Notes

Exploring the Connection among Rest Top quality as well as Pulse rate Variability between Female Nurse practitioners.
The purpose of this study was to evaluate the incidence of laryngeal pathology found during bedside flexible endoscopic evaluation of swallowing (FEES) in a community hospital.

A retrospective study among patients who underwent a bedside FEES examination from May 2018 to May 2019. Criteria to perform a bedside FEES exam were patients who were identified through nursing screening swallowing evaluation and failed a bedside clinical evaluation of swallowing by a speech language pathologist. Patient demographics, recent intubation, duration of intubation, dysphonia complaints, laryngeal exam findings, consultation to otolaryngology and intervention were reviewed.

Seventy-five patients had an inpatient bedside FEES. All (100%) had subjective complaints of swallowing. 29 (38.66%) had laryngeal pathology identified on FEES examination including unilateral vocal fold immobility (9), fungal infections (6), vocal fold lesion (3), edema (3), erythema (3), vocal process granuloma (2), unilateral TVF Hemorrhage (1), unilateral TVF paresis (1), suspected superior laryngeal nerve palsy (1). Seventeen of the twenty-nine (58.6%) examinations with incidental laryngeal finding received an otolaryngology referral. Twenty-three of the twenty-nine patients with laryngeal findings (79.3%) were intubated during the hospitalization.

Bedside FEES is a well-established method to evaluate swallowing function in an inpatient population. Even in a community hospital, routine FEES examinations led to a high rate of detection of clinically significant laryngeal pathology.
Bedside FEES is a well-established method to evaluate swallowing function in an inpatient population. Even in a community hospital, routine FEES examinations led to a high rate of detection of clinically significant laryngeal pathology.
Emerging evidence indicates that metformin has anti-inflammatory effect; however, the results differ concerning randomized controlled trails of the effect of metformin on inflammatory markers in type 2 diabetes (T2D) patients.

This study reassessed the data on the effect of metformin treatment on inflammatory markers in T2D patients through a systematic review and meta-analysis.

A systematic search was performed in the PubMed, ISI Web of Science, EMBASE, Cochrane Library and Scopus databases to collect relevant published data up to September 2020. Data of each study was combined using random-effects model. Subgroup analysis was performed based on subgroups of the treatment duration, dose and target population.

Thirteen RCTs including 1776 participants with T2D were analyzed. Although CRP levels significantly decreased [SMD -0.76 mg/L; 95% CI (-1.48, -0.049); P = 0.036] in patients with T2D following metformin treatment, circulating levels of TNF-α [SMD -0.17 pg/mL; 95% CI (-0.55, 0.20); P = 0.37] and IL-6 [SMD -0.06 pg/mL; 95% CI (-0.38, 0.25); P = 0.69] were insignificant after metformin treatment. Compared to treatment duration of less than 24 weeks, longer treatment duration (more than 24 weeks) was associated with reduced level of CRP.

Based on available evidence from RCTs in this meta-analysis, metformin decreased CRP level. However, strategies for the treatment of inflammation should focus on metformin in patients with T2D.

The present study evidences that therapy with metformin can reduces CRP level significantly in T2D patients compared to other inflammatory markers.
The present study evidences that therapy with metformin can reduces CRP level significantly in T2D patients compared to other inflammatory markers.
A prior publication introduced the Strome-Blitzer balloon's ability to obtain circumferential esophageal cytologic sampling. This GLP study was requisite for FDA approval to determine if equivalent cell capture and cellularity was observed with the balloon compared to surface sampling brushes and to determine the balloon's usability for naive otolaryngologists.

Three naïve users tested the Hobbs brush and Strome-Blitzer balloon on 4 Yorkshire swine. Four anatomical sites were sampled, beginning distally and ending proximally. In 2 animals, the balloon was used first distally and in the remaining 2, 4 new Hobbs brushes were used distally first. Moving proximally, the balloon and brushes were sequentially alternated. In follow-the-leader fashion, the balloon was introduced trans-orally followed by an endoscope to the desired site. The balloon was inflated exposing the abrasive strips to contact the esophageal mucosa. Moving the balloon 1 to 2 cm superiorly and inferiorly effected circumferential cell capture. The balloon was collapsed and removed, preserving the cellularity. The Hobbs brush was passed through the scope's channel. Four brushes, 1 per quadrant, obtained the samples at an anatomical site. The balloon was rated as pass/fail on the following delivery, kinking, usability, and malfunction. A blinded veterinary pathologist evaluated the cytology.

There was no device malfunction, mucosal trauma, or difficulty with device use. Balloon cytologic samples were comparable in cellularity and quality to the brush.

A single balloon sampling was comparable to 4 brushes in capturing diagnostically relevant cellular volumes and architecture. Naïve users easily performed the procedures after reading the guidelines.

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Given the ubiquity of statin use and prevalence of thyroid diseases, such as thyroid cancer, hyperthyroidism, and thyroiditis, understanding their association deserves further attention.

To examine the association between statin use and thyroid cancer, thyrotoxicosis, goiter, and thyroiditis.

Using Tricare data, 2 propensity score (PS)-matched cohorts of statin users and nonusers were formed (1) a PS-matched general cohort (all patients aged 30-85 years) and (2) a PS-matched healthy cohort (excluded patients with cardiovascular diseases or severe comorbidities). Outcomes were thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. Odds ratios (ORs) and 95% CIs of outcomes were estimated using conditional regression analysis.

Of 43 438 patients, the PS-matched general cohort matched 6342 statin users to 6342 nonusers. The OR of thyroid cancer was 0.62 (95% CI = 0.39-0.996). There was no significant difference between statin users and nonusers in risk of thyrotoxicosis (OR = 0.88; 95% CI = 0.71-1.09), goiter (OR = 0.9; 95% CI = 0.77-1.03), or thyroiditis (OR = 0.78; 95% CI = 0.53-1.15). In the PS-matched healthy cohort (3351 statin users to 3351 nonusers), there was no difference between statin users and nonusers in any outcome. Limitations of the study include its retrospective observational design and use of administrative codes in outcomes ascertainment.

This study did not demonstrate any association of statins with harmful effects on thyroid diseases, which offers assurance to clinicians and patients. Furthermore, statin use appears to be associated with a decreased risk of thyroid cancer, but more studies are needed.
This study did not demonstrate any association of statins with harmful effects on thyroid diseases, which offers assurance to clinicians and patients. Furthermore, statin use appears to be associated with a decreased risk of thyroid cancer, but more studies are needed.
Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts.

To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts.

Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. selleckchem A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (D
), vascular origin of compressing vessels, diameter of vessel (D
) and trigeminal nerve (D
) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsiblemprove the prediction of responsible contacts for radiologists.
To determine changes in the residency experience early in the COVID-19 pandemic and evaluate wellness measures among otolaryngology residents.

A web-based survey was administered to U.S. otolaryngology residents. Responses to the Shirom-Melamed Burnout Measure (SMBM) and the Generalized Anxiety Disorder-7 scale were recorded along with data on burnout, demographics, wellness, sleep, training, and education.

119 U.S. otolaryngology residents representing 27 of 42 states with otolaryngology residency programs responded to the survey. 24.4% (95% CI 17.0-31.8%) self-reported some level of burnout, while 10.9% met SMBM criteria for "clinically relevant" burnout. 51.3% experienced more stress, and 58.8% reported more anxiety during the COVID-19 pandemic. Compared to males, females had a higher prevalence of burnout (38.9% vs 12.3%,
 = .001) and anxiety (75.9% vs 43.8%,
 < .001). PGY-2s had a greater mean SMBM index (3.64) and higher rates of self-reported burnout (54.2%) than their counterparts at otheacted by the pandemic, but remote didactics and educational opportunities increased. These findings may inform otolaryngology residency programs on the need to promote resident wellness and aid in devising strategies to improve the educational experience during this unique global health crisis as well as in the long term.Introduction Inhaled drugs are important in the treatment of many lung pathologies, but to be therapeutically effective they must reach unbound concentrations at their effect site in the lung that are adequate to interact with their pharmacodynamic properties (PD) and exert the pharmacological action over an appropriate dosing interval. Therefore, the evaluation of pharmacokinetic (PK)/PD relationship is critical to predict their possible therapeutic effect.Areas covered We review the approaches used to assess the PK/PD relationship of the major classes of inhaled drugs that are prescribed to treat pulmonary pathologies.Expert opinion There are still great difficulties in producing data on lung concentrations of inhaled drugs and interpreting them as to their ability to induce the desired therapeutic action. The structural complexity of the lungs, the multiplicity of processes involved simultaneously and the physical interactions between the lungs and drug make any PK/PD approach to drug delivery design for inhalation medications extremely challenging. New approaches/methods are increasing our understanding of what happens to inhaled drugs, but they are still not ready for regulatory purposes. Therefore, we must still rely on plasma concentrations based on the axiom that they reflect both the extent and the pattern of deposition within the lungs.Polycyclic Aromatic Hydrocarbons (PAHs) are chemicals, which can occur in barbecued or grilled foods, and particularly in meats. They originate from incomplete combustion of the heat source, pyrolysis of organic compounds, or fat-induced flame formation. This review therefore summarizes relevant parameters for mitigation of especially carcinogenic PAHs in barbecued meat. Consumption of PAHs increases the risk of cancer, and thus the relevance for the mitigation of PAHs formation is very high for barbecued meat products. Parameters such as heat source, barbecue geometry, and meat type as well as marinating, adding spices, and other antioxidants reduce the final benzo[a]pyrene and PAHs concentrations and minimize the exposure. Overall, mitigation of carcinogenic PAHs from barbecuing includes removal of visual charring, reducing fat pyrolysis by minimizing dripping from the meat onto the heat source, the use of acidic marinades or choosing leaner cuts of meat. Estimation of human exposure to barbecued meat, includes several challenges such as substantial differences in barbecuing frequencies and practices, heat sources and meat types used for grilling.
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