Objectives: Drug-induced sleep endoscopy (DISE) is increasingly being used in children with obstructive sleep apnea (OSA) to identify specific sites of upper airway obstruction and plan surgical interventions. This study aims to test the reliability and validity of a new grading system for pediatric DISE procedures (PedDISE-8). Methods: We conducted a retrospective chart review of children 0 to 18 years old with OSA who underwent DISE. Four independent raters reviewed and graded each video recording twice using the PedDISE-8. Eight upper airway sites were evaluated: inferior turbinates, adenoid, velum, tonsils/lateral pharyngeal walls, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. Intraclass correlation coefficients were calculated to determine inter-rater and intra-rater rating reliability for each site. External validity was assessed by analyzing the correlation between the number of sites with severe obstruction and polysomnographic data. Results: DISE recordings were reviewed for 86 pediatric patients, 59.5% of whom were male and 26.7% were obese. The median age was 3.5 (IQR 2.4-5.3) years, and the median obstructive apnea-hypopnea index (oAHI) was 5.5 (IQR 3.1-10.4). Moderate to good inter-rater and intra-rater reliability were found for all eight sites (intraclass correlation coefficient 0.67 to 0.88 and 0.71 to 0.87, respectively). The number of sites with severe obstruction correlated positively with the oAHI (τ = 0.119, P = .004). Conclusions: The PedDISE-8 grading system demonstrated good inter-rater and intra-rater reliability and external validity. It can be used in children undergoing DISE for OSA.
Journal Article Evolutionary Response to Human Infectious Diseases Get access George J. Armelagos, George J. Armelagos Search for other works by this author on: Oxford Academic Google Scholar John R. Dewey John R. Dewey Search for other works by this author on: Oxford Academic Google Scholar BioScience, Volume 20, Issue 5, March 1970, Pages 271–275, https://doi.org/10.2307/1295204 Published: 01 March 1970 Article history Accepted: 18 April 1969 Published: 01 March 1970
Studies of hominid fossils have frequently reported that one of their outstanding characteristics is their heavily worn teeth. Many skeletal remains of modern man also show this condition of dental attrition, which is probably related to certain cultural activities. The varieties of foods consumed by primitive man and the specialized tool functions of the teeth have left significant marks in the form of worn occlusal surfaces over the dental arches. This paper discusses some of the functions of the teeth indicated by these marks and suggests that tooth wear should be studied carefully in order to gain significant information about the activities of past populations.
Bi‐allelic inactivation of the PKD1 gene results in Autosomal Dominant Polycystic Kidney Disease (ADPKD), a common and lethal disorder. ADPKD is thought to follow a two‐hit pathway, where one inherited mutation in PKD1 is followed later by somatic inactivation of the other allele. Loss of PKD1 expression results in cysts, which are clonal in nature and can number in the thousands. The mechanisms are unclear, but human PKD1 appears prone to mutagenesis and inactivation. Interestingly, naturally occurring ADPKD is observed in humans, cats, and pigs, but not mice. We have therefore compared PKD1 gene sequences across species to determine if there are shared sequence or structural characteristics that could explain PKD1 instability. Despite conservation of PKD1 organization and coding across species, we find an over‐representation of G/C content and tandem repeats in PKD1 from species that are naturally prone to ADPKD. It is already established that guanine‐rich DNA triggers site‐specific genetic instability via the formation of G‐quadruplex (G4) DNA structures. Cytosine repeats also support structures called, i‐motifs, which have the potential to induce site‐specific genetic instability. We find that the human, feline, and porcine PKD1 genes are rich in G and C tandem repeats and G4 sequences, while murine Pkd1 is not. Circular dichroism spectroscopy demonstrates that structure formation occurs under physiological conditions. The possibility that G4 DNA contributes to PKD1 instability is further supported by the fact that cataloged somatic mutations are clustered near predicted G4 forming motifs. Our results identify G4 DNA and i‐motifs as structures that may form on both strands of the PKD1 gene, uncovering a molecular rationale to explain the instability of the gene and the emergence of cysts in ADPKD carriers. Support or Funding Information WMed Pilot Grant Program This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .
Objectives Globus pharyngeus (GP) is a perplexing problem that accounts for 4% of referrals to otolaryngologists. Workup can be extensive and may not be definitive in terms of etiology. The concern that lingers is that of a subtle cancer, which can prolong anxiety and increase testing cost. The aim of this study was to identify the incidence of head and neck cancer (HNC) in patients diagnosed with GP. Methods Longitudinal data were captured from two academic institutions, identifying patients with a new diagnosis of globus pharyngeus in 2015. The patient cohort was tracked for at least 4 years to assure follow‐up and ability to determine if a HNC developed. Additional demographic data was also collected to determine most common consults, treatments, and testing employed. Results Excluding patients with previous diagnosis of HNC, 377 patients were identified who presented with GP in 2015 that had at least 4 years of follow‐up. Demographics were predominantly women (64.65%), with a mean age of 56.48 years at diagnosis, and the most common provider specialty on the first visit was otolaryngology (39.52%). Four patients ultimately developed HN cancer, for an overall incidence of 1% for the 4‐year period of 2015–2019. Conclusions Given the long‐term follow‐up of this population, the overall incidence of developing a head and neck cancer, with a presenting symptom of globus, is low. This is the largest study to date to report the percentage of patients endorsing GP to then subsequently develop HNC. This helps otolaryngologists to reassure patients who have a normal comprehensive exam, flexible endoscopy, and targeted studies. Level of Evidence 4 Laryngoscope , 134:1147–1154, 2024
Acute changes in electrolyte levels can result in severe physiologic complications. Rapid treatment of abnormally elevated potassium levels is essential due to the increased risk of potentially fatal cardiac arrhythmias. However, there are a number of circumstances that can lead to falsely elevated serum potassium levels, including fist clenching during phlebotomy and hemolysis of hematocytes during laboratory processing. Here we present a case of an elderly woman with chronic lymphocytic leukemia who presented with lower left quadrant pain and hematochezia. Laboratory tests revealed an elevated serum potassium level (7.5 mmol/L) on initial testing, in the absence of hyperkalemia symptoms, EKG changes, and hemolysis of the blood specimen. Abdominal CT revealed inflammatory changes consistent with diverticulitis. She was treated with intravenous calcium, insulin, glucose, and bicarbonate for her hyperkalemia and admitted for treatment for diverticulitis. A subsequent serum potassium level (3.9 mmol/L) and discussion with the hospitalist suggested a diagnosis of leukolysis-induced pseudohyperkalemia, and further treatment of hyperkalemia was halted. This case serves to remind current and future physicians about the importance of maintaining clinical suspicion and clarifying unexpected laboratory readings when the clinical picture and results do not completely align.
