bluuebunny/crossref_metadata_2025 huggingface dataset:
Coding and Reimbursement for Vestibular Tests by the U.S. Centers for Medicare and Medicaid Services (CMS)
Authors: Fife Terry D. , Desmond Alan L. , Kerber Kevin A.
Published: October 2021

Coding and insurance reimbursement is a part of the healthcare system in the United States but is subject to periodic modifications. In addition to changes in the evaluation and management (E/M) codes that took effect in 2021, there are some differences in coding for some diagnostic vestibular function test procedures. Two new codes for vestibular myogenic evoked potential testing were added and previous codes for auditory evoked potential codes 92585 and 92586, which some facilities had used to bill for vestibular myogenic evoked potential testing, have been eliminated. This article outlines the current state of coding and reimbursement by CMS for vestibular procedures.
Hearing Results in 151 Primary Stapedotomies for Otosclerosis: The Effects of Using Different Audiologic Parameters and Criteria on Success Rates
Authors: Saerens Morgane , Van Damme Jean-Philippe , Bihin Benoit , Garin Pierre
Published: October 2021

Objective:

To describe the 151 hearing results of primary stapedotomy for otosclerosis using different criteria of success rates.

Design:

Retrospective case series of 151 patients with a diagnosis of otosclerosis and operated on by the same surgeon with the same technique, using a CO2 laser. Patients with revision surgery were excluded. The audiometric data were extracted from the patient files and divided into three groups: early postoperative follow-up (<1 mo after surgery), mid-term follow up (between 1 mo and 1 yr), and late postoperative follow-up (>1 yr).

Results:

The postoperative air-bone gap (ABG) was 10 dB or less in 45.2% in the mid-term follow up. For this same follow-up, ABG closure less or equal than 20 dB was achieved in 95.6% of cases. The lower percentage of patients with a postoperative ABG closure of less than or equal to 10 dB can be due to the high rate of bone conduction (BC) overclosure of 15.65%. The functional success described as an air conduction (AC) threshold less than or equal to 30 dB was achieved in 52.2% of patients. The mean speech reception threshold (SRT) in the mid-term follow up was 27.4 dB. The analysis of the data according to the Amsterdam Hearing Evaluation Plots (AHEPs) shows a success rate of 87% at early follow-up.

Conclusions:

The success rate is mainly dependent on the definition and criteria as a measure of success. An analysis of the evolution of the BC is mandatory to avoid a false positive success rate when the ABG closure is used. Therefore, the use of the AHEPs would acquire additional information. The hearing outcome has also been based on the speech audiometry and the number of patients achieving an AC less than or equal to 30 dB as a more realistic measure of success. Our series confirms good long term hearing results achieved in stapedotomy surgery with the CO2 laser.
Radiological Follow-up After the Bony Obliteration Tympanoplasty in Detecting Residual Cholesteatoma: Towards an Optimal Postoperative MR Imaging Protocol
Authors: van der Toom Hylke F. E. , van Dinther Joost J. S. , Zarowski Andrzej , Baazil Adrianus H. A. , De Foer Bert , Bernaerts Anja , Casselman Jan W. , Offeciers Erwin
Published: October 2021

Introduction and Aim:

There is no consensus in literature on the most optimal follow-up imaging protocol for non-echoplanar diffusion-weighted magnetic resonance imaging (non-EP DW MRI) after the canal wall-up bony obliteration tympanoplasty. Clearly, no residual cholesteatoma should be missed but on the other hand, unnecessary MR controls should be avoided. The aim of this study is to evaluate the postoperative results of non-EP DW MRI after canal wall-up bony obliteration tympanoplasty surgery at our Institute and to propose an optimal postoperative MR imaging scheme based on our data.

Material and Methods:

Retrospective cohort study; all 271 patients who underwent the bony obliteration tympanoplasty between January 2010 and January 2016 with follow-up at our Institute were included. A postoperative MR imaging was systematically performed at 1 year after surgery and repeated at either 5 or both 3 and 5 years after surgery, based on the preferences of the surgeon. Variables of interest were retrieved from electronic patient records.

Results:

The median follow-up time was 60 months (inter-quartile range 56–62 mo). Two hundred seventy-one patients (100%) received a 1-year MRI, 107 (39%) a 3-year MRI, and 216 (79.7%%) a 5-year MRI. Residual cholesteatoma was found in nine cases (3.3%), corresponding with an estimated residual rate at 5 years follow-up of 3.7% when using Kaplan–Meier analysis. Of these nine cases, six cases of residual cholesteatoma (66.7%) were detected at the 1-year MRI (12–14 mo postsurgery), two cases (22.2%) at the 3-year MRI (35–39 mo postsurgery), and one case (11.1%) at the 5-year MRI (51 mo postsurgery, in this patient no 3-year MRI was performed). An uncertain MRI result was found in 15 cases, presenting as relatively hyperintense lesions. However, subsequent follow-up scans did not show persistent evidence for residual disease in 14 of these 15 cases.

Conclusions:

A postoperative MRI scan after 1 and 5 years is essential to detect early and late residual cholesteatoma. In our cohort, 22.2% of residual cases were detected at the 3-year MRI. However, this percentage could potentially have been higher when all patients would have received a 3-year MRI. Therefore, in order to detect residual disease as soon as possible, we propose to perform an MRI scan at 1, 3, and 5 years after the bony obliteration tympanoplasty. In cases with an unclear MR result, we suggest a repeat MRI after 12 months.
Endoscopic Transcanal Labyrinthectomy for Intractable Meniere's Disease: An Alternative to Transmastoid Labyrinthectomy?
Authors: Lee Se A , Lee Yun Ji , Lee Jong Dae
Published: October 2021

Objective:

To describe a novel approach for intractable Ménière's disease exclusively through a transcanal endoscopic ear surgery (TEES) approach.

Patient:

A 56-year-old male with intractable Ménière's disease despite conservative treatment and chemical labyrinthectomy.

Interventions:

Transcanal endoscopic labyrinthectomy.

Main Outcome Measure:

Subjective vertigo control, surgical morbidity.

Results:

The TEES approach provided a wide exposure of the oval window. This facilitated removal of stapes crura and footplate. After widening of the oval window, the perilymph was suctioned, and gentamicin was injected through the oval window. The oval window was obliterated using the perichondrium of the tragal cartilage and fibrin glue. After 2 years of follow-up, there was no recurrence of vertigo.

Conclusions:

As a compelling alternative to the transmastoid approach, we propose endoscopic labyrinthectomy as an option for patients with intractable MD without functional hearing who have failed chemical labyrinthectomy. Additional studies are needed to determine the risk-benefit profile of this technique.
Impact of Duration of Deafness on Speech Perception in Single-Sided Deafness Cochlear Implantation in Adults
Authors: Nassiri Ashley M. , Wallerius Katherine P. , Saoji Aniket A. , Neff Brian A. , Driscoll Colin L. W. , Carlson Matthew L.
Published: October 2021

Objective:

To evaluate the impact of prolonged auditory deprivation on speech perception outcomes in adult acquired single-sided deafness (SSD) cochlear implant (CI) recipients.

Study Design:

Retrospective case series.

Setting:

Tertiary care academic center.

Patients:

Acquired SSD in adults with and without prolonged duration of deafness (defined as >10 yr) who underwent CI between 2014 and 2019.

Interventions:

CI.

Main Outcome Measures:

Consonant-nucleus-consonant (CNC) and AzBio in quiet scores within first year of follow-up.

Results:

A total of 35 adult patients with SSD were evaluated, with a median overall duration of deafness of 2.4 years (interquartile range [IQR] 1.2–6.0 yr): seven patients with prolonged auditory deprivation (median 18 yr, IQR 15–28) were compared with 28 SSD patients with duration of deafness less than 10 years (median 1.7 yr, IQR 1.1–3.2). At last follow-up, the median CNC scores were 39% (IQR 31–64) and 54% (IQR 46–64) for the prolonged and shorter duration of deafness cohorts, respectively (p = 0.3). The median AzBio scores were 66% (IQR 65–68) and 72% (IQR 60–82) for the prolonged and shorter duration of deafness cohorts, respectively (p = 0.6). In a separate analysis evaluating duration of deafness as a continuous variable across all 35 patients, Spearman correlation coefficients for associations of duration of deafness with most recent CNC and AzBio scores were –0.02 (p = 0.9) and 0.02 (p = 0.9), respectively.

Conclusions:

Adult CI recipients with acquired SSD, with and without prolonged auditory deprivation, demonstrated comparable speech perception scores. Prolonged duration of deafness alone should not preclude a motivated SSD patient from undergoing cochlear implantation.
Anticoagulation management post-transjugular intrahepatic portosystemic shunt in portal hypertension associated with myeloproliferative neoplasms
Authors: Abou-Ismail Mouhamed Yazan , Prchal Josef T. , Deininger Michael W. , Parker Charles J. , Lim Ming Y.
Published: October 2021

Portal hypertension (pHTN) complicates myeloproliferative neoplasms (MPNs), and usually occurs due to Budd–Chiari syndrome or splanchnic vein thrombosis. Current management modalities for MPN-associated pHTN include anticoagulation, transjugular intrahepatic portosystemic shunt (TIPS), and orthotopic liver transplant. Data on the thrombotic and bleeding outcomes of this practice is of poor quality, and whether direct oral anticoagulants (DOACs) are effective in this setting is unknown. We describe failure of DOACs to prevent post-TIPS complications in two case reports of patients with MPN-associated pHTN and review the associated literature. We conducted a comprehensive search in Embase (embase.com), Scopus (scopus.org), and PubMed for existing data on MPN-associated pHTN post-TIPS procedure. Four studies (n = 251) of patients with pHTN post-TIPS were eligible (MPN, n = 143). A review of the literature suggests that patients with MPN-associated pHTN may be at higher risk for post-TIPS complications including stent thrombosis and stenosis, compared with other causes of thrombotic pHTN. DOAC use has not been studied in this setting. While further studies to guide optimal management of MPN-associated pHTN post-TIPS are needed, available evidence suggests that life-long anticoagulation is warranted. DOACs should not be considered standard of care because of lack of evidence of efficacy.
Identification of Breast Cancer Survivors With High Symptom Burden
Authors: Whisenant Meagan S. , Williams Loretta A. , Mendoza Tito , Cleeland Charles , Chen Tsun-Hsuan , Fisch Michael J. , Shi Quiling
Published: October 2021

Background

While women diagnosed with breast cancer have increased survival when compared with other cancers, survivorship may include residual symptom burden from treatment and continuing endocrine therapies.

Objective

The objective of this study was to identify subgroups of breast cancer survivors experiencing similar symptom severity.

Methods

Participants were 498 women with breast cancer, not on active treatment. Symptom severity was self-reported using the MD Anderson Symptom Inventory. Target symptoms were included in a latent profile analysis. Factors related to subgroup membership and differences in quality of life (QOL) and functioning were explored using logistic regression.

Results

Mean age was 60.11 (SD, 11.32) years, 86.1% were white, and 79.1% were receiving endocrine therapy. Target symptoms included fatigue (reported at ≥5 by 22.8% of women), sleep disturbance (24.8%), and trouble remembering (17.2%). Two subgroups were identified: low symptom severity (77.0% of women) and high (23.0%). Older women (odds ratio [OR], 0.971; 95% confidence interval [CI], 0.952–0.989) and employed women (OR, 0.621; 95% CI, 0404–0.956) were less likely to be in the high subgroup; women with poorer performance status (OR, 1.653; 95% CI, 1.188–2.299) were more likely to be in the high subgroup. Women in the high subgroup reported lower QOL (P = .000) and greater interference with functioning (P = .000).

Conclusions

Two subgroups of women with distinct symptom severity were identified.

Implications for Practice

Identification of women at risk for high symptoms during survivorship may allow clinicians to intensify their approach to symptom management, thereby mitigating poor outcomes and impairments in QOL.
Predictors for Telephone Outreach Post-hospital Discharge
Authors: Vergara Franz H. , Budhathoki Chakra , Sheridan Daniel J. , Davis Jean E. , Sullivan Nancy J.
Published: October 2021

Purpose of Study:

The specific aims of this study were to examine whether sociodemographic variables and medical–surgical diagnoses were associated with telephone follow-up (TFU) reach rates, emergency department visits, and hospital readmissions.

Primary Practice of Setting:

Acute care inpatient units in an academic medical center.

Methodology and Sample:

A correlational design was utilized, and a prospective medical record review of patients was conducted while implementing face-to-face prehospital discharge meeting interventions. The study sample (N = 176) included adult patients in two neurosurgical wards who were admitted between June 2016 and September 2016. Parametric and nonparametric tests were used to explore the balance between the intervention group receiving a face-to-face prehospital discharge meeting and comparison group receiving standard prehospital discharge care. Bivariate statistics were employed to determine associations between variables.

Results:

A total of 15 sociodemographic and medical–surgical variables were used to correlate TFU reach rates, emergency department (ED) visits, and readmission rates. Educational attainment (p = .002), employment status (p = .014), parental status (p = .010), and hospital service (p = .039) had significant differences between the intervention and comparison groups. Results demonstrated an improved reach rate for the intervention group but despite the differences in the groups, phi and Cramer's V coefficients did not correlate any associations with TFU reach rate, ED visits, and readmission rates with sociodemographic and surgical variables. This outcome affirmed that despite the similarities and differences in the sample, a face-to-face meeting prehospital discharge is an effective intervention to improve telephone outreach.

Implications to Case Management Practice:

There is a need to determine the most cost-effective way to increase TFU reach rates to prevent subsequent ED visits and hospital readmissions. There is also a need to develop a tool that can predict the hardest-to-reach patients posthospital discharge, so that case managers can meet those patients before leaving the hospital. In addition, it is important to identify alternative methods of “face-to-face” interactions during the COVID-19 pandemic crises. Case managers must explore ways with caution to leverage secured digital technology to bridge the gap of communicating with patients and family members when hospital visitations are limited.
Virtual Interviewing for Pediatric Emergency Medicine Fellowship—A National Survey
Authors: van der Laan Lyndsey , George Rachel , Nesiama Jo-Ann , Nagler Joshua , Langhan Melissa L. , Yen Kenneth , Ngo Thuy L. , Rose Jerri A. , Caglar Derya , Kant Shruti , Ciener Daisy , Feng Sing-Yi
Published: October 2021

Objective

This study aimed to evaluate both applicant and interviewer satisfaction with the virtual interviewing process for pediatric emergency medicine (PEM) fellowship in hopes to improve the fellowship interviewing process. It was proposed that fellowship programs and applicants would prefer virtual interviews over traditional interviews.

Methods

A survey developed in collaboration with UT Southwestern PEM fellowship leaders and national PEM leaders was sent to all PEM fellowship applicants and programs at the conclusion of the 2020 interview season and rank list submission. The applicant survey obtained information on ease of virtual interviews and whether applicants felt that they obtained adequate information from virtual interviews to make informed program selections. Program director surveys collected data on thoughts and feelings about virtual interviews and obstacles encountered during the recruitment season. Both surveys asked about costs for interviews and interview type preference.

Results

A response rate of 49% from applicants and 47% from programs was obtained. Virtual interview days were similar in the amount of time and staff hours used compared with traditional days. Applicants spent less on virtual interviews compared with those who underwent traditional interviews (average $725 vs $4312). Programs received more applications than the prior year and spent less money during the virtual cycle. The majority of the applicants (90%) were comfortable with the virtual interview platform, and most (66%) agreed that virtual interviews provided adequate information to determine program rank. Geography was the number 1 rank determining factor. Programs and applicants preferred a form of in-person interviews.

Conclusions

Virtual interviews provide cost savings for both applicants and programs. Despite this, both parties prefer a form of in-person interviews.
Sources of Medications Used by Children and Adolescents for Intentional Ingestion
Authors: Larson Emma K. , Johnson Kyle P. , Sheridan David C.
Published: October 2021

Introduction

Suicide is a leading cause of death among adolescents. Oregon ranks 17th nationally for youth suicide rates, and ingestion of medications as a means of suicide is common. Despite the high prevalence of intentional poisoning among youth in Oregon, information about medications used by children and adolescents for attempted suicide, in particular the sources of medications, is not readily available.

Methods

The objective of this study is to describe types and sources of medications used for intentional ingestion among patients seen by the Doernbecher Children's Hospital Child and Adolescent Psychiatry Consultation-Liaison Service. This was a retrospective analysis of patients seen by the Child and Adolescent Psychiatry Consultation-Liaison Service for intentional ingestion from 2015 to 2017. Data on 434 total intentional ingestions were collected, including demographic information, types of medications ingested, and sources of both over-the-counter (OTC) and prescription (Rx) medications. Ingestions without intent of suicide were excluded. Descriptive analysis of ingestion data was performed.

Results

Intentional ingestions included Rx and OTC medications in similar frequencies. For Rx medications, 68% of ingestions included patients' own Rxs. Eighty-eight percent of ingestions that were not the patients' own Rx belonged to someone else living in their home. For OTC medications, 66% of medications were available at home.

Conclusions

Intentional ingestions among adolescents most frequently involve medications that are readily available in their homes, and these include both OTC and Rx medications. This study highlights the importance of securing medications at home as a preventative measure and the importance of anticipatory guidance for primary care providers.
Contributions of Community-Based Organizations Funded by the Centers for Disease Control and Prevention's HIV Testing Program
Authors: Marano-Lee Mariette , Williams Weston , Uhl Gary , Eke Adanze , Joshua Tanesha , Xu Songli , Carter Jarvis , Rakestraw Antonya , Dunbar Erica
Published: October 2021

Context:

HIV testing is a critically important first step in preventing and reducing HIV transmission. Community-based organizations (CBOs) are uniquely positioned to provide HIV testing and other prevention services to populations disproportionately affected by HIV infection.

Objective:

The purpose of this analysis was to assess CDC-funded health department (HD) and CBO testing programs during 2012-2017, including the number of tests and HIV positivity.

Design:

This is an analysis of National HIV Prevention Program Monitoring and Evaluation HIV testing data submitted between 2012 and 2017 to CDC.

Setting:

Sixty-one CDC-funded state and local HDs in the United States, Puerto Rico, and the US Virgin Islands and between 122 and 175 CDC-funded CBOs, depending on the year.

Participants:

Persons who received HIV testing at CDC-funded CBOs and HDs.

Main Outcome Measure:

The number of HIV tests and positivity at CBOs were compared with HDs overall and to HDs in non-health care settings that, like CBOs, include HIV risk data and are in similar locations.

Results:

CBOs accounted for 7625 (8%) new diagnoses but conducted only 3% of the almost 19 million CDC-funded HIV tests from 2012 to 2017. Newly diagnosed HIV positivity at CBOs (1.4%) was nearly 3 times the new positivity at HDs overall (0.5%) and twice that of new positivity at HDs in non-health care settings (0.7%). A higher proportion of tests at CBOs were conducted among groups at risk, and new HIV positivity was higher for most demographic and population groups than new HIV positivity at HDs in non-health care settings.

Conclusion:

These findings demonstrate the essential role CDC-funded CBOs have in reaching, testing, and diagnosing groups at high risk for acquiring HIV infection.
Performance, Detection, Contamination, Compliance, and Cointervention Biases in Rehabilitation Research
Authors: Armijo-Olivo Susan , Mohamad Norazlin , Sobral de Oliveira-Souza Ana Izabela , de Castro-Carletti Ester Moreira , Ballenberger Nikolaus , Fuentes Jorge
Published: October 2021

Bias is a systematic error that can cause distorted results leading to incorrect conclusions. Intervention bias (i.e., contamination bias, cointervention bias, compliance bias, and performance bias) and detection bias are the most common biases in rehabilitation research. A better understanding of these biases is essential at all stages of research to enhance the quality of evidence in rehabilitation trials. Therefore, this narrative review aims to provide insights to the readers, clinicians, and researchers about contamination, cointervention, compliance, performance, and detection biases and ways of recognizing and mitigating them. The literature selected for this review was obtained mainly by compiling the information from several reviews looking at biases in rehabilitation. In addition, separate searches by biases and looking at reference lists of selected studies as well as using Scopus forward citation for relevant references were used.

This review provides several strategies to guard against the impact of bias on study results. Clinicians, researchers, and other stakeholders are encouraged to apply these recommendations when designing and conducting rehabilitation trials.
Therapeutic Ultrasound and Shockwave Therapy for Tendinopathy
Authors: Smallcomb Molly , Khandare Sujata , Vidt Meghan E. , Simon Julianna C.
Published: October 2021

Tendon injury is prevalent and costly in the United States, comprising 45% of the 66 million musculoskeletal injuries and costing $114 billion annually. Surgical and therapeutic methods, such as arthroscopic surgery, dry needling, and physical therapy, produce mixed success in reintroducing a healing response in tendinopathy due in part to inconsistent dosing and monitoring. Ultrasound is one therapeutic modality that has been shown to noninvasively induce bioeffects in tendon that may help promote healing. However, results from this modality have also been mixed. This review compares the current state of the field in therapeutic ultrasound and shockwave therapy, including low-intensity therapeutic ultrasound, extracorporeal shockwave therapy, and radial shockwave therapy, and evaluates the efficacy in treating tendinopathies with ultrasound. We found that the mixed successes may be attributed to the wide variety of achievable parameters within each broader treatment type and the lack of standardization in measurements and reporting. Despite mixed outcomes, all three therapies show potential as an alternative therapy with lower-risk adverse effects than more invasive methods like surgery. There is currently insufficient evidence to conclude which ultrasound modality or settings are most effective. More research is needed to understand the healing effects of these different therapeutic ultrasound and shockwave modalities.
A Monte Carlo Simulation to Estimate the Additional Cost Associated With Adverse Medication Events Leading to Intraoperative Hypotension and/or Hypertension in the United States
Authors: Nanji Karen C. , Shaikh Sofia D. , Jaffari Alireza , Franz Calvin , Bates David W.
Published: October 2021

Objectives

Intraoperative hypertension and hypotension are common and often related to adverse medication events (AMEs). The study objective is to estimate the annual additional fully allocated costs to the U.S. healthcare system related to AMEs associated with clinically significant intraoperative hypertension and hypotension.

Methods

Using anesthesia-trained observers in randomly selected operating rooms, we estimated the rates of clinically significant intraoperative hypotension and hypertension. We conducted systematic literature reviews to estimate incidence and additional costs of acute kidney injury (AKI), acute myocardial injury, and stroke after intraoperative hypotension and hypertension. We used Monte Carlo simulation to estimate annual costs to the U.S. healthcare system.

Results

Intraoperative hypotension (mean arterial pressure <55 mm Hg for >6 minutes) occurred in 11 of 277 operations (3.97%), hypotension (>30% drop from baseline mean arterial pressure in patients with coronary artery disease) in 9 operations (3.25%) and hypertension in 14 operations (5.05%). After hypotension, incremental incidence of AKI was 1.46% (additional cost $17,289/case), acute myocardial injury was 0.75% ($21,340/case), and stroke was 0.05% ($19,903/case). After hypertension, incremental stroke incidence was 4.76% ($28,320/case). Annually in the United States, we estimated 11,513 cases of AKI, 5914 of acute myocardial injury, 345 of stroke after intraoperative hypotension, and 47,774 cases of stroke after intraoperative hypertension, costing the U.S. $1.7 billion (90% confidence interval, $1.4–$2.0 billion), of which $923 million (90% confidence interval, $763–$1101 million) is preventable.

Conclusions

Adverse medication events related to blood pressure are frequent, costly, and can cause considerable patient harm. Cost estimates for these events may provide a means of prioritizing safety improvements to reduce cost of care and improve patient outcomes.
Coronary artery plaque progression and cardiovascular risk scores in men with and without HIV-infection
Authors: Shaikh Kashif , Bhondoekhan Fiona , Haberlen Sabina , Nakanishi Rine , Roy Sion K. , Alla Venkata M. , Brown Todd T. , Lee Juhwan , Osawa Kazuhiro , Almeida Shone , Rahmani Sina , Nezarat Negin , Sheidaee Nasim , Kim Michael , Jayawardena Eranthi , Kim Nicolas , Hathiramani Nicolai , Palella Frank J. , Witt Mallory , Ahmad Khadije , Kingsley Lawrence , Post Wendy S. , Budoff Matthew J.
Published: October 2021

Objective:

The aim of this study was to assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants.

Methods:

We studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. CAP at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS), and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression.

Results:

We studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and noncalcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 [95% confidence interval (95% CI) 2.4–12.1, P < 0.001)] and 7.7 (95% CI 3.1–19.1, P < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low-risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, odds ratio (OR) 2.8 (95% CI 1.4–5.8, P < 0.01) and OR 2.4 (95% CI 1.2–4.8, P < 0.05), respectively (P values for interaction by HIV = 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile, although in HIV-infected men, high-risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE.

Conclusion:

PCE and FRS categories predict CAP progression better in HIV-uninfected than in HIV-infected men. Improved CVD risk scores are needed to identify high-risk HIV-infected men for more aggressive CVD risk prevention strategies.
Retroposition of the Vestigial Cartilage in Patients With Microtia: A Novel Technique to Enhance Projection of the Reconstructed Ear
Authors: Badawy Mohamed Samir , Elshahat Ahmed
Published: October 2021

Background:

The projection of the reconstructed auricle is an important step in ear reconstruction. The novel use of the vestigial cartilage can successfully replace the projection piece harvested from the costal cartilage, improve the three-dimensional contour of the reconstructed auricle, and help deepening of the concha, compensate for mastoid atrophy in patients with hemifacial microsomia.

Methods:

A total of 34 patients with microtia were included and classified according to the Nagata classification. Anotia and atypical cases with deficient cartilage are excluded. Two-stage auricle reconstruction was performed. The first stage included retroposition of the vestigial cartilage, framework implantation and lobule transposition. After 3 to 6 months, the second stage was performed and included elevation of the reconstructed auricle and coverage by split-thickness skin graft.

Results:

The results were satisfactory regarding the shape, symmetry, maintenance of the auriculocephalic angle, and stability of the reconstructed ear. The vestigial cartilage was classified into 3 different types according to its shape. Type 1(V1) cartilage is a sausage-shaped cartilage that can be directly used as a projection piece. Type 2(V2) cartilage is a flat-shaped cartilage that should be folded upon itself. Type 3(V3) cartilage is an atypical type where the cartilage does not have a specific shape. This type can be used as it is or reconfigured with sutures according to the amount of projection needed. Moreover, 87% of patients were satisfied with the appearance of their new ears, 90% of patients can wear their glasses or sunglasses, and 94% of patients can easily clean their new ear.

Conclusions:

According to the shape and amount of the available vestigial cartilage, it can be used as a projection piece either alone or with an augmentation piece from the costal cartilage.
Development and Application of Three Steps Training Mode for Endoscopic Transnasal Transsphenoidal Approach
Authors: Li Chuzhong , Zhu Haibo , Zheng Jiaping , Liu Chunhui , Gui Songbai , Zhao Peng , Bai Jiwei , Zhang Yazhuo
Published: October 2021

Objective:

The model of endoscopic transnasal transsphenoidal approach (METTA) were made and the application of the 3-steps training mode in the endoscopic transnasal transsphenoidal approach (ETTA) training was discussed.

Methods:

The plastic skull model was used to make a simple METTA model; the multicolor and multi-material 3D printing technology was used to make a METTA simulation model and the perfusion cadaver head specimen was used as the gold standard training model. Then 3 neurosurgeons evaluated the 3 types of models. Level 1 training group only received perfusion cadaveric head specimen training; level 2 training group with 3D printing METTA model plus cadaver head specimen training, and level 3 training group with simple model, 3D printing model and cadaver head specimen training group. The authenticity of the model and the training effect were evaluated according to the operation time and the damage degree to the surrounding structures.

Results:

The results showed that perfusion cadaveric head specimens scored the highest in each item. The simplified model was superior to the 3D printing METTA in simulating the shape and elasticity of pituitary tumor tissue. The score of surgical skill training was the same as that of 3D printing METTA. In terms of the training effect, the doctors who had received 3 steps training had the highest score, which was better than the other 2 groups.

Conclusions:

The application of 3 steps training mode with simple training model, 3D printing model and perfusion cadaver head specimen can improve the effect of ETTA operation training.
Three-Dimensional Measurement of the Zygomatic–Maxillary Complex in Unilateral Cleft Lip and Palate Patients With Maxillary Retrusion
Authors: Zheng Yilue , Jiang Chanyuan , Ma Hengyuan , Yin Ningbei , Zhai Junya , Tong Haizhou , Song Tao
Published: October 2021

The purpose of this study was to investigate the anatomical features of the zygomatic–maxillary complex in unilateral cleft lip and palate (UCLP) patients with maxillary retrusion. Individuals were grouped and craniofacial measurements were carried out for 34 individuals in the UCLP with maxillary retrusion group (UMRG) and 50 from a control group (CG). The authors measured the length, width, and height of the maxilla and zygoma and also measured predetermined regions on the midface in each group. Independent sample group t tests were performed to determine differences between groups (with significance set at P < 0.05). Multiple points on the midface (the most posterior point on the contour of the maxillary alveolar process, lowest point of the zygomaticomaxillary suture, furthest point to the zygomatic self-base plane, superior point in the infraorbital foramen, and lowest point of the inferior margin of the orbit) to the coronal plane were smaller in the UMRG than in the CG (all results P < 0.05). In addition, the maxillary length was significantly reduced in the UMRG than in the CG (P < 0.05). In summary, for the UCLP patients with maxillary retrusion, the deficiency in the midface gradually reduced going upward, with the deficiency in the maxillary alveolar level the most serious. The zygoma was influenced to a lesser extent.
Outcomes of Bifocal Transport Distraction Osteogenesis for Repairing Complicated Unilateral Alveolar Cleft
Authors: Altaweel Alaa Abdelqader , Lababidy Adeeb Safwan , Abd-Ellatif El-Patal Mohamed , Elsayed Shadia Abdelhameed , Eldin Mohamed Shams , Dabbas Jamal , Meneim Marwa Hassan Abd-El , Kharma Mohamed Yaser
Published: October 2021

Objectives:

This study aimed to assess the outcomes of bifocal transport distraction osteogenesis (BTDO) for closure of a wide or previously failed unilateral alveolar cleft.

Methods:

Patient in this study had a large alveolar cleft that had not healed with bone grafts. Bone-borne distraction was used under general anesthesia. Intraoperative complications as bleeding and trauma to neighboring teeth were documented. Postoperative complications as wound dehiscence, paresthesia, infection, and bleeding were recorded. Complications including changes in bone segment movement, activation force loss, and occlusal interferences were observed during the activation phase. During the consolidation phase, problems including gingival recession, pulpal vitality, and cosmetic concerns were evaluated. Postoperative, periapical, occlusal, and orthopantomograms were used to evaluate bone gain and bone generation in the distracted area.

Results:

Ten patients (6 males and 4 females) with unilateral alveolar cleft were included, with mean age of 9.5 ± 2.5 years. Average cleft width was 12.25 ± 2.54 mm. There was no intraoperative or postoperative bleeding. Only 1 patient had a wound dehiscence (10%). All patients had mild postoperative pain and edema in upper lip. Only 1 patient complained of numbness in infraorbital nerve's innervated region. Radiographs revealed bone formation in cleft area and bone healing in distracted chamber.

Conclusions:

Bifocal transport distraction osteogenesis improves success rate of an alveolar cleft treatment especially a wide or previously failed one. This technique associated with minimal complications when careful planning and cooperation from a patient are combined. It can be recommended when other modalities for alveolar cleft are failed. Patients also tolerate the device well.
Increased Plasma Hyaluronan Levels are Associated With Acute Traumatic Coagulopathy
Authors: Walker Shannon C. , Richter Robert P. , Zheng Lei , Ashtekar Amit R. , Jansen Jan O. , Kerby Jeffrey D. , Richter Jillian R.
Published: October 2021

Introduction:

Acute traumatic coagulopathy (ATC) is an endogenous impairment in hemostasis that often contributes to early mortality after trauma. Endothelial glycocalyx damage is associated with trauma-induced coagulation abnormalities; however, the specific relationship between hyaluronan (HA), a key glycocalyx constituent, and ATC has not been evaluated.

Methods:

We performed a secondary analysis of prospectively collected data from a recent study in which trauma patients (>18 years) admitted to our Level I trauma center with an ABC Score≥2 were enrolled. Partial thromboplastin time (PTT), international normalized ratio (INR), and thromboelastography (TEG) parameters were recorded at arrival. Injury characteristics and clinical outcomes were obtained. Plasma HA levels were measured in healthy controls (HC) and in trauma subjects at arrival (t = 0 h) and 12, 24, and 48 h. ATC was defined as admission INR>1.2 or PTT≥36.5 s. Comparisons of HA levels were assessed, and Spearman's correlations were performed between 0 h and 24 h HA levels, coagulation measures and clinical outcomes. P values < 0.05 were considered significant.

Results:

Forty-eight trauma patients and 22 controls were enrolled for study. Sixteen trauma subjects were coagulopathic at admission. HA levels in subjects with ATC were higher than non-coagulopathic subjects at all time points and elevated above HC levels at 24 and 48 h. At arrival, HA levels correlated with TEG R-time, PTT, and INR. HA levels at 24 h correlated with increased transfusion requirements and intensive care unit and hospital lengths of stay.

Conclusion:

Shed HA is associated with early coagulation abnormalities in trauma patients, which may contribute to worse outcomes. These findings highlight the need for additional studies to evaluate the mechanistic role of HA in ATC.
Long-Term Outcomes After Midurethral Mesh Sling Surgery for Stress Urinary Incontinence
Authors: Dejene Sara Z. , Funk Michele Jonsson , Pate Virginia , Wu Jennifer M.
Published: October 2021

Objectives

Although midurethral mesh slings are the criterion standard surgical treatment for stress urinary incontinence (SUI), limited data exist regarding long-term outcomes. Thus, our objectives were to evaluate the long-term risk of sling revision and the risk of repeat SUI surgery up to 15 years after the initial sling procedure and to identify predictors of these outcomes.

Methods

Using a population-based cohort of commercially insured individuals in the United States, we identified women aged 18 years or older who underwent a sling procedure between 2001 and 2018. For sling revision, we evaluated indications (mesh exposure or urinary retention). We estimated the cumulative risks of sling revision and repeat SUI surgery annually using Kaplan-Meier survival curves and evaluated predictors using Cox proportional hazards models.

Results

We identified 334,601 mesh sling surgical procedures. For sling revision, the 10-year and 15-year risks were 6.9% (95% confidence interval [CI], 6.7–7.0) and 7.9% (95% CI, 7.5–8.3), with 48.7% of sling revisions associated with mesh exposure. The 10-year and 15-year risks of repeat SUI surgery were 14.5% (95% CI, 14.2–14.8) and 17.9% (95% CI, 17.3–18.6). Women aged 18–29 years had an elevated risk for both sling revision (hazard ratio, 1.20; 95% CI, 1.15–1.25) and repeat SUI surgery (hazard ratio, 1.30; 95% CI, 1.25–1.37) compared with women 70 years and older.

Conclusions

In our study population, the 15-year risk of sling revision was 7.9%, with nearly half of revisions due to mesh exposure. These findings provide critical long-term data to support informed decisions for women and health care providers considering midurethral mesh slings.
Kidney Transplantation After Rescue Allocation—the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis
Authors: Assfalg Volker , Miller Gregor , Stocker Felix , van Meel Marieke , Groenevelt Tiny , Tieken Ineke , Ankerst Donna , Renders Lutz , Novotny Alexander , Hartmann Daniel , Jell Alissa , Rahmel Axel , Wahba Roger , Mühlfeld Anja , Bouts Antonia , Ysebaert Dirk , Globke Brigitta , Jacobs-Tulleneers-Thevissen Daniel , Piros László , Stippel Dirk , Heller Katharina , Eisenberger Ute , van Laecke Steven , Weimer Rolf , Rosenkranz Alexander R. , Berger Stefan , Fischer Lutz , Kliem Volker , Vondran Florian , Sester Urban , Schneeberger Stefan , Harth Ana , Kuypers Dirk , Függer Reinhold , Arnol Miha , Christiaans Maarten , Weinmann-Menke Julia , Krüger Bernd , Hilbrands Luuk , Banas Bernhard , Hakenberg Oliver , Minnee Robert , Schwenger Vedat , Heyne Nils , van Zuilen Arjan , Reindl-Schwaighofer Roman , Lopau Kai , Hüser Norbert , Heemann Uwe
Published: October 2021

Background.

At Eurotransplant (ET), kidneys are transferred to “rescue allocation” (RA), whenever the standard allocation (SA) algorithms Eurotransplant Kidney Allocation System (ETKAS) and Eurotransplant Senior Program (ESP) fail. We analyzed the outcome of RA.

Methods.

Retrospective patient clinical and demographic characteristics association analyses were performed with graft outcomes for 2422 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25 481 after SA from 71 centers across all ET countries from 2006 to 2018.

Results.

Numbers of DDRTs after RA increased over the time, especially in Germany. RA played a minor role in ESP versus ETKAS (2.7% versus 10.4%). RA recipients and donors were older compared with SA recipients and donors, cold ischemia times were longer, waiting times were shorter, and the incidence of primary nonfunction was comparable. Among ETKAS recipients, HLA matching was more favorable in SA (mean 3.7 versus 2.5). In multivariate modeling, the incidence of graft loss in ETKAS recipients was reduced in RA compared with SA (subdistribution hazard ratio, 0.80; 95% confidence interval [0.70-0.91], P < 0.001), whereas other outcomes (mortality, death with functioning graft (DwFG)) were not significantly different. None of the 3 outcomes were significantly different when comparing RA with SA within the ESP program.

Conclusions.

Facing increased waiting times and mortality on dialysis due to donor shortage, this study reveals encouragingly positive DDRT outcomes following RA. This supports the extension of RA to more patients and as an alternative tool to enable transplantation in patients in countries with prohibitively long waiting times or at risk of deterioration.
Antibody Responses to Minor Histocompatibility Antigens After Solid Organ Transplantation
Authors: Zorn Emmanuel , See Sarah B.
Published: October 2021

Antibody-mediated rejection (AMR) is a major barrier to long-term graft survival following solid organ transplantation (SOT). Major histocompatibility antigens mismatched between donor and recipient are well-recognized targets of humoral alloimmunity in SOT and thought to drive most cases of AMR. In contrast, the implication of minor histocompatibility antigens (mHAs) in AMR has not been fully investigated, and their clinical relevance remains controversial. Recent technological advances, allowing for genome-wide comparisons between donors and recipients, have uncovered novel, polymorphic mHA targets with potential influence on the graft outcome following SOT. Here, we review these latest studies relating to mHAs and discuss their clinical significance.
Pleistocene Park, and other designs on deep time in the Interwar United States
Authors: Laurence Alison
Published: October 2021

Precisely how to reconstruct the planetary past is not predetermined. This article compares three contemporary plans, dreamed up in the United States during the Interwar and Depression years, that deploy diverse techniques to evoke extinct environments. Building on Martin Rudwick's historicization of ‘scenes from deep time’, this article develops the concept of designs on deep time to explain how public displays of the planetary past circulate anything-but-neutral ideas about past and present to awed audiences. By detailing three contemporary designs on deep time—Pleistocene Park at the La Brea Tar Pits, a sensational World's Fair exhibit called ‘The World a Million Years Ago’, and a dinosaur park where living fossils and ancient plants approximated a Mesozoic atmosphere—this article captures diverse philosophies about how to construct persuasive encounters with the prehistoric past. It also demonstrates how, despite disparate approaches, these designers of deep time displays all used the planetary past to legitimate present regimes and foster faith in human progress. During the 1920s and 1930s, when the wounds of war, changing demographics, and economic depression collaborated to dispute a prevailing myth of American progress, deep time by design buoyed faith in a better future.
Phase tipping: how cyclic ecosystems respond to contemporary climate
Authors: Alkhayuon Hassan , Tyson Rebecca C. , Wieczorek Sebastian
Published: October 2021

We identify thephase of a cycleas a new critical factor for tipping points (critical transitions) in cyclic systems subject to time-varying external conditions. As an example, we consider how contemporary climate variability induces tipping from a predator–prey cycle to extinction in two paradigmatic predator–prey models with an Allee effect. Our analysis of these examples uncovers a counterintuitive behaviour, which we call phase tipping orP-tipping, where tipping to extinction occurs only from certain phases of the cycle. To explain this behaviour, we combine global dynamics with set theory and introduce the concept ofpartial basin instabilityfor attracting limit cycles. This concept provides a general framework to analyse and identify easily testable criteria for the occurrence of phase tipping in externally forced systems, and can be extended to more complicated attractors.