Yotam Lior

Objective: To systematically review the literature on voice outcomes following laryngochondroplasty (LCP). Data Sources: PubMed, Scopus, and Embase. Review Methods: A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Studies published in English between January 1990 and January 27, 2026, evaluating voice quality after LCP, were eligible. Included study designs were randomized controlled clinical trials, cohort studies, case‐control studies, and case series. Extracted data encompassed study design, sample size, surgical technique, voice assessment methods, and reported outcomes. Results: Of 344 articles identified, 126 duplicates were removed, and 162 articles were excluded by screening title and The full texts of the remaining 44 articles were reviewed, and 20 met the eligibility criteria, representing a cohort of 760 patients. Most studies relied on subjective or qualitative voice assessments; only two incorporated objective acoustic analyses. Postoperative voice changes were reported in 98 of 777 patients (12.6%), more in patients operated via the transcervical approach (13%), than via the transvestibular approach (5.2%). Fewer reports of voice changes were found when utilizing the transcervical technique with vocal fold localization than without (2.8% vs 29.6%, respectively). More reports of voice changes were found in studies from lead authors affiliated with Otolaryngology‐Head and Neck Surgery departments than in those affiliated with plastic surgery departments (15.3% vs 9.9%, respectively). Conclusions: Voice changes may occur following LCP, and the surgical approach may affect the risk. Larger prospective studies using standardized and objective voice measures are needed to confirm these findings.

Background: Epidural analgesia is commonly used for pain control after major lower‐limb orthopedic surgery in children, but it is associated with a risk of postoperative urinary retention. Consequently, urinary catheters are often placed and left in situ for the full duration of epidural analgesia, despite the potential risks of prolonged catheterization, including discomfort, ward reinsertion, and urinary tract infection. Aims: To assess the impact of implementing a standardized institutional urinary catheter management protocol on postoperative urinary catheter outcomes in children less than age 18 years, undergoing major lower‐limb orthopedic surgery with postoperative epidural analgesia. Methods: Single‐center, retrospective, observational study on children who met the above criteria in the study period before (1/2019–6/2021) and after (7/2021–7/2023) initiation of a urinary catheter management protocol. The protocol mandated intra‐operative urinary catheter placement and early removal on postoperative day 1, while continuing epidural analgesia as long as 5 days. Results: A total of 93 children were included in this study: 47 before and 46 after initiation of the protocol. Demographic data were similar. Children treated according to the new protocol required significantly fewer ward urinary catheter insertions (2.2% vs. 19.1% respectively, p = 0.003) and had significantly faster removal of urinary catheter (1 [1‐1] vs. 3 [2‐3] days, p < 0.001) without subsequent urinary catheter insertion despite similar epidural analgesia duration. There was no difference in occurrence of urinary tract infection. Conclusions: Implementation of a standardized institutional urinary catheter management protocol, mandating intraoperative catheter placement and removal on postoperative day 1, despite ongoing epidural analgesia, was associated with reduced urinary catheter duration and fewer postoperative ward catheter insertions in pediatric patients undergoing major lower‐limb orthopedic surgery.

Technological advancements have made 3D printing more accessible and affordable for both individuals and institutions. Despite significant efforts by the International Medical Device Regulators Forum to standardize 3D printing regulations for medical use, challenges remain. We conducted a survey to gather insights from physician end-users on their opinions regarding the regulation of 3D printing in medicine. Additionally, since FDA guidance is often adopted internationally, this survey aimed to capture the demographics of physician end-users globally and provide a snapshot of the current use of 3D printing in clinical practice and research. After developing and validating a 26-question survey, we emailed it to the corresponding authors of all PubMed-indexed publications on 3D printing in medicine. Participants received an introductory email explaining the survey's purpose and an invitation to participate. Only responses from participants who declared themselves to be physicians were accepted. The survey was open for responses from April 5th to May 3rd, 2022, with weekly reminders sent until the response period closed. Responses with at least 80% survey completion were accepted for analysis. Out of 951 surveys sent, we received 114 responses (11.9%) with an average completion rate of 89%. Most respondents were from Europe (35.5%) and North America (30.9%), followed by Australia and New Zealand (9.1%). The majority were affiliated with academic institutions (83.9%) and were primarily surgeons (49.1%). The most common application of 3D printing was surgical planning (74.1%), followed by medical education (61.6%). Nearly 50% of respondents used open-source segmentation software without FDA approval. Most had access to an onsite printer (82.2%) and specially trained staff to assist with segmentation (53.4%). The integration of 3D printing technologies into clinical practice will continue to grow. This paper presents the largest survey of physicians practicing 3D printing to date. Given the underrepresentation of this key demographic within regulatory bodies, the opinions and positions of physician respondents reported here should be considered in the development and application of new guidelines and regulations in the field.

To assess which margin status, surgical bed margin (SBM) or tumor margin (TM) correlates best with outcome following transoral laser microsurgery (TLM) for early (Tis-T2N0M0) glottic cancer. A retrospective cohort study including patients with early (T1-2) glottic cancer. Data on TM status, SBM status, recurrence rate, and disease-free survival (DFS) were retrieved from the medical records of all patients who underwent vocal fold (VF) cordectomy due to Tis-T2N0M0 glottic squamous cell carcinoma from January 2013 to February 2021. Only patients with available data on both SBM and TM status were included in the study. Forty patients, 34 (85%) with disease-free SBM and TM, and 6 (15%) with disease-free SBM but involved TM, were included. Four (10%) patients developed recurrence, all in the group of both disease-free SBM and TM. The recurrence, 2-year disease free survival and survival at the end of follow-up (median 37.5 months) rates were 11%, 94.1% and 97.1% and 0%, 100% and 100%, in the groups of disease-free SBM and TM and disease-free SBM but involved TM, respectively. There were no statistically significant group differences. TM involvement, in the presence of disease-free SBM, did not compromise outcome.

Background: For patients undergoing abdominal surgery, postoperative pulmonary complications (PPCs) are a major source of morbidity and mortality. The use of point-of-care ultrasonography (POCUS), and specifically POCUS of the lungs, has seen many advancements in recent years. Objectives: We hypothesize that perioperative lung ultrasonography can be used as a predictor for PPCs. Methods: In a Single, 1000 beds, trauma level I medical center, patients presenting for elective intra-abdominal surgery with no severe pulmonary or cardiac diseases were evaluated preoperatively with a standardized 12-point lung ultrasound exam. A second identical exam was performed after surgery in the post-anesthesia care unit. PPCs were also documented. All lung ultrasound exams were presented to a blinded researcher and a lung ultrasound score (LUS) was calculated. Statistical analysis comparing pre- and postoperative LUS and PPC scores were performed. Results: A total of 61 patients were evaluated. The pre-surgery median LUS was 0 (in the range of 0–6) and the post-surgery median LUS was 3 (in the range of 0–14). The pre- to postsurgical LUS delta was 3.4 (standard deviation of 3.3). A postoperative LUS of 6 or more was defined as “high.” A High LUS did not correlate with prolonged post-anesthesia care unit or hospital stay, prolonged oxygen support, or number of desaturation events. Conclusion: For elective abdominal surgery in relatively healthy patients, preoperative LUS usually begins at a normal level and becomes worse after general anesthesia. However, this difference in LUS is not significantly associated with clinically relevant postoperative pulmonary complications such as prolonged oxygen therapy, pneumonia, and noninvasive or invasive mechanical ventilation. Trial registration: Clinicaltrials.gov identifier: NCT05502926. Summary: This paper explores the use of point-of-care ultrasonography as a predictor for postoperative pulmonary complications. The findings suggest that while the lung ultrasound score worsens with general anesthesia, the differences are not significantly associated with postoperative pulmonary complications.

α1-Antitrypsin (AAT), an acute-phase reactant not unsimilar to C-reactive protein (CRP), is a serine protease inhibitor that harbors tissue-protective and immunomodulatory attributes. Its concentrations appropriately increase during conditions of extensive tissue injury, and it induces immune tolerance, in part, by inhibiting the enzymatic activity of the inflammatory serine protease, proteinase 3 (PR3). Typically administered to patients with genetic AAT deficiency, AAT treatment was recently shown to improve outcomes in patients with steroid-refractory graft-versus-host disease (GVHD). GVHD represents a grave outcome of allogeneic hematopoietic stem cell transplantation (HSCT), a potentially curative intervention for hematological diseases. The procedure requires radio/chemotherapy conditioning of the prospective marrow recipient, a cytotoxic process that causes vast tissue injury and, in some formats, interferes with liver production of AAT. To date, changes in the functional profile of AAT during allogeneic HSCT, and during the cytotoxic intervention that precedes HSCT, are unknown. The present study followed 53 patients scheduled for allogeneic HSCT (trial registration NCT03188601). Serum samples were tested before and after HSCT for AAT and CRP levels and for intrinsic anti-proteolytic activity. The ex vivo response to clinical-grade AAT was tested on circulating patient leukocytes and on a human epithelial cell line treated with patient sera in a gap closure assay. According to the ex vivo experiments, circulating leukocytes responded to AAT with a favorable immune-regulated profile, and epithelial gap closure was enhanced by AAT in sera from GVHD-free patients but not in sera from patients who developed GVHD. According to serum collected prior to HSCT, non-relapse mortality was reliably predicted by combining three components: AAT and CRP levels and serum anti-proteolytic activity. Taken together, HSCT outcomes are significantly affected by the anti-proteolytic function of circulating AAT, supporting early AAT augmentation therapy for allogeneic HSCT patients.

Background: While commonly thought to be effective for management of limb and junctional hemorrhage, the manual pressure points technique was excluded from leading prehospital guidelines over a decade ago following the publication of a single human-volunteers study presenting unfavorable results. This work aimed to re-assess the efficacy and feasibility of the femoral and supraclavicular pressure points technique for temporary hemorrhage control distal to the pressure point.Methods: A prospective, non-randomized, human volunteer, controlled environment study. In the study 35 healthy male combat medics (age 21.1 ± 1.3 years) received brief training after which they were requested to apply pressure in the femoral and supraclavicular points in attempts to stop regional blood flow, measured distally by Doppler ultrasound. Success rates in achieving flow cessation in under 2 minutes, time required for achievement of flow cessation, and cumulative flow cessation duration within a 3-minute follow-up after initial success were measured. Results: For the supraclavicular point, success rates were 97.1% with a mean time to success of 12.5 (±20.9) seconds, lasting for 76.2% (±23.7) of the follow-up time. For the femoral point, success rates were 100% with a mean time to success of 5.5 (±4.3) seconds, lasting for 98.7% (±3.8) of the follow-up time.Conclusions: Manual pressure on the femoral and supraclavicular points is an applicable and efficient method for temporary hemorrhage control distal to the pressure point. As such, with additional study, this method may be considered for re-introduction to prehospital care guidelines and training programs.

Epidural analgesia is effective and an accepted treatment for postoperative pain. Urinary retention is a known complication, but its description is mostly in the adult literature. Management of urinary catheter (UC) placement and removal is an important consideration in children receiving epidural analgesia. This is a single-center, retrospective observational study which examined UC management in children undergoing lower extremity orthopedic surgery under general anesthesia with or without epidural analgesia from January 2019–June 2021. Of 239 children included, epidural analgesia was used in 57 (23.8%). They were significantly younger and had more co-morbidities. In total, 75 UCs were placed in the OR, 9 in the ward, and 7 re-inserted. UC placement in the epidural group was more common (93% vs. 17%, p < 0.001) and remained longer (3 days vs. 1 day, p = 0.01). Among children without intra-operative UC, ward placement was more common in the epidural cohort (60% vs. 1.6%, p = 0.007). OR UC placement and ward re-insertion were more common in children with neuromuscular disease (61% vs. 22%, p < 0.001), (17% vs. 3%, p = 0.001), respectively. Based on these findings, we hypothesize that it is justifiable to routinely place a UC intra-operatively in children who undergo hip or lower extremity surgery and are treated with epidural analgesia, and caution is advised before early UC removal in orthopedic children with NMD.

Wound healing requires a non-compromising combination of inflammatory and anti-inflammatory processes. Human α1-antitrypsin (hAAT), a circulating glycoprotein that rises during acute-phase responses and during healthy pregnancies, is tissue-protective and tolerance-inducing; although anti-inflammatory, hAAT enhances revascularization. hAAT blocks tissue-degrading enzymes, including neutrophil elastase; it is, therefore, unclear how wound healing might improve under hAAT-rich conditions. Here, wound healing was examined in the presence of recombinant hAAT (hAAT^WT) and protease-inhibition-lacking hAAT (hAAT^CP). The impact of both hAAT forms was determined by an epithelial cell gap closure assay, and by excisional skin injuries via a microemulsion optimized for open wounds. Neutrophilic infiltration was examined after 8 h. According to results, both hAAT forms accelerated epithelial gap closure and excisional wound closure, particularly at early time points. Unlike dexamethasone-treated wounds, both resulted in closed borders at the 8-h time point. In untreated and hAAT^CP-treated wounds, leukocytic infiltrates were widespread, in hAAT^WT-treated wounds compartmentalized and in dexamethasone-treated wounds, scarce. Both hAAT forms decreased interleukin-1β and increased VEGF gene expression. In conclusion hAAT improves epithelial cell migration and outcomes of in vivo wounds irrespective of protease inhibition. While both forms of hAAT allow neutrophils to infiltrate, only native hAAT created discrete neutrophilic tissue clusters.