Facial measurements in IAW are much different from NAWW, and these results will assist in preoperative planning. Several features are correlated with attractiveness in IAW: larger and wider-set eyes, a smaller midface, a smaller nose with greater tip rotation, smaller ears and a larger mouth. Attractive IAW display many measurements typical of average IAW and several measurements that reflect average NAWW values. These results contribute to concepts of transcultural aesthetics--for a minority ethnic group, facial beauty appears to be an assimilation of deep-rooted ethnic features with prevailing cultural traits and aesthetic standards.

BackgroundDelirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes.MethodsWe conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions.ResultsThe point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21).ConclusionsDelirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

Current evidence supporting TIVA is limited to a handful of inconsistently controlled and reported studies. Standardized grading of visibility scores and preoperative characteristics would better establish the role of TIVA in endoscopic sinus surgery.

Electromechanical reshaping (EMR) provides a means of producing shape change in the cartilage by initiating oxidation–reduction reactions in mechanically deformed specimens. This paper evaluates the effect of voltage and application time on specimen shape change using needle electrodes. Rabbit septal cartilage specimens (20 mm × 8 mm × 1 mm, n = 200) were bent 90° in a precision-machined plastic jig. Optimal electrode placement and the range of applied voltages were estimated using numerical modeling of the initial electric field within the cartilage sample. A geometric configuration of three platinum needle electrodes 2 mm apart from each other and inserted 6 mm from the bend axis on opposite ends was selected. One row of electrodes served as the anode and the other as the cathode. Constant voltage was applied at 1, 2, 4, 6, and 8 V for 1, 2, and 4 min, followed by rehydration in phosphate buffered saline. Samples were then removed from the jig and bend angle was measured. In accordance with previous studies, bend angle increased with increasing voltage and application time. Below a voltage threshold of 4 V, 4 min, no clinically significant reshaping was observed. The maximum bend angle obtained was 35.7 ± 1.7° at 8 V, 4 min.

Electromechanical reshaping (EMR) of cartilage is a novel technique that has significant potential for use in facial reconstructive surgery. EMR achieves permanent shape change by initiating electrochemical redox reactions in the vicinity of stress concentrations, thereby altering mechanical properties of tissue matrix. This study reports the use of a six electrode needle-based geometric configuration to reshape cartilage. Rectangular samples (24 x 12 x 1 mm) of rabbit nasal septal cartilages were bent at a right angle in a precision-machined reshaping jig. Two parallel arrays of three platinum needle electrodes were each inserted into cartilage along the bend at 3 mm from the bend line. One array served as an anode and the other as cathode. Constant voltage at 1, 2, 4, 6, and 8 volts was applied to the arrays for 2 minutes. The specimens were then removed from the jig and rehydrated for 15 minutes in phosphate buffered saline. Following rehydration, bend angles and thicknesses were measured. Bend angle increased with increasing voltage and application time. No statistically significant bending was observed below 6 volts for 2 minutes application time. Maximum bend angle of 33 ± 8 degrees or reshaping degree of 33% was observed at 8 volts applied for 2 minutes. Current flow was small (< 0.1 A) for each case. Sample thickness was 0.9 ± 0.2 mm. ANOVA analysis showed that cartilage thickness had no significant impact on the extent of reshaping at given voltage and application time. The six needle electrode geometric configuration conforms to the voltage-and time-dependent trends predicted by previous EMR studies. In the future, the reshaping properties of other geometric configurations will be explored.

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Objectives To image cholesteatoma using optical coherence tomography (OCT) and correlate the results with clinical findings and conventional observations obtained using binocular microscopy and histology. OCT is a high-resolution optical imaging modality that generates cross-sectional images of turbid media, such as tissue with resolution approaching that of light microscopy. OCT relies on intrinsic differences in tissue optical properties for image contrast. Study Design In vivo prospective clinical study. Setting University Medical Center. Patients Patients with cholesteatoma undergoing otologic surgery. Intervention Using a commercial OCT imaging system, we obtained cross-sectional images (resolution, ~10 μm; depth penetration, ~1 mm) of cholesteatomas. Main Outcome Measures Images are obtained by raster scanning a single mode fiber across the interior of the probe. The imaging probe is sterilized and inserted into the middle ear or mastoid under microscopic guidance, and still images of the middle ear or mastoid mucosa and cholesteatoma when present were obtained. Results OCT images of cholesteatomas demonstrate differences in signal intensity, which are distinct from those of normal or inflamed middle ear/mastoid mucosa. Identification of keratin in cholesteatoma, even if very thin, distinguished it from inflamed mucosa. Conclusion This is the first study that systematically used OCT to image cholesteatoma during otologic surgery. Cholesteatomas can be distinguished from normal or inflamed adjacent mucosa.

Standardized anatomic dimensions of the OEAC provide important measurements for design of novel in-the-canal hearing aids and specialized earplugs and assist in defining average sizes for canalplasty procedures.