Genetic variation is prevalent among individuals of the same species and yet the potential effects of genetic variation on developmental outcomes are frequently suppressed. Understanding the mechanisms that are responsible for this suppression is an important goal. Previously, we found that the microRNA miR-9a mitigates the impact of natural genetic variants that promote the development of scutellar bristles in adult Drosophila. Here we find that miR-9a does not affect the impact of genetic variants that inhibit the development of scutellar bristles. We show this using both directional and stabilizing selection in the laboratory. This specificity of action suggests that miR-9a does not interact with all functional classes of developmental genetic variants affecting sensory organ development. We also investigate the impact of miR-9a on a fitness trait, which is adult viability. At elevated physiological temperatures, miR-9a contributes to viability through masking genetic variants that hinder adult viability. We conclude that miR-9a activity in different developmental networks contributes to suppression of natural variants from perturbing development. KEYWORDS Drosophila; miRNA; heritability; sensory organs; development O RGANISMS are subject to conditions of genetic variation, and yet their morphological development is often robust to such challenges. Hence, developmental outcomes are rendered uniform even in the face of variable conditions of existence. The relationship between this developmental robustness and phenotypic variation in natural populations has long been remarked upon, and Waddington (1942) coined the word canalization to describe the process. As development becomes more robust, less phenotypic variation is observed among individuals in a population (Scharloo 1991;de Visser et al. 2003;Siegal and Leu 2014). This has implications not only for the relationship between genotype and phenotype, but also for evolution (Gibson and Wagner 2000;Gibson and Dworkin 2004;Wagner 2012). In one sense, robustness inhibits evolvability since it suppresses the phenotypic variation that selection acts upon. However, when a phenotype is robust to the effects of mutations, then genetic variation can potentially accumulate in a neutral state. This might permit a broad set of connected genotypes to express the same phenotype (Wagner 2012). Later, if canalization is impaired, the effects of the previously cryptic genetic variation are revealed as phenotypic variability. These can be subject to selection, thus enhancing evolvability.Morphological variation is a consequence of variable development between individuals. Development, in turn, is the complex outcome of dynamic interactions between regulatory molecules. Developmental dynamics have been successfully simulated by biochemical reaction network models, which vary in size, topology, and circuit composition and depend upon the specific developmental process, tissue type, and species (Kitano 2004;Stathopoulos and Levine 2005;Wunderlich and DePace 2011). Studie...
Communities often call upon their university hospitals to help with health screening events. Otolaryngologists can play an important role in prevention and education. We recently evaluated 285 community members at an oral cancer screening event at a community health “expo.” An intake form and oral exam identified 67 with conditions that warranted further evaluation: 16 for dental follow-up; 25 for further ear, nose, and throat (ENT) evaluation; and 26 for primary care follow-up. One patient was identified with laryngeal cancer after referral for dysphonia. The event served to increase awareness of oral cancer among high-risk patients via educational materials and podium presentations. There was a positive effect on our university’s credibility and reputation in the local community. Medical students interested in ENT received valuable supervised hands-on experience. This screening event identified opportunities for collaboration with local dental societies and primary care physicians for prevention and early detection of oral cancer.
Objectives: The purpose of this study was to assess the nationwide incidence of ear foreign body (FB) presentations to the emergency department (ED) and analyze the most common FB consumer products encountered. Methods: The National Electronic Injury Surveillance System (NEISS) was evaluated for ED visits that included “ear foreign bodies” from 2010 through 2019. The most frequent foreign bodies were identified and organized by demographics. Results: A total of 20,545 ear FB cases were found, with an estimated 608,860 ED visits nationwide. Female patients (56%) were more likely to have jewelry and first aid equipment FBs. Males between the ages of 5 and 15 years were significantly ( P < 0.05) more likely to have paper products, pens/pencils, and desk supplies in their ears. Conclusion: Ear FBs represent a substantial proportion of healthcare expenditures. Although children are the most commonly affected individuals, all ages require further education and preventive measures.
Objective: Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution’s VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist. To assess financial feasibility, we conducted a cost analysis of our VACs comprised of 2 half-day multidisciplinary physician attended clinics (5 specialists at our main campus and 2 specialists at a satellite clinic) and a half-day nurse practitioner clinic. Method: Assessment of net revenue based on net collections for clinic, professional, operative, hospital setting, and facility charges generated during 12 consecutive monthly VACs beginning July 1, 2015. Expense calculations included provider and staff salaries, benefits, supply costs, and clinic leasing costs. Results: There were 469 clinic visits, of which 202 were new patient evaluations. Sixty-eight patients underwent 93 procedures under general anesthesia, including procedures performed by our interventional radiologist, most commonly sclerotherapy or embolization (n = 37), surgical interventions including endoscopy (n = 36), or laser procedures (n = 20). Three patients were admitted. Fifty-seven patients received a new diagnosis different from that for which they were referred. Gross revenue was $1 810 525, and net revenue was 42.5%, or $783 152. Expenses totaled $453 415 for a net positive revenue of $329 737. Conclusion: When including direct downstream revenue, particularly from operative procedures, our VAC program operates on a net positive margin, making the program financially feasible.
Introduction: Tracheal agenesis (TA) is rare and usually fatal. Few survivors with concomitant tracheoesophageal fistulae (TEF) who underwent ligation of the distal esophagus with creation of a spit-fistula and neo-trachea from the proximal esophagus exist. We report a novel surgical technique whereby the esophagus is divided longitudinally to preserve a functional alimentation tract and a parallel neo-trachea. We review the literature of reported cases, including survivors beyond 12 months. Methods: Case report and literature review. Results: A female infant with prenatal polyhydramnios was born at 35 weeks gestation with immediate respiratory distress and absent cry. Oxygenation was maintained with a laryngeal mask airway. Despite a normal appearing larynx, she could not be intubated and emergent neck exploration disclosed no cervical trachea. The patient was placed on extra corporeal membranous oxygenation (ECMO), and later diagnosed with TA, Floyd Type I. Parental desire for reconstruction but refusal of a spit-fistula necessitated a novel procedure. The esophagus was divided longitudinally via a microstapler to preserve the original alimentary tract and create a parallel neo-trachea originating from the TEF and terminating as a cervical stoma. The healing process was complicated but the baby was ultimately discharged to home where she developed normally neurologically until succumbing one night to accidental decannulation at 16 months of age. Conclusion: We describe a novel surgical approach to manage TA. This includes avoiding creation of a spit fistula and preserving the native esophagus. We then survey the literature, reporting the survivorship duration and operative management of 174 reported cases of TA.
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