Objective To quantify the cost incurred during the match process for otolaryngology applicants, determine sources of expenditures, and highlight potential methods to alleviate financial burden of the match process. Study Design Cross-sectional. Study Setting Online survey. Subjects and Methods An electronic survey was sent via email to those who applied to the otolaryngology residency programs at Dartmouth-Hitchcock Medical Center and MedStar Georgetown University Hospital during the 2016 application cycle. Questions regarding demographics and experiences with the match were multiple choice, and questions regarding cost were open answer. Data were downloaded and analyzed on Excel and Minitab software. Results Twenty-eight percent of the total 370 applicants completed the survey. The mean cost of away rotations was $2500 (95% confidence interval [CI], $2224-$2776). With application fees and the cost of interviewing, the mean total cost of applying for the 2016 otolaryngology match was $6400 (95% CI, $5710-$7090), with a total range of $1200 to $20,000. Twenty-eight percent of students did not have sufficient funds for applying and interviewing despite seeking out additional monetary resources. Conclusion In 2016, otolaryngology applicants spent a mean of $8900 (95% CI, $7935-$9865) on away rotations, applications, and interviewing. Half of the applicants obtained additional funding to cover this cost, while 28% still did not have sufficient funding. Methods of decreasing cost may include instituting a cap on application number, videoconferencing interviews, regionalizing interviews, and adjusting the interview timeline.

Background Sickness presenteeism among healthcare professionals can compromise patient safety. To better understand what motivates this phenomenon, especially among trainees, the authors investigated attitudes of medical students, resident physicians, and faculty physicians about working when sick with what might be an infectious condition. Methods In 2012–2013, the authors employed a mixed methods, two-stage, cross-sectional survey at the University of Iowa Hospitals and Clinics of medical students (third-year students in the first survey and fourth-year students in the second survey), resident physicians in Internal Medicine, Pediatrics, and Family Medicine (first-year residents in the first survey and second-year residents in the second survey), and faculty physicians in Internal Medicine, Pediatrics, and Family Medicine. The first survey included one open-ended question querying attitudes about sickness presenteeism, answers to which underwent content analysis that identified 17 codes used to develop 23 additional closed-ended questions for a second survey. Results 127 participants completed the second survey (44% response rate). Sixty percent of these participants felt obligated to work when sick; and 33% felt obligated to work with influenza-like symptoms (fever, myalgias, cough), with residents and students being more likely to do so than faculty (67% vs. 35% vs. 14%, p = 0.001). Most participants (83%) were motivated to work when sick to avoid creating more work for colleagues, and residents and students were more likely than faculty physicians to want to avoid negative repercussions (84% vs 71% vs. 25%, p < 0.001) or appear lazy or weak (89% vs 75% vs. 40%, p < 0.001). Most participants also recognized the need to avoid spreading infections to patients (81%) or colleagues (75%). Conclusions When deciding whether to work when sick, students, residents, and faculty report a mixture of motivations that focus on the interests of patients, colleagues, and themselves. Awareness of these mixed motivations, particularly among trainees, can help inform interventions aimed at limiting instances of sickness presenteeism to support a culture of patient safety and counter any tendencies toward a hidden curriculum of efficiency and achievement.

Cell processes, including growth cones, respond to biophysical cues in their microenvironment to establish functional tissue architecture and intercellular networks. The mechanisms by which cells sense and translate biophysical cues into directed growth are unknown. We used photopolymerization to fabricate methacrylate platforms with patterned microtopographical features that precisely guide neurite growth and Schwann cell alignment. Pharmacologic inhibition of the transient receptor potential cation channel subfamily V member 1 (TRPV1) or reduced expression of TRPV1 by RNAi significantly disrupts neurite guidance by these microtopographical features. Exogenous expression of TRPV1 induces alignment of NIH3T3 fibroblasts that fail to align in the absence of TRPV1, further implicating TRPV1 channels as critical mediators of cellular responses to biophysical cues. Microtopographic features increase RhoA activity in growth cones and in TRPV1-expressing NIH3T3 cells. Further, Rho-associated kinase (ROCK) phosphorylation is elevated in growth cones and neurites on micropatterned surfaces. Inhibition of RhoA/ROCK by pharmacological compounds or reduced expression of either ROCKI or ROCKII isoforms by RNAi abolishes neurite and cell alignment, confirming that RhoA/ROCK signaling mediates neurite and cell alignment to microtopographic features. These studies demonstrate that microtopographical cues recruit TRPV1 channels and downstream signaling pathways, including RhoA and ROCK, to direct neurite and cell growth.

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Objectives This study aimed to: describe the incidence of thyroid gland involvement in advanced laryngeal cancer, analyse patterns of spread to the thyroid and elucidate predictors of thyroid involvement. Methods A retrospective review was performed on patients who underwent laryngectomy from 1991 to 2015 as a primary or salvage treatment for squamous cell carcinoma of the larynx, hypopharynx or base of tongue. The incidence of thyroidectomy during total laryngectomy, type of thyroidectomy, incidence of gland involvement, route of spread, and positive predictors of spread were analysed and reported. Results A total of 188 patients fit the inclusion criteria. Of these, 125 (66 per cent) underwent thyroidectomy. The thyroid was involved in 10 of the 125 patients (8 per cent), 9 by direct extension and 1 by metastasis. Cartilage invasion was a predictor of thyroid gland involvement, with a positive predictive value of 26 per cent. Conclusion There is a low incidence of thyroid gland involvement in laryngeal carcinoma. Most cases of gland involvement occurred by direct extension. Thyroidectomy during laryngectomy should be considered for advanced stage tumours with cartilage invasion.

There are distinct advantages and disadvantages between bioresorbable and permanent implants in orbital floor reconstruction. Our aim was to compare the outcomes and complications of resorbable implants and permanent implants in orbital floor fracture repair. A retrospective chart review was performed on all patients who underwent orbital floor fracture repair at a rural, tertiary care center from 2011 through 2016. Main outcome measures included improvement in diplopia, ocular motility, enophthalmos, hypoglobus, and infraorbital nerve sensation. A total of 87 patients underwent orbital floor reconstruction. After exclusion criteria were applied, 22 patients were included in the absorbable implant cohort, and 20 patients in the nonabsorbable implant cohort. All absorbable implants were composed of poly L-lactide/poly glycolide/poly D-lactide (PLL/PG/PDL), and nonabsorbable implants included both titanium/porous polyethylene (Ti/PPE) composite and titanium (Ti) mesh. Mean fracture surface area was 2.1 cm2 (standard deviation [SD]:± 0.9 cm2, range: 0.4–3.6 cm2) for the absorbable implant group and 2.3 cm2 (SD: ± 1.1 cm2, range: 0.6–4.4 cm2) for the nonabsorbable implant group ( p = 0.58). There were no significant differences in diplopia, ocular motility, enophthalmos, hypoglobus, and infraorbital nerve sensation between absorbable and nonabsorbable implant groups. The mean follow-up time for absorbable and nonabsorbable implant groups was 622 (SD ± 313) and 578 (SD ± 151) days respectively ( p = 0.57). For moderate-size orbital floor fracture repairs, there is no difference in outcomes between absorbable implants consisting of PLL/PG/PDL and nonabsorbable implants consisting of Ti mesh or Ti/PPE combination.

Background IncobotulinumtoxinA is an effective neuromodulator for treating glabellar rhytids. The relationship between dose and reduction in rhytid severity is well established. However, effects of escalating doses on the treatment duration response are less understood. Objective To assess effects of increasing doses of incobotulinumtoxinA on the treatment duration for glabellar rhytids. Methods A randomized, double-blind, Phase IV study was conducted at a fully accredited, outpatient surgical facility. Subjects (31 female, 7 male) with moderate-to-severe glabellar rhytids were randomized to one of three incobotulinumtoxinA dose groups: 20, 60, or 100 units. Effect duration was determined by calculating the time to return to baseline for dynamic glabellar lines during maximal contraction. Follow-up was completed through 1 year, and adverse events were monitored. Results The median duration of effect was 120 (95%-CI [90, 180]) days, 180 (95%-CI [180, 210]) days, and 270 (95% CI [240, 330]) days for the 20, 60, and 100 U groups respectively. A Wald chi-square test from the Cox regression on the primary efficacy variable indicated a statistically significant effect of dose group on time to baseline (Chi square = 54.63; df = 2; p &lt; 0.001). Hazard ratios were HR = 0.21 (95%-CI = [0.10; 0.43] for 60 U vs. 20 U group, and HR = 0.06 (95%-CI [0.10; 0.43]) for 100-U vs 20 U group, indicating a statistically longer return to baseline for both 60 and 100 U cohorts. Conclusions There is a dose-dependent relationship between incobotulinumtoxinA and duration of effect in the glabella.

Objective Micro- and nano-scale surface features have emerged as potential tools to direct neurite growth into close proximity with next generation neural prosthesis electrodes. However, the signaling events underlying the ability of growth cones to respond to topographical features remain largely unknown. Accordingly, this study probes the influence of [Ca2+]i and cyclic nucleotide levels on the ability of neurites from spiral ganglion neurons (SGNs) to precisely track topographical micropatterns. Approach Photopolymerization and photomasking were used to generate micropatterned methacrylate polymer substrates. Dissociated SGN cultures were plated on the micropatterned surfaces. Calcium influx and release from internal stores were manipulated by elevating extracellular K+, maintenance in calcium-free media, or bath application of various calcium channel blockers. Cyclic nucleotide activity was increased by application of cpt-cAMP or 8-Br-cGMP. Main results Elevation of [Ca2+]i by treatment of cultures with elevated potassium reduced neurite alignment to physical microfeatures. Maintenance of cultures in Ca2+-free medium or treatment with the non-selective voltage-gated calcium channel blocker cadmium or L-type Ca2+ channel blocker nifedipine did not signficantly alter SGN neurite alignment. By contrast, ryanodine or xestospongin C, which block release of internal calcium stores via ryanodine-sensitive channels or inositol-1,4,5-trisphosphate receptors respectively, each significantly decreased neurite alignment. Cpt-cAMP significantly reduced neurite alignment while 8-Br-cGMP significantly enhanced neurite alignment. Conclusion Manipulation of [Ca2+]i or cAMP levels significantly disrupts neurite guidance while elevation of cGMP levels increases neurite alignment. The results suggest intracellular signaling pathways similar to those recruited by chemotactic cues are involved in neurite guidance by topographical features.