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Article ; Online: Nuances in Forehead Flap Reconstruction for Large Nasal Defects.

Szeto, Betsy / Jacobs-El, Hannah / Park, Stephen S

Facial plastic surgery clinics of North America

2023 Volume 32, Issue 2, Page(s) 271–279

Abstract: The forehead flap is a time-tested and robust resurfacing flap used for nasal reconstruction. Owing to its excellent color and texture match, acceptable donor site morbidity, and robust and independent blood supply that can support both structural and ... ...

Abstract	The forehead flap is a time-tested and robust resurfacing flap used for nasal reconstruction. Owing to its excellent color and texture match, acceptable donor site morbidity, and robust and independent blood supply that can support both structural and internal lining grafts, this flap remains the workhorse flap for resurfacing large nasal defects. Various nuances of this technique relating to defect and template preparation, flap design, flap elevation, flap inset, donor site closure, and pedicle division are discussed in this article. These nuances are the guiding principles for improved outcomes using a forehead flap for the reconstruction of large nasal defects.
MeSH term(s)	Humans ; Rhinoplasty/methods ; Forehead/surgery ; Nose/surgery ; Surgical Flaps/blood supply ; Nose Neoplasms/surgery
Language	English
Publishing date	2023-12-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1315178-2
ISSN	1558-1926 ; 1064-7406
ISSN (online)	1558-1926
ISSN	1064-7406
DOI	10.1016/j.fsc.2023.11.002
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Article ; Online: Coronavirus disease 2019, vitamin D and kidney function.

Szeto, Betsy / Fan, Lena / Nickolas, Thomas L

Current opinion in nephrology and hypertension

2021 Volume 30, Issue 4, Page(s) 387–396

Abstract: Purpose of review: The purpose of this review is to summarize the emerging studies analyzing the association between vitamin D and risk of COVID-19 infection and severity, as well as the early interventional studies investigating the protective effect ... ...

Abstract	Purpose of review: The purpose of this review is to summarize the emerging studies analyzing the association between vitamin D and risk of COVID-19 infection and severity, as well as the early interventional studies investigating the protective effect of vitamin D supplementation against COVID-19. Recent findings: Studies investigating the association between vitamin D levels and risk of COVID-19 infection and risk of severe disease and mortality among those infected have yielded mixed results. Thus far, the majority of studies investigating the association between vitamin D and COVID-19 have been observational and rely on vitamin D levels obtained at the time of admission, limiting causal inference. Currently, clinical trials assessing the effects of vitamin D supplementation in individuals with COVID-19 infection are extremely limited. Randomized, interventional trials may offer more clarity on the protective effects of vitamin D against COVID-19 infection and outcomes. Summary: Decreased levels of vitamin D may amplify the inflammatory effects of COVID-19 infection, yet, data regarding the mortality benefits of vitamin D supplementation in COVID-19-infected individuals are still limited. Current observational data provides the impetus for future studies to including randomized controlled trials to determine whether vitamin D supplementation in COVID-19-infected individuals with kidney disease can improve mortality outcomes.
MeSH term(s)	COVID-19/complications ; COVID-19/physiopathology ; COVID-19/therapy ; Dietary Supplements ; Humans ; Kidney/physiopathology ; Vitamin D/metabolism ; Vitamin D/therapeutic use ; Vitamin D Deficiency/etiology ; Vitamin D Deficiency/physiopathology ; Vitamin D Deficiency/therapy ; Vitamins/pharmacology ; Vitamins/therapeutic use
Chemical Substances	Vitamins ; Vitamin D (1406-16-2)
Language	English
Publishing date	2021-05-14
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1151092-4
ISSN	1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
ISSN (online)	1473-6543 ; 1535-3842
ISSN	1062-4813 ; 1062-4821
DOI	10.1097/MNH.0000000000000723
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Zs.A 3686: Show issues

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Article ; Online: Obstructive Sleep Apnea and Ambulatory Surgery: Who Is Truly at Risk? Response to Editorial.

Twersky, Rebecca S / Szeto, Betsy / Simon, Brett

Anesthesia and analgesia

2019 Volume 130, Issue 1, Page(s) e32

MeSH term(s)	Ambulatory Surgical Procedures ; Humans ; Polysomnography ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/epidemiology
Language	English
Publishing date	2019-11-01
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000004503
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Article ; Online: Low vitamin D status is associated with hearing loss in the elderly: a cross-sectional study.

Szeto, Betsy / Valentini, Chris / Lalwani, Anil K

The American journal of clinical nutrition

2020 Volume 113, Issue 2, Page(s) 456–466

Abstract: Background: The elderly are at increased risk of both hearing loss (HL) and osteoporosis. Bone mineral density (BMD) has been putatively linked to HL. However, the roles of serum calcium concentrations and vitamin D status have yet to be elucidated.: ... ...

Abstract	Background: The elderly are at increased risk of both hearing loss (HL) and osteoporosis. Bone mineral density (BMD) has been putatively linked to HL. However, the roles of serum calcium concentrations and vitamin D status have yet to be elucidated. Objectives: The purpose of this study was to examine the relation between vitamin D status, parathyroid hormone (PTH), total calcium, BMD, and HL in a nationally representative sample of elderly adults. Methods: Using the NHANES (2005-2010), audiometry and BMD data of 1123 participants aged ≥70 y were analyzed in a cross-sectional manner. HL was defined as pure tone averages >25 dB HL at 500, 1000, and 2000 Hz (low frequency); 500, 1000, 2000, and 4000 Hz (speech frequency); and 3000, 4000, 6000, and 8000 Hz (high frequency) in either ear. Multivariable logistic regression was used to examine the relation between HL and total 25-hydroxyvitamin D [25(OH)D], PTH, total calcium, and BMD, adjusting for covariates. Results: In multivariable analyses, total 25(OH)D < 20 ng/mL was found to be associated with greater odds of low-frequency HL (OR: 2.02; 95% CI: 1.28, 3.19) and speech-frequency HL (OR: 1.96; 95% CI: 1.12, 3.44). A 1-unit decrease in femoral neck BMD (OR: 4.55; 95% CI: 1.28, 16.67) and a 1-unit decrease in total spine BMD (OR: 6.25; 95% CI: 1.33, 33.33) were found to be associated with greater odds of low-frequency HL. Serum PTH and total calcium were not found to be associated with HL. Conclusions: In the elderly, low vitamin D status was associated with low-frequency and speech-frequency HL. Low vitamin D status may be a potential risk factor for age-related HL.
MeSH term(s)	Aged ; Aging ; Bone Density ; Calcium/blood ; Cross-Sectional Studies ; Frailty ; Hearing Loss/etiology ; Humans ; Nutrition Surveys ; Vitamin D/blood ; Vitamin D Deficiency/complications
Chemical Substances	Vitamin D (1406-16-2) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2020-11-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	280048-2
ISSN	1938-3207 ; 0002-9165
ISSN (online)	1938-3207
ISSN	0002-9165
DOI	10.1093/ajcn/nqaa310
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Article: Pyrolyzed Ultrasharp Glassy Carbon Microneedles.

Zhou, Chaoqun / Aksit, Aykut / Szeto, Betsy / Li, Richard L / Lalwani, Anil K / Kysar, Jeffrey W

Advanced engineering materials

2022 Volume 24, Issue 11

Abstract: Polymeric microneedles fabricated via two-photon polymerization (2PP) lithography enable safe medical access to the inner ear. Herein, the material class for 2PP-lithography-based microneedles is expanded by pyrolyzing 2PP-fabricated polymeric ... ...

Abstract	Polymeric microneedles fabricated via two-photon polymerization (2PP) lithography enable safe medical access to the inner ear. Herein, the material class for 2PP-lithography-based microneedles is expanded by pyrolyzing 2PP-fabricated polymeric microneedles, resulting in glassy carbon microneedles. During pyrolysis the microneedles shrink up to 81% while maintaining their complex shape when the exposed surface-area-to-volume ratio (SVR) is 0.025 < SVR < 0.04, for the temperature history protocol used herein. The derived glassy carbon is confirmed with energy-dispersive X-ray spectroscopy and Raman spectroscopy. The pyrolyzed glassy carbon has Young's modulus 9.0 GPa. As a brittle material, the strength is stochastic. Using the two-parameter Weibull distribution, the glassy carbon has Weibull modulus of 3.1 and characteristic strength of 710 MPa. The viscoelastic response has characteristic time scale of about 10000 s. In vitro experiments demonstrate that the glassy carbon microneedles introduce controlled perforations across the guinea pig round window membrane (RWM) from the middle ear space into the inner ear, without damaging the microneedle. The resultant controlled perforation of RWM is known to enhance diffusion of therapeutics across the RWM in a predictable fashion. Hence, the glassy carbon microneedles can be deployed for mediating inner ear delivery.
Language	English
Publishing date	2022-11-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2016980-2
ISSN	1527-2648 ; 1438-1656
ISSN (online)	1527-2648
ISSN	1438-1656
DOI	10.1002/adem.202270046
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Article ; Online: Radiologic Assessment of the Sinonasal Tract, Nasopharynx and Mastoid Cavity in Patients with SARS-Cov-2 Infection Presenting with Acute Neurological Symptoms.

Moonis, Gul / Mitchell, Ryan / Szeto, Betsy / Lalwani, Anil K

The Annals of otology, rhinology, and laryngology

2021 Volume 130, Issue 11, Page(s) 1228–1235

Abstract: Background: Acute neurological sequela in patients with COVID-19 infection include acute thromboembolic infarcts related to cytokine storm and post infectious immune activation resulting in a prothrombotic state. Radiologic imaging studies of the ... ...

Abstract	Background: Acute neurological sequela in patients with COVID-19 infection include acute thromboembolic infarcts related to cytokine storm and post infectious immune activation resulting in a prothrombotic state. Radiologic imaging studies of the sinonasal tract and mastoid cavity in patients with COVID-19 infection are sparse and limited to case series. In this report, we investigate the radiologic involvement of nasal cavity, nasopharynx, paranasal sinuses, and mastoid cavity in patients with SARS-CoV-2 infection who presented with acute neurological symptoms. Methods: Retrospective review of medical records and neuroradiologic imaging in patients diagnosed with acute COVID-19 infection who presented with acute neurological symptoms to assess radiologic prevalence of sinus and mastoid disease and its correlation to upper respiratory tract symptoms. Results: Of the 55 patients, 23 (42%) had partial sinus opacification, with no evidence for complete sinus opacification. The ethmoid sinus was the most commonly affected (16/55 or 29%). An air fluid level was noted in 6/55 (11%) patients, most commonly in the maxillary sinus. Olfactory recess and mastoid opacification were uncommon. There was no evidence of bony destruction in any of the studies, Cough, nasal congestion, rhinorrhea, and sore throat were not significantly associated with any radiological findings. Conclusion: In patients who present with acute neurological symptoms, COVID-19 infection is characterized by limited and mild mucosal disease within the sinuses, nasopharynx and mastoid cavity. Level of evidence: 4.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/physiopathology ; Correlation of Data ; Diagnostic Techniques, Neurological ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Mastoid/diagnostic imaging ; Middle Aged ; Nasopharynx/diagnostic imaging ; Neuroimaging/methods ; Neurologic Examination/methods ; New York/epidemiology ; Paranasal Sinuses/diagnostic imaging ; Prevalence ; SARS-CoV-2/isolation & purification ; Symptom Assessment/methods ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2021-02-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	120642-4
ISSN	1943-572X ; 0003-4894
ISSN (online)	1943-572X
ISSN	0003-4894
DOI	10.1177/0003489421995070
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Article: Inner Ear Gene Delivery: Vectors and Routes.

Valentini, Chris / Szeto, Betsy / Kysar, Jeffrey W / Lalwani, Anil K

Hearing, balance and communication

2020 Volume 18, Issue 4, Page(s) 278–285

Abstract: Objectives: Current treatments for hearing loss offer some functional improvements in hearing, but do not restore normal hearing. The aim of this review is to highlight recent advances in viral and non-viral vectors for gene therapy and to discuss ... ...

Abstract	Objectives: Current treatments for hearing loss offer some functional improvements in hearing, but do not restore normal hearing. The aim of this review is to highlight recent advances in viral and non-viral vectors for gene therapy and to discuss approaches for overcoming barriers inherent to inner ear delivery of gene products. Data sources: The databases used were Medline, EMBASE, Web of Science, and Google Scholar. Search terms were [("cochlea" or "inner ear" or "transtympanic" or "intratympanic" or "intracochlear" or "hair cells" or "spiral ganglia" or "Organ of Corti") and ("gene therapy" or "gene delivery")]. The references section of resulting articles was also used to identify relevant studies. Results:* Both viral and non-viral vectors play important roles in advancing gene delivery to the inner ear. The round window membrane is one significant barrier to gene delivery that intratympanic delivery methods attempt to overcome through diffusion and intracochlear delivery methods bypass completely. Conclusions: Gene therapy for hearing loss is a promising treatment for restoring hearing function by addressing innate defects. Recent technological advances in inner ear drug delivery techniques pose exciting opportunities for progress in gene therapy.
Language	English
Publishing date	2020-08-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2754905-7
ISSN	2169-5725 ; 2169-5717
ISSN (online)	2169-5725
ISSN	2169-5717
DOI	10.1080/21695717.2020.1807261
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Article ; Online: A Novel 3D-Printed Head Holder for Guinea Pig Ear Surgery.

Valentini, Chris / Ryu, Young Jae / Szeto, Betsy / Yu, Michelle / Lalwani, Anil K / Kysar, Jeffrey

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

2021 Volume 42, Issue 9, Page(s) e1197–e1202

Abstract: Background: Otologic surgery in guinea pig requires head immobilization for microscopic manipulation. Existing commercially available stereotaxic frames are expensive and impede access to the ear as they rely on ear bars or mouthpieces to secure the ... ...

Abstract	Background: Otologic surgery in guinea pig requires head immobilization for microscopic manipulation. Existing commercially available stereotaxic frames are expensive and impede access to the ear as they rely on ear bars or mouthpieces to secure the head. Method: Prototype head holders were designed using the Solidworks 2019 software and 3D-printed using Formlabs Form 2 Printers with photopolymer resin. The head holder consists of a C-shaped brace with adjustable radial inserts of 1/4-20 UNC standard screws with cone point tips providing head fixation for animals of various sizes. The C-shaped brace is attached to a rod that can be secured to a commercially available micromanipulator. The head holder design was tested during in vivo guinea pig experiments where their head motion with (n = 22) and without the head holder (n = 2) was evaluated visually through a stereotaxic microscope at 24× magnification during surgery. Results: The head holder design was easy to use and allowed for both nose cone administration of anesthesia and access to the ear for intraoperative auditory testing and manipulation. Functionally, the head holder successfully minimized head movement. Furthermore, harvested round window membranes evaluated at 72 hours following surgery showed precise perforations with the use of head holder. Conclusion: The novel 3D-printed head holder enables simultaneous access for nose cone administration of anesthesia and surgical manipulation of the ear and brain. Moreover, it provides a modular, intuitive, and economical alternative to commercial stereotaxic devices for minimizing head motion during small animal surgery.
MeSH term(s)	Animals ; Brain ; Guinea Pigs ; Head/surgery ; Otologic Surgical Procedures ; Printing, Three-Dimensional
Language	English
Publishing date	2021-06-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2036790-9
ISSN	1537-4505 ; 1531-7129
ISSN (online)	1537-4505
ISSN	1531-7129
DOI	10.1097/MAO.0000000000003255
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Article ; Online: Antibiotic adverse effects in pediatric acute rhinosinusitis: Systematic review and meta-analysis.

Axiotakis, Lucas G / Szeto, Betsy / Gonzalez, Joseph N / Caruana, Francesco F / Gudis, David A / Overdevest, Jonathan B

International journal of pediatric otorhinolaryngology

2022 Volume 156, Page(s) 111064

Abstract: Background: Pediatric acute bacterial rhinosinusitis (ABRS) is often treated with oral antibiotics, with limited insight into adverse effects (AEs) across drug classes. In this systematic review and meta-analysis, we characterize AE incidence associated ...

Abstract	Background: Pediatric acute bacterial rhinosinusitis (ABRS) is often treated with oral antibiotics, with limited insight into adverse effects (AEs) across drug classes. In this systematic review and meta-analysis, we characterize AE incidence associated with oral antibiotics in these patients. Methodology/principal: We searched PubMed and Embase for English-language articles published from 1985 to September 2020 reporting AEs of oral antibiotic therapy for ABRS patients aged 0-18 years. Six-hundred and sixty-six articles underwent title and abstract screening, identifying 154 articles for full-length review. Results: Eleven articles were included, most of which reported individual and aggregate AE incidences. Amoxicillin/clavulanate, amoxicillin, cephalosporin/carbacephem, and placebo groups were identified. Random-effects meta-analysis of prospective groups identified appreciable incidences of diarrhea and abdominal pain, and low incidence of rash, for amoxicillin-clavulanate and amoxicillin. All antibiotics as well as placebo were associated with non-zero overall AE incidence. Children receiving antibiotics were about twice as likely to incur any AE during treatment in placebo-controlled studies, though this association was not significant. High heterogeneity limited most point estimates, with risk of bias, typically in outcomes measurement, detected in most studies. Conclusions: Reporting of AEs associated with oral antibiotic use in pediatric ABRS is limited in current literature. Adverse effects are non-negligible, but may not significantly exceed placebo.
MeSH term(s)	Acute Disease ; Amoxicillin/adverse effects ; Amoxicillin-Potassium Clavulanate Combination/adverse effects ; Anti-Bacterial Agents/adverse effects ; Child ; Humans ; Prospective Studies ; Sinusitis/drug therapy
Chemical Substances	Anti-Bacterial Agents ; Amoxicillin-Potassium Clavulanate Combination (74469-00-4) ; Amoxicillin (804826J2HU)
Language	English
Publishing date	2022-02-16
Publishing country	Ireland
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2022.111064
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Zs.A 1507: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Anatomic, physiologic, and proteomic consequences of repeated microneedle-mediated perforations of the round window membrane.

Leong, Stephen / Aksit, Aykut / Szeto, Betsy / Feng, Sharon J / Ji, Xiang / Soni, Rajesh K / Olson, Elizabeth S / Kysar, Jeffrey W / Lalwani, Anil K

Hearing research

2023 Volume 432, Page(s) 108739

Abstract: Background: We have developed 3D-printed microneedle technology for diagnostic aspiration of perilymph and intracochlear delivery of therapeutic agents. Single microneedle-mediated round window membrane (RWM) perforation does not cause hearing loss, ... ...

Abstract	Background: We have developed 3D-printed microneedle technology for diagnostic aspiration of perilymph and intracochlear delivery of therapeutic agents. Single microneedle-mediated round window membrane (RWM) perforation does not cause hearing loss, heals within 48-72 h, and yields sufficient perilymph for proteomic analysis. In this study, we investigate the anatomic, physiologic, and proteomic consequences of repeated microneedle-mediated perforations of the same RWM at different timepoints. Methods: 100-μm-diameter hollow microneedles were fabricated using two-photon polymerization (2PP) lithography. The tympanic bullae of Hartley guinea pigs (n = 8) were opened with adequate exposure of the RWM. Distortion product otoacoustic emissions (DPOAE) and compound action potential (CAP) were recorded to assess hearing. The hollow microneedle was introduced into the bulla and the RWM was perforated; 1 μL of perilymph was aspirated from the cochlea over the course of 45 s. 72 h later, the above procedure was repeated with aspiration of an additional 1 μL of perilymph. 72 h after the second perforation, RWMs were harvested for confocal imaging. Perilymph proteomic analysis was completed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: Two perforations and aspirations were performed in 8 guinea pigs. In six, CAP, DPOAE, and proteomic analysis were obtained; in one, only CAP and DPOAE results were obtained; and in one, only proteomics results were obtained. Hearing tests demonstrated mild hearing loss at 1-4 kHz and 28 kHz, most consistent with conductive hearing loss. Confocal microscopy demonstrated complete healing of all perforations with full reconstitution of the RWM. Perilymph proteomic analysis identified 1855 proteins across 14 samples. The inner ear protein cochlin was observed in all samples, indicating successful aspiration of perilymph. Non-adjusted paired t-tests with p < 0.01 revealed significant changes in 13 of 1855 identified proteins (0.7%) between the first and second aspirations. Conclusions: We demonstrate that repeated microneedle perforation of the RWM is feasible, allows for complete healing of the RWM, and minimally changes the proteomic expression profile. Thus, microneedle-mediated repeated aspirations in a single animal can be used to monitor the response to inner ear treatments over time.
MeSH term(s)	Animals ; Guinea Pigs ; Chromatography, Liquid ; Proteomics ; Tandem Mass Spectrometry ; Round Window, Ear/metabolism ; Cochlea/metabolism ; Perilymph/metabolism ; Hearing Loss/metabolism
Language	English
Publishing date	2023-03-14
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	282629-x
ISSN	1878-5891 ; 0378-5955
ISSN (online)	1878-5891
ISSN	0378-5955
DOI	10.1016/j.heares.2023.108739
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