Han Zhang

Objective: The most commonly employed diagnostic criteria for identifying thyroid nodules include Thyroid Imaging and Reporting Data System (TI‐RADS) and American Thyroid Association (ATA) guidelines. The purpose of this systematic review and meta‐analysis is to determine the inter‐rater reliability of thyroid ultrasound criteria.Methods: We performed a library search of MEDLINE (Ovid), EMBASE (Ovid), and Web of Science for full‐text articles published from January 2005 to June 2022. We included full‐text primary research articles that used TI‐RADS and/or ATA guidelines to evaluate thyroid nodules in adults. These included studies must have calculated inter‐rater reliability using any validated metric. The Quality Appraisal for Reliability Studies (QAREL) was used to assess study quality. We planned for a random‐effects meta‐analysis, in addition to covariate and publication bias analyses. This study was performed in accordance with Preferred Reporting Items for a Systematic Review and Meta‐analysis guidelines and registered prior to conduction (International prospective register of systematic reviews—PROSPERO: CRD42021275072).Results: Of the 951 articles identified via the database search, 35 met eligibility criteria. All studies were observational. The most commonly utilized criteria were ACR Thyroid Imaging and Reporting Data System (TI‐RADS) and/or ATA criteria, while the majority of studies employed Κ statistics. For ACR TI‐RADS, the pooled Κ was 0.51 (95% confidence interval [CI]: 0.42, 0.57; n = 7) while for ATA, the pooled Κ was 0.52 (95% CI: 0.37, 0.67; n = 3). Due to the small number of studies, covariate or publication bias analyses were not performed.Conclusion: Ultrasound criteria demonstrate moderate inter‐rater reliability, but these findings are impacted by poor study quality and a lack of standardization. Laryngoscope, 133:485–493, 2023

Objectives: To evaluate the success rates of canalith repositioning maneuvers (CRM) in the treatment of patients diagnosed with bilateral benign paroxysmal positional vertigo (BiBPPV).Study Design: Systematic review.Methods: A comprehensive search of only English studies in PubMed, Ovid (1946 to the present), and Embase (1974 to the present) databases was done up until January 1, 2021. Studies that diagnosed patients with BiBPPV specifically and evaluated the CRM success from all published years were included. Studies were excluded if follow‐up was less than 6 months or if they failed to distinguish BiBPPV from ipsilateral multi‐canal BPPV. A total of nine studies were included with a total study population of 325 patients. Included studies were evaluated for bias with the National Institutes of Health (NIH) Study Quality Assessment Tool. Success rates of CRM, number of treatments required, and disease recurrence rates were extracted.Results: The overall success rate was compiled using a fixed‐effect binary inverse variance model and was 95.2% (CI: 92.9%–97.5%). A qualitative review suggested treating the more affected side first on separate visits until resolved, followed by contralateral treatment (recommendation). The mean number of treatments was 2.9 (CI: 2.4–3.4), and the recurrence rate was 19.8% (CI: 11.7%–27.9%). There was a higher proportion of trauma etiology of BiBPPV compared to unilateral, with an odds ratio of 8.9 (CI: 5.1–15.3).Conclusions: Overall, this meta‐analysis shows high success rates for CRM in the treatment of BiBPPV. Rates are similar to CRM efficacy for unilateral BPPV. Laryngoscope, 132:640–647, 2022

Objective: To determine the variables that are predictive of failed decannulation (FD), delayed decannulation (DD), and days to decannulation in patients who underwent head and neck cancer resection with free tissue transfer reconstruction for head and neck squamous cell carcinoma.Design: Case series with chart review.Setting: Tertiary care otolaryngology–head and neck surgery referral center.Subject and Methods: Patients (N = 108) were included who underwent head and neck cancer resection with free tissue transfer reconstruction and tracheostomy between 2011 and June 2014. Patients with laryngectomy, previous tracheostomy, and other airway pathology necessitating tracheotomy were excluded. Preoperative patient variables and cancer site/staging variables were analyzed, as well as extent of structures resected and type of reconstruction. Univariate and multivariate binary logistic and Cox regression analyses were used to determine predictors of FD and DD. Cox regression analysis was used to determine predictors of days to decannulation.Results: Of the 108 included patients, 16 had FD, and 26 had DD. Univariate analysis demonstrated that advanced stage (r = 0.233, P =. 021), total glossectomy (r = 0.924, P <. 001), anterolateral thigh flap reconstruction (r = 0.906, P <. 001), smoking at time of surgery (r = 0.319, P =. 002), and pack years (r = 0.322, P =. 001) were associated with FD. Cox regression analysis showed that total glossectomy, exp(B) = 15.837 (95% confidence interval [95% CI]: 1.949‐128.679); anterolateral thigh flap reconstruction, exp(B) = 8.439 (95% CI: 2.435‐29.620); and smoking status, exp(B) = 2.970 (95% CI: 1.617‐5.456) were independent predictors of days to decannulation and FD.Conclusions: Patients with total glossectomy defects and those who continue to smoke are at increased risk for FD and DD. Aggressive smoking cessation programs may decrease the risk of FD and DD. Patients should be counseled about their risk profiles.

Within the kitchen the potential for burn injuries arising from contact with hot surfaces, flames, hot liquid, and steam hazards is high. The chef’s uniform can potentially offer some protection against such burns by providing a protective barrier between the skin and the thermal hazard, although the extent to which can provide some protection is unknown. The purpose of this study was to examine whether fabrics used in chefs’ uniforms were able to provide some protection against thermal hazards encountered in the kitchen. Fabrics from chefs’ jackets and aprons were selected. Flammability of single- and multiple-layered fabrics was measured. Effect of jacket type, apron and number of layers on hot surface, hot water, and steam exposure was also measured. Findings showed that all of the jacket and apron fabrics rapidly ignited when exposed to a flame. Thermal protection against hot surfaces increased as layers increased due to more insulation. Protection against steam and hot water improved with an impermeable apron in the system. For wet thermal hazards increasing the number of permeable layers can decrease the level of protection due to stored thermal energy. As the hands and arms are most at risk of burn injury increased insulation and water-impermeable barrier in the sleeves would improve thermal protection with minimal compromise to overall thermal comfort.