Gender Differences in Compensation, Mentorship, and Work‐Life Balance within Facial Plastic Surgery

xlomafota13 shared this article with you from Inoreader Gender Differences in Compensation, Mentorship, and Work‐Life Balance within Facial Plastic Surgery Via The Laryngoscope Objectives Our objective was to identify gender differences in work‐life balance, professional advancement, workload, salary, and career satisfaction among facial plastic and reconstructive surgeons. Study Design Cross‐Sectional Survey. Methods American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) members were invited by email to respond to a confidential 25‐question online survey. The survey had a response rate of 12%. There were a total of 139 participants; 23 participants were in training and 116 were either board‐eligible or board‐certified facial plastic surgeons. Collected variables included general demographics, personal life, academic involvement, career development, workload, and career satisfaction. Results Forty percent of participants were female. Fifty‐nine percent of female participants were 25–35 years old compared with 15% of male participants. The majority of male participants were over 45 years old (63%) while only 19% of female participants fell into this age category (P < .0001). Women were more likely to be in a relationship with a physician (35% vs. 19%) or non‐physician full‐time professional (55% vs. 31%). The vast majority of men had children (89%) while only half of women (52%) had children. On average, women with children had fewer children than men (P < .0001). No gender difference was seen with respect to working full versus part‐time (P = .81). Participants were equally satisfied with a surgical career regardless of gender. Conclusion Although significant progress has already been made towards closing the gender gap, gender disparities remain both professionally and personally for facial plastic surgeons. With an increasing number of women in medicine, we should continue to strive to close the gender gap. Level of Evidence 4 Laryngoscope, 131:E787–E791, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

In‐Office KTP Laser for Treating Hereditary Hemorrhagic Telangiectasia–Associated Epistaxis

xlomafota13 shared this article with you from Inoreader In‐Office KTP Laser for Treating Hereditary Hemorrhagic Telangiectasia–Associated Epistaxis Via The Laryngoscope Objective To evaluated the efficacy and safety of in‐office potassium titanyl phosphate (KTP) laser treatment for the management of epistaxis in hereditary hemorrhagic telangiectasia (HHT) patients. Methods A retrospective case series of all HHT patients over age of 18 who underwent in‐office KTP laser treatment from July 1, 2017 to December 31, 2019 was performed. The primary outcome measure was the epistaxis severity score (ESS) pre‐ and post‐procedure. Secondary outcome measures included patient reported pain (on a 10‐point Likert‐type scale), and procedural adverse events and complications. Results A total of 16 patients underwent KTP in‐office laser treatment during the review period. There was both a clinically and statistically significant decrease in the ESS after in‐office laser treatment, baseline ESS –7.24, SD 1.71, follow up ESS –4.92, SD 1.83 (mean difference 2.94, 95% confidence interval, 1.83–4.04, P < .0001). There were no reported adverse events or complications associated with the procedure. The mean pain score reported was 0.19, SD 0.75. The average blood loss was 10.8 mL, SD 37.3. The majority of patients (62.5%, 10/16) had no blood loss during the procedure. Conclusion Clinically and statistically significant decreases were noted in the ESS of HHT patients after in‐office KTP laser photocoagulation. The procedure was well tolerated by patients, without any adverse events or complications. Level of Evidence 4 Laryngoscope, 131:E689–E693, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Wendler Glottoplasty on Acoustic Measures of Voice

xlomafota13 shared this article with you from Inoreader Effect of Wendler Glottoplasty on Acoustic Measures of Voice Via The Laryngoscope Objectives Voice therapy has been the primary treatment for voice feminization in transfemale patients due to concerns that surgery worsens voice quality. We aim to determine the impact of Wendler glottoplasty on acoustic measures of voice. Study Design Retrospective case series. Methods Transgender female patients treated for vocal feminization with Wendler glottoplasty at a single tertiary care center were identified. Pre‐ and postoperative measures were taken with the Kay Elemetrics Real‐Time Pitch, Analysis of Dysphonia in Speech and Voice, and Multidimensional Voice Program. Results Twenty‐eight patients were included in this study. There were no statistically significant changes in fundamental frequency variation, peak amplitude variation, soft phonation index, noise‐to‐harmonics ratio, cepstral peak prominence, or cepstral spectral index of dysphonia at a significance level of P < .05. Average speaking fundamental frequency (SF0) increased from 143 Hz after voice therapy to 163 Hz after surgery (P = .0009). Lower range decreased in 61% and increased in 26% of patients. Upper range decreased in 52% and increased in 48% of patients. Conclusions Wendler glottoplasty does not worsen voice quality based on acoustic measures. Although most patients experience an increase in average SF0, effects on vocal range are variable with approximately half of patients experiencing a reduction and half experiencing an increase in upper pitch limit. Level of Evidence 4 Laryngoscope, 131:583–586, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different?

xlomafota13 shared this article with you from Inoreader A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different? Via The Laryngoscope Objectives/Hypothesis Several recent studies have observed a high incidence of duodenoscope microbial contamination and an association of contamination with healthcare‐acquired infections. This study sought to quantify nasopharyngoscope microbial contamination relative to that of other endoscope categories and characterize the manufacturers, outcomes, and microbial profiles associated with these cases. Study Design Retrospective, cross‐sectional study. Methods A total of 3,865 adverse events were collected from 2013 to 2019 using the US Food and Drug Administration Manufacturer and User Facility Device Experience database. The fraction of total device failures associated with contamination was quantified for nasopharyngoscopes, bronchoscopes, duodenoscopes, and gastroscopes. Odds ratios of nasopharyngoscope contamination compared to that of bronchoscopes, duodenoscopes, or gastroscopes were calculated, and significance was assessed by χ2 analysis. The Kruskal‐Wallis test was used for nonparametric testing of significance. Results Nasopharyngoscope device failures were reported at an incidence of 0.646 per month; 34.1% involved contamination, comparable to the frequency observed for bronchoscopes (23.4%, P = .118), duodenoscopes (29.2%, P = .493), and gastroscopes (45.3%, P = .178). The frequency of device contamination was observed to be significantly higher for a particular endoscope manufacturer regardless of endoscope category (Kruskal‐Wallis P = .021). In instances of contamination, nasopharyngoscopes were significantly less associated with patient harm or death than bronchoscope (odds ratio [OR] = 10.2) and duodenoscope (OR = 4.81) cases. Conclusions Although the rates of contamination were comparable across all endoscope categories, nasopharyngoscope contamination was less commonly associated with patient harm or death. In an era of rising healthcare costs, determining adequate disinfection standards for nasopharyngoscopes and their impact on patient safety is crucial. Level of Evidence NA Laryngoscope, 131:598–605, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

xlomafota13 shared this article with you from Inoreader ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization Via The Laryngoscope Objectives We implement a novel enhanced recovery after surgery (ERAS) protocol with pre‐operative non‐opioid loading, total intravenous anesthesia, multimodal peri‐operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30‐day readmissions. Methods Retrospective cohort study comparing 132 ERAS vs. 66 non‐ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double‐blind fashion by two teams. Results Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P = .004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P = .002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P = .000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P = .010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P = .000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P = .000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P = .000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P = .000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P = .000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P = .017). There were no differences between ERAS and non‐ERAS patients in hospital LOS, ICU LOS, complication rates, and 30‐day readmissio ns. Conclusion Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates. Level of Evidence 3 Laryngoscope, 131:E792–E799, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lateral Chest Placement of IPG for Hypoglossal Nerve Stimulator Implantation

xlomafota13 shared this article with you from Inoreader Case Report: Lateral Chest Placement of IPG for Hypoglossal Nerve Stimulator Implantation Via The Laryngoscope Hypoglossal nerve stimulation for the treatment of obstructive sleep apnea is an increasingly common procedure. The hypoglossal nerve is stimulated by an implanted pulse generator that is placed in a subcutaneous pocket in the upper chest over the pectoralis muscle. A pressure sensor is placed through a separate incision between two ribs to detect respiratory effort. This case reports an alternative implantation of the device and pressure sensor through a single shared incision lateral to the breast in a thin patient with a previous history of breast cancer, mastectomy, and subpectoral breast implant reconstruction. Laryngoscope, 131:E1010–E1012, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The HSP90 inhibitor RGRN‐305 exhibits strong immunomodulatory effects in human keratinocytes

xlomafota13 shared this article with you from Inoreader The HSP90 inhibitor RGRN‐305 exhibits strong immunomodulatory effects in human keratinocytes Via Experimental Dermatology Abstract Keratinocytes are the key cellular target for IL‐17A‐mediated effects in psoriasis and HSP90 is important for IL‐17A‐mediated signalling. RGRN‐305 is a novel HSP90 inhibitor reported to reduce psoriatic phenotypes in preclinical animal models. The aim of this study was to investigate the effect of RGRN‐305 on a psoriasis‐like inflammatory response in human keratinocytes in vitro. Using RT‐qPCR we demonstrated a significantly increased expression of the HSP90 isoforms HSP90AB1, HSP90B1 and TRAP1 in lesional compared with nonlesional psoriatic skin. In a psoriasis‐like setting where keratinocytes were stimulated with TNFα and/or IL‐17A, we analysed the mRNA expression using the NanoString nCounter technology and demonstrated that the HSP90 inhibitor RGRN‐305 significantly reduced the IL‐17A‐ and TNFα‐induced gene expression of a number of proinflammatory genes, including the psoriasis‐associated genes CCL20, NFKBIZ, IL36G, and IL23A. In agreement with the mRNA data, the protein level of CCL20, IκBζ and IL‐36γ were inhibited by RGRN‐305 as demonstrated by western blotting and ELISA. Interestingly, when keratinocytes were stimulated with a TLR3 agonist, RGRN‐305 also demonstrated potent immunomodulatory effects, significantly inhibiting poly(I:C)‐induced expression of the proinflamma tory genes TNFα, IL1B, IL6, and IL23A. Taken together, our data support a role for HSP90 not only in the pathogenesis of psoriasis, but also in broader immune responses. Therefore, HSP90 provides an attractive target for the treatment of psoriasis and other diseases where the innate immune system plays an important role. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.