Evaluating skills requires developing relevant grading tools that could potentially be used for self-assessments. The goal of our study was to assess the relevance of a self-assessment (SA) grid used for a skin suture exercise as compared to an evaluation carried out at the same time by an expert, while also identifying any factors likely to influence it. Between 2018 and 2022, an assessment grid for a skin suture exercise was used during skills assessment sessions with first-year trainee surgeons. The students were given a self-assessment grid to fill out at the same time. The results of the SA and the expert evaluation (EE) in this grid were analyzed and compared, then set against the anxiety scores of the trainees based on the STAI Y-A. A comparative analysis of trainees with a tendency to over- or underestimate themselves was carried out to identify the factors that could contribute to them misjudging their skills. The data for 70 trainee doctors was analyzed. The mean of the difference in score between the SA and the EE was 2 points lower for SA than EE (p < 0.001). The mean score for the STAI Y-A was 36.2 (± 8.9) and the learner’s anxiety had no effect on the EE but did affect the SA. When learners showed low self-confidence, they underestimated themselves, but examiners also had a tendency to give them lower grades. In multivariate analysis, the less experience a learner had, the more they tended to overestimate their abilities. Anxiety and self-confidence affect self-assessment, but external assessment does not seem to be affected by the learner’s stress levels. Formative self-reflection based on the use of SA grids should be introduced during medical studies so as to adjust the level of technical skill perceived by trainees and to make simulation-based training more effective.

•Case of an isolated cricoid fracture following an assault by manual strangulation.•A cricoid fracture is a potential indicator of third party involvement, or even of a homicide.•Cricoid fractures are under-diagnosed and require a meticulous examination.•Complications and major sequelae should be taken into account.

Hearing impairment (HI) is a prevalent neurosensory condition globally, impacting 5% of the population, with over 50% of congenital cases attributed to genetic etiologies. In Tunisia, HI underdiagnosis prevails, primarily due to limited access to comprehensive clinical tools, particularly for syndromic deafness (SD), characterized by clinical and genetic heterogeneity. This study aimed to uncover the SD spectrum through a 14-year investigation of a Tunisian cohort encompassing over 700 patients from four referral centers (2007–2021). Employing Sanger sequencing, Targeted Panel Gene Sequencing, and Whole Exome Sequencing, genetic analysis in 30 SD patients identified diagnoses such as Usher syndrome, Waardenburg syndrome, cranio-facial-hand-deafness syndrome, and H syndrome. This latter is a rare genodermatosis characterized by HI, hyperpigmentation, hypertrichosis, and systemic manifestations. A meta-analysis integrating our findings with existing data revealed that nearly 50% of Tunisian SD cases corresponded to rare inherited metabolic disorders. Distinguishing between non-syndromic and syndromic HI poses a challenge, where the age of onset and progression of features significantly impact accurate diagnoses. Despite advancements in local genetic characterization capabilities, certain ultra-rare forms of SD remain underdiagnosed. This research contributes critical insights to inform molecular diagnosis approaches for SD in Tunisia and the broader North-African region, thereby facilitating informed decision-making in clinical practice.

BACKGROUND:Subtotal and total lower eyelid tissue loss after tumour excision is a complex issue for reconstructive surgeons. The anterior and posterior flaps must be restored to avoid compromising the functional and aesthetic prognosis of the eye. This study used a septal chondromucosal graft for the posterior lamella and a fasciocutaneous flap pedicled on the temporal artery for the anterior lamella. METHOD:We conducted a 10-year monocentric retrospective study, including 18 patients who were treated using a septal chondromucosal graft with a temporal artery pedicle flap following tumour excision. We collected demographic and medico-surgical data related to flap survival, absence of ectropion, lagophthalmos and other post-operative complications. The aesthetic outcome was judged using a grading scale during the last follow-up consultation. RESULTS:All grafts and flaps survived, whereas 2 patients required early repeat surgery (1 for ectropion and 1 for graft site haematoma). None of the patients developed lagophthalmos. Two patients had distal flap injuries that healed with local care. All patients were satisfied with the aesthetic outcome at the last follow-up visit. CONCLUSION:Combining a septal chondromucosal graft with a fasciocutaneous flap pedicled to the temporal artery for total lower eyelid reconstruction is a reliable method with satisfactory functional and cosmetic outcomes.

Falls are associated with hearing loss, which might be explained by the onset of gait disorders. The objective of this study was to examine the association between Age-Related Hearing Loss (ARHL) and gait disorders assessed with GAITrite® walkway in a population of fallers aged 75 and over while accounting for the vestibular function. We examined data from 53 older patients (mean 84.2 ± 5.1 years; 64

Dalla scoperta di due categorie di cellule sensoriali con ruoli diversi nell’organo del Corti, le cellule ciliate esterne amplificatrici e le cellule ciliate interne trasduttrici, lo studio dei loro ciuffi stereociliari ha rivelato un’architettura estremamente specializzata attorno a una meccanotrasduzione dalle prestazioni che raggiungono i limiti estremi della fisica, rispondendo con precisione a pressioni acustiche la cui ampiezza copre un intervallo da uno a un milione, per deflessioni alla soglia uditiva appena superiori al picometro. Parallelamente alle stereociglia e alla meccanotrasduzione, lo studio delle sinapsi uditive ha rivelato l’esistenza di sottili meccanismi di neurotrasmissione che consentono una codifica precisa delle intensità e delle strutture temporali fini. Sono state affinate le conoscenze sulla fisiologia dei fluidi endococleari, la loro produzione, la loro omeostasi ionica e il riciclo degli ioni coinvolti nella trasduzione. L’avvento della genetica, rapidamente seguito da quello della fisiologia molecolare, ha così permesso di scomporre i meccanismi fisiologici per iniziare a comprendere realmente il normale funzionamento dell’udito e come esso sia influenzato secondo la fisiopatologia del deficit. Così, grazie all’elettrofisiologia, questi progressi permettono oggi di precisare la diagnosi e di ipotizzare di risalire all’origine del danno uditivo. Lo scopo di questo articolo è aggiornare lo stato delle conoscenze che vanno dall’anatomia macroscopica alla fisiopatologia molecolare, a supporto della logica che dovrebbe ormai permettere di risalire alla causa precisa di una sordità neurosensoriale per rimediare ai disturbi percettivi che essa comporta e ipotizzare delle strade terapeutiche mirate.

Desde el descubrimiento de dos categorías de células sensoriales con papeles diferentes en el órgano de Corti, las células ciliadas externas amplificadoras y las células ciliadas internas transductoras, el estudio de sus penachos de estereocilios ha mostrado una arquitectura muy especializada alrededor de una mecanotransducción con rendimientos que se sitúan en los límites últimos de la física, capaces de una reacción precisa a presiones acústicas cuya amplitud abarca un intervalo de uno a un millón, con deflexiones en el umbral auditivo que apenas superan el picómetro. En paralelo a los estereocilios y la mecanotransducción, el estudio de las sinapsis auditivas ha revelado la existencia de mecanismos sutiles de neurotransmisión que permiten una codificación precisa de las intensidades y de las estructuras temporales finas. Los conocimientos de la fisiología de los líquidos endococleares, su producción, su homeostasis iónica, el reciclado de los iones implicados en la transducción se han perfeccionado. La aparición de la genética, seguida rápidamente de la de la fisiología molecular, ha permitido descomponer los mecanismos fisiológicos para comenzar a comprender realmente los rendimientos auditivos normales y el modo en el que se ven afectados según la fisiopatología del déficit. De este modo, gracias a la electrofisiología, estos progresos permiten en la actualidad precisar el diagnóstico y plantear llegar hasta el origen de la afectación auditiva. El objetivo de este artículo es recapitular el estado de los conocimientos que van desde la anatomía macroscópica hasta la fisiopatología molecular, para poder llegar a la causa precisa de una sordera neurosensorial con el fin de solucionar los trastornos perceptivos que provoca y plantear pistas terapéuticas dirigidas.

Objectives This study aimed to investigate predictive factors for revision surgery in otosclerosis. Methods This was a retrospective, multicentre study in four tertiary centres. The primary objective was to investigate factors that were predictive of the need for revision stapes surgery. Results The ‘revision’ group included 145 patients, and the ‘control’ group included 143 patients. This study identified statistically significant predictive factors for the need for revision surgery: younger age, active smoking status, dyslipidaemia and high blood pressure. There was no statistically significant difference between the two groups in terms of surgical technique or stapedotomy technique. Conclusion This study showed that patients who are candidates for primary stapes surgery with younger age, active smoking status, dyslipidaemia and high blood pressure are at higher risk of needing revision surgery. A holistic approach prior to stapes surgery with multidisciplinary assessment is recommended. These results are important for better patient counselling on expected outcomes and risks.

We report the case of a 59-year-old, obese woman who underwent prolonged prone position during the medical management of an acute respiratory distress syndrome induced by SARS-CoV-2 infection, complicated by a masseter muscle pressure injury. Such side effect may be underestimate in intensive care units and should be prevent by prophylactic dressings on facial weight-bearing sites. The understanding of facial deep tissue injury is essential to guide clinical detection and management of such a complication in COVID-19 patients.

Syndromic hearing loss (SHL) represent a frequent origin of deafness worldwide. Aiming at improving the molecular diagnosis of SHL in Morocco, we analyzed two consanguineous families with Alport syndrome (AS) and Carnevale, Mingarelli, Malpuech, and Michels syndrome (3MC). Using whole exome sequencing, we identified two novel homozygous variants, the p.(Gly1385Arg) in COL4A3 in two siblings of the first family, and the p.(Gly476Arg) in MASP1 in the simplex case of the second family, respectively. Molecular modelling and stability analyses of the mutated proteins disclosed changes in the structure and destabilization of the wild-type structure. Our data, in the line with previous genetic analyses, illustrate the molecular variability of these two forms of SHL, and contribute to expand the molecular diagnosis of deafness in Morocco.

Background Vitamin D supplementation has been proposed as a treatment for Coronavirus Disease 2019 (COVID-19) based on experimental data and data from small and uncontrolled observational studies. The COvid19 and VITamin d TRIAL (COVIT-TRIAL) study was conducted to test whether a single oral high dose of cholecalciferol (vitamin D3) administered within 72 hours after the diagnosis of COVID-19 improves, compared to standard-dose cholecalciferol, the 14-day overall survival among at-risk older adults infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Methods and findings This multicenter, randomized, controlled, open-label, superiority trial involved collaboration of 9 medical centers in France. Patients admitted to the hospital units or living in nursing homes adjacent to the investigator centers were eligible if they were ≥65 years, had SARS-CoV-2 infection of less than 3 days, and at least 1 COVID-19 worsening risk factor (among age ≥75 years, SpO2 ≤94%, or PaO 2 /FiO 2 ≤300 mm Hg). Main noninclusion criteria were organ failure requiring ICU, SpO2 ≤92% despite 5 L/min oxygen, life expectancy <3 months, vitamin D supplementation >800 IU/day during the preceding month, and contraindications to vitamin D supplements. Eligible and consenting patients were randomly allocated to either a single oral high-dose (400,000 IU) or standard-dose (50,000 IU) cholecalciferol administered under medical supervision within 72 hours after the diagnosis of COVID-19. Participants and local study staff were not masked to the allocated treatment, but the Steering Committee and the Data and Safety Monitoring Board were masked to the randomization group and outcome data during the trial. The primary outcome was 14-day overall mortality. Between April 15 and December 17, 2020, of 1,207 patients who were assessed for eligibility in the COVIT-TRIAL study, 254 met eligibility criteria and formed the intention-to-treat population. The median age was 88 (IQR, 82 to 92) years, and 148 patients (58%) were women. Overall, 8 (6%) of 127 patients allocated to high-dose cholecalciferol, and 14 (11%) of 127 patients allocated to standard-dose cholecalciferol died within 14 days (adjusted hazard ratio = 0.39 [95% confidence interval [CI], 0.16 to 0.99], P = 0.049, after controlling for randomization strata [i.e., age, oxygen requirement, hospitalization, use of antibiotics, anti-infective drugs, and/or corticosteroids] and baseline imbalances in important prognostic factors [i.e., sex, ongoing cancers, profuse diarrhea, and delirium at baseline]). The number needed to treat for one person to benefit (NNTB) was 21 [NNTB 9 to ∞ to number needed to treat for one person to harm (NNTH) 46]. Apparent benefits were also found on 14-day mortality due to COVID-19 (7 (6%) deaths in high-dose group and 14 (11%) deaths in standard-dose group; adjusted hazard ratio = 0.33 [95% CI, 0.12 to 0.86], P = 0.02). The protective effect of the single oral high-dose administration was not sustained at 28 days (19 (15%) deaths in high-dose group and 21 (17%) deaths in standard-dose group; adjusted hazard ratio = 0.70 [95% CI, 0.36 to 1.36], P = 0.29). High-dose cholecalciferol did not result in more frequent adverse effects compared to the standard dose. The open-label design and limited study power are the main limitations of the study. Conclusions In this randomized controlled trial (RCT), we observed that the early administration of high-dose versus standard-dose vitamin D3 to at-risk older patients with COVID-19 improved overall mortality at day 14. The effect was no longer observed after 28 days. Trial registration ClinicalTrials.gov NCT04344041 .

Objectives:To evaluate the impact of a bootcamp for new residents in surgery, in terms of both knowledge and skills improvement and psychological support. Design:Prospective inclusion of all the 59 new residents in surgery from 2018 to 2020. Analysis of their perception of the training and comparison of the bootcamp and control groups (n = 9, including the residents who could not attend the bootcamp) with respect to the results of their skills evaluations and surgical knowledge. Setting:A two-day bootcamp is organized every year in October since 2013 at the All'Sims simulation center (University Hospital, Angers, France) just before the beginning of the internship. A subsequent skills evaluation takes place partly in the operating room and partly as an objective structured clinical examination (OSCE). Participants:New residents from the different surgical specialties and gynecology, after having given their written consent. Results:Among the 50 residents who attended the bootcamp, knowledge in surgical skills improved by 10% (p<0.001). The median skills score on each OSCE station was at least one point higher in the bootcamp group than in the control group, predominantly in the suturing task (13.9+/-3.0 vs 11.5 +/- 1.6, p = 0.03). The reported usefulness level of the different surgical skills training when evaluated in consideration of daily practice varied from 50% to 95%. Feelings of ease and competency were quite well correlated with the reported usefulness of a given skill, especially since the task was a more generic one. Conclusion:Preparatory courses are of great interest for all surgical specialties as they improve procedural skills and knowledge as well as self-confidence during the first weeks of a resident's internship. As medical training continues to vary significantly between the different universities, such surgical curricula should be developed at a national level to standardize the surgical level of all new residents.

HomeRadiologyVol. 306, No. 1 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyOssification of Stylohyoid Complex in Eagle SyndromeAdèle Rohée-Traoré , Sophie BoucherAdèle Rohée-Traoré , Sophie BoucherAuthor AffiliationsFrom the Department of Maxillofacial Surgery (A.R.T.) and Department of ENT and Head and Neck Surgery (S.B.), Angers University Hospital, CHU d’Angers, 4 rue Larrey, 49933 Angers, France; Faculty of Medicine, Angers University, Angers, France (A.R.T., S.B.); and MitoLab Team, MitoVasc Institute, CNRS UMR6015, INSERM U1083, Angers, France (S.B.).Address correspondence to A.R.T. (email: [email protected]).Adèle Rohée-Traoré Sophie BoucherPublished Online:Aug 30 2022https://doi.org/10.1148/radiol.220367MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Online supplemental material is available for this article.A 47-year-old man presented to the ear, nose, and throat surgery department with a 1-month history of intermittent dull pain, localized in left antero-latero-cervical and retromolar regions. The pain was incompletely relieved by paracetamol and worsened by eating. He had no relevant medical history. At oral examination, a bony prominence was felt during left tonsillar fossa palpation. Orthopantomography was performed, showing an additional bone from the skull base to the hyoid bone (Fig E1 [online]). CT scan with three-dimensional reconstruction (Figure; Movies E1, E2 [online]) showed a 7.4-cm ossified stylohyoid complex on the left, merged with the homolateral lesser cornu of the hyoid bone. Eagle syndrome was diagnosed. The patient declined surgery. He received analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) during painful episodes. After 2 months follow-up, he remained satisfied with medical management.A 47-year-old man presented to the ear, nose, and throat surgery department with a 1-month history of intermittent pain, localized in left antero-latero-cervical and retromolar regions. CT scan with three-dimensional reconstruction shows an ossified stylohyoid complex on the left (arrows), merged with the homolateral lesser cornu of the hyoid bone (arrowhead).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie E1: Movie file of the volume rendered neck CT with 360 degrees of rotation.Download Original Video (19.9 MB)Get the Flash Player to see this video.Movie E2: Movie file of the original axial neck CT.Download Original Video (11.0 MB)Classically, Eagle syndrome manifests with cervical pain, dysphagia, and a foreign body sensation associated with an elongated styloid process. An elongated styloid process has a prevalence in approximately 4% of the population, among which approximately 4%–10% have symptoms. Eagle syndrome occurs more frequently in elderly women between 60 and 79 years of age. Neck CT scan is the reference standard for diagnosis. Eagle syndrome can be medically managed with analgesics, NSAIDs, and corticosteroid injections. When indicated, surgical removal through an intraoral or cervical approach can be used (1,2).Disclosures of conflicts of interest: A.R.T. No relevant relationships. S.B. No relevant relationships.References1. Badhey A, Jategaonkar A, Anglin Kovacs AJ, et al. Eagle syndrome: A comprehensive review. Clin Neurol Neurosurg 2017;159:34–38. Crossref, Medline, Google Scholar2. Costantinides F, Vidoni G, Bodin C, Di Lenarda R. Eagle’s syndrome: signs and symptoms. Cranio 2013;31(1):56–60. Crossref, Medline, Google ScholarArticle HistoryReceived: Feb 15 2022Revision requested: Mar 7 2022Revision received: Apr 19 2022Accepted: Apr 21 2022Published online: Aug 30 2022Published in print: Jan 2023 FiguresReferencesRelatedDetailsRecommended Articles Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common PitfallsRadioGraphics2017Volume: 37Issue: 1pp. 323-345Imaging the External Ear: Practical Approach to Normal and Pathologic ConditionsRadioGraphics2022Volume: 42Issue: 2pp. 522-540Nontraumatic Head and Neck EmergenciesRadioGraphics2019Volume: 39Issue: 6pp. 1808-1823Traumatic Neck and Skull Base InjuriesRadioGraphics2019Volume: 39Issue: 6pp. 1796-1807CT of Skull Base Fractures: Classification Systems, Complications, and ManagementRadioGraphics2021Volume: 41Issue: 3pp. 762-782See More RSNA Education Exhibits It’S Time To Leave No Stone Unturned: Reviewing The Hyoid-larynx Complex And Styloid Process Anatomy And Associated LesionsDigital Posters2021Congenital Craniofacial Anomalies: A Rational On ImagingDigital Posters2021How the Radiologist Can Help: Important Anatomic Landmarks in the Treatment of Oral Cavity, Oropharyngeal and Laryngeal Carcinoma and Their Impact on Surgical Options, Esthetic, Functional and Psychological ChallengesDigital Posters2019 RSNA Case Collection Primary Calvarial Lymphoma RSNA Case Collection2021Temporal bone fibrous dysplasiaRSNA Case Collection2020Congenital Midline Cervical CleftRSNA Case Collection2021 Vol. 306, No. 1 Supplemental MaterialMetrics Altmetric Score PDF download

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The decline of speech intelligibility in presbycusis can be regarded as resulting from the combined contribution of two main groups of factors: (1) audibility-related factors and (2) age-related factors. In particular, there is now an abundant scientific literature on the crucial role of suprathreshold auditory abilities and cognitive functions, which have been found to decline with age even in the absence of audiometric hearing loss. However, researchers investigating the direct effect of aging in presbycusis have to deal with the methodological issue that age and peripheral hearing loss covary to a large extent. In the present study, we analyzed a dataset of consonant-identification scores measured in quiet and in noise for a large cohort (n = 459, age = 42–92) of hearing-impaired (HI) and normal-hearing (NH) listeners. HI listeners were provided with a frequency-dependent amplification adjusted to their audiometric profile. Their scores in the two conditions were predicted from their pure-tone average (PTA) and age, as well as from their Extended Speech Intelligibility Index (ESII), a measure of the impact of audibility loss on speech intelligibility. We relied on a causal-inference approach combined with Bayesian modeling to disentangle the direct causal effects of age and audibility on intelligibility from the indirect effect of age on hearing loss. The analysis revealed that the direct effect of PTA on HI intelligibility scores was 5 times higher than the effect of age. This overwhelming effect of PTA was not due to a residual audibility loss despite amplification, as confirmed by a ESII-based model. More plausibly, the marginal role of age could be a consequence of the relatively little cognitively-demanding task used in this study. Furthermore, the amount of variance in intelligibility scores was smaller for NH than HI listeners, even after accounting for age and audibility, reflecting the presence of additional suprathreshold deficits in the latter group. Although the non-sense-syllable materials and the particular amplification settings used in this study potentially restrict the generalization of the findings, we think that these promising results call for a wider use of causal-inference analysis in audiology, e.g., as a way to disentangle the influence of the various cognitive factors and suprathreshold deficits associated to presbycusis.

Rechercher les critères susceptibles d'aider à la décision d'intubation à partir de la présentation clinique et des données fibroscopiques d'adultes pris en charge pour épiglottite aiguë, et d'en étudier les caractéristiques (cliniques, biologiques) et la prise en charge. Le diagnostic d'épiglottite était établi sur la présence d'un œdème de l'épiglotte associé à des signes généraux de sepsis chez 28 patients de deux hôpitaux entre 2005 et 2016. Une analyse rétrospective univariée puis multivariée, entre les groupes de patients I (intubés) et S (surveillés), était réalisée à partir des données cliniques et fibroscopiques. Dix patients ont été intubés (36 %). Une analyse monovariée retrouvait 4 variables interagissant avec l'intubation. En multivarié, ces associations restaient suggestives pour la dyspnée (RC = 50,6 ; IC95 % = [2,7 ; 940,1]) et l'extension œdémateuse à la margelle laryngée (RC = 42,2 ; IC95 % = [2,2 ; 799,5]). L'aire sous la courbe permettant d'identifier les patients ventilés à partir de ces 2 seuls critères, était de 90,8 %, en faveur d'une excellente discrimination du modèle. L'intubation doit toujours être discutée face à un diagnostic d'épiglottite. La dyspnée, et l'extension de l'œdème à la margelle laryngée, semblent être les deux principaux critères à prendre en compte dans la décision d'intubation.