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We construct an fpqc gerbe $\mathcal {E}_{\dot {V}}$ over a global function field F such that for a connected reductive group G over F with finite central subgroup Z, the set of $G_{\mathcal {E}_{\dot {V}}}$-torsors contains a subset $H^{1}(\mathcal {E}_{\dot {V}}, Z \to G)$ which allows one to define a global notion of (Z-)rigid inner forms. There is a localization map $H^{1}(\mathcal {E}_{\dot {V}}, Z \to G) \to H^{1}(\mathcal {E}_{v}, Z \to G)$, where the latter parametrizes local rigid inner forms (cf. [8, 6]) which allows us to organize local rigid inner forms across all places v into coherent families. Doing so enables a construction of (conjectural) global L-packets and a conjectural formula for the multiplicity of an automorphic representation $\pi $ in the discrete spectrum of G in terms of these L-packets. We also show that, for a connected reductive group G over a global function field F, the adelic transfer factor $\Delta _{\mathbb {A}}$ for the ring of adeles $\mathbb {A}$ of F serving an endoscopic datum for G decomposes as the product of the normalized local transfer factors from [6].
Upper gastrointestinal bleeding (UGIB) is a common and costly emergency. Mortality from UGIB is around 10%, although 80–85% of patients experience only a single episode. Most episodes are self-limited, and resolve spontaneously. Failure to accurately identify those at high risk for re-bleed may result in significant morbidity and mortality. As a result, many patients are admitted to the hospital at a significant cost. Patients can be stratified based on a scoring system, and can have an early endoscopic procedure. Hydration, proton pump inhibitors, serial hemoglobin/hematocrit measurements, serial orthostatics, radiology studies such as CT scan or CT angiogram, and gastroenterology consult for early endoscopy can be done in the OU.
This study aimed to compare the efficacy of endoscopic type I tympanoplasty/myringoplasty with (ETMFE) or without tympanomeatal flap elevation (ETMFNE).
Methods
A thorough search of the PubMed, Embase and Cochrane Library databases was executed. The Review Manager 5.4 software was used for synthesising data, with forest plots illustrating the results for each outcome. Assessment of potential publication bias was conducted using funnel plots and Egger’s test.
Results
The meta-analysis included data from seven studies with 839 patients. The results demonstrated no significant difference in graft success rates (risk ratio = 1.01; 95 per cent confidence interval: 0.98–1.04; p = 0.54) or air–bone gap improvement (mean difference = –0.08; 95 per cent confidence interval: –2.02–1.85; p = 0.93) between the ETMFE and ETMFNE groups. However, the ETMFE group showed a pronounced increase in operation time (mean difference = 19.50; 95 per cent confidence interval: 10.75–28.25; p < 0.0001).
Conclusion
ETMFNE could be a preferable option for tympanic membrane perforation, offering similar efficacy to ETMFE but with reduced surgical time, particularly in appropriately selected cases.
This study compared endoscopic and microscopic tympanoplasty regarding surgical duration and clinical outcomes for chronic suppurative otitis media.
Methods
Retrospective study included patients who underwent either endoscopic or microscopic tympanoplasty at King Abdullah Medical City between January 2020 and May 2022. It compared the groups’ surgical duration, residual perforation incidence, post-operative pain and audiological outcomes.
Results
The study included 58 patients, 29 of whom underwent endoscopic and 29 underwent microscopic tympanoplasty. Endoscopic tympanoplasty had a significantly shorter average surgical duration (75.46 ± 21.04 minutes) than microscopic (126.66 ± 34.27 minutes). Non-significant differences were detected between groups regarding residual perforation, post-operative pain or hearing improvements.
Conclusion
Both procedures resulted in non-significant differences regarding hearing and surgical complications. However, endoscopic tympanoplasty had a significantly shorter surgical duration, making it a preferable option due to reducing time required. Further randomized studies should be conducted to answer which approach is superior.
To evaluate the efficacy and safety of the dumbbell-shaped tragal cartilage–perichondrium air-filled chamber technique versus the gelatine sponge packing method for small–medium tympanic membrane perforations.
Methods
A retrospective analysis of 68 patients (39 air-filled chamber, 29 gelatine sponge) treated between January 2020 and September 2024. Pre- and post-operative assessments included pure tone audiometry, air–bone gap, tympanic membrane healing, and visual analogue scale scores.
Results
Healing rates were similar (89.7 per cent vs 93.1 per cent, p = 0.959). At six months, pure tone audiometry and air–bone gap improvements were comparable (p > 0.05). At one month, the air-filled chamber group showed better hearing recovery (pure tone audiometry: 19.71 vs 24.27 dB HL; air–bone gap: 7.28 vs 12.28 dB HL; both p < 0.05) and lower pain scores (1.13 vs 1.59, p = 0.022). Complications and operative times were similar.
Conclusion
The air-filled chamber technique is a safe and effective alternative, offering superior early hearing recovery, reduced discomfort, and comparable long-term outcomes to the gelatine sponge method.
Arthur packets have been defined for pure real forms of symplectic and special orthogonal groups following two different approaches. The first approach, due to Arthur, Moeglin, and Renard uses harmonic analysis. The second approach, due to Adams, Barbasch, and Vogan uses microlocal geometry. We prove that the two approaches produce essentially equivalent Arthur packets. This extends previous work of the authors and J. Adams for the quasisplit real forms.
Edited by
James Ip, Great Ormond Street Hospital for Children, London,Grant Stuart, Great Ormond Street Hospital for Children, London,Isabeau Walker, Great Ormond Street Hospital for Children, London,Ian James, Great Ormond Street Hospital for Children, London
The demand for procedural sedation is increasing in children of all ages who due to anxiety, medical need or the requirements of the intervention or investigation need a periprocedural plan consisting non-pharmacological and pharmacological approaches. While paediatric procedural sedation is practised by many medical and nursing specialists, for varied indications and in differing hospital locations it remains the responsibility of anaesthetists to have a comprehensive understanding of this discipline in order to advance this field and maintain safety standards. In the past decade, guidelines have been developed to ensure that children who undergo sedation are managed by clinicians who can competently assess their needs, take informed consent and plan and deliver a safe and effective sedation strategy in multiple scenarios, such as for painless imaging, painful procedures, dentistry and endoscopy. Recent updated fasting guidelines which are less restrictive means that children will be hydrated, less irritable and more stable when sedated. The drug dexmedetomidine and its extremely favourable respiratory profile and low rate of airway and respiratory complications have changed the face of sedation for painless imaging and are allowing a greater range of children to have these procedures without the need for general anaesthesia. The field of procedural sedation for children is rapidly growing in popularity amongst both clinicians and patients, and it is therefore vital for paediatric anaesthetists to stay up to date and aware of guidelines and advances.
This study measured the effectiveness of an in-house designed, cast silicone airway model in addressing the lack of easily accessible, validated transoral laser microsurgery simulation models.
Methods
Participants performed resection of two marked vocal fold lesions on the model. The model underwent face, content and construct validation assessment using a five-point Likert scale questionnaire measuring the mean resection time for each lesion and the completeness of lesion excision. Comparative analyses were performed for these measures.
Results
Thirteen otolaryngologists participated in this study. The model achieved validation threshold on all face and content measures (median, ≥4). Construct validation was demonstrated by the improvement in mean resection time between lesions one and two (86 vs 54 seconds, W = 11, p = 0.017). The mean resection time was lower amongst more senior otolaryngologists (61.5 vs 107.1 seconds, W = 11, p = 0.017).
Conclusion
This synthetic silicone model is a low-cost, easily reproducible, high-fidelity synthetic airway model, demonstrating face, content and construct validity.
Head and neck cancer has a 5 per cent incidence of synchronous primary cancer. Synchronous primary cancers are commonly detected with imaging and flexible nasoendoscopy. Routine panendoscopy is still being used to screen for synchronous primary cancers. The aim was to establish the method of detection of synchronous primary cancer.
Methods
A retrospective cohort study of newly diagnosed head and neck cancer patients with a synchronous primary cancer, presented at the West of Scotland Head and Neck Multidisciplinary Team from December 2020 to August 2022. This study is Level 3 evidence.
Results
A total of 2325 patients were presented to the Multi-Disciplinary Team with head and neck cancer and 54 (2.3 per cent) had SPC; 63.8 per cent (30) of patients had a panendoscopy. All patients with comprehensive out-patient assessment had their synchronous primary cancer detected on examination or imaging, without the need for panendoscopy.
Conclusion
Panendoscopy did not detect any new synchronous primary cancer in patients assessed with flexible nasoendoscopy and imaging. With modern high-resolution imaging and fibreoptics, panendoscopy does not play a role in the detection of synchronous primary cancers.
Recurrent respiratory papillomatosis is a rare disease characterised by growth of papilloma within the respiratory tract. The disease course is variable but can require frequent surgical interventions alongside adjuvant medical treatments. There is no definitive curative treatment or gold-standard guidelines for management. We aimed to evaluate current and potential future adjuvant treatments and propose a management guideline for adult patients.
Methods
Relevant articles were identified through searching databases, reference lists and grey literature.
Results
Systemic bevacizumab appears to be the most effective adjuvant treatment currently available. However, intralesional cidofovir also achieves a high complete-response rate in adults and the Gardasil vaccine demonstrates preventative and therapeutic value. The INO-3107 DNA vaccine is a promising potential future adjuvant treatment.
Conclusions
This review provides a detailed examination of current and potential future adjuvant treatments. Based on the literature, we have developed a management guideline for adult patients with recurrent respiratory papillomatosis.
This observational study investigates migratory foreign bodies in the upper aerodigestive tract, emphasising clinical presentation, assessment and factors contributing to extraluminal migration.
Methods
Conducted across multiple medical centres in India, the study included 15 patients aged 11 to 70 years. Detailed observations, demographic information, clinical history, radiological findings and intra-operative outcomes were compiled.
Results
Fifteen patients presented with varied symptoms. Fish and chicken bones, along with metal wires, were common foreign bodies. Computed tomography scans played a crucial role in diagnosis, confirming extraluminal migration. Neck exploration successfully retrieved foreign bodies in most cases, with varied sites of impaction.
Conclusion
Migratory foreign bodies, although rare, pose significant challenges for otolaryngologists. Early recognition, thorough diagnosis and meticulous neck exploration, is crucial for effective management, preventing severe complications. This study adds valuable insights to the understanding of migratory foreign bodies, contributing to the existing literature in otolaryngology practice.
To compare the diagnostic accuracy of angled otoendoscopy with pure tone audiometry in predicting ossicular discontinuity in patients of mucosal chronic otitis media.
Methods
Ninety-four patients were included in this prospective study. A 2.7-mm 30° otoendoscope was used to examine ossicular status preoperatively. Hearing thresholds were recorded by pure tone audiometry. Intraoperative ossicular status was recorded as the gold standard. Otoendoscopic findings were recorded as per the criteria has been devised by the authors of this manuscript.
Results
Otoendoscopy was conclusive in 56 (59.6 per cent) patients, with 100 per cent sensitivity, 95.56 per cent specificity, 84.62 per cent positive predictive value, and 100 per cent negative predictive value in the conclusive group. Overall (in 94 patients), diagnostic test values of otoendoscopy were 73.33 per cent sensitivity, 97.47 per cent specificity, 84.62 per cent positive predictive value, and 95.06 per cent negative predictive value. As per the ROC curve, air–bone gap > 38.12dB had the optimal diagnostic test values, with 73 per cent sensitivity, 72 per cent specificity, 33.3 per cent positive predictive value, and 93.4 per cent negative predictive value.
Conclusion
Angled otoendoscopy has better diagnostic accuracy (93.6 per cent) than pure tone audiometry (72.3 per cent; p < 0.001) for preoperative ossicular discontinuity prediction in patients of mucosal chronic otitis media.
Oesophageal soft food bolus obstruction is a common presentation to emergency departments. Often these patients are given medication with little evidence of efficacy. Although many cases self-resolve, some require removal of the obstruction. Delay in removal can lead to complications such as oesophageal perforation and mediastinitis. Traditionally, removal was performed by ENT surgeons using rigid oesophagoscopy, but oesophago-gastro duodenoscopy offers a safer alternative that does not require a general anaesthetic.
Method
The current performance, pathways and outcomes of patients attending emergency departments across three health boards in Scotland were reviewed.
Results
In total, 313 patients admitted for oesophageal soft food bolus obstruction were identified. Mixed practice for a single common presentation was observed. In addition, it was found that the majority of patients are already managed by surgery and gastroenterology services with good outcomes and low morbidity.
Conclusion
Patients presenting with soft food bolus obstruction should be referred to local surgery and gastroenterology services in the first instance.
Flexible upper aerodigestive endoscopy is often performed in the emergency setting. To prevent nosocomial infection on-call clinicians must have access to decontaminated endoscopes.
Methods
A telephone survey of 104 ENT units in England replicated previous cycles conducted 10 and 20 years ago. The on-call clinician was asked about decontamination practices, training and cross-cover.
Results
Seventy-one clinicians participated of which 68 had an endoscope available out-of-hours. Twenty-five (36.8 per cent) used single-use endoscopes. Twenty-three (51.1 per cent) of the 45 clinicians using re-usable endoscopes decontaminated them themselves, an increase from 43.3 per cent in 2013 and from 35.1 per cent in 2002. Overall 91.2 per cent had safe practices, up from 68.7 per cent in 2013 and 48 per cent in 2002. One hundred per cent had been trained in decontamination, compared to 37.3 per cent in 2013 and 12.1 per cent in 2002. On-call clinicians from the ENT department increased to 91.5 per cent, compared to 63 per cent in 2013.
Conclusion
There has been a dramatic increase in patient safety, underpinned by the introduction of single-use endoscopes, increased training and reduced cross-cover.
Developing skills in rigid endoscopy poses challenges to the surgical trainee. This study investigates whether a modified manikin can improve the technical skill of junior operators by providing direct quantitative feedback.
Methods
A force-sensing pad was incorporated into the oral cavity of a life support manikin. Junior trainees and senior otolaryngologists were invited to perform rigid endoscopy and received real-time feedback from the force sensor during the procedure.
Results
There was a significant inverse correlation between operator seniority and the weight applied to the oral cavity (p < 0.0001). All junior trainee operators applied less weight after five attempts (346 ± 90.95 g) compared to their first attempt (464 ± 85.79 g). This gave a statistically significant decrease of 118 g (standard deviation = 107.27 g, p = 0.007) when quantitative feedback was provided to learning operators.
Conclusion
This low-cost, simple model allows trainees to rehearse a high-risk procedure in a safe environment and adjust their operative technique.
Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches.
Methods
This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed.
Results
The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well.
Conclusion
This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patient's history, the nature and location of the foreign body, and associated risks.
Quaternionic automorphic representations are one attempt to generalize to other groups the special place holomorphic modular forms have among automorphic representations of $\mathrm {GL}_2$. Here, we use ‘hyperendoscopy’ techniques to develop a general trace formula and understand them on an arbitrary group. Then we specialize this general formula to study quaternionic automorphic representations on the exceptional group $G_2$, eventually getting an analog of the Eichler–Selberg trace formula for classical modular forms. We finally use this together with some techniques of Chenevier, Renard and Taïbi to compute dimensions of spaces of level-$1$ quaternionic representations. On the way, we prove a Jacquet–Langlands-style result describing them in terms of classical modular forms and automorphic representations on the compact-at-infinity form $G_2^c$.
The main technical difficulty is that the quaternionic discrete series that quaternionic automorphic representations are defined in terms of do not satisfy a condition of being ‘regular’. A real representation theory argument shows that regularity miraculously does not matter for specifically the case of quaternionic discrete series.
We hope that the techniques and shortcuts highlighted in this project are of interest in other computations about discrete-at-infinity automorphic representations on arbitrary reductive groups instead of just classical ones.
Retropharyngeal lymphadenectomy is challenging. This study investigated a minimally invasive approach to salvage retropharyngeal lymphadenectomy in patients with nasopharyngeal carcinoma.
Methods
An anatomical study of four fresh cadaveric heads was conducted to demonstrate the relevant details of retropharyngeal lymphadenectomy using the endoscopic transoral medial pterygomandibular fold approach. Six patients with nasopharyngeal cancer with retropharyngeal lymph node recurrence, who underwent retropharyngeal lymphadenectomy with the endoscopic transoral medial pterygomandibular fold technique at the Eye and ENT Hospital of Fudan University from July to December 2021, were included in this study.
Results
The anatomical study demonstrated that the endoscopic transoral medial pterygomandibular fold approach offers a short path and minimally invasive approach to the retropharyngeal space. The surgical procedure was well tolerated by all patients, with no significant post-operative complications.
Conclusion
The endoscopic transoral medial pterygomandibular fold approach is safe and efficient for retropharyngeal lymphadenectomy.
Non-fatal strangulation as a consequence of a sexual assault attack or domestic violence represents serious bodily harm. Otolaryngologists have an important role in documenting physical findings and managing airway symptoms. This study aimed to describe our otolaryngology department's experience managing patients referred from the sexual assault referral centre who suffered non-fatal strangulation.
Method
A retrospective analysis of patients suffering non-fatal strangulation referred to the Manchester University Hospitals NHS Foundation Trust Otolaryngology Department from Saint Mary's Sexual Assault Referral Centre in Manchester between 1 January 2017 and 31 December 2019 was carried out.
Results
A total of 86 patients were referred from Saint Mary's Sexual Assault Referral Centre. Of these patients, 56 were given telephone advice and the remaining 30 were seen by the on-call otolaryngology team. In addition, 20 out of 30 (66.6 per cent) patients underwent fibre-optic nasal endoscopy. Common presenting symptoms were neck pain (81.4 per cent), dyspnoea (80.2 per cent) and dizziness (72.1 per cent). Five patients had identifiable laryngeal injury on endoscopy.
Conclusion
Meticulous documentation is recommended when managing patients who suffer non-fatal strangulation because medical records may be used as evidence in criminal investigations.
This study evaluated the relationship between frontal pain as a symptom in chronic frontal sinusitis and radiological and endoscopic findings, quality of life and disease severity. The aim was to determine its utility as a marker in chronic frontal sinusitis and in surgical decision-making.
Method
This was a prospective study of 51 consecutive patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Patients ranked their frontal pain score on a numerical rating scale from 0 to 10. Facial pain or pressure, Sino-Nasal Outcome Test-22, Nasal Obstruction Symptom Evaluation score, Lund–Mackay score and modified Lund–Kennedy score were also collated. Statistical analysis was performed using analysis of variance and Pearson correlation coefficient.
Results
Frontal pain scores were low and demonstrated no correlation with the extent of frontal sinus disease radiologically or the severity of overall sinus disease endoscopically. Higher frontal pain scores significantly correlated with poorer quality-of-life.
Conclusion
This study does not support the use of frontal pain as a sensitive or specific marker of chronic frontal sinus disease.