traditional pathogens such as .
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http://dx.doi.org/10.3390/pathogens9100835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602121PMC
October 2020

Cerebrospinal Fluid Leak After Nasal Swab Testing for Coronavirus Disease 2019.

JAMA Otolaryngol Head Neck Surg 2020 12;146(12):1179-1181

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City.

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http://dx.doi.org/10.1001/jamaoto.2020.3579DOI Listing
December 2020

Factors Associated With the Choice of Radiation Therapy Treatment Facility in Head and Neck Cancer.

Laryngoscope 2021 05 26;131(5):1019-1025. Epub 2020 Aug 26.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.

Objective: To analyze the clinicodemographic characteristics and treatment outcomes of patients receiving postoperative radiation therapy (PORT) at a different treatment facility rather than the initial surgical facility for head and neck cancer.

Study Design: Retrospective cohort analysis.

Methods: Utilizing the National Cancer Data Base, 2004 to 2015, patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma were studied. Multivariate analysis was completed with multivariate regression and Cox proportional hazard model, and survival outcomes were examined using Kaplan-Meier analysis.

Results: A total of 15,181 patients who had surgery for a head and neck cancer at an academic/research center were included in the study population. Of the study population, 4,890 (32.2%) patients completed PORT at a different treatment facility. Treatment at a different facility was more common among patients who were ≥65 years old, white, Medicare recipients, those with a greater distance between residence and surgical treatment facility, and with lower income within area of residence (each P < .05). Overall survival was worse in patients completing PORT at a different treatment facility versus at the institution where surgery was completed (61.9% vs. 66.4%; P = .002).

Conclusions: PORT at a different facility was more common in older individuals, Medicare recipients, those with greater distance to travel, and lower-income individuals. Completing PORT outside the hospital where surgery was performed was associated with inferior survival outcomes among head and neck cancer patients.

Level Of Evidence: 3 Laryngoscope, 131:1019-1025, 2021.
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http://dx.doi.org/10.1002/lary.29033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907264PMC
May 2021

Comparison of media and standards for SARS-CoV-2 RT-qPCR without prior RNA preparation.

medRxiv 2020 Sep 17. Epub 2020 Sep 17.

Department of Molecular Biosciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712, USA.

Since the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there have been demands on the testing infrastructure that have strained testing capacity. As a simplification of method, we confirm the efficacy of RNA extraction-free RT-qPCR and saline as an alternative patient sample storage buffer. In addition, amongst potential reagent shortages, it has sometimes been difficult to obtain inactivated viral particles. We have therefore also characterized armored SARS-CoV-2 RNA from Asuragen as an alternative diagnostic standard to ATCC genomic SARS-CoV-2 RNA and heat inactivated virions and provide guidelines for its use in RT-qPCR.
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http://dx.doi.org/10.1101/2020.08.01.20166173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418746PMC
September 2020

Prevalence and Risk of Metastatic Thyroid Cancers and Management Outcomes: A National Perspective.

Laryngoscope 2021 01 23;131(1):237-244. Epub 2020 Jun 23.

Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.

Objectives: Examine the prevalence and risk of metastasis in thyroid cancers and management outcomes.

Study Design: Retrospective analysis of the National Cancer Database, 2004-2014.

Methods: The study population included adult (≥ 18 years) patients with thyroid cancer. Analysis included multivariate logistic regression and Cox hazard ratio modeling.

Results: A total of 152,979 patients were included. Distant metastasis was reported in 1,867 (1.22%) patients. The distribution of metastatic cases based on pathology and tumor size were as follows in descending order: papillary thyroid carcinoma (PTC) 1 to 4 cm (30.53%), PTC > 4 cm (19.34%), undifferentiated (UTC) > 4 cm (14.14%), PTC < 1 cm (8.46%), follicular thyroid carcinoma (FTC) > 4 cm (7.28%), FTC 1 to 4 cm (5.52%), medullary thyroid cancer (MTC) ≤ 4 cm (3.96%), MTC > 4 cm (3.91%), UTC ≤ 4 cm (3.32%), Hürthle (HCC ) > 4 cm (2.09%), and HCC 1 to 4 cm (1.45%). Significant predictors of distant metastasis, while controlling for tumor pathology and size, included older age, male gender, non-White minorities, presence of multiple comorbidities, minimal, gross extrathyroidal extension (ETE), lymphovascular invasion (LVI), and concomitant central and lateral lymph node metastasis (LNM) (P < .05 each). The risk of distant metastasis in the absence of nodal metastasis, ETE, and LVI was highest for FTC > 4 cm.

Conclusion: Although the risk of metastasis in well-differentiated thyroid carcinoma (WDTC) is low, the prevalence of metastatic thyroid cancer is highest in WDTC population because it is the most common type of thyroid cancer. Certain pathological features, including minimal ETE and central LNM, are associated with a higher prevalence of metastatic disease.

Level Of Evidence: NA Laryngoscope, 131:237-244, 2021.
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http://dx.doi.org/10.1002/lary.28722DOI Listing
January 2021

What Is the Best Approach to Prevent Advanced-Stage Pressure Injuries After Pediatric Tracheotomy?

Laryngoscope 2021 06 22;131(6):1196-1197. Epub 2020 Jun 22.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

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http://dx.doi.org/10.1002/lary.28878DOI Listing
June 2021

Experimental metatranscriptomics reveals the costs and benefits of dissolved organic matter photo-alteration for freshwater microbes.

Environ Microbiol 2020 08 11;22(8):3505-3521. Epub 2020 Jul 11.

Oregon State University, Corvallis, OR, USA.

Microbes and sunlight convert terrigenous dissolved organic matter (DOM) in surface waters to greenhouse gases. Prior studies show contrasting results about how biological and photochemical processes interact to contribute to the degradation of DOM. In this study, DOM leached from the organic layer of tundra soil was exposed to natural sunlight or kept in the dark, incubated in the dark with the natural microbial community, and analysed for gene expression and DOM chemical composition. Microbial gene expression (metatranscriptomics) in light and dark treatments diverged substantially after 4 h. Gene expression suggested that sunlight exposure of DOM initially stimulated microbial growth by (i) replacing the function of enzymes that degrade higher molecular weight DOM such as enzymes for aromatic carbon degradation, oxygenation, and decarboxylation, and (ii) releasing low molecular weight compounds and inorganic nutrients from DOM. However, growth stimulation following sunlight exposure of DOM came at a cost. Sunlight depleted the pool of aromatic compounds that supported microbial growth in the dark treatment, ultimately causing slower growth in the light treatment over 5 days. These first measurements of microbial metatranscriptomic responses to photo-alteration of DOM provide a mechanistic explanation for how sunlight exposure of terrigenous DOM alters microbial processing and respiration of DOM.
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http://dx.doi.org/10.1111/1462-2920.15121DOI Listing
August 2020

Impact of outcomes data on the management of postoperative hypocalcemia in head and neck endocrine surgery patients.

Am J Otolaryngol 2020 Jul - Aug;41(4):102477. Epub 2020 Apr 6.

Wake Forest Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America. Electronic address:

Postoperative hypocalcemia is a well-described outcome following thyroid and parathyroid surgery with symptoms ranging from clinically insignificant laboratory findings to tetany and seizures. The aims of this study were 1. To identify the characteristics and management patterns of postoperative hypocalcemia in head and neck endocrine surgery patients and 2. To compare outcomes between patients treated with empiric calcium and patients treated using a biochemically driven calcium replacement algorithm. Clinical electronic medical record (EMR) data was collected from patients who had undergone total thyroidectomy, completion thyroidectomy, and/or parathyroidectomy at Wake Forest Baptist Medical Center (WFBMC), a tertiary referral and academic institution. Between July 1, 2016, and June 30, 2017, 298 adult patients underwent surgery by a WFBMC Head & Neck (H&N) endocrine surgeon. Objective calcium and parathyroid hormone levels, postoperative supplementation with calcium and Vitamin D, 30-day physician access line (PAL) phone call utilization, emergency department (ED) encounters, and readmission rates were queried. The overall rate of hypocalcemia was 17.4%. No statistically significant difference in PAL utilization, ED visits, or readmissions was found between the empiric supplementation group and those whose supplementation was biochemically directed (PAL 5.0% vs. 5.0% [p = 0.983], ED visit 3.3% vs. 2.5% [p = 0.744], Readmission 1.7% vs. 0% [p = 0.276]). The overall postoperative rates of hypocalcemia and hypoparathyroidism following H&N endocrine surgery were consistent with the reported literature. Neither method of calcium supplementation was superior in reducing PAL utilization, ED encounters, or readmission.
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http://dx.doi.org/10.1016/j.amjoto.2020.102477DOI Listing
October 2020

Presentation and Outcomes of Elderly Patients Undergoing Head and Neck Surgeries: A National Perspective.

Otolaryngol Head Neck Surg 2020 08 24;163(2):335-343. Epub 2020 Mar 24.

Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.

Objectives: To examine clinical profile and outcomes of elderly patients (65-90 years) undergoing head and neck surgeries in the United States.

Study Design: A retrospective cross-sectional analysis.

Setting: The Nationwide Readmissions Database, 2010 to 2015.

Subjects And Methods: Adult (≥18 years) patients who underwent head and neck surgeries. Analysis included χ test and logistic analysis.

Results: A total of 113,602 and 32,580 patients <65 and ≥65 years old, respectively, were included. Patients ≥65 years old were more likely to have multiple comorbidities (62.8% vs 32.6%, < .001) and to present with head and neck cancer (19.8% vs 11.4%, < .001). The most common comorbidity was diabetes (21.0%). The most common cancer types by site were mouth (29.12%), thyroid (28.08%), and nonmelanoma skin cancer (13.22%). The percentage of geriatric patients who underwent head and neck surgeries increased from 21.8% in 2010 to 25.0% in 2015 ( < .001). A total of 5450 (16.85%) patients developed postoperative complications, and the most common complications were pulmonary related (10.55%), bleeding (6.96%), acute renal failure (6.01%), and infection (3.97%). Blood transfusion was required in 3.53% of the patients. Readmission prevalence was 0.32%, and mortality risk was twice as likely (odds ratio, 2.05; 95% confidence interval, 1.77-2.38; < .001). Independent risk factors of mortality were older age, multiple comorbidities, type of surgery, blood transfusion, and tracheostomy ( < .05, each).

Conclusion: Elderly patients currently represent 25% of patients admitted for head and neck surgery. This population should be provided with a different level of care due to a higher risk of complications and mortality.
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http://dx.doi.org/10.1177/0194599820911727DOI Listing
August 2020

Analysis of patients who decline treatment for squamous cell carcinoma of the head and neck: National perspective.

Head Neck 2020 04 2;42(4):698-707. Epub 2020 Jan 2.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Background: To analyze demographic and socioeconomic factors that influence patients' decisions to decline treatment for head and neck squamous cell carcinoma (SCC).

Methods: Retrospective cohort analysis utilizing the National Cancer Data Base of patients with oral cavity/oropharyngeal, hypopharyngeal, and laryngeal SCC.

Results: A total of 166 204 patients were included, of which 689 patients declined all treatment. Among early-stage (I-II) patients, Charlson/Deyo score ≥ 3, hypopharyngeal cancer, and no insurance or Medicare were more likely to decline all recommended treatment (P < .05). Among advanced stage (III-IV) patients, females (odds ratio 1.27, 95% confidence interval 1.05-1.53; P = .013), Charlson Deyo score ≥ 1, non-oral cavity cancers, and closer distance between patient's area of residence from treating facility were more likely to decline all treatment (P < .05).

Conclusions: Female patients and patients with no insurance, Medicare, or Medicaid are more likely to decline recommended treatment for SCC of the head and neck. Educational status is not predictive of declining treatment.
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http://dx.doi.org/10.1002/hed.26040DOI Listing
April 2020

Surgical management of Eagle syndrome: A 17-year experience with open and transoral robotic styloidectomy.

Am J Otolaryngol 2020 Mar - Apr;41(2):102324. Epub 2019 Nov 12.

Wake Forest University Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, Medical Center Boulevard, Winston-Salem, NC 27157, USA. Electronic address:

Eagle Syndrome (ES) is a rare disorder that can present with symptoms ranging from globus sensation to otalgia that is attributed to an elongated styloid process and/or calcified stylohyoid ligament. No standardized treatment algorithm exists, and although various surgical approaches have been described, data on the use of transoral robotic surgery (TORS) in this population is limited. To investigate the utility of TORS in the treatment of ES, a retrospective review in 19 ES patients was carried out at a single academic, tertiary medical center between 2000 and 2017. Nineteen patients underwent twenty-one styloid resections: 6 performed via TORS and 15 via transcervical approach. Across all patients, 90% reported some degree of lasting improvement in symptoms while 55% reported significant improvement. When TORS was compared to transcervical resection, there was no difference in the subjective rate of "meaningful" (83 vs. 57%) versus rate of "non-meaningful" symptom improvement (17 vs. 43%) (p = 0.35). There was a trend towards less estimated blood loss (EBL), operative time, and post-operative length of stay (LOS) with TORS versus transcervical cases (9.2 mL vs. 30.0 mL, 98 vs. 156 min, and 0.7 vs. 1.2 days); however, these did not reach statistical significance (p = .11, 0.13, and 0.42, respectively). Three patients experienced complications associated with an open approach, as compared to none with TORS. In select patients, TORS styloidectomy is a reasonable surgical alternative to traditional transoral and transcervical techniques as it provides similar symptom improvement, and reduced length of stay, blood loss, and operative time.
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http://dx.doi.org/10.1016/j.amjoto.2019.102324DOI Listing
August 2020

Long-term audiologic outcomes after cochlear implantation for single-sided deafness.

Laryngoscope 2020 07 11;130(7):1805-1811. Epub 2019 Nov 11.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.

Objectives: To evaluate the long-term audiometric outcomes, sound localization abilities, binaural benefits, and tinnitus assessment of subjects with cochlear implant (CI) after a diagnosis of unilateral severe-to-profound hearing loss.

Method: The study group consisted of 60 (mean age 52 years, range 19-84) subjects with profound hearing loss in one ear and normal to near-normal hearing in the other ear who underwent CI. Data analysis included pre- and postoperative Consonant-Nucleus-Consonant (CNC) Word scores, AzBio Sentence scores, pure tone thresholds, sound localization, and Iowa Tinnitus Handicap Questionnaire scores.

Results: Preoperative average duration of deafness was 3.69 years (standard deviation 4.31), with an average follow-up time of 37.9 months (range 1-87). CNC and AzBio scores significantly improved (both P < 0.001) postoperatively among the entire cohort, and there was much heterogeneity in outcomes with respect to deafness etiology subgroup analysis. Sound localization abilities tended to improve longitudinally in the entire cohort. Binaural benefits using an adaptive Hearing in Noise Test test showed a significant (P < 0.001) improvement with head shadow effect. Utilizing the Iowa Tinnitus Handicap Questionnaire, there was significant improvement in social, physical, and emotional well-being (P = 0.011), along with hearing abilities (P = 0.001).

Conclusions: This case series is the largest cohort of CI SSD subjects to date and systematically analyzes their functional outcomes. Subjects have meaningful improvement in word understanding, and sound localization tends to gradually improve over time. Binaural benefit analysis showed significant improvement with head shadow effect, which likely provides ease of listening.

Level Of Evidence: 4 Laryngoscope, 130:1805-1811, 2020.
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http://dx.doi.org/10.1002/lary.28358DOI Listing
July 2020

Primary Laryngectomy Versus Salvage Laryngectomy: A Comparison of Outcomes in the Chemoradiation Era.

Laryngoscope 2020 09 25;130(9):2179-2185. Epub 2019 Oct 25.

Department of Otolaryngology-Head and Neck Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, U.S.A.

Objective: To compare primary total laryngectomy (TL) versus salvage TL and analyze the functional outcomes, complications, recurrence rates, and survival.

Study Design: Case series with chart review.

Setting: Tertiary care center.

Subjects And Methods: Fifteen-year retrospective analysis of 208 patients with laryngeal squamous cell carcinoma treated by TL was completed. Outcome measures included survival, swallowing rehabilitation, speech rehabilitation, complications, and assessment of comorbidity. Survival estimates were analyzed with Kaplan-Meier method, and regression analysis utilized the Cox proportional hazards model.

Results: Alaryngeal speech was not significantly different between primary TL and salvage TL, 68% versus 82% (P = 0.14). Comparing primary and salvage TL, the perioperative complication rate was 33% versus 48% (P = 0.036). Thirty-six percent of primary TL patients had recurrence compared to 26% of salvage patients. Five-year overall survival rates between primary TL and salvage TL were not significantly different (P = 0.68). Comorbidity was an independent predictor of survival.

Conclusions: Development of a functional voice was not significantly different between salvage and primary TL patients, with a majority achieving alaryngeal speech. Perioperative complications were more prevalent in the salvage TL group. Recurrence and survival are significantly associated with comorbidity status.

Level Of Evidence: 4 Laryngoscope, 130:2179-2185, 2020.
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http://dx.doi.org/10.1002/lary.28343DOI Listing
September 2020
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