The safety of outpatient UPPP for obstructive sleep apnea: a retrospective review of 40 cases

We retrospectively reviewed the outcomes of 40 patients who had undergone outpatient uvulopalatopharyngoplasty (UPPP) for the treatment of moderate to severe obstructive sleep apnea (OSA) in order to determine the safety of the procedure in an outpatient setting. Postoperatively, 36 of the 40 patients (90%) were discharged home the day of surgery without morbidity; 3 other patients stayed overnight for nonmedical reasons, and 1 patient who was already an inpatient remained hospitalized for unrelated medical issues. No postoperative complications occurred, and all patients reported a resolution of OSA symptoms and improvement in sleep. Based on a combination of our data and those of previous studies, we conclude that patients with significant OSA can safely undergo UPPP as an outpatient procedure. We recommend that guidelines regarding the perioperative care of patients with OSA be adjusted to include consideration of treatment in an outpatient setting.     

External laryngotracheal trauma

Differences in acute external injuries of the larynx and cervical trachea between peacetime and war trauma were studied. Twenty-six patients with peacetime injuries and 39 patients with war injuries were retrospectively analyzed. The incidence of peacetime laryngotracheal injuries was 0.91% of the total number of patients hospitalized for head and neck injuries. In the groups of wounded in action (WIA) and killed in action (KIA) with head and neck war injuries, the incidence of laryngotracheal injuries was 4.8 and 6.2%, respectively. According to the type of the wound, blunt injuries were most common among peacetime and penetrating wounds among war injuries. There was no difference between peacetime and war injuries according to the wound localization. War wounds were more severe, caused more extensive local tissue and organ defects, were associated with a greater number of lesions to the neck and other body regions and more often required reconstructive surgical procedures than peacetime injuries. The mortality of war laryngotracheal injuries was two times greater than that of peacetime lesions (9 vs. 3.8%).     

Crystallization Using Reverse Micelles and Water-in-Oil Microemulsion Systems: The Highly Selective Tool for the Purification of Organic Compounds from Complex Mixtures

The active pharmaceutical ingredient orlistat is usually manufactured using a semi-synthetic procedure, producing crude product and complex mixtures of highly related impurities with minimal side-chain structure variability. It is therefore crucial for the overall success of industrial/pharmaceutical application to develop an effective purification process. In this communication, we present the newly developed water-in-oil reversed micelles and microemulsion system-based crystallization process. Physiochemical properties of the presented crystallization media were varied through surfactants and water composition, and the impact on efficiency was measured through final variation of these two parameters. Using precisely defined properties of the dispersed water phase in crystallization media, a highly efficient separation process in terms of selectivity and yield was developed. Small-angle X-ray scattering, high-performance liquid chromatography, mass spectrometry, and scanning electron microscopy were used to monitor and analyze the separation processes and orlistat products obtained. Typical process characteristics, especially selectivity and yield in regard to reference examples, were compared and discussed.     

Analysis of the Accuracy of Mass Difference-Based Measurement of Dry Clutch Friction Material Wear

The paper demonstrates that the dry clutch friction plate wear rate, measured based on the plate mass difference method, exhibits a transient behavior after each change of friction interface temperature level. The effect is hypothesized to be caused by a temperature-dependent change in the moisture content/mass level in the friction material. To test this hypothesis, a series of synchronized characterization experiments have been conducted by using two friction plates, one for wear tests and the other for drying in an oven under the same temperature conditions. Based on the analysis of test results, a moisture content compensation procedure, which reduces the transient wear rate from being 100% to being 50% higher compared to stabilized wear rate, is proposed and verified. The gained insights are used to set recommendations on the organization of routine wear characterization experiments aimed at avoiding the effect of moisture content influence on the accuracy of wear measurement. The main recommendations are to minimize the number of temperature target level changes through proper design of the experiment, insert a run-in test after every long test pause, and execute a pre-heat, blind wear test at the beginning of each test day.     

Structured report improves radiology residents’ performance in reporting chest high-resolution computed tomography: a study in patients with connective tissue disease

PURPOSEThe study aimed to evaluate the performance of radiology residents (RRs) when using a dedicated structured report (SR) template for chest high-resolution computed tomography (HRCT) in patients with suspected connective tissue disease–interstitial lung disease (CTD–ILD), compared to the traditional narrative report (NR).METHODSWe retrospectively evaluated 50 HRCT exams in patients with suspected CTD–ILD. A chest-devoted radiologist reported all HRCT exams as the reference standard, pointing out pulmonary fibrosis findings (i.e., honeycombing, traction bronchiectasis, reticulation, and volume loss), the presence and pattern of ILD, and possible other diagnoses. We divided 4 RRs into 2 groups according to their expertise level. In each group, RRs reported all HRCT examinations alternatively with NR or SR, noting each report’s reporting time. The Cohen’s Kappa, Wilcoxon, and McNemar tests were used for statistical analysis.RESULTSRegarding the pulmonary fibrosis findings, we found higher agreement between RRs and the reference standard reader when using SR than NR, regardless of their expertise level, except for volume loss.RRs’ accuracy for “other diagnosis” was higher when using SR than NR, moving from 0.48 to 0.66 in the novel group (P = .035) and from 0.44 to 0.80 in the expertise group (P < .001). No differences in accuracy were found between ILD presence and ILD pattern. The reporting time was significantly lower (P = .001) when using SR than NR.CONCLUSION SR is of value in increasing the reporting of critical chest HRCT findings in the complex CTD–ILD scenario and should be used early and systematically during residency.

Main points

• Structured report helps radiology residents to detect fibrosis findings.
• Structured report aids radiology residents not to overlook alternative diagnoses.
• Radiology residents’ reporting time is shorter when the report is structured.

Interstitial lung diseases (ILD) are heterogeneous lung pathologies classified as idiopathic or secondary.¹ Among the latter, many cases are framed as connective tissue disease (CTD)-associated ILD (CTD–ILD). The term CTD refers to a heterogeneous group of autoimmune disorders causing immune-mediated organ dysfunction. This group includes rheumatoid arthritis, systemic sclerosis, Sjogren’s syndrome, antisynthetase syndrome, polymyositis, dermatomyositis, systemic lupus erythematosus, and mixed connective tissue disease.² Notably, nearly 40% of patients with CTD develop ILD, thus testifying this condition’s epidemiological relevance.³Chest high-resolution computed tomography (HRCT) is considered the reference standard for imaging CTD-ILD.^4,5 CTD-ILD may manifest with different typical HRCT patterns of lung involvement, including usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), NSIP overlap OP (NSIP–OP), and lymphocytic interstitial pneumonitis (LIP).⁶The structured report (SR) is a radiology report model aimed to improve the readability of conventional narrative reports (NR) by referring clinician and, ultimately, lead to higher clinical usefulness.^7,8 Various benefits of SR have been identified in training environments, for example, it aids in training report organization and teaching critical anatomy, key findings, and complications, with improved reporting uniformity and efficiency.⁹ These advantages led international institutions supporting high-quality post-graduation education (i.e., the European Union of Medical Specialists and the Accreditation Council for Graduate Medical Education) to promote understanding and using SR as a requirement for radiology residents (RRs).^10,11 Various studies explored the value of SR as a teaching tool for RRs regarding diverse diagnostic settings and techniques (e.g., chest radiograph, head and neck ultrasound, cervical spine computed tomography [CT], CT angiography, maxillofacial CT, and CT enterography).^12–17 Indeed, in an article demonstrating higher completeness and effectiveness of SR than NR for chest radiograph, Marcovici and Taylor¹² argued that SR might help RRs by promoting and reinforcing a rational cognitive approach at the time of imaging interpretation. Of note, while generally promoting SR implementation during residency programs, some authors warned about SR’s potential downsides due to a questionable impact on accuracy compared to NR.^14,17,18To the best of our knowledge, no published studies have evaluated the impact of chest HRCT structured reporting on RRs’ performance. The pleomorphism of the many possible lung presentations at HRCT, sometimes with overlapping imaging features, may be difficult to interpret for a non-chest-devoted radiologist and, even more, for RRs. In this light, an SR template for HRCT and CTD–ILD has recently proved to be a valuable tool for radiologists, with high referring clinicians’ perceived report quality.¹⁹ We believe this SR model may provide a valuable framework for RRs approaching the HRCT study of CTD–ILD. Thus, the study’s purpose was to evaluate RRs’ performance when using a dedicated SR model for chest HRCT in patients with suspected CTD–ILD compared to the traditional NR.     

Using an extractive Fourier transform infrared spectrometer for improving cleanroom air quality in a semiconductor manufacturing plant

A mobile extractive Fourier transform infrared (FTIR) spectrometer was successfully used to locate, identify, and quantify the "odor" sources inside the cleanroom of a semiconductor manufacturing plant. It was found that ozone (O(3)) gas with a peak concentration of 120 ppm was unexpectedly releasing from a headspace of a drain for transporting used ozonized water and that silicon tetrafluoride (SiF(4)) with a peak concentration of 3 ppm was off-gassed from silicon wafers after dry-etching processing. When the sources of the odors was pinpointed by the FTIR, engineering control measures were applied. For O(3) control, a water-sealed pipeline was added to prevent the O(3) gas (emitting from the ozonized water) from entering the mixing unit. A ventilation system also was applied to the mixing unit in case of O(3) release. For SiF(4) mitigation, before the wafer-out chamber was opened, N(2) gas with a flow rate of 150 L/min was used for 100 sec to purge the wafer-out chamber, and a vacuum system was simultaneously activated to pump away the purging N(2). The effectiveness of the control measures was assured by using the FTIR. In addition, the FTIR was used to monitor the potential hazardous gas emissions during preventative maintenance of the semiconductor manufacturing equipment.