Objectives: Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. Methods: This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. Results: Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. Conclusions: Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.

Background: Torso hemorrhages are increasingly controlled by transient employment of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Few studies report patients' conditions after the initial resuscitation period using REBOA, especially in a rural setting. We present a highly successful 1-year post-operative recovery using REBOA for retroperitoneal and pelvic exsanguination. Methods: A 36-year-old female suffered a constellation of traumatic injuries after being ejected from her motorcycle. She arrived at a rural level 1 trauma center shortly thereafter. Results: REBOA was employed to control profuse hemorrhaging and the patient had a highly resilient recovery after one year. A literature review was conducted to highlight the points of contention regarding the controversial use of REBOA. Conclusion: REBOA can produce favorable results with minimal long-term deficits when controlling pelvic exsanguination.

Objective: To study the long-term outcomes of pediatric chronic rhinosinusitis (CRS) after surgical treatment. Methods: Cross-sectional survey of patients who were treated surgically for CRS as children more than 10 years ago. Survey included SNOT-22 questionnaire, additional functional endoscopic sinus surgery (FESS) since last treatment, status of allergic rhinitis and asthma, and availability of any CT scan sinus/face for review. Results: About 332 patients were contacted by phone or email. Seventy-three patients filled the survey (22.5% response rate). Current age was 26 years (±+/−4.7, 15.3-37.8 years). Age at initial treatment was 6.8 years (+/−3.1, 1.7-14.7 years). Fifty-two patients (71.2%) had FESS and adenoidectomy, and 21 patients (28.8%) had adenoidectomy only. Follow-up since surgical treatment was 19.3 years (+/−4.1). SNOT-22 score was 34.5 (+/−22.2). None of the patients had any additional FESS for the duration of the follow-up, and only 3 patients had septoplasty and inferior turbinoplasty as adults. Twenty-four patients had CT scan sinuses/face available for review. Scans were obtained at an average of 14 years after surgical intervention (+/−5.2). CT LM score was 0.9 (+/−1.9), compared to 9.3 at time of their surgery (+/−5.9) ( P < .0001). Currently 45.8% and 36.9% of patients have asthma and AR, compared to 35.6% and 40.6% respectively as kids ( P = .897 and P = .167). Conclusion: Children who had surgery for CRS do not seem to have CRS as adults. However, patients continue to have active allergic rhinitis that may affect their quality of life.

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Clean energy may offer a more environmentally friendly outcome than fossil fuels. However, clean energy is beset by uncertainties when the sun does not shine through and the wind does not blow. Worse still, science has not yet overcome scalability issues that are compounded by lack of technological knowhow on how to store solar and wind energy. The electrical “green-outs” of August 2020 in California are a reminder that without storage facilities for clean energy, utilities are driven to spot markets for electricity rendered from traditional sources of energy as economic setbacks occur due to compromised supplies of electricity. Without means of energy storage, new technology cannot fully replace the old. One can only hope that the dream to build a future based on renewable energy will lead to discoveries that will overcome scalability and storage issues.