Vaping is suggested to be a risk factor for poor wound healing akin to smoking. However, the molecular and histologic mechanisms underlying this postulation remain unknown. Our study sought to compare molecular and histologic changes in cutaneous flap and non-flap tissue between vaping, smoking and control cohorts. Animal
Elective rhinoplasty surgeons' fees vary considerably and are influenced by geographic surgeon density, surgeon's experience, local economic factors, patient demand, and other factors. The American Board of Facial Plastic and Reconstructive Surgery, the American Society of Plastic Surgery, and other organizations certify physicians who profess expertise in rhinoplasty. We sought to determine if specific board certification or experience correlates with higher rhinoplasty fee. An internet search was conducted of seven U.S. metropolitan areas using the search terms “rhinoplasty and “city name.” Top search results were surveyed for rhinoplasty fee, years of experience, annual volume of rhinoplasties, board certification, and other demographic data. Using both univariate and multivariate comparisons, the data were analyzed for forces having significant correlation with rhinoplasty fee. Sixty-seven surgeons were included in the study. The average price for ABFPRS certified surgeons was significantly higher than surgeons with other board certifications ($10,550.00 ± 3,722.10 compared with $8,524.50 ± 2816.30, p = 0.0142). The volume of rhinoplasties performed per year was also significantly correlated with fee charged for rhinoplasty by the surgeon (r = 0.37773, p = 0.032). Additionally, surgeons practicing on the West Coast (LA) charged significantly higher fees ($12,059.09 ± 3014.53) compared with the Mid United States. ($8316.07 ± 2449.43) and the East Coast ($9152.86 ± 3639.78) (p = 0.0047). On multivariable linear regression, controlling for volume of rhinoplasty and region of the United States, ABFPRS certified surgeons charged significantly higher fees for rhinoplasty (p = 0.0230). ABFPRS board certification correlates with higher fees charged for rhinoplasty. Other important variables include surgeon's annual rhinoplasty and practice on the West Coast.
An infant with severe congenital laryngomalacia presented with inspiratory stridor when feeding, crying, or supine, relieved by prone or upright repositioning. Suprasternal retractions, hypoxemia, feeding difficulties, and failure to thrive prompted admission to the pediatric intensive care unit. Symptoms of sleep disordered breathing contributed to the severity of her laryngomalacia. Overnight polysomnography confirmed severe obstructive sleep apnea and sleep-related hypoxemia. The patient underwent supraglottoplasty with resolution of the wake hypoxemia but with residual stridor and apnea. Revision supraglottoplasty led to remission of the stridor and obstructive sleep apnea but emergence of central sleep apnea. This case discusses the clinical features, diagnostic evaluation, and management of congenital laryngomalacia. Supraglottoplasty, reserved for infants with moderate or severe laryngomalacia, is the treatment of choice. Obstructive sleep apnea improves but usually does not fully remit after supraglottoplasty. Central sleep apnea is not uncommon in infants with laryngomalacia and may reflect immature or abnormal brainstem nuclei regulating regulation of respiration during sleep.
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