Faculty Bibliography

OBJECTIVE: To examine speech perception outcomes as related to a reduction in the number of functional electrodes postimplantation and to determine the effect of electrode reduction on subsequent device failure. STUDY DESIGN: Retrospective review. SETTING: Tertiary academic referral center. PATIENTS: Of 1,520 children and adults with full insertions of the Advanced Bionics, Med El, and Nucleus devices, 15 (1%) were patients. Patients were included in the study if all electrodes were functional at initial stimulation, but the number of electrodes in use was subsequently reduced at follow-up programming sessions. Exclusion criteria included partial and split-array electrode insertions. INTERVENTION(S): Patients with bilateral severe to profound sensorineural hearing loss underwent either unilateral or bilateral cochlear implantation. MAIN OUTCOME MEASURE(S): Postimplantation speech perception tests obtained with a full complement of functional electrodes were performed and the results compared to those obtained with 1 or more electrodes removed from the user program. Electrode deactivation was also correlated with device failure. RESULTS AND CONCLUSION: The results of this study indicate that deactivation of cochlear implant electrodes is relatively uncommon, and although the deactivation does not have a direct influence on speech performance outcomes, the loss of 5 or more electrodes can suggest impending device failure. Additionally, those patients with electrode deactivation coupled with a decline in speech perception scores should also be considered at risk for device failure

The deviated nasal dorsum is a complex problem with a variety of proposed solutions. Straightening the deviated nose should be focused on maximizing cosmetic outcome while preserving or improving nasal function. Deviations can occur in one or a combination of the nasal thirds. A simple approach to treatment is to develop a strategy for each third of the nose. Tailoring maneuvers to alleviate problems in each specific third helps the surgeon deal with deviations in an effective and straightforward manner

The standard treatment for locally advanced urothelial bladder carcinoma is radical cystectomy or chemoradiation. Sarcomatoid urothelial carcinoma, a rare tumour, is treated with radical cystectomy because the response to radiation therapy alone is poor in other sarcomas. We report a case of high-grade hyperinvasive urothelial bladder carcinoma with sarcomatoid differentiation. The patient refused cystectomy, and so a chemoradiation regimen was devised for her treatment. She completed the regimen and has since demonstrated a complete response to chemoradiation therapy clinically and pathologically by biopsy. The patient has therefore been able to attain a complete response while preserving a functional bladder

OBJECTIVES: We studied the effect of transforming growth factor (TGF)-beta on immortalized human vocal fold fibroblasts. METHODS: Normal human vocal fold fibroblasts were subjected to sequential lentiviral transduction with genes for human telomerase (hTERT) and SV40 large T antigen in order to produce an 'immortalized' cell line of normal phenotype. After confirmation of vocal fold fibroblast transfection, these cells, referred to as HVOX, were treated with various concentrations of exogenous TGF-beta1 and assayed for collagen secretion, migration, and proliferation. In addition, components of the TGF-beta signaling pathway were examined in this cell line. RESULTS: TGF-beta stimulated collagen secretion and migration without altering proliferation of HVOX. HVOX constitutively expressed type I and II TGF-beta receptors, as well as messenger RNA for the Smad signaling proteins and for all TGF-beta isoforms. Exogenous TGF-beta1 induced temporally dependent alterations in Smad2 and Smad3 gene expression. TGF-beta increased Smad7 expression at both 4 and 24 hours. Prolonged exposure to TGF-beta decreased TGF-beta1 gene expression. CONCLUSIONS: Insight into the underlying pathophysiology of vocal fold fibrosis is likely to yield improved therapeutic strategies to mitigate vocal fold scarring. Our data suggest that TGF-beta signaling may be both paracrine and autocrine in this vocal fold fibroblast cell line, and we therefore propose that TGF-beta may be a reasonable target for therapies to prevent and/or treat vocal fold fibrosis, given its putative role in both acute and chronic vocal fold injury, as well as its effects on vocal fold fibroblasts

OBJECTIVE/HYPOTHESIS: Oxidative damage mediates the lower airway response to cigarette smoke (CS). In the vocal folds, the tissue phenotype is both distinct and largely uncharacterized. We sought to investigate the effects of CS on the oxidative status and fibroblast phenotype in the vocal folds. Specifically, we hypothesized that CS would induce a hypermetabolic fibroblast phenotype and altered oxidative metabolism potentially providing insight into the relationship among CS, Reinke's edema (RE), and malignancy. STUDY DESIGN: In vivo/in vitro. METHODS: Heme oxygenase (HO)-1 gene expression was examined in human tissue. In vitro, the effects of cigarette smoke condensate (CSC) on HO-1 gene expression and secretion was assayed. In addition, CS-mediated intracellular reactive oxygen species synthesis was quantified, and compared to the response in pulmonary fibroblasts (HFL). We then examined the effects of CSC on migration and proliferation in human vocal fold fibroblasts (HVOX). RESULTS:: HO-1 expression was approximately 4-fold higher in RE samples versus vocal fold polyps. CSC induced HO-1 gene expression and secretion in a time- and dose-dependent fashion in vitro. CSC also increased intracellular ROS in both HVOX and HFL. CSC decreased HVOX proliferation and migration in a dose-dependent manner. CONCLUSIONS: These data suggest that the fibroblast phenotype is influenced by smoke. Our data suggest that the antioxidant response in the vocal fold tissue may be one mechanism of chemoprotection, a putative explanation for the observation that RE rarely transforms to malignancy. In addition, CSC does not appear to induce a hypermetabolic fibroblast phenotype as expected

This paper presents an optimal path planning method of steerable electrode arrays for robot assisted cochlear implant surgery In this paper, the authors present a novel design of steerable electrode arrays that can actively bend at the up An embedded strand in the electrode array provides an active steering degrees of freedom (DoF) This paper addresses the calibration of the steerable electrode arrays and the optimal path planning for inserting it into planar and three dimensional scala tympani models The goal of the path planning is to minimize the intracochlear forces that the electrode array applies on the walls of the scala tympam during insertion This problem is solved by designing insertion path planning algorithms that provide best fit between the shape of the electrode aunty and the curved scala tympani during insertion Optimality measures that account fittape discrepancies between the steerable electrode array and the scala tympam are used to solve for the optimal path planning of the robot Different arrangements of DoF and insertion speed force feedback (ISFF) are simulated and experimentally validated in this paper A quality of insertion metric describing the gap between the steerable electrode array and the scala tympam model is presented and as correspondence to the insertion force is shown The results of using 1DoF 2DoF and 4DoF electrode array insertion setups are compared The 1DoE insertion setup fiver nonsteerable electrode arrays The 2DoF insertion setup uses single axis insertion with steerable electrode arrays. The 4DoF insertion setup allows full control of the insertion depth and the approach angle of the electrode with respect to the cochlea while using steerable electrode arrays It is shown that living steerable electrode arrays significantly reducer the maximal insertion force (59.6% or more) and effectively prevents buckling of the electrode array The 4DoF Insertion setup further reduces the maximal electrode insertion forces The results of using ISFF for steerable electrodes show a slight decrease in the insertion forcer in contrast to a slight increase for nonsteerable electrodes These results show that further research is required in order to determine the optimal ISFF control law and its effectiveness in reducing electrode invention fortes [DOI 10.1115/1.3039513]

OBJECTIVE: To determine whether a 3-day course of postoperative antibiotics is as effective as a 7-day course in reducing pain and reducing time to resumption of a normal diet and level of activity following pediatric tonsillectomy. DESIGN: A prospective, randomized, placebo-controlled trial. SETTING: Academic medical center. PATIENTS: Forty-nine patients were enrolled in the study. Preoperative demographic information was obtained. INTERVENTIONS: Tonsillectomy with or without adenoidectomy was performed by the senior author (J.J.) using electrocautery. Patients were randomized to receive either a 3- or 7-day course of amoxicillin. MAIN OUTCOME MEASURES: Parents were asked to record the following information: analgesic use for the first 7 postoperative days, postoperative days the child initiated his or her usual diet and level of activity, and medical treatment for oral hemorrhage or dehydration. RESULTS: Of the 49 patients, 26 were randomized to receive 7 days of postoperative antibiotics (group A) and 23 to receive 3 days of antibiotics, followed by 4 days of placebo (group B). Results were obtained for 47 of the enrolled patients (96%). No statistically significant difference was noted between the 2 groups with regard to postoperative pain or time to resumption of a normal diet and level of activity. CONCLUSION: A 3-day course of antibiotics following pediatric tonsillectomy is as effective as a 7-day course with regard to postoperative analgesic use and resumption of normal diet and level of activity. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00662987