bluuebunny/crossref_metadata_2025 huggingface dataset:
Altered Circulating Cell-free Mitochondrial DNA of Patients with Congenital Scoliosis
Authors: Yang Guanteng , Tang Mingxing , Zhang Hongqi , Li Jiong , Xiao Lige , Guo Chaofeng
Published: December 2020

Study Design.

Case–control study.

Objective.

The aim of this study was to estimate the relationship between circulating cell-free DNA (ccf DNA) and clinical parameters of patients with congenital scoliosis (CS).

Summary of Background Data.

CS is a complex spinal deformity characteristic of congenital vertebral malformations. Although numerous studies have centered on the etiology of CS, the cause of CS remains unclear. Previously, we reported that circulating cell-free DNA (ccf DNA) is altered in adolescent idiopathic scoliosis (AIS). However, the relationship between ccf DNA and the clinical parameters of patients with CS remains unclear.

Methods.

The plasma of peripheral blood from 35 patients with CS and 32 age-matched controls was collected for ccf DNA analysis. Quantitative PCR was used to detect ccf n-DNA and ccf mt-DNA levels, and correlation analyses between ccf n-DNA and ccf mt-DNA levels were conducted. Receiver-operating characteristic (ROC) curves were used to analyze the sensitivity and specificity of ccf n-DNA and ccf mt-DNA levels to different characteristics.

Results.

The plasma ccf mt-DNA levels of both ND1 and CYTC were significantly decreased in patients with CS compared with levels in controls both in total and by sex, whereas the plasma ccf n-DNA levels showed no significant difference. There is no difference in both ccf mt-DNA and ccf n-DNA between S-SDV and M-SDV according to The International Consortium for Vertebral Anomalies and Scoliosis (ICVAS) classification. The ROC curve analyses showed a reliable sensitivity and specificity of CS predicted by ccf mt-DNA levels in total but failed to distinguish different ICVAS types.

Conclusion.

Significantly decreased plasma ccf mt-DNA levels were observed in patients with CS compared with those in controls. Although this finding has limited significance for clinical practice, it indicates that ccf mt-DNA may predict the onset or development of CS. Further studies should focus on the role of ccf mt-DNA in embryo development and whether ccf mt-DNAs could be considered as a marker for prenatal screening in development disorder like CS.

Level of Evidence: 4
Who Will Require Revision Surgery Among Neurologically Intact Patients with Proximal Junctional Failure After Surgical Correction of Adult Spinal Deformity?
Authors: Park Se-Jun , Park Jin-Sung , Nam Yunjin , Choi Youn-Taek , Lee Chong-Suh
Published: December 2020

Study Design.

Retrospective study.

Objective.

To identify the risk factors for revision surgery among neurologically intact patients with proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery.

Summary of Background Data.

PJF following long fusion for ASD is a well-recognized complication that negatively affects clinical outcomes. However, revision surgery is not required for every patient with PJF especially if the patient does not present with neurologic deficit. Identifying the risk factors of revision surgery is necessary to determine who will need revision surgery as well as when is the right time for the revision surgery.

Methods.

Sixty-nine neurologically intact patients with PJF following ASD surgery were followed up with more than 2 years after PJF development or until undergoing revision surgery. PJF was divided into ligamentous failure (proximal junctional angle [PJA] of more than 20°) and bony failure. According to the conduct of revision surgery, two groups (revision and no revision) were created. Risk factors for revision surgery were analyzed in univariate and multivariate analysis with regard to patient, surgical and radiographic variables.

Results.

The mean age at the time of PJF development was 70.9 years. There were 45 patients with bony failure and 24 with ligamentous failure. Revision surgery was performed for 23 patients (33.3%). Multivariate analysis revealed that bony failure (odds ratio: 10.465) and PJA (odds ratio: 1.131) were significant risk factors. For those with bony failure, the cutoff value of PJA for performing revision surgery was calculated as 22°. The revision rate was significantly highest in patients (63.6%) with bony failure + PJA 22° or higher followed by patients (26.1%) with bony failure + PJA less than 22° and patients (12.5%) with ligamentous failure (P = 0.002).

Conclusion.

Bony failure with PJA of greater than 22° increased the likelihood for revision surgery. Therefore, early surgical intervention should be considered in these patients.

Level of Evidence: 4
A Comparison of Three Different Positioning Techniques on Surgical Corrections and Postoperative Alignment in Cervical Spinal Deformity (CD) Surgery
Authors: Morse Kyle W. , Lafage Renaud , Passias Peter , Ames Christopher P. , Hart Robert , Shaffrey Christopher I. , Mundis Gregory , Protopsaltis Themistocles , Gupta Munish , Klineberg Eric , Burton Doug , Lafage Virginie , Kim Han Jo.
Published: December 2020

Study Design.

Retrospective review of a prospective multicenter cervical deformity database.

Objective.

To examine the differences in sagittal alignment correction between three positioning methods in cervical spinal deformity surgery (CD).

Summary of Background Data.

Surgical correction for CD is technically demanding and various techniques are utilized to achieve sagittal alignment objectives. The effect of different patient positioning techniques on sagittal alignment correction following CD remains unknown.

Methods.

Patients with sagittal deformity who underwent a posterior approach (with and without anterior approach) with an upper instrumented vertebra of C6 or above. Patients with Grade 5, 6, or 7 osteotomies were excluded. Positioning groups were Mayfield skull clamp, bivector traction, and halo ring. Preoperative lower surgical sagittal curve (C2–C7), C2–C7 sagittal vertical axis (cSVA), cervical scoliosis, T1 slope minus cervical lordosis (TS–CL), T1 slope (T1S), chin-brow vertebral angle (CBVA), C2–T3 curve, and C2–T3 SVA was assessed and compared with postoperative radiographs. Segmental changes were analyzed using the Fergusson method.

Results.

Eighty patients (58% female) with a mean age of 60.6 ± 10.5 years (range, 31–83) were included. The mean postoperative C2–C7 lordosis was 7.8° ± 14 and C2–C7 SVA was 34.1 mm ± 15. There were overall significant changes in cervical alignment across the entire cohort, with improvements in T1 slope (P < 0.001), C2–C7 (P < 0.001), TS–CL (P < 0.001), and cSVA (P = 0.006). There were no differences postoperatively of any radiographic parameter between positioning groups (P > 0.05). The majority of segmental lordotic correction was achieved at C4–5–6 (mean 6.9° ± 11). Additionally, patients who had bivector traction applied had had significantly more segmental correction at C7–T1–T2 compared with Mayfield and halo traction (4.2° vs. 0.3° vs. –1.7° respectively, P < 0.027).

Conclusion.

Postoperative cervical sagittal correction or alignment was not affected by patient position. The majority of segmental correction occurred at C4–5–6 across all positioning methods, while bivector traction had the largest corrective ability at the cervicothoracic junction.

Level of Evidence: 4
Mental Health Associated With Postoperative Satisfaction in Lumbar Degenerative Surgery Patients
Authors: Rahman Rafa , Zhang Bo , Andrade Nicholas S. , Ibaseta Alvaro , Kebaish Khaled M. , Riley Lee H. , Cohen David B. , Jain Amit , Lee Sang H. , Sciubba Daniel M. , Skolasky Richard L. , Neuman Brian J.
Published: December 2020

Study Design:

Retrospective review of prospectively collected data

Objective:

To assess the association between preoperative and postoperative mental health status with postoperative satisfaction in lumbar degenerative surgery patients.

Summary of Background Data:

Poor preoperative mental health has been shown to negatively affect postoperative satisfaction among spine surgery patients, but there is limited evidence on the impact of postoperative mental health on satisfaction.

Materials and Methods:

Adult patients undergoing surgery for lumbar degenerative conditions at a single institution were included. Mental health was assessed preoperatively and 12 months postoperatively using Patient-Reported Outcomes Measurement Information System Depression and Anxiety scores. Satisfaction was assessed 12 months postoperatively using North American Spine Society Patient Satisfaction Index. The authors evaluated associations between mental health and satisfaction with univariate and multivariable logistic regression to adjust for confounders. Preoperative depression/anxiety level was corrected for postoperative depression/anxiety level, and vice versa. Statistical significance was assessed at α=0.05.

Results:

A total of 183 patients (47% male individuals; avg. age, 62 y) were included. Depression was present in 27% preoperatively and 29% postoperatively, and anxiety in 50% preoperatively and 31% postoperatively. Ninteen percent reported postoperative dissatisfaction using the North American Spine Society Patient Satisfaction Index. Univariate analysis identified race, family income, relationship status, current smoking status, change in pain interference, and change in physical function as potential confounders. In adjusted analysis, odds of dissatisfaction were increased in those with mild postoperative depression (adjusted odds ratio=6.1; 95% confidence interval, 1.2–32; P=0.03) and moderate or severe postoperative depression (adjusted odds ratio=7.5; 95% confidence interval, 1.3–52; P=0.03). Preoperative and postoperative anxiety and preoperative depression were not associated with postoperative satisfaction.

Conclusions:

Following lumbar degenerative surgery, patients with postoperative depression, irrespective of preoperative depression status, have significantly higher odds of dissatisfaction. These results emphasize the importance of postoperative screening and treatment of depression in spine patients with dissatisfaction.

Level of Evidence:

Level III—nonrandomized cohort study.
Comparing Investigation Between Bilateral Partial Laminectomy and Posterior Lumbar Interbody Fusion for Mild Degenerative Spondylolisthesis
Authors: Sugiura Tsuyoshi , Okuda Shinya , Takenaka Shota , Nagamoto Yukitaka , Matsumoto Tomiya , Takahashi Yoshifumi , Iwasaki Motoki
Published: December 2020

Study Design:

A retrospective comparative study.

Objective:

The present study aims to compare the surgical outcomes between bilateral partial laminectomy (BPL) and posterior lumbar interbody fusion (PLIF) in patients with mild degree of slippage.

Summary of Background Data:

To date, there have not been established surgical procedures for patients with mild degree of slippage. Moreover, sufficient studies that have compared surgical outcomes between BPL and PLIF are very few.

Materials and Methods:

In this retrospective study, the authors enrolled 202 consecutive patients with degenerative spondylolisthesis with slippage at L3 or L4 of >3% who underwent spine surgery between 2005 and 2015. Patients were grouped into those who underwent single-segment PLIF (n=106) and those who underwent BPL (n=51). To adjust for potential confounders, the inverse probability of treatment weighting based on the propensity score was used. Surgical outcomes were compared between the BPL and PLIF groups. The threshold age for the final recovery rate of >70% was evaluated using receiver operating characteristic curve analyses to assess the limit of age to achieve good outcomes. Patients who underwent reoperation in both groups were also evaluated.

Results:

Operation time and blood loss were significantly lower in the BPL group. The final recovery rate was similar between the groups without age stratification. The cutoff age to achieve a final recovery rate of >70% was 75 years in the PLIF group, and the final recovery rate was significantly higher in the PLIF group than in the BPL group in patients aged less than 75 years but not in patients aged 75 years or older. In addition, the reoperation rate was similar between groups, and all reoperations in the PLIF group were for adjacent segment disease.

Conclusions:

BPL is one of the useful options in patients with mild degenerative spondylolisthesis, particularly in patients aged more than 75 years.
Bariatric Surgery Before Elective Anterior Cervical Discectomy and Fusion (ACDF) in Obese Patients Is Associated With Reduced Risk of 90-Day Postoperative Complications and Readmissions
Authors: Malik Azeem T. , Noria Sabrena , Xu Wendy , Retchin Sheldon , Yu Elizabeth S. , Khan Safdar N.
Published: December 2020

Study Design:

This was a national database study.

Objective:

The objective of this study was to assess the impact of prior bariatric surgery (BS) on altering 90-day postoperative outcomes following elective anterior cervical discectomy and fusions (ACDFs).

Summary of Background Data:

Though obesity has previously been shown to be linked with adverse outcomes following elective spine surgical procedures, the effectiveness of weight-loss strategies such as BS has not been explored.

Methods:

The PearlDiver program was used to query the 2007–2013 100% Medicare Standard Analytical Files (SAF100) for patients undergoing an elective ACDF. The study cohort was divided into 2 groups—(1) obese ACDF patients (body mass index ≥35 kg/m2) receiving a BS procedure within 2 years before an ACDF and (2) obese ACDF patients (body mass index ≥35 kg/m2) without a known history of a BS procedure within the last 2 years. Multivariate regression analyses were used to assess the impact of a BS procedure on postoperative outcomes following ACDF while adjusting for age, sex, region, and Elixhauser Comorbidity Index.

Results:

A total of 411 ACDF patients underwent BS within the 2 years before an ACDF. Multivariate analysis showed that undergoing BS before an elective ACDF was associated with a significantly reduced risk of pulmonary complications [odds ratio (OR)=0.53; P=0.002], cardiac complications (OR=0.69; P=0.012), sepsis (OR=0.69; P=0.035), renal complications (OR=0.54; P=0.044), and 90-day readmissions (OR=0.53; P=0.015).

Conclusions:

Surgery-induced weight loss before an ACDF in obese patients is associated with reduced 90-day complication and readmission rates. Orthopaedic and bariatric surgeons should counsel obese patients on the benefits of BS following ACDFs.
Antinociception produced by nonsteroidal anti-inflammatory drugs in female vs male rats
Authors: Craft Rebecca M. , Hewitt Kelly A. , Britch Stevie C.
Published: December 2020

The primary aim of this study was to examine sex differences in acute antinociceptive and anti-inflammatory effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in rats. Complete Freund’s adjuvant (CFA) was administered to adult Sprague–Dawley rats to induce pain and inflammation in one hindpaw; 2.5 h later, vehicle or a single dose of the NSAIDs ibuprofen (1.0–32 mg/kg) or ketoprofen (0.1–10 mg/kg), or the COX-2-preferring inhibitor celecoxib (1.0–10 mg/kg) was injected i.p. Mechanical allodynia, heat hyperalgesia, biased weight-bearing, and hindpaw thickness were assessed 0.5–24 h after drug injection. Ibuprofen and ketoprofen were more potent or efficacious in females than males in reducing mechanical allodynia and increasing weight-bearing on the CFA-injected paw, and celecoxib was longer-acting in females than males on these endpoints. In contrast, ketoprofen and celecoxib were more potent or efficacious in males than females in reducing hindpaw edema. When administered 3 days rather than 2.5 h after CFA, ketoprofen (3.2–32 mg/kg) was minimally effective in attenuating mechanical allodynia and heat hyperalgesia, and did not restore weight-bearing or significantly decrease hindpaw edema, with no sex differences in any effect. Neither celecoxib nor ketoprofen effects were significantly attenuated by cannabinoid receptor 1 or 2 (CB1 or CB2) antagonists in either sex. These results suggest that common NSAIDs administered shortly after induction of inflammation are more effective in females than males in regard to their antinociceptive effects, whereas their anti-inflammatory effects tend to favor males; effect sizes indicate that sex differences in NSAID effect may be functionally important in some cases.
Blockade of α1 subtype GABAA receptors attenuates the development of tolerance to the antinociceptive effects of midazolam in rats
Authors: Lewter Lakeisha A. , Golani Lalit K. , Cook James M. , Li Jun-Xu
Published: December 2020

Benzodiazepines bind to and act on α1-3 and α5-containing GABAA receptors. Previous studies suggest that different GABAA receptor α-subtypes mediate the various behavioral effects of benzodiazepines, which raises the possibility of combining benzodiazepines with subtype-selective GABAA receptor antagonists to improve the therapeutic profiles of benzodiazepines. This study examined the GABAA receptor subtype mediation of the tolerance to midazolam-induced antinociception in rats. Midazolam (3.2 mg/kg) significantly reduced the locomotion in rats which was prevented by the selective α1-preferring GABAA receptor antagonist β-carboline-3-carboxylate-t-butyl ester (βCCt) (3.2 mg/kg). Midazolam increased the paw withdrawal threshold as tested by the von Frey filament assay in the complete Freund’s adjuvant-induced inflammatory pain model in rats, and this effect was not altered by βCCt or another α1-preferring GABAA receptor antagonist 3-propoxy-β-carboline hydrochloride (3PBC). Repeated treatment with midazolam in combination with vehicle, βCCt or 3PBC (twice daily) for 7 days led to a progressive increase of the ED50 values in the midazolam- and vehicle-treated rats, but not in other rats, suggesting the development of tolerance to midazolam but not to the combination of midazolam with α1-preferring GABAA receptor antagonists. These results suggest the essential role of the α1-subtype of GABAA receptors in mediating the development of tolerance to midazolam-induced antinociceptive effects and raise the possibility of increasing therapeutic profiles of benzodiazepines by selectively blocking specific α-subtypes of GABAA receptors.
INTRAOPERATIVE THREE-DIMENSIONAL FLUORESCEIN ANGIOGRAPHY–GUIDED PARS PLANA VITRECTOMY FOR BRANCH RETINAL VEIN OCCLUSION
Authors: Imai Hisanori , Tetsumoto Akira , Yamada Hiroko , Hayashida Mayuka , Otsuka Keiko , Miki Akiko , Nakamura Makoto
Published: December 2020

Purpose:

To show surgical results of the intraoperative 3D fluorescein angiography–guided pars plana vitrectomy for branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere.

Methods:

The NGENUITY 3D visualization system was used for the digital-assisted vitrectomy. Three-dimensional fluorescein angiography–guided pars plana vitrectomy was performed in three patients with branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere.

Results:

In all eyes, the scatter retinal photocoagulations for a nonperfusion area, depicted as hypofluorescein, and the segmentation and delamination of the perivascular fibrovascular proliferative membrane, depicted as hyperfluorescein, could be safely performed on the same screen while implementing intraoperative 3D fluorescein angiography.

Conclusion:

Three-dimensional fluorescein angiography–guided pars plana vitrectomy, a novel approach that fully uses the advantages of digital-assisted vitrectomy, can be one of the useful techniques for the treatment of branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere.
Frequency of Contact Lens Complications Between Contact Lens Wearers Using Multipurpose Solutions Versus Hydrogen Peroxide in the United States and Canada
Authors: Tichenor Anna A. , Cofield Stacey S. , Gann Drew , Elder Marian , Ng Alison , Walsh Karen , Jones Lyndon W. , Nichols Jason J.
Published: December 2020

Objectives:

To retrospectively compare frequency of contact lens (CL) complications in soft CL users of hydrogen peroxide (H2O2) and multipurpose solutions (MPS).

Methods:

This was a multicenter, retrospective chart review of CL records from each patient's three most recent eye examinations at academic and private practices. Patients must have used the same solution type for at least 3 years. Univariate analyses were conducted using t tests, and chi-square or Fisher's exact test for categorical measures.

Results:

There were 1,137 patients included, with 670 (59%) using MPS and 467 (41%) H2O2. In total, 706 (62%) experienced at least one complication; 409 used MPS and 297 used H2O2. There was no difference in the proportion of patients experiencing at least one complication between MPS (61%) and H2O2 (64%) (P=0.38). Multipurpose solutions users were more likely to report discomfort compared with H2O2 users (P=0.04). Presumed microbial keratitis was experienced by 16 MPS and nine H2O2 users (P=0.60).

Conclusions:

No significant differences were found in the frequency of CL complications between MPS and H2O2. H2O2 users were less likely to report discomfort and thus switching to a H2O2 system may be an alternative in CL users with discomfort.
Nanoparticle-based therapeutics of inflammatory bowel diseases: a narrative review of the current state and prospects
Authors: Yang Mei , Zhang Yujie , Ma Yana , Yan Xiangji , Gong Liuyun , Zhang Mingzhen , Zhang Baojun
Published: December 2020

Inflammatory bowel disease (IBD), such as Crohn disease and ulcerative colitis, are chronic relapsing disorders of the gastrointestinal tract. Characterized pathologically by intestinal inflammation and epithelial injury, great challenges exist for the treatment of IBD due to its complicated etiology and incurable nature. Traditional strategies rely on frequent and long-term administration of high dosages of anti-inflammatory drugs, which inevitably cause side effects. Therefore, novel therapeutic methods and drug delivery systems capable of improving therapeutic effect while simultaneously decreasing side effects need to be developed. The emergence of nanotechnology provides alternative approaches for diagnosis and treatment of IBD, as nanoparticles (NPs) have unique physicochemical properties such as targeting to the site of inflammation and the ability to alter the pharmacokinetics of traditional drugs. This review first introduces the pathophysiological features and microenvironment of IBD, and then summarizes different strategies and mechanisms of NP-based colon-targeted drug delivery systems, including size-dependent, multi-stimuli responsive, active targeting, intestinal microbiota-related, and novel natural-derived NP-mediated drug delivery systems. We also discuss applications of nanozymes and NP-based imaging in diagnostics and treatment of IBD. Finally, challenges and prospects in the field are proposed to promote the development of targeted drug delivery for IBD treatment.
Antitumor immune responses induced by photodynamic and sonodynamic therapy: a narrative review
Authors: Chen Hong , Dai Zhifei
Published: December 2020

The immune system has the function of immune surveillance to resist the occurrence and development of tumors, and is essential for inhibition of tumor metastasis. Nevertheless, tumor cells can still suppress immune responses through multiple mechanisms to escape recognition and elimination. Photodynamic and sonodynamic therapy involve systemic or local use of sensitizers followed by light or ultrasound treatment of the affected area, leading to tumor cell death by various mechanisms. The capability of the immune system is essentially affected by photodynamic and sonodynamic therapy. To understand the tumor therapeutic mechanisms of photodynamic and sonodynamic therapy and to explore the use of these modalities for improvement of the antitumor immune effect, extensive preclinical and clinical studies have been carried out. Besides direct killing of tumors, photodynamic and sonodynamic therapy also cause inflammatory reactions, achieve antitumor immune responses, and potentially prevent tumor recurrence, thereby treating both primary and metastatic tumors. In this review, we summarize the antitumor immune responses induced by photodynamic and sonodynamic therapy, describe the processes of the antitumor immune responses in detail, and discuss the clinical applications of the resulting antitumor immunity.
A Micro-Computed Tomography Study of Round Window Anatomy and Implications for Atraumatic Cochlear Implant Insertion
Authors: Cornwall Hannah Louisa , Marway Prabhvir Singh , Bance Manohar
Published: December 2020

Hypothesis:

The goal of this study was to interrogate high-resolution three-dimensional reconstructions of round window anatomy to illustrate and characterize structural variability with implications for atraumatic cochlear implant insertion.

Background:

Cochlear implants are increasingly used to improve sound detection in patients with substantial residual hearing. However, traumatic cochlear implant insertion through the round window involving upward deviation of the electrode into the spiral ligament, basilar membrane, and osseous spiral lamina, medial impaction on the modiolus, or interscalar excursion into the scala vestibuli are associated with lower rates of hearing preservation and poorer speech perception.

Successful atraumatic insertion is dependent on an anatomical understanding of the middle and inner ear. The round window bony niche lacks distinct demonstrable anatomical landmarks for the position of the round window membrane, and there is limited guidance on the amount of bony overhang that can be safely drilled away. A greater understanding of the anatomical variation around the round window could enhance treatment efficacy.

Methods:

Fourteen human cadaver temporal bones were imaged using microcomputed tomography. Resulting scans were digitally reconstructed, segmented, and measured.

Results:

Round window niche walls vary substantially in size and projection. Round window average short diameter measured 1.30 mm (range 1.07–1.44), and is limited by the crista fenestrae at the inferoanterior margin of the round window. Crista fenestrae size and morphology varied considerably. Reconstructions with solid and translucent panels are presented.

Conclusion:

Anatomical heterogeneity should be considered in cochlear implant selection, drilling, and choice of insertion vector.
A Three-arm, Single-blind, Randomized Controlled Trial Examining the Effects of Notched Music Therapy, Conventional Music Therapy, and Counseling on Tinnitus
Authors: Piromchai Patorn , Srisukhumchai Chompunut , Kasemsiri Pornthep , Vatanasapt Patravoot , Thanawirattananit Panida , Chayaopas Nichtima , Srirompotong Somchai , Yimtae Kwanchanok
Published: December 2020

Objective:

To compare the efficacy of three common interventions for tinnitus patients: notched music therapy, conventional music therapy, and counseling.

Study Design:

Randomized, single-blinded, controlled, three-arm trial.

Method:

This study was conducted from January 2018 to January 2019. Eligible subjects were randomized into three groups. The first group received notched music therapy (n = 25), the second received conventional music therapy (n = 24), and the third received counseling only (n = 26). The three groups did not differ in terms of demographic data including age, sex, tinnitus duration, affected side, hearing level, side of tinnitus, and frequency of tinnitus. The patients were followed up on at month 1, 2, and 3 after initiation of therapy.

Results:

Tinnitus Handicap Inventory scores gradually decreased in all groups. The mean differences in Tinnitus Handicap Inventory score from baseline for patients who received notched music therapy, conventional music therapy, and counseling only were 20.49, 27.83, and 17.79 points, respectively (p < 0.05). However, there was no statistically significant difference among the groups (p = 0.246).

Conclusion:

There was no difference between the treatments. The selection of these therapies for tinnitus treatment may depend on the unique needs and proclivities of patients.

Trial registration:

clinicaltrials.in.th/TCTR20180225002.
The Long-Term Stability of the Electrical Stapedial Reflex Threshold
Authors: Pitt Cache , Muñoz Karen , Schwartz Sarah , Kunz John M.
Published: December 2020

Objectives:

To 1) describe changes in the electrical stapedial reflex threshold (eSRT), within and across patients over time and 2) to identify the clinical relationship between eSRT and an individual's upper limit of loudness.

Study Design:

Retrospective chart review and analysis using a multilevel modeling approach to describe changes in eSRT over time.

Setting:

Secondary care center.

Patients:

Two-hundred five cochlear implant recipients treated at the cochlear implant center during a 3-year time period.

Intervention(s):

Cochlear implantation, eSRT testing, and, electrical upper limits of loudness.

Main Outcome Measure(s):

The eSRT over multiple appointments and the cochlear implant recipients’ final upper limits of loudness.

Results:

Analysis of the eSRT testing indicated stability over time; no global trend was seen in trajectory across the population, b = –0.010, p = 0.899. The relationship between eSRT and user upper limits of loudness revealed a mean decrease of 19.47, units for manufacturer 1, 30.53 units for manufacturer 2, and 0.7 units for manufacturer 3.

Conclusion:

Electrical stapedial reflex thresholds remain consistent for individual subjects over time with implant experience being the only variable correlated with eSRT stability (increase in 5% of one standard deviation with each year of experience). In addition, a clinical relationship between eSRT and behaviorally set upper limits of loudness was identified for all three cochlear implant manufacturers available in the United States.
Effectiveness of Place-based Mapping in Electric-Acoustic Stimulation Devices
Authors: Dillon Margaret T. , Canfarotta Michael W. , Buss Emily , Hopfinger Joseph , O’Connell Brendan P.
Published: December 2020

Background:

The default mapping procedure for electric-acoustic stimulation (EAS) devices uses the cochlear implant recipient's unaided detection thresholds in the implanted ear to derive the acoustic settings and assign the lowest frequency filter of electric stimulation. Individual differences for speech recognition with EAS may be due to discrepancies between the electric frequency filters of individual electrode contacts and the cochlear place of stimulation, known as a frequency-to-place mismatch. Frequency-to-place mismatch of greater than 1/2 octave has been demonstrated in up to 60% of EAS users. Aligning the electric frequency filters via a place-based mapping procedure using postoperative imaging may improve speech recognition with EAS.

Methods:

Masked sentence recognition was evaluated for normal-hearing subjects (n = 17) listening with vocoder simulations of EAS, using a place-based map and a default map. Simulation parameters were based on audiometric and imaging data from a representative 24-mm electrode array recipient and EAS user. The place-based map aligned electric frequency filters with the cochlear place frequency, which introduced a gap between the simulated acoustic and electric output. The default map settings were derived from the clinical programming software and provided the full speech frequency range.

Results:

Masked sentence recognition was significantly better for simulated EAS with the place-based map as compared with the default map.

Conclusion:

The simulated EAS place-based map supported better performance than the simulated EAS default map. This indicates that individualizing maps may improve performance in EAS users by helping them achieve better asymptotic performance earlier and mitigate the need for acclimatization.
Considerations for a Revised Adult Cochlear Implant Candidacy Evaluation Protocol
Authors: Biever Allison , Amurao Carly , Mears Megan
Published: December 2020

Objective:

To compare the current metrics used in adult cochlear implant candidacy evaluations for consistency and applicability, and to make a recommendation for an updated assessment battery.

Study Design:

Prospective, multicenter, within-subject clinical trial.

Setting:

North American cochlear implant programs including private practices, universities, and hospital centers.

Patients:

One hundred adult hearing aid users scoring 40% or less on monosyllabic words in quiet in the aided test ear who presented for cochlear implantation evaluation.

Intervention:

Subjects underwent unilateral cochlear implantation.

Main Outcome Measures:

Speech perception measured via Consonant-Nucleus-Consonant words in quiet and AzBio sentences in noise. Patient-reported hearing disability measured via the Speech, Spatial, and Qualities of Hearing Scale administered preoperatively and at 6 months postoperatively.

Results:

Significant group mean improvement on all speech perception measures and SSQ subscales postoperatively with possible floor effects observed in objective background noise testing preoperatively and a broad range of variability seen postoperatively.

Conclusions:

Consonant-Nucleus-Consonant words are an effective tool to clinically evaluate hearing ability over time. Adjustment of cochlear implant screening protocols to prioritize monosyllabic words over sentences in noise as the chief determining factor appears justified, and this test can be supplemented by the SSQ for a holistic and applicable assessment of cochlear implant candidacy.
Assessment of Frequency-Place Mismatch by Flat-Panel CT and Correlation With Cochlear Implant Performance
Authors: Zanetti Diego , Conte Giorgio , Di Berardino Federica , Lo Russo Francesco , Cavicchiolo Sara , Triulzi Fabio
Published: December 2020

Objective:

To calculate the frequency allocation mismatch in a group of very selected cochlear implant (CI) recipients and to contrast it with the speech perception performances.

Study Design:

Cross-sectional observational prospective study.

Settings:

Tertiary Audiological Department, University hospital.

Patients:

Fifteen adults receiving the same CI array by the same surgeon through a posterior tympanotomy, round window approach.

Main Outcome Measures:

1) High definition flat panel computed tomography (FPCT) control of the intracochlear position of each electrode contact, and computation of the relative frequency allocation mismatch; 2) analysis of speech perception outcomes in relation with the mismatch.

Results:

Despite a consistent and reproducible surgical procedure with the same intracochlear array, significant deviations from the frequency allocation tables (FAT) assigned by default by the manufacturer were observed in this study.

Their influences on speech perception performances were negligible in the simple tasks of words or sentences recognition in quiet (and, to a lesser extent also in noise). The greatest effect of a significant mismatch was observed for the vocal-consonant-vocal (VCV) sequences recognition under noise masking, the emotional and the linguistic prosody recognition, and the phonemes discrimination of the Auditory Speech Sound Evaluation (A§E) test.

Conclusions:

The greatest frequency-to-place occurred at the high frequencies. The effect was rather irrelevant on simple words and sentences recognition, while it negatively impacted on the more complex perceptual tasks
Enlarged Vestibular Aqueduct: Hearing Progression and Cochlear Implant Candidacy in Pediatric Patients
Authors: Hodge Sarah E. , Thompson Nicholas J. , Park Lisa R. , Brown Kevin D.
Published: December 2020

Hypothesis/Objective:

Investigate the rate of hearing loss progression and incidence of cochlear implant candidacy in children with enlarged vestibular aqueduct (EVA).

Background:

EVA is the most common congenital malformation of the inner ear, is responsible for a large percentage of children with hearing loss, and is associated with hearing loss progression. Rates and degree of progression of hearing loss to cochlear implantation candidacy have not been well described.

Methods:

Review of children with EVA who presented to a single academic medical center. Audiometric data were reviewed to determine subjects who met criteria for cochlear implantation (≥75 dB pure-tone average) at presentation. For those not meeting criteria, serial audiometric data were reviewed for progression to candidacy.

Results:

A total of 257 ears met inclusion criteria. One hundred ninety-two (74.7%) met cochlear implant candidacy criteria by age 12, yet only 117 ears (60.9%) actually received implants before turning 13. One hundred fifty-three ears (59.5%) met implant candidacy criteria at presentation. Nearly 50% of those not initially meeting implantation criteria had a ≥15 dB shift in pure-tone average by age 12, with 37.5% of this subgroup meeting implant candidacy criteria before their teen years at an average age of 7.10 years.

Conclusion:

The majority of children with EVA reach cochlear implant candidacy before reaching adulthood, yet implantation rates for candidate ears remain at 60% and delay in implantation persist. Parents of children with EVA should be counseled on the likelihood of progression and closely monitored for cochlear implant candidacy.
A year with the GLIM diagnosis of malnutrition – does it work for older persons?
Authors: Cederholm Tommy , Barazzoni Rocco
Published: December 2020

Purpose of review

In early 2019, the Global Leadership Initiative on Malnutrition (GLIM) concept was published advocating a two-step procedure, that is, screening followed by confirmation of the malnutrition diagnosis requiring a combination of phenotypic and etiologic criteria. This review summarizes 14 publications that have applied the GLIM criteria in older populations.

Recent findings

Four studies miss data on muscle mass. The mandatory screening appears missing in some studies. Two studies report that criterion validity is fair to good when compared with Subjective Global Assessment as semigold standard. Most studies report strong predictive validity when mortality is used as outcome. Not unexpectedly malnutrition relates strongly to sarcopenia as low muscle mass is a GLIM criterion. Overall, the lack of guidance on how to assess muscle mass and disease burden/inflammation in the original GLIM publication provides uncertainties on how to interpret the results.

Fourteen exclusively retrospective studies in older adult cohorts are summarized. In several cases, the data sets are imperfect or incomplete. Still, criterion and predictive validity for GLIM appears well acceptable when applied for older adults. Continuing global implementation efforts are justified. The GLIM consortium needs to provide guidance on assessment of muscle mass and disease burden/inflammation. Moreover, further prospective validation studies are needed to add knowledge for the future GLIM format updates.
Protein intake and renal function in older patients
Authors: Narasaki Yoko , Rhee Connie M. , Kramer Holly , Kalantar-Zadeh Kamyar
Published: December 2020

Purpose of review

Chronic kidney disease (CKD) is highly prevalent in elderly patients. There is growing recognition of the importance of attention to dietary protein intake (DPI) in this population given their predisposition to age-related changes in kidney function and coexisting comorbidities (i.e., hypertension). We reviewed the impact of DPI on kidney health and survival and the role of dietary protein management in older CKD patients.

Recent findings

While kidney function parameters including glomerular filtration rate (GFR) and renal plasma flow are slightly lower in elderly patients irrespective of CKD status, the kidneys’ ability to compensate for increased DPI by augmentation of GFR is preserved until 80 years of age or less. However, long-term consumption of high DPI in individuals of older age and/or with CKD may contribute to kidney function deterioration over time. Prescription of a plant-dominant low-protein diet of 0.6–0.8 g/kg/day with more than 50% from plant sources or very low protein diets less than 0.45 g/kg/day supplemented with essential amino acids or their keto-analogues may be effective in preserving kidney function in older patients and their younger counterparts, while also monitoring for development of protein–energy wasting (PEW).

Using tailored precision nutrition approaches in prescribing plant-dominant low DPI that also maintains adequate energy and nitrogen balance may ameliorate kidney function decline while also preventing development of PEW in elderly patients with CKD.
Therapeutic strategies for sarcopenic obesity: a systematic review
Authors: Poggiogalle Eleonora , Parrinello Edda , Barazzoni Rocco , Busetto Luca , Donini Lorenzo M.
Published: December 2020

Purpose of review

Tough plenty of literature investigated therapeutic options for body composition changes targeting elderly people, evidence concerning potential treatments of sarcopenic obesity as a unique condition is scarce. The aim of the present review was to summarize recent evidence regarding treatment of sarcopenic obesity in adult and older individuals.

Recent findings

Exercise-based interventions were effective in ameliorating lean mass or sarcopenia-related indices and reducing total adiposity. Importantly, in one study, modifications of body composition were obtained in the absence of significant changes in body mass index. The majority of studies relied on resistance training, and all provided with beneficial effects in body composition. Conversely, effects in terms of muscle strength and functional ability were heterogeneous. Electrical acupuncture and whole-body electromyostimulation associated with nutritional supplementation resulted to be novel effective strategies in inducing body composition changes. Nonetheless, findings from nutritional supplementations are not conclusive, leading to conflicting results on strength and functional outcomes.

Specific interventions could improve sarcopenic obesity, but overall significance is limited by scarcity of data and lack of uniformity in the definition of sarcopenic obesity itself. Further research should clarify optimal treatment options for sarcopenic obesity in age classes other than the geriatric population.
Does Community Outsourcing Improve Timeliness of Care for Veterans With Obstructive Sleep Apnea?
Authors: Kaul Bhavika , Hynes Denise M. , Hickok Alex , Smith Connor , Niederhausen Meike , Totten Annette M. , Whooley Mary A. , Sarmiento Kathleen
Published: December 2020

Background:

Providing timely access to care has been a long-standing priority for the Veterans Affairs Healthcare System. Recent strategies to reduce long wait times have focused on purchasing community care by a fee-for-service model. Whether outsourcing Veterans Affairs (VA) specialty care to the community improves access is unclear.

Objectives:

We compared time from referral to treatment among Veterans whose care was provided by VA versus community care purchased by the VA, using obstructive sleep apnea as an example condition.

Methods:

This was a retrospective cohort study of Northern California Veterans seeking sleep apnea care through the San Francisco VA Healthcare System between 2012 and 2018. We used multivariable linear regression with propensity score matching to investigate the relationship between time to care delivery and care setting (VA provided vs. VA-purchased community care). A total of 1347 Northern California Veterans who completed sleep apnea testing within the VA and 88 Veterans who completed sleep apnea testing in the community had complete data for analysis.

Results:

Among Northern California Veterans with obstructive sleep apnea, outsourcing of care to the community was associated with longer time from referral to therapy (mean±SD, 129.6±82.8 d with VA care vs. 252.0±158.8 d with community care, P<0.001) and greater loss to follow-up.

Conclusions:

These findings suggest that purchasing community care may lead to care fragmentation and not improve wait times nor improve access to subspecialty care for Veterans.
COVID-19 in Children With Cancer: A Single Low-Middle Income Center Experience
Authors: Ebeid Fatma S.E. , Ragab Iman A. , Elsherif Nayera H.K. , Makkeyah Sara , Mostafa Salwa , Eltonbary Khadiga , Matbouly Safa , Mostafa Aya , Goma Heba , Agwa Sara H. , Hafez Hala M. , Girgis Samia , El Gendy Yasmin G. , El-Sayed Manal H.
Published: December 2020

Background:

Coronavirus disease-2019 (COVID-19) could be associated with morbidity and mortality in immunocompromised children.

Objective:

The objective of this study was to measure the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among hospitalized children with cancer and to detect the associated clinical manifestations and outcomes.

Methodology:

A prospective noninterventional study including all hospitalized children with cancer conducted between mid-April and mid-June 2020 in Ain Shams University Hospital, Egypt. Clinical, laboratory, and radiologic data were collected. SARS-CoV-2 infection was diagnosed by reverse transcription polymerase chain reaction tests in nasopharyngeal swabs.

Results:

Fifteen of 61 hospitalized children with cancer were diagnosed with SARS-CoV-2. Their mean age was 8.3±3.5 years. Initially, 10 (66.7%) were asymptomatic and 5 (33.3%) were symptomatic with fever and/or cough. Baseline laboratory tests other than SARS-CoV-2 reverse transcription polymerase chain reaction were not diagnostic; the mean absolute lymphocyte count was 8.7±2.4×109/L. C-reactive protein was mildly elevated in most of the patients. Imaging was performed in 10 (66.7%) patients with significant radiologic findings detected in 4 (40%) patients. Treatment was mainly supportive with antibiotics as per the febrile neutropenia protocol and local Children Hospital guidance for management of COVID-19 in children.

Conclusions:

Pediatric cancer patients with COVID-19 were mainly asymptomatic or with mild symptoms. A high index of suspicion and regular screening with nasopharyngeal swab in asymptomatic hospitalized cancer patients is recommended.
Population-level effectiveness of a national HIV preexposure prophylaxis programme in MSM
Authors: Estcourt Claudia , Yeung Alan , Nandwani Rak , Goldberg David , Cullen Beth , Steedman Nicola , Wallace Lesley , Hutchinson Sharon
Published: December 2020

Objective:

The aim of this study was to evaluate Scotland's national HIV preexposure prophylaxis (PrEP) programme in relation to PrEP uptake and associated population-level impact on HIV incidence among MSM.

Design:

A retrospective cohort study within real-world implementation.

Methods:

Comparison of HIV diagnoses from national surveillance data and HIV incidence within a retrospective cohort of HIV-negative MSM attending sexual health clinics from the National Sexual Health information system between the 2-year periods pre(July 2015–June 2017) and post(July 2017–June 2019) introduction of PrEP.

Results:

Of 16 723 MSM attending sexual health services in the PrEP period, 3256 (19.5%) were prescribed PrEP. Between pre-PrEP and PrEP periods, new HIV diagnoses among MSM declined from 229 to 184, respectively [relative risk reduction (RRR): 19.7%, 95% confidence interval (95% CI) 2.5–33.8]; diagnosed recently acquired infections declined from an estimated 73 to 47, respectively (35.6%, 95% CI 7.1–55.4). Among MSM attending sexual health clinics, HIV incidence per 1000 person-years declined from 5.13 (95% CI 3.90–6.64) pre-PrEP to 3.25 (95% CI 2.30–4.47) in the PrEP period (adjusted IRR 0.57, 95% CI 0.37–0.87). Compared with the pre-PrEP period, incidence of HIV was lower in the PrEP period for those prescribed PrEP (aIRR 0.25, 95% CI 0.09–0.70) and for those not prescribed PrEP (aIRR 0.68, 95% CI 0.43–1.05).

Conclusion:

We demonstrate national population-level impact of PrEP for the first time in a real-world setting. HIV incidence reduced in MSM who had been prescribed PrEP and, to a lesser extent, in those who had not. Promotion of the benefits of PrEP needs to extend to MSM who do not access sexual health clinics.