Objectives YouTube is the second most visited website in the world and can be a useful resource for patients to gain insight into surgical procedures. A multitude of studies have evaluated the quality of otolaryngology-specific healthcare information available on the YouTube platform, but to our knowledge, the online content regarding functional endoscopic sinus surgery available on this site has not been systematically evaluated. Study Design Cross sectional study. Setting Online. Methods YouTube was searched using the keywords “sinus surgery.” Variables including video length, total number of views, authorship (academic, private practice physician, patient, or third party), objective (advertisement, informative, or patient perspective), inclusion of intra-operative footage, and discussion of balloon sinuplasty were recorded and analyzed by a single reviewer. Results Two-hundred twenty-two videos met inclusion criteria, with a median length of 4 minutes, and a median of 3349 views. The majority of videos were informative (n = 145, 65%), narrated (n = 151, 68%), and did not mention balloon sinuplasty (n = 189, 85%) nor contain intra-operative footage (n = 116, 52%). Private practice physicians were the most common authors (n = 113, 51%), followed by patients (n = 70, 32%), third parties (n = 28, 13%) and academics (n = 11, 5%). Conclusions Sinus surgery is one of the most common ambulatory procedures performed. Online resources such as YouTube can be useful for improving health literacy and patient comfort with medical topics such as functional endoscopic sinus surgery, but it is important for clinicians and patients to understand that there is a spectrum in the authorship, content, and quality of sinus surgery related videos posted online.

MAVS is a mitochondrial outer membrane protein that activates innate antiviral signaling by recognizing cytosolic viral RNAs and DNAs. While the discovery of MAVS is the first molecular evidence that links mitochondria to innate immune mechanisms, it is still unclear whether MAVS affects mitochondrial cell death as a member of caspase activation and recruitment domain (CARD)-containing proteins. We found that MAVS interacts with Bax through CARD by Yeast two-hybrid and a series of immunoprecipitation (IP) assay, which led us to hypothesize that MAVS functions not only in the innate antiviral mechanisms but also in the mitochondrial cell death pathway. Methods: 1) We examined molecular interaction between MAVS and Bax under oxidative stress by IP using isolated myocytes with H2O2 stimulation and the heart post ischemia-reperfusion (I/R). 2) We evaluated the effect of MAVS on mitochondrial membrane potential and apoptosis under H2O2 stimulation using isolated myocytes with adenoviral MAVS knockdown. 3) We investigated the impact of MAVS on %myocardial infarction (%MI) post I/R using cardiac-specific MAVS knockout (cKO) and transgenic (cTg) mice which we have originally generated. 4) We examined the effect of MAVS on recombinant Bax (rBax)-mediated cytochrome c release using isolated mitochondria from wild type (WT) and MAVS KO mice. Results: 1) The amount of Bax pulled down with MAVS was significantly increased in isolated myocytes with 0.2 mM H2O2 compared to those without stimulation (mean±SD; 1.808±0.14, n=5, p<0.001) and in the heart post I/R compared to sham (2.2±1.19, n=3, p=0.0081). 2) Myocytes with MAVS knockdown showed clear abnormalities in mitochondrial membrane potential and caspace-3 cleavage with 0.2 mM H2O2 compared to control cardiomyocytes. 3) MAVS cKO had significantly larger %MI than WT (81.9 ± 5.8% vs. 42.6 ± 13.6%, n=8, p=0.0008). In contrast, MAVS cTg had significantly smaller %MI that WT (30.0 ± 4.8% vs. 49.2 ± 4.8%, n=10, p=0.0113). 4) Mitochondria from MAVS KO exhibited cytochrome c release after incubation with 2.5 μ g of rBax while those from WT required 10 μ g of rBax. Conclusion: These results demonstrate that MAVS protects cardiomyocyte under oxidative stress by interfering with Bax-mediated cytochrome c release from mitochondria.