Salvage surgery for recurrent squamous cell carcinoma of the head and neck: Systematic review and meta‐analysis

xlomafota13 shared this article with you from Inoreader Salvage surgery for recurrent squamous cell carcinoma of the head and neck: Systematic review and meta‐analysis Via Head & Neck Abstract The present study aims to estimate a pooled hazard ratio (HR) comparing overall survival (OS) for salvage surgery compared to nonsurgical management of recurrent head and neck squamous cell carcinoma (HNSCC). PubMed/MEDLINE and Embase-Ovid were searched on March 5, 2020, for English-language articles reporting survival for salvage surgery and nonsurgical management of recurrent HNSCC. Meta-analysis of HR estimates using random effects model was performed. Fifteen studies reported survival for salvage surgery and nonsurgical management of recurrence. Five-year OS ranged from 26% to 67% for the salvage surgery groups, compared to 0% to 32% for the nonsurgical management groups. Six studies reported HRs comparing salvage surgery to nonsurgical management; the pooled HR was 0.25 (95% CI [0.16, 0.38]; p < 0.0001). Selection for salvage surgery was associated with one quarter of the mortality rate associated with nonsurgical management in light of confounding facto rs including subsite and treatment intent. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Airway injury from transoral endoscopic thyroidectomy vestibular approach

xlomafota13 shared this article with you from Inoreader Airway injury from transoral endoscopic thyroidectomy vestibular approach Via Head & Neck Abstract Background The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel technique that eliminates a cervical scar. This procedure carries unique risks, and data on outcomes are needed as more cases are performed. Methods We describe two cases of airway injury during the TOETVA. A description of the procedure and management of the injuries is outlined. Results In one case, a 3-mm injury in the thyrohyoid membrane was identified. The TOETVA was converted to an open approach due to significant inflammation in the setting of Graves' and the repair was performed while open. In the second case, a fracture occurred from the thyroid notch to Broyle's ligament without avulsion. A primary repair was endoscopically performed. Conclusions Airway injury is a possible complication of both open thyroidectomy and TOETVA. For TOETVA, trauma is most likely to occur in the midline during Hegar dilation and trocar placement through the central incision. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Perfusion-Decellularized Larynx as a Natural 3D Scaffold in a Rabbit Model

xlomafota13 shared this article with you from Inoreader Perfusion-Decellularized Larynx as a Natural 3D Scaffold in a Rabbit Model Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Introduction: Decellularized larynges could be used as scaffolds to regenerate the larynx. The purpose of this study was to establish a perfusion decellularization protocol to produce a 3-dimensional whole laryngeal extracellular matrix (ECM) scaffold in a rabbit model. Methods: The larynges of 20 rabbits assigned to the study group were harvested and decellularized using a perfusion decellularization protocol, while the larynges of 10 rabbits in the control group were harvested and untreated. Macroscopic and microscopic morphological analyses, a molecular analysis, a cellular content analysis, and scanning electron microscopy were performed. Results: A histological analysis showed the absence of cellular components, the presence of the ECM, and an intact cartilage structure filled with chondrocytes. The mean total DNA amounts of the native larynx, decellularized larynx, and decellularized cartilage-free larynx were 1,826.40, 434.70, and 41.40 μg/µL, respectively; those for the decellularized larynx and decellularized cartilage-free larynx were significantly lower (p #x3c; 0.001 and p #x3c; 0.001, respectively). The total amount of DNA in the decellularized sample was significantly lower compared to that in the native sample, at 57.2% in cartilage (p #x3c; 0.001), 2.4% in the thyroid gland (p #x3c; 0.001), 2.7% in muscle (p #x3c; 0.001), 1.6% in vessels (p #x3c; 0.001), and 4.8% in the vocal cords (p #x3c; 0.001). Conclusion: Our perfusion decellularization protocol is feasible and reproducible to produce a 3-dimensional whole laryngeal ECM scaffold in a rabbit. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diversity in Academic Laryngology: An Evaluation of Academic Advancement and Research Productivity

xlomafota13 shared this article with you from Inoreader Diversity in Academic Laryngology: An Evaluation of Academic Advancement and Research Productivity Via The Laryngoscope Background Diversity within the medical profession with respect to sex and racial minorities has been shown to have a positive effect on health and healthcare. Characterization of a field is key to evaluating trends and the advancement of diversity in an otolaryngology subspecialty. Study Design Observational study. Methods A comprehensive list of all the academic laryngologists was compiled from the Accreditation Council for Graduate Medical Education accredited otolaryngology residency programs in 2020. The last 20 past presidents of the American Laryngological Association (ALA) and American Broncho-Esophogological Association (ABEA) were analyzed. Academic rank and years in practice were determined from departmental websites, with online search tools used as secondary resources. The h-index was utilized as a measure of research productivity. Regression analysis was performed to analyze these variables. Results There are 184 academic laryngologists in the 124 programs. The majority of the population is Caucasian 76.6% (141/184), followed by Asian 16.3% (30/184), African American 4.34% (8/184), and then Hispanic 1% (2/184). There are 47 full professors with 83% Caucasian, 14.1% Asian, and 2.1% African American and 91.5% male and only 8.5% female. Past ALA presidents were 90% male and for the ABEA 75% male. H-index revealed a statistically significant difference between Caucasian and African American colleagues [P value (<.0005)]. Conclusions Minorities are disproportionately underrepresented in laryngology. Women are less likely to be in leadership roles in laryngology and become full professors. Laryngology lags behind other surgical specialties in the representation of minorities and women. Continued efforts should be made to increase diversity in the field of laryngology, especially in regard to underrepresented minorities. Level of Evidence N/A Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data

xlomafota13 shared this article with you from Inoreader Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data Via The Laryngoscope Objectives/Hypothesis To characterize and identify predictors of 30-day adverse events in patients undergoing laryngeal framework surgery (LFS). Study Design This study is a retrospective analysis of the National Surgical Quality Improvement dataset. Methods LFS cases were identified from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2018. Demographic variables, patient comorbidities, and perioperative outcomes (any adverse event, 30-day readmission, 30-day reoperation, and unplanned intubation) were extracted. Patient-specific and surgery-specific factors associated with perioperative adverse events were examined using descriptive statistics and univariate logistic regression (LR). Results Of 283 patients who underwent LFS, 225 underwent laryngoplasty medialization, 56 underwent laryngoplasty medialization with arytenoidectomy or arytenoidopexy via an external approach, and 2 underwent local myocutaneous or fasciocutaneous advancement flap along with laryngoplasty. Medical comorbidities were present in 33.6% of patients and 57.9% were American Society of Anesthesiologists (ASA) Class III/IV (57.9%). LFS was performed as same-day surgery in 30.7% of cases. Fourteen patients (4.9%) suffered an adverse condition within 30 days following surgery. In univariate LR, ASA Class III or IV (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.2–30.1) was the only predictor associated with any adverse event. Arytenoid adduction (AA) was associated with increased risk of reoperation within 30 days of the initial surgery (OR 6.4, 95% CI 1.0–49). Conclusions LFS is a generally safe procedure with infrequent perioperative adverse events. In the ACS-NSQIP database, ASA classification of III or IV was associated with a higher risk for any 30-day adverse event and AA was associated with a higher risk for 30-day reoperation. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ear, nose and throat manifestations of autoimmune and autoinflammatory diseases: a rheumatology perspective

xlomafota13 shared this article with you from Inoreader Message: Skip to main contentSkip to article Elsevier logo Journals & Books Search ScienceDirect Outline Ear involvement Nose and sinus involvement Oral involvement Throat involvement Fundings Conflicts of interest References Brazilian Journal of Otorhinolaryngology Brazilian Journal of Otorhinolaryngology Available online 22 October 2021 In Press, Corrected ProofWhat are Corrected Proof articles? Brazilian Journal of Otorhinolaryngology Editorial Ear, nose and throat manifestations of autoimmune and autoinflammatory diseases: a rheumatology perspective Author links open overlay panelSamuel de OliveiraAndradeaSimoneAppenzellerb https://doi.org/10.1016/j.bjorl.2021.05.015Get rights and content Under a Creative Commons licenseopen access Ear, nose and throat (ENT) manifestations are an important hallmark of inflammatory rheumatic diseases, varying from mild to life-threatening manifestations. They can be the first symptoms or occur during the course of the disease. The correct identification of the underlying physiopathology (inflammation, thrombosis or infection) and proper treatment of ENT symptoms are therefore of importance in diagnosis and followup of patients with inflammatory rheumatic disease. Many classification criteria include ENT manifestations, such as granulomatosis with polyangiitis (GPA), Behçet disease (BD), relapsing polychondritis (RP), eosinophilic granulomatosis with polyangiitis (EGPA) and Cogan syndrome (GS). Other autoimmune/autoinflammatory diseases are characterized by widespread inflammation and may present with ENT symptoms, such as sarcoidosis, rheumatoid arthritis (RA), Sjogren syndrome (SS), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).1, 2, 3, 4, 5 In this editorial, we will review on the main ENT manifestations that have been described in inflammatory rheumatic diseases. Ear involvement Outer ear Auricular chondritis is present in 20% at the onset of RP and 90% during the course of the disease. The entire ear is swollen, red and painful at contact. The continuous inflammation can result in pinna cauliflower deformity or ossification of the connective tissue. RP is characterized by a rare multisystem disease accepted as a complex autoimmune disorder affecting proteoglycan-rich structures and cartilaginous tissues, especially the auricular pinna, cartilage of the nose, tracheobronchial tree and various organ's connective components. Auricular chondritis can also be observed in GPA. It is a rare autoimmune disorder characterized by granulomatous inflammation and small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA). GPA has a broad clinical spectrum that ranges from predominantly granulomatous manifestations restricted to the respiratory tract to severe, life-threatening necrotizing vasculitis.1, 2, 3 Middle ear Otalgia, secretory otitis media and otorrhea can be observed in GPA and imunoglobulin G4 related disease (IgG4-RD). IgG4-RD is a chronic inflammatory disease that involves many tissues such as pancreas, lacrimal and salivary glands. Ear manifestations are more common in the middle ear, and the inner ear is rarely affected. Recurrent mastoiditis and facial numbness can also be observed.4 Inner ear Sensorineural hearing loss (SNHL) can be observed in a variety of systemic autoimmune/autoinflammatory diseases, having a prevalence of 21-69% for RA, 8-28% for SLE, 21-46% for SS and 20-77% for systemic sclerosis. Possible mechanisms include disease related (vasculitis, thrombosis or antibody-mediated) and medication related (ototoxic effect). The presence of vestibuloauditory symptoms, as sudden onset tinnitus and vertigo that can present with nausea, vomiting, ataxia and nystagmus in association especially with non-infectious interstitial keratitis, but also other symptoms (conjunctivitis, uveitis, episcleritis, scleritis, optic neuritis) should raise the suspicion of Cogan Syndrome (CS).1, 2 SNHL in association with increased inflammatory markers and the presence of recurrent fever in the absence of infection should alert otolaryngologists to the possibility of autoinflammatory diseases. Systemic autoinflammatory diseases (SIAD) are a group of disorders caused by a dysregulation of the innate immune system. One of most common monogenic SIAD associated with hearing loss is mutation of NOD- like receptor gene (NLRP3), a condition known as NLRP3-associated autoinflammatory disease (NLRP3-AID), formerly known as Cryopyrin-associated periodic syndrome (CAPS). Muckle Wells syndrome (MWS) is the intermediate form of CAPS and can develop to progressive SNHL, secondary to chronic inflammation of the internal ear. SNHL in MWS often rapidly progresses from mild high tone deficits to complete deafness. Early hearing loss primarily affects high frequencies of > 6 kHz reflecting the characteristic high sensitivity pattern of hair cells to injury as described in other systemic condit ions. Cochlear enhancement on fluid attenuation inversion recovery MRI (FLAIR- MRI) is more frequent in patients with a higher prevalence of hearing loss, providing some insight into the mechanisms of SNHL in MWS.5 Nose and sinus involvement Nasal involvement in GPA is present in approximately 42% of patients. Other associated symptoms related to GPA activity are nasal inflammation, chronic sinusitis, and nasal crusting with or without bloody rhinorrhea. Nasal chondritis can affect up to 15% of patients of RP. The inflammation involves the bridge of the nose, causing nasal pain, redness and swelling, being less marked than the ears. Nasal obstruction is rare. Both RP and GPA can progress to permanent damage, such as characteristic 'saddle-nose' deformity or septal perforation.1 EGPA is a rare necrotizing ANCA-associated vasculitis. EGPA is characterized by the presence of asthma, peak blood eosinophilia and small-size vessel vasculitis. There are many nasal manifestations associated with the disease, such as chronic sinusitis, nasal crusting, allergic rhinitis and bilateral diffuse polyposis. The presence of these manifestations associated with vasculitis in biopsy or ANCA positivity should rise the suspicion of EGPA. Oral involvement Sicca syndrome is by far the most frequent oral manifestation in autoimmune diseases, being present in more than 95% of patients with SS. Xerostomia may lead to secondary problems like oral candidiasis, dental caries and periodontal disease. In addition to that, sicca symptoms can lead to hoarseness and non-productive cough. Recurrent parotitis is present in 30-50% of patients and is characterized by a firm, diffuse, non-tender swelling. It is important in differentiate it from recurrent juvenile parotitis, where ANA antibodies are generally absent. BD is a systemic vasculitis, affecting vessels of variable sizes. It is characterized by a myriad of systemic manifestations, including mucocutaneous, arthritis, vascular, neurological and gastrointestinal. Recurrent oral ulceration is the most frequent presenting ENT symptom (95% of patients), typically being multiple and variable size (2-20 mm) and occur extensively on the buccal membrane, tongue, palate and in the oropharynx. The ulcers are classically painful, surrounded by erythema and the larger ones heal with scarring. Six or more painful, recurrent ulcers, of variable size with surrounding erythema occurring on the soft palate or oropharynx should heighten suspicion of BD.1, 2 SLE mucous membrane involvement is characterized by oral ulcers. Classical lesions are asymptomatic, occur at the hard palate and are characterized by whitish plaques with erythema in the center and keratotic striae in the periphery with areas of telangiectasia.1, 2 Throat involvement Laryngeal chondritis is an important symptom of RP and it manifests as pain above the thyroid gland and dysphonia, causing laryngomalacia or stenosis in more severe cases. Hypoglottic stenosis, due to granulomatous inflammation of GPA occurs in 2-20% and is a potential life-threatening complication and is associated with systemic involvement. Dyspnea, voice changes and cough are the most common symptoms, and audible stridor is present in most severe cases.1 RA is a chronic inflammatory disease characterized by symmetrical inflammatory joint disease that may evolve to joint damage and bone destruction. Laryngeal manifestations of RA involve cricoarytenoid joint (CJ) arthritis and rheumatoid nodules. The symptoms of CJ arthritis in the acute stage are often fullness in the throat or a feeling of tension, in addition to hoarseness, odynophagia or dysphagia, as well as pain worsening by speaking. Chronic disease can be manifest by a husky voice and stridor.1, 2 In summary, inflammatory rheumatic are rare diseases that present with a wide spectrum of ENT manifestations. A high index of suspicion is necessary for timely diagnosis. ENT specialists have a crucial role in referring patients with possible inflammatory diseases to rheumatologists. Fundings National Council for Scientific and Technological Development (CNPQ): 306723/2019-0. Coordination of Superior Level Staff Improvement (CAPES): 001. Conflicts of interest The authors declare no conflicts of interest. References 1 C. Gera, N. Kumar Otolaryngologic Manifestations of Various Rheumatic Diseases: Awareness and Practice Among Otolaryngologists Indian J Otolaryngol Head Neck Surg, 67 (2015), pp. 366-369 CrossRefView Record in ScopusGoogle Scholar 2 R.J. Gusmão, F.L. Fernandes, A.C. Guimarães, L. Scaramussa, Z. Sachetto, H.F. Pauna, et al. Otorhinolaryngological findings in a group of patients with rheumatic diseases Rev Bras Reumatol, 54 (2014), pp. 172-178 ArticleDownload PDFCrossRefView Record in ScopusGoogle Scholar 3 M. Felicetti, D. Cazzador, R. Padoan, A.L. Pendolino, C. Faccioli, E. Nardello, et al. Ear, nose and throat involvement in granulomatosis with polyangiitis: how it presents and how it determines disease severity and long-term outcomes Clin Rheumatol, 37 (2018), pp. 1075-1083 CrossRefView Record in ScopusGoogle Scholar 4 Q. Ren, J. Su, D. Zhang, X. Ding Otological IgG4-Related Disease With Inner Ear Involvement: A Case Report and Review of Literature Ear Nose Throat J (2020), 10.1177/0145561320976411 Online ahead of print Google Scholar 5 T. Welzel, J.B. Kuemmerle-Deschner Diagnosis and Management of the Cryopyrin-Associated Periodic Syndromes (CAPS): What Do We Know Today? J Clin Med, 10 (2021), p. 128 CrossRefGoogle Scholar © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. Recommended articles How I do it a microsurgical neurovascular decompression for hemifacial spasm European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 138, Supplement 3, 2021, pp. 91-92 Purchase PDFView details New method to prevent salivary fistula after parotidectomy British Journal of Oral and Maxillofacial Surgery, Volume 57, Issue 8, 2019, pp. 801-802 Purchase PDFView details An unusual nasal polyp European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 138, Issue 6, 2021, pp. 493-496 Purchase PDFView details 12Next Citing articles (0) Elsevier logo About ScienceDirect Remote access Shopping cart Advertise Contact and support Terms and conditions Privacy policy We use cookies to help provide and enhance our service and tailor content and ads. By continuing you agree to the use of cookies. Copyright © 2021 Elsevier B.V. or its licensors or contributors. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. RELX group home page Provide feedback Ear, nose and throat manifestations of autoimmune and autoinflammatory diseases: a rheumatology perspective Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Oct 22:S1808-8694(21)00168-3. doi: 10.1016/j.bjorl.2021.05.015. Online ahead of print. NO ABSTRACT PMID:34732358 | DOI:10.1016/j.bjorl.2021.05.015 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

'Use of pedicled corticoperiosteal flap in resistant cases of distal femur non-union: Our learning experience'

xlomafota13 shared this article with you from Inoreader "Use of pedicled corticoperiosteal flap in resistant cases of distal femur non-union: Our learning experience" Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 7:S1748-6815(21)00446-0. doi: 10.1016/j.bjps.2021.09.004. Online ahead of print. ABSTRACT INTRODUCTION: Nonunion of distal femur is a complex problem with the added burden of poor bone stock, osteopenia, and joint contracture. Various procedures are described ranging from osteosynthesis using auto/allograft, to use of mega prosthesis. Use of vascularized corticoperiosteal flap based on descending genicular artery and superomedial genicular artery is a new technique to provide living vascular graft for the nonunion site. Although few free corticoperiosteal flap reconstructions have been reported in the past for these distal femur nonunions, this flap has seldom been used as a pedicled variety. Through this article, we aimed at highlighting the main obstacles faced while using pedicled corticoperiosteal flap for these patients given its dearth in literature. MATERIALS AND METHODS: Five patien ts of at least two previously failed osteosynthesis for distal femur fracture non-union were selected for performing corticoperiosteal flaps. The intraoperative findings that were both favourable and unfavourable were documented along with the outcome of procedure in the form of callus formation or fracture healing. RESULTS: Dissection of the flap was more tedious in these cases than when performed for a different indication in a virgin territory. However, despite the previous trauma resulting in decreased pliability of their vessels, all flaps were viable at the end of procedure with favourable cosmetic and functional outcomes. CONCLUSION: Despite the complexities in flap harvest, use of the less morbid and technically easier "Pedicled corticoperiosteal flap" and osteosynthesis along with the auto technique is a worthwhile option for retaining the native joint with favourable outcome in non-unions of distal femur. PMID:34732336 | DOI:10.1016/j.bjps.2021.09.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A comparison of robotic versus laparoscopic distal pancreatectomy: Propensity score matching analysis

xlomafota13 shared this article with you from Inoreader A comparison of robotic versus laparoscopic distal pancreatectomy: Propensity score matching analysis Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background The aim of this study was to assess the perioperative and pathologic outcomes of robotic distal pancreatectomy compared with a laparoscopic approach. Methods A total of 121 robotic distal pancreatectomies and 992 laparoscopic distal pancreatectomies were retrospectively evaluated, comparing the demographic, perioperative and pathologic outcomes. After 1:2 propensity score matching with 11 demographic variables, the factors were analyzed again. Results Following propensity score matching, 104 robotic distal pancreatectomy patients were compared with 208 laparoscopic distal pancreatectomy patients. The operation time and proportion of spleen preservation were not different between the groups. The rates of open conversion were lower, whereas the hospital costs were higher in the robotic group. Other perioperative outcomes and pathologic factors did not differ between the groups. Conclusions Although robotic distal pancreatectomy is more expensive, this operation is feasible, with a higher probability of proceeding with the planned operation and with low open conversion rate. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ultrasound and Sialogram Correlates to Parotid Immunoglobulin G4-Related Disease

xlomafota13 shared this article with you from Inoreader Ultrasound and Sialogram Correlates to Parotid Immunoglobulin G4-Related Disease Via ear nose throat Ear Nose Throat J. 2021 Nov 3:1455613211051651. doi: 10.1177/01455613211051651. Online ahead of print. ABSTRACT Immunoglobulin G4 (IgG4)-related disease is an immune-mediated disorder that commonly manifests in the salivary glands. As a recently described disorder, the description and classification of IgG4-related disease is an ongoing process. Diagnosis of IgG4-related disease requires integration of clinical history, histopathology, and radiographic findings, including ul trasonography and sialography. In this case report, we correlate parotid ultrasonographic and sialographic findings in a patient with proven IgG4-related disorder confirmed from analysis of previous submandibular gland resections. We aim to highlight the utility of multimodality imaging in the diagnosis of IgG4-related disease. PMID:34732104 | DOI:10.1177/01455613211051651 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lip angioedema after indirect contact with a sea anemone

xlomafota13 shared this article with you from Inoreader Lip angioedema after indirect contact with a sea anemone Via ear nose throat Ear Nose Throat J. 2021 Nov 3:1455613211055704. doi: 10.1177/01455613211055704. Online ahead of print. ABSTRACT Sea anemones are marine animals that can produce toxins causing severe angioedema. Swimmers and divers should be aware of sea anemone species that can cause local and systemic toxic reactions and avoid indirect or direct skin contact. High index of suspicion, full laboratory workup, and treatment with steroids and antibiotics are imperative for an uneventful recove ry. PMID:34732103 | DOI:10.1177/01455613211055704 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.