bluuebunny/crossref_metadata_2025 huggingface dataset:
Olivine in kimberlites and related rocks – macrocrysts, dunitic nodules and megacrysts from the same metasomatized source
Authors: Arndt Nicholas , Cordier Carole , Boullier Anne-Marie , Batanova Valentina , Magnin Valerie , Findling Nathaniel
Published: August 2022

Kimberlites carry a dense cargo of olivine. Although normally referred to as macrocrysts, much of this olivine is present as multi-grain xenoliths of dunite. Because of their well-rounded outlines, we refer to these objects as ‘nodules’ and apply the term to both multigranular and monogranular varieties. Although compositions within each nodule are very uniform, the entire population displays an enormous variation in Fo content (100*Mg/(Mg + Fe), cation proportions), from close to Fo95 to about Fo82. The change is continuous and there is no indication of separate Fo-rich and Fo-poor populations. Likewise, the sizes, internal textures and habits of Fo-rich and Fo-poor olivines are indistinguishable. Fo-poor nodules have compositions like those of olivines of the megacryst suite and they share similar sizes and internal structures. We propose that the dunite nodules in kimberlites and olivines of the megacryst suite have a common origin. In our interpretation, almost all olivines in kimberlites, except for the marginal rims and rinds, are fragments of dunite that was produced during interaction between mantle peridotite and CO2-rich fluid. Analogues of this process can be found in ophiolites where dunite is the product of reaction between basaltic magma and peridotite. In-situ reactive crystallisation eliminated pyroxene leaving only olivine with Fo contents ranging from higher to lower Fo than in the host peridotite. This interaction occurred near the base of the lithosphere and not during transit of kimberlite towards the surface.
Sentimental Business Cycles
Authors: Lagerborg Andresa , Pappa Evi , Ravn Morten O
Published: August 2022

We estimate the dynamic causal effects of consumer sentiment shocks in the US. We identify autonomous changes in survey evidence on consumer confidence using fatalities in mass shootings as an instrument. We find the instrument to be significant for an aggregate index of consumer expectations and also back up the identification scheme with micro evidence that exploits the geographical variation in mass shootings. Sentiment shocks have real macroeconomic effects. A negative sentiment shock is recessionary: It sets off a persistent decline in consumer confidence and induces a contraction in industrial production, private sector consumption and in the labour market, while having less evident nominal effects. Finally, sentiment shocks explain a non-negligible part of the cyclical fluctuations in consumer confidence and real macroeconomic aggregates.
16Science and Medicine
Authors: Ramos Adela , Spratt Danielle
Published: August 2022

This review considers three monographs that use innovative archival recovery techniques to expand our understanding of the connections between the history of science and medicine and sociopolitical and cultural phenomena across the early modern period to the present. Divided into three sections, our review first considers Kalle Kananoja’s Healing Knowledge in Atlantic Africa: Medical Encounters, 1500–1850, which demonstrates the ways that Atlantic African healers resisted colonial influence and adapted their practices to reflect innovative uses of global plant-based medicines. Part 2 of this review, Black Reproductive Health, examines Sara Clarke Kaplan’s The Black Reproductive: Unfree Labor and Insurgent Motherhood, which, importantly, revises longstanding assumptions about the ways that we understand and document reproductive health and justice, especially in the American Black community. Part 3, ‘Healthy’ Eating, discusses Elizabeth A. Williams’s Appetite and Its Discontents: Science, Medicine, and the Urge to Eat, 1750–1950, which deconstructs the so-called connection between appetite and wellness in science and medicine. We have chosen to focus on these works both for the important new insights that they offer to the field of the history of science and because they each speak to contemporary crises in public health and health inequity that continue to affect our local and global landscapes. We suggest that works such as these have the capacity not only to expand our field but also to counteract narratives of white supremacy and other cultural beliefs that stigmatize and oppress; these works show us how expanding our understanding of the origins and current practices of medical knowledge beyond our traditional Western narratives can help provide healthier and more equitable forms of care and wellness.
LncRNA‐412.25 activates the LIF/STAT3 signaling pathway in ovarian granulosa cells of Hu sheep by sponging miR‐346
Authors: Yao Xiaolei , El‐Samahy Mohamed AbdFatah , Li Xiaodan , Bao Yongjin , Guo Jiahe , Yang Fan , Wang Zhibo , Li Kang , Zhang Yanli , Wang Feng
Published: August 2022

Although long non‐coding RNAs (lncRNAs) are reported to regulate follicular development and reproductive disease pathogenesis, the underlying mechanisms have not been elucidated. In this study, lncRNA expression profiling of different‐sized healthy follicles from Hu sheep with different prolificacy revealed 50 613 lncRNAs. Numerous lncRNAs were differentially expressed among different comparison groups. This study characterized one novel transcript, lncRNA‐412.25 (from healthy follicles with a diameter of >5 mm), which was predominantly expressed in the high prolificacy group and localized to the cytoplasm of granulosa cells (GCs). LncRNA‐412.25 knockdown promoted and inhibited Hu sheep GC apoptosis and proliferation, respectively. Interestingly, lncRNA‐412.25 could directly bind to miR‐346, which can target the gene of leukemia inhibitory factor (LIF). Knockdown of lncRNA‐412.25 promoted GC apoptosis by downregulating LIF expression, where this effect was attenuated by miR‐346. Moreover, the miR‐346 inhibitor mitigated the lncRNA‐412.25 knockdown‐induced downregulation of phosphorylated protein of signal transducer and activator of transcription 3 (STAT3), which was validated using immunofluorescence analysis. Our results demonstrated that lncRNA‐412.25 regulates GC proliferation and apoptosis in Hu sheep by binding to miR‐346 and then activating the LIF/STAT3 pathway. These findings provide novel insights into the mechanisms underlying prolificacy in sheep.
Supporting Breastfeeding Physicians Across the Educational and Professional Continuum: A Call to Action
Authors: Ortiz Worthington Rebeca , Adams Dara R. , Fritz Cassandra D.L. , Tusken Megan , Volerman Anna
Published: August 2022

The benefits of breastmilk and lactation are well established for both infants and women. National organizations recommend exclusively breastfeeding for the first 6 months of life and continued breastfeeding for the first 1–2 years of life. For physicians, childbearing years often coincide with key periods of training and their early career. Physician mothers have high rates of initiating breastfeeding but low success in maintaining breastfeeding. Breastfeeding discontinuation among physicians is a well-described, multifactorial issue that has persisted for decades. Reasons for discontinuation include inadequate access to pumping rooms, insufficient workplace and coworker support, and constrained schedules. Pumping is viewed as a burden to teammates and superiors, and physicians are often required to make up time spent pumping. Vague or absent policies to support breastfeeding by accreditation organizations and institutions create workplace conflict and impose additional stress on breastfeeding physicians, who devote significant time, energy, and mental reserves navigating clinical responsibilities, workplace relationships, and licensing requirements to pump. The authors propose several recommendations to improve the environment, support, and resources for breastfeeding physicians with a focus on what individuals, institutions, and professional organizations can do. Creating lactation policies that allow breastfeeding physicians equitable participation in the workplace is a matter of reproductive justice. Improving the collective awareness and support for breastfeeding trainees and physicians is a critical step in recruiting, retaining, and supporting women in medicine.
Preoperative Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Mastectomy: A Randomized, Participant- and Observer-masked, Sham-controlled Study
Authors: Ilfeld Brian M. , Finneran John J. , Swisher Matthew W. , Said Engy T. , Gabriel Rodney A. , Sztain Jacklynn F. , Khatibi Bahareh , Armani Ava , Trescot Andrea , Donohue Michael C. , Schaar Adam , Wallace Anne M.
Published: August 2022

Background

Ultrasound-guided percutaneous cryoneurolysis is an analgesic technique in which a percutaneous probe is used to reversibly ablate a peripheral nerve(s) using exceptionally low temperature, and has yet to be evaluated with randomized, controlled trials. Pain after mastectomy can be difficult to treat, and the authors hypothesized that the severity of surgically related pain would be lower on postoperative day 2 with the addition of cryoanalgesia compared with patients receiving solely standard-of-care treatment.

Methods

Preoperatively, participants at one enrolling center received a single injection of ropivacaine, 0.5%, paravertebral nerve block at T3 or T4, and perineural catheter. Participants subsequently underwent an active or sham ultrasound–guided percutaneous cryoneurolysis procedure of the ipsilateral T2 to T5 intercostal nerves in a randomized, patient- and observer-masked fashion. Participants all received a continuous paravertebral block with ropivacaine, 0.2%, until the early morning of discharge (usually postoperative day 2). The primary endpoint was the average pain level measured using a 0 to 10 numeric rating scale the afternoon of postoperative day 2. Participants were followed for 1 yr.

Results

On postoperative day 2, participants who had received active cryoneurolysis (n = 31) had a median [interquartile range] pain score of 0 [0 to 1.4] versus 3.0 [2.0 to 5.0] in patients given sham (n = 29): difference –2.5 (97.5% CI, –3.5 to –1.5), P < 0.001. There was evidence of superior analgesia through month 12. During the first 3 weeks, cryoneurolysis lowered cumulative opioid use by 98%, with the active group using 1.5 [0 to 14] mg of oxycodone compared with 72 [20 to 120] mg in the sham group (P < 0.001). No oral analgesics were required by any patient between months 1 and 12. After 1 yr chronic pain had developed in 1 (3%) active compared with 5 (17%) sham participants (P < 0.001).

Conclusions

Percutaneous cryoneurolysis markedly improved analgesia without systemic side effects or complications after mastectomy.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Skin Biopsy in Pediatric Oncology/Hematopoietic Stem Cell Transplantation Patients
Authors: Bui Justin , Harvey Nathan T. , Berry Bligh , Chan Jonathan , Ramachandran Shanti , Gough Hazel , Wood Benjamin A.
Published: August 2022

The aim of this study was to review the dermatopathological findings in skin biopsy specimens from pediatric oncology and hematopoietic stem cell transplantation patients over a 20-year period. Three hundred fifty-two skin biopsies from 240 patients were reviewed, and the findings were grouped into 6 categories: index neoplasms, nonindex neoplasms, infections, graft-versus-host disease, other treatment complications, and others. Among the index neoplasms identified on skin biopsy, the most common conditions were Langerhans cell histiocytosis (14 patients) and melanoma (7 patients), with other hematological malignancies and an array of soft-tissue tumors accounting for the bulk of the remainder. Neoplastic conditions common in general dermatopathological practice such as basal cell carcinoma and squamous cell carcinoma were uncommon, each being identified in only 1 patient younger than the age of 18, although basal cell carcinomas developing subsequently in young adult life were identified in 7 patients. Infections were common, with infectious agents or viral cytopathic effects (not including human papillomavirus) identified in 34 biopsies. A significant proportion (74%) represented invasive fungal infections, which are of very significant clinical importance. Biopsies performed for a clinical suspicion of graft-versus-host seldom showed histological features to suggest an alternative diagnosis, with only a single case suggesting a diagnosis of toxic erythema of chemotherapy identified.
Enfortumab Vedotin–Associated Toxic Epidermal Necrolysis-like Toxic Erythema of Chemotherapy
Authors: Birmingham Suzanne W. , Moon Deborah J. , Kraus Christina N. , Lee Bonnie A.
Published: August 2022

Enfortumab vedotin is an antibody–drug conjugate used for treatment of urothelial cancer. It has recently been associated with several reports of Stevens Johnson syndrome/toxic epidermal necrolysis (TEN). In this report, we describe the case of a 63-year-old man who developed widespread, near full–thickness desquamation, clinically mimicking TEN but with histologic features of toxic erythema of chemotherapy. This distinction is significant because it may have implications for prognosis and treatment. Further investigation is needed to ascertain the incidence of true TEN versus clinical imitators in patients with enfortumab vedotin–related cutaneous toxicity.
Sweat Gland Carcinoma With Neuroendocrine Differentiation of the Areola as a Potential Clinicopathologic Mimicker of Male Breast Carcinoma and Syringocystadenocarcinoma Papilliferum
Authors: Bun Shota , Goto Keisuke , Oishi Takuma , Kiyohara Yoshio , Tsutsumida Arata , Yoshikawa Shusuke
Published: August 2022

Sweat gland carcinoma with neuroendocrine differentiation (SCAND) is a newly proposed tumor entity of primary cutaneous apocrine/eccrine adnexal tumor with neuroendocrine differentiation. The histopathologic variations are not yet well known. In this article, we present a case of SCAND mimicking male breast cancer and syringocystadenocarcinoma papilliferum. A 68-year-old man presented with a reddish 12-mm nodule on his left areola. No lymph node or distant metastases were observed. The patient was disease free 1 year and 9 months after the tumor was surgically resected but died of cerebral hemorrhage. Histopathological examination revealed a predominantly intradermal tumor with marked syringotropism, mimicking a component of mammary ductal carcinoma in situ. In addition, another tissue section displayed a cup-shaped papillated tumor with syringocystadenocarcinoma papilliferum–like features, which were also seen because of marked syringotropism. Diffuse immunoexpression of cytokeratin 7, cytokeratin 19, chromogranin A, synaptophysin, INSM1, estrogen receptor, carcinoembryonic antigen, epithelial membrane antigen, and GATA3 was observed in the tumor, but no BRAF immunoexpression was seen. The present case would help us to understand the histopathological variation and differential diagnosis of SCAND. The histopathological diagnosis of male breast cancer or syringocystadenocarcinoma papilliferum should be made by ruling out SCAND.
Major Histotypes in Skin Melanoma: Nodular and Acral Lentiginous Melanomas Are Poor Prognostic Factors for Relapse and Survival
Authors: Tas Faruk , Erturk Kayhan
Published: August 2022

The histological subtype is not considered one of the major prognostic factors in melanoma, yet it is known to have an impact on survival. The aim of this study was to investigate the clinical significance of histological subtypes and the possible impacts of clinicopathological factors on the course of melanoma patients of all stages. A total of 1017 cutaneous melanoma patients were analyzed retrospectively. Four major melanoma histotypes that were studied in this study were as follows: (1) superficial spreading melanoma (SSM), (2) nodular melanoma (NM), (3) acral lentiginous melanoma (ALM), and (4) lentigo maligna melanoma (LMM). Unlike SSMs and LMMs, there were statistically significant correlations between NMs and ALMs and most aggressive histopathological prognostic indicators, such as higher Clark level (P = 0.0001), thick Breslow depth (P = 0.0001), presence of ulceration (P = 0.0001), and lymphovascular invasion (P = 0.0001). Furthermore, NMs and ALMs were also associated with advanced clinical stages, that is, node involvement and metastasis. Relapse rates for nonmetastatic melanomas were higher in NMs (39.6%) and ALMs (35.3%) than in SSMs (24.3%) and LMMs (10.3%) (P = 0.0001). Additionally, 5-year relapse-free survival rates were 90.5%, 70.5%, 55.7%, and 50.5% in LMMs, SSMs, ALMs, and NMs, respectively (P = 0.0001). Moreover, 5-year overall survival rates plummeted from 84.3% in LMMs to 74.8%, 64.3%, and 46% in SSMs, ALMs, and NMs, respectively (P = 0.0001). In conclusion, we observed that the histologic subtype was an independent predictor for relapse and outcome for cutaneous melanoma patients. Both NM and ALM had unfavorable prognoses, and they were associated with known poor pathological and clinical indicators.
Impact of a Powered Prosthetic Ankle-Foot Component on Musculoskeletal Pain in Individuals with Transtibial Amputation: A Real-World Cross-Sectional Study with Concurrent and Recalled Pain and Functional Ratings
Authors: Cacciola Cory E. , Kannenberg Andreas , Hibler Karl D. , Howell Jared
Published: August 2022

Introduction

Traditionally, lower-limb prostheses are composed of passive components, which provide a fraction of the push-off power of the natural ankle-foot complex. In individuals with transtibial amputation (TTA), this leads to deviations and compensatory mechanisms. Studies have reported significant unloading of the sound limb and knee joint with a powered prosthetic ankle-foot. However, despite the promising biomechanical evidence on unloading, no study has yet investigated the impact of powered prosthetic ankle-foot on musculoskeletal pain.

Methods

A total of 250 individuals fit with a powered prosthetic ankle-foot component were invited to participate in an institutional review board–approved cross-sectional study. Participants completed a survey, which collected typical prosthetic history information as well as Numerical Pain Rating Scales across different body regions, the Socket Comfort Score (SCS), the Activity of Daily Living domain of the Knee Injury and Osteoarthritis Outcome Score (KOOS-ADL), and the Oswestry Disability Index (ODI) for both their current and past prosthetic ankle-foot. The differences between results across the two ankle-feet were evaluated in subgroups dependent on the user's current foot.

Results

A total of 57 individuals met the inclusion criteria after completion of the online survey. Forty-one subjects (71.9%) identified as current powered ankle-foot users. Sixteen subjects (28.1%) reported to have used a powered ankle-foot in the past but have since abandoned it. The current powered ankle-foot users' group saw no significant difference in SCSs. The current passive foot users reported significantly (P = 0.002) better socket comfort for the prosthesis with the passive foot. The original and recall-adjusted median ratings of pain in the group of 41 current powered ankle-foot users showed significantly less pain in all three body segments. In the group of 41 current powered ankle-foot users, both the original and recall-adjusted KOOS-ADL and ODI scores were significantly better for the powered ankle-foot.

Conclusions

Individuals in active daily life with TTA may experience relief of sound knee, amputated side knee, and low-back pain, as well as pain-related restrictions in activities of daily living function with use of a powered ankle-foot mechanism.

Clinical Relevance

Providing the right patient with a powered ankle-foot has the potential to decrease the individual's pain. The individual may also have fewer pain-related functional restrictions when attempting to achieve activities of daily living.
Lessons Learned from Managing Antithrombotic Therapy in Children Supported with Pediatric Ventricular Assist Devices
Authors: Murray Jenna M. , Miera Oliver , Stiller Brigitte , Maeda Katsuhide , Almond Christopher S.
Published: August 2022

Stroke, thromboembolism, and bleeding are the most recognized complications associated with pediatric ventricular assist devices (VADs) and the leading cause of death and disability on VAD support. Recently, newer antithrombotic strategies like bivalirudin have emerged that appear to be associated with a reduction in the neurologic event rates, especially for smaller pediatric-specific VADs like the Berlin Heart and PediMag/CentriMag systems where the risk of stroke is the highest. While contemporary antithrombotic therapies have likely contributed to lowering adverse event rates, we speculate that clotting and bleeding adverse events may have dropped because of a variety of other seemingly small changes to antithrombotic management that are independent of the antithrombotic agents used. This view is supported by recent reports documenting low stroke rates with anticoagulants other than bivalirudin, a drug that may have a wider therapeutic window but is not available in all locations throughout the world. The primary purpose of this report is 1) to summarize contemporary antithrombotic regimens used for smaller pediatric VADs today associated with low event rates in the United States and abroad and () to review 10 practical lessons learned and pitfalls to avoid that we believe to be important to reducing bleeding and clotting events based on our collective experience managing pediatric VADs over the past 20 years irrespective of the antithrombotic agents used.
Outcomes of Patients Referred for Cardiac Rehabilitation after Left Ventricular Assist Device Implantation
Authors: Shaaban Adnan , Schultz Jessica , Leonard John , Martin Cindy M. , Kamdar Forum , Alexy Tamas , Thenappan Thenappan , Pritzker Marc , Shaffer Andrew , John Ranjit , Cogswell Rebecca
Published: August 2022

A single-center continuous-flow left ventricular assist device (LVAD) cohort (n = 503) was reviewed for patients with information on cardiac rehabilitation (CR) participation (n = 273) over a 13-year period. The analysis was then limited LVAD recipients who fit into three main CR categories: those who graduated CR (n = 138), those who were able to but declined participation (n = 61), and those who were too sick to complete or start CR (n = 28). To assess the association between CR categories and mortality and hospitalizations on LVAD support, multivariate cox regression and negative binomial regression analyses were performed, respectively. Among those who started CR and had the opportunity to finish (enough follow-up time, insurance coverage), 79% graduated. Those who graduated CR had a 96% survival at 1 year (95% confidence interval [CI], 91–98). Compared with the graduated group, those in the too sick group had an increased hazards rate of mortality (hazard ratio, 2.85; 95% CI, 1.49–5.44; p < 0.01) and an increase in the incidence rate of hospitalizations (incidence rate ratio, 1.74; 95% CI, 1.14–2.66, p = 0.01). This study is the largest to date to report outcomes of LVAD recipients referred for CR. The lower readmission rates and high survival in the group that graduated CR provides further evidence for the safety of CR in LVAD recipients.
A systematic review and meta-analysis of anesthesia type on hip fracture post-surgery outcomes
Authors: Leibold Christopher , Falbo Ryan , Gupta Anil , Miller Richard , Pederson John M. , Malpe Manashree
Published: August 2022

Objective:

To compare technical, clinical, and safety outcomes among hip fracture patients treated with procedures supplemented by general anesthesia (GA) or spinal/regional anesthesia (S/R).

Data sources:

We searched for original studies on PubMed, Ovid MEDLINE, Ovid Embase, and Cochrane databases.

Study selection:

Studies that reported clinical outcomes in patients that underwent hip fracture surgery, had available data on type of anesthesia administered, and clinical follow-up data were selected for data extraction.

Data extraction:

The primary outcomes of interest were odds of mortality, including in-hospital, 30-day, 90-day, and 1-year mortality. Various adverse events (AEs) were also compared.

Data synthesis:

Twenty-eight studies met our selection criteria, including 190,394 patients. A total of 107,314 (56.4%) patients were treated with procedures involving GA while 83,080 (43.6%) were treated with procedures involving S/R. There was no difference in 30-day or >1-year mortality rates between the GA and SR groups; however, compared to S/R group, the GA group had a significantly higher odds of in-hospital (P = .004) and 90-day mortality (P = .004). There was no difference in odds of adverse events between the GA and the S/R group.

Conclusions:

Patients administered S/R for hip fracture procedures demonstrate lower risk of in-hospital mortality and 90-day mortality compared to patients administered GA.

Level of evidence:

Therapeutic level III.
Open tibial shaft fracture management in Argentina: an evaluation of treatment standards in diverse resource settings
Authors: MacKechnie Madeline C. , Albright Patrick D. , Garabano Germán , Bidolegui Fernando , Pereira Sebastian , Pesciallo Cesar Angel , Miclau Theodore ,   Argentina Study Group (Corporate Authors)†
Published: August 2022

Background:

Argentina is a country with varying access to orthopedic surgical care. The Argentine Association of Trauma and Orthopedics (AATO) “Interior Committee” was developed to address potential regional differences and promote standardization of orthopedic trauma care. The paper assesses the level of national standardization of the management of open tibia fractures across 9 provinces in Argentina.

Methods:

Utilizing a matched-comparison group design, management of these injuries were assessed and compared between 3 groups: an “AATO Exterior Committee” consisting of surgeons that practice in Buenos Aires, and 2 “Interior Committees,” comprising surgeons that practice in outlying provinces, 1 of which is affiliated with the AATO, and 1 that is not affiliated with the AATO. The study was conducted in 2 phases: phase 1 assessed open tibia fracture management characteristics, and phase 2 evaluated the management of soft-tissue wound coverage following open fractures.

Results:

Soft-tissue coverage procedures for Gustilo Anderson Type IIIB fractures were more commonly performed by orthopedic surgeons in Interior Committees than the AATO Exterior Committee. Greater rates of definitive wound coverage within 7 days post-injury were reported in both Interior Committees compared to the Exterior Committee. Plastic surgeons were reported as more available to those in the AATO Exterior Committee group than in the AATO Interior Committees.

Conclusion:

While treatment patterns were evident among groups, differences were identified in the management and timing of soft-tissue coverage in Gustilo Anderson Type IIIB fractures between the Exterior Committee and both Interior Committees. Future targeted educational and surgical hands-on training opportunities that emphasize challenges faced in resource-limited settings may improve the management of open tibia fractures in Argentina.
Endoscopic Over Under Cartilage Tympanoplasty Is Not Inferior to Underlay Cartilage Tympanoplasty
Authors: Erbele Isaac D. , Fink Madelinn R. , Mankekar Gauri , Son Leslie S. , Arriaga Moisés A. , Mehta Rahul
Published: August 2022

Objective:

Evaluate whether elevating the tympanic membrane from the malleus during endoscopic tympanoplasty may negatively affect postoperative hearing outcomes or perforation rates by comparing 2 similar endoscopic tympanoplasty techniques.

Study Design:

Retrospective cohort.

Setting:

Tertiary care center.

Patients:

Endoscopic over-under cartilage tympanoplasties age and gender matched to endoscopic underlay cartilage tympanoplasties between January 2015 and January 2019. Exclusion criteria included preoperative or intraoperative cholesteatoma, performance of mastoidectomy or ossicular chain reconstruction, and lack of postoperative audiogram.

Interventions:

Endoscopic cartilage tympanoplasty via over-under or underlay technique.

Main Outcome Measures:

Pre- and postoperative pure-tone average and word recognition score, graft success.

Results:

A total of 52 patients were evaluated: 26 endoscopic over-under cartilage tympanoplasties were matched to endoscopic underlay cartilage tympanoplasties. Both groups demonstrated a statistically significant improvement in air conduction hearing (9 dB [P < 0.001] and 6 dB [P < 0.01], respectively), and bone pure-tone average did not worsen in either group (P < 0.001 and P < 0.05, respectively). Postoperative air conduction pure-tone average was statistically noninferior in the over-under group compared with the underlay group (P < 0.05). Reperforation was present in 3 patients (12%) in the underlay group and none in the over-under group, but this difference was not statistically significant (P = 0.24).

Conclusions:

Endoscopic over-under cartilage tympanoplasty effectively closes tympanic membrane perforations and improves hearing, without greater risk than underlay tympanoplasty. Elevating the tympanic membrane from the malleus does not confer worsen hearing outcomes.
Otology-Neurotology 2020 US Workforce Distribution
Authors: Casazza Geoffrey C. , Kesser Bradley W. , Strumpf Andrew M. , Gurgel Richard K. , Hashisaki George T.
Published: August 2022

Objective:

Determine the geographic and per capita distribution of otology-neurotology physician-surgeons within the United States.

Study Design:

National database review.

Setting:

United States.

Methods:

The American Neurotology Society and ENThealth.org membership databases were queried to identify otology-neurotology physician-surgeons within the United States. Physician-surgeons were divided by regional national census areas, state, and by largest population statistical area based on 2019 US Census population estimates. The number of otology-neurotology physician-surgeons per 1 million persons was calculated for each population designation.

Results:

Four-hundred eighty-two physician-surgeons were identified, representing 49 states and the District of Columbia. The New England division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island) was the most concentrated region (1.89), whereas the West-South-Central (Texas, Oklahoma, Arkansas, Louisiana) was the least concentrated region (1.23) per million persons. The highest concentration of physician-surgeons by state is within the District of Columbia (4.25), Vermont (3.21), North Dakota (2.62), Massachusetts (2.61), and New York (2.21) (per million), whereas Mississippi (0.67), Georgia (0.66), Idaho (0.56), New Mexico (0.48), and Wyoming (0.0) were the least concentrated per million persons. Increasing number of physician-surgeons was significantly correlated by state (r
2 = 0.9; P < 0.0001), largest statistical area (r
2 = 0.88; P < 0.0001), and census region (r
2 = 0.95; P < 0.0005).

Conclusions:

Otology-neurotology physician-surgeons are evenly distributed across the United States; however, certain areas are likely underrepresented. Variability in clinical practice may account for under or overrepresentation not captured in this analysis.
Incidence of Concomitant Semicircular Canal Dehiscence With Otosclerosis
Authors: Walker Brian A. , Thorwarth Ryan M. , Stull Lindsey L. , Hoxworth Joseph M. , Deep Nicholas L. , Weisskopf Peter A.
Published: August 2022

Objective:

The concurrence of otosclerosis and superior semicircular canal dehiscence (SSCD) presents a diagnostic challenge and failure to differentiate between these 2 diagnoses results in mischaracterization and unsuccessful surgery. The objective of this study is to identify the incidence of SSCD in patients who have computed tomography (CT) evidence of otosclerosis.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral hospital.

Patients:

Adults with CT scan of the temporal bone diagnosed with radiological unilateral or bilateral fenestral otosclerosis from January 1995 to April 2018.

Methods:

Retrospective review of patient imaging from a multi-center tertiary-referral health system from January 1995 to April 2018. Imaging was reviewed to quantify the incidence of SSCD among patients with CT-diagnosed bilateral fenestral otosclerosis. Poor quality imaging was excluded from review.

Results:

One-thousand two-hundred eight patients (1214 CT scans) were identified with otosclerosis, of which 373 were diagnosed with fenestral otosclerosis (663 ears) with imaging of sufficient quality for review. This population was predominantly female (57.2%) with bilateral fenestral otosclerosis (78%). Of these, 23 ears (3.5%) had definitive evidence of SSCD, with an additional 15 ears (2.3%) with possible radiographic evidence of SSCD. There was no significant difference in laterality between the SSCD and otosclerosis.

Conclusions:

Among 373 patients with fenestral otosclerosis per CT temporal bone imaging at a tertiary referral hospital, as many as 8.3% of patients had radiographic evidence of SSCD. Given this incidence, it continues to be important to consider SSCD when diagnosing and treating otosclerosis.
Rationally Designed Magnetic Nanoparticles for Cochlear Drug Delivery: Synthesis, Characterization, and In Vitro Biocompatibility in a Murine Model
Authors: Goyal Mukund M. , Zhou Nancy J. , Vincent Philippe F. Y. , Hoffman Elina S. , Goel Shiv , Wang Chao , Sun Daniel Q.
Published: August 2022

Hypothesis:

Magnetic nanoparticles (MNPs) for cochlear drug delivery can be precisely engineered for biocompatibility in the cochlea.

Background:

MNPs are promising drug delivery vehicles that can enhance the penetration of both small and macromolecular therapeutics into the cochlea. However, concerns exist regarding the application of oxidative, metal-based nanomaterials to delicate sensory tissues of the inner ear. Translational development of MNPs for cochlear drug deliver requires specifically tuned nanoparticles that are not cytotoxic to inner ear tissues. We describe the synthesis and characterization of precisely tuned MNP vehicles, and their in vitro biocompatibility in murine organ of Corti organotypic cultures.

Methods:

MNPs were synthesized via 2-phase ligand transfer process with precise control of nanoparticle size. Core and hydrodynamic sizes of nanoparticles were characterized using electron microscopy and dynamic light scattering, respectively. In vitro biocompatibility was assayed via mouse organ of Corti organotypic cultures with and without an external magnetic field gradient. Imaging was performed using immunohistochemical labeling and confocal microscopy. Outer hair cell, inner hair cell, and spiral ganglion neurites were individually quantified.

Results:

Monocore PEG-MNPs of 45 and 148 nm (mean hydrodynamic diameter) were synthesized. Organ of Corti cultures demonstrated preserved outer hair cell, inner hair cell, and neurite counts across 2 MNP sizes and doses, and irrespective of external magnetic field gradient.

Conclusion:

MNPs can be custom-synthesized with precise coating, size, and charge properties specific for cochlear drug delivery while also demonstrating biocompatibility in vitro.
Immediate Improvement in Subjective Visual Vertical and Disequilibrium Predicts Resolution of Benign Paroxysmal Positional Vertigo Following Single Canalith Repositioning Maneuver
Authors: Little Christine C. , Schwam Zachary G. , Campo Marc , Gurley James , Hujsak Bryan , Cosetti Maura K. , Kelly Jennifer
Published: August 2022

Objective:

To evaluate whether immediate post-canalith repositioning maneuver (CRM) vestibular changes are predictive of benign paroxysmal positional vertigo (BPPV) resolution.

Study Design:

Retrospective cohort study.

Setting:

Tertiary referral center.

Patients:

Adults (n = 27) with posterior canal BPPV.

Interventions:

Single CRM with Frenzel goggles.

Main Outcome Measures:

The Visual Analog Scale (VAS) for disequilibrium, the subjective visual vertical (SVV), the subjective visual horizontal (SVH), and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) were administered pre- and immediately following single CRM. Dix-Hallpike was performed 1–3 weeks after CRM to assess for BPPV resolution. Pre- and post-treatment vestibular assessments were compared between groups to determine if post-CRM vestibular changes could predict BPPV resolution.

Results:

The change in VAS score following CRM treatment was statistically different between patients who responded to CRM treatment (n = 15) and those who did not (n = 12), (–0.07 points versus –2.40 points, respectively; P = 0.03). Likewise, a significantly greater improvement in SVV score was observed for CRM responders compared with CRM nonresponders (0.92° versus –0.06°, respectively; P = 0.02). Change in SVH and mCTSIB scores did not differ significantly between groups. Additionally, patient age was found to predict outcome of CRM treatment, with older patients more likely to experience persistent BPPV (P ≤ 0.01).

Conclusions:

Immediate improvement in VAS and SVV scores following CRM may be useful in predicting resolution of BPPV and may assist in directing the timing and need for future interventions. Younger age may have a favorable predictive value for improvement following single CRM.
Single-dose radiation therapy without additional surgery as a treatment for heterotopic ossification developing after transfemoral amputation, a case report
Authors: Zorn Devon , Lombardo Joseph , Poiset Spencer , Gutman Michael , Cappelli Louis , Hurwitz Mark , Ankam Nethra
Published: August 2022

Heterotopic ossification (HO) is the development of mature lamellar bone in soft tissues. HO can occur in up to 23% of patients after amputation. HO is often painful, causing significant dysfunction. While radiotherapy is used to prevent HO prior to formation, there is a dearth of literature on using radiotherapy to treat existing HO. This case report describes the use of late radiotherapy for the management of existing HO that developed after a transfemoral amputation. A 61-year-old female with peripheral artery disease of her bilateral lower extremities status post stenting and ultimately left transfemoral amputation was diagnosed with symptomatic HO limiting her function. Another surgery was not felt to be warranted. She was not improving with medical therapy and was prescribed 800 cGy in one fraction. Following treatment, she experienced significant relief in her pain, allowing her to resume physical therapy and use of her prosthesis. There are no other published examples of using radiation alone for treatment of HO formation after transfemoral amputation without surgical revision of the bone formation. Our case shows possible utility in single-dose radiation as a treatment to prevent progression of HO, especially when limiting functional progress.
Optimized Camera-Based Patient Positioning in CT
Authors: Manava Panagiota , Galster Marco , Ammon Josefin , Singer Julian , Lell Michael M. , Rieger Vera
Published: August 2022

Objective

The aim of this study was to evaluate whether a 3-dimensional (3D) camera can outperform highly trained technicians in precision of patient positioning and whether this transforms into a reduction in patient exposure.

Materials and Methods

In a single-center study, 3118 patients underwent computer tomography (CT) scans of the chest and/or abdomen on a latest generation single-source CT scanner supported with an automated patient positioning system by 3D camera. One thousand five hundred fifty-seven patients were positioned laser-guided by a highly trained radiographer (camera off) and 1561 patients with 3D camera (camera on) guidance. Radiation parameters such as effective dose, organ doses, CT dose index, and dose length product were analyzed and compared. Isocenter accuracy and table height were evaluated between the 2 groups.

Results

Isocenter positioning was significantly improved with the 3D camera (P < 0.001) as compared with visual laser-guided positioning. Absolute table height differed significantly (P < 0.001), being higher with camera positioning (165.6 ± 16.2 mm) as compared with laser-guided positioning (170.0 ± 20.4 mm). Radiation exposure decreased using the 3D camera as indicated by dose length product (321.1 ± 266.6 mGy·cm; camera off: 342.0 ± 280.7 mGy·cm; P = 0.033), effective dose (3.3 ± 2.7 mSv; camera off: 3.5 ± 2.9; P = 0.053), and CT dose index (6.4 ± 4.3 mGy; camera off: 6.8 ± 4.6 mGy; P = 0.011). Exposure of radiation-sensitive organs such as colon (P = 0.015) and red bone marrow (P = 0.049) were also lower using the camera.

Conclusions

The introduction of a 3D camera improves patient positioning in the isocenter of the scanner, which results in a lower and also better balanced dose reduction for the patients.
Brachial Plexus Magnetic Resonance Neurography
Authors: Davidson Emily J. , Tan Ek T. , Pedrick Emily G. , Sneag Darryl B.
Published: August 2022

Magnetic resonance neurography of the brachial plexus (BP) is challenging owing to its complex anatomy and technical obstacles around this anatomic region. Magnetic resonance techniques to improve image quality center around increasing nerve-to-background contrast ratio and mitigating imaging artifacts. General considerations include unilateral imaging of the BP at 3.0 T, appropriate selection and placement of surface coils, and optimization of pulse sequences. Technical considerations to improve nerve conspicuity include fat, vascular, and respiratory artifact suppression techniques; metal artifact reduction techniques; and 3-dimensional sequences. Specific optimization of these techniques for BP magnetic resonance neurography greatly improves image quality and diagnostic confidence to help guide nonoperative and operative management.
Study on Size Estimation of Prosthesis in Rhinoplasty Based on Mechanical Test and Analysis
Authors: Cai Zhen , Wan Yongping , Zhang Hui
Published: August 2022

Rhinoplasty is a common plastic surgery. The determination of prosthesis size for rhinoplasty has long been dependent on the surgeon’s experience. Some of the patients suffered from complications after the surgery. In this paper, we present a method for estimating the size of prosthesis in rhinoplasty. A nasal tension tester is designed and implemented. On the basis of the mechanical theory of Hyperelastic Materials, an algorithm for inverse calculation of material parameters is proposed; On the basis of the material parameters, an algorithm for estimating the safety range of nasal stretch is established. The nasal tension tester can obtain the nasal tension data without harming the subject. Our results show that different subjects generally have different nasal skin elasticity and tolerance to skin stretch. Therefore, the selection of prosthesis size for rhinoplasty should not be generalized, but should be tested and calculated separately for each subject. The results of this study are helpful for doctors to quantitatively understand the skin condition of the subject ‘s nose and the safe range of nasal stretch, based on which the determination of prosthesis size can be made for rhinoplasty.
Training Program for Orthopedic Residents in Forefoot Osteotomy Skills
Authors: Ledermann Gerardo , Kuroiwa Aron , González Nicolas , Silva Isadora , Villa Andres
Published: August 2022

Introduction

An effective simulation program allows both the acquisition of surgical skills on the simulated model and the transfer of these skills to a surgical scenario. We designed a forefoot osteotomy training program and sought to determine the transferability to a cadaveric surgical scenario.

Methods

Eleven orthopedic residents and 2 foot and ankle surgeons were included. A foot simulator was used. All residents were instructed on the surgical techniques of Chevron, Akin, and triple Weil osteotomies. Eight junior residents (trainees) were enrolled in a supervised simulation program. Baseline assessment was performed on the simulator with the Objective Structured Assessment of Technical Skills (OSATS) and the Imperial College Surgical Assessment Device (ICSAD). After baseline, trainees completed a training program and had a final evaluation of proficiency on the simulator and on cadaveric specimens. Three senior residents with no simulated training (controls) and experts were assessed for comparison.

Results

All trainees improved from a baseline OSATS score of 11 points (9–20) to a final score of 35 points (33–35) in the simulator and 34 points (32–34) in the cadaveric specimen (P < 0.01). Compared with baseline, the ICSAD results improved in path length (391 [205–544] to 131 [73–278] meters, P < 0.01) and number of movements (2756 [1258–3338] to 992 [478–1908], P < 0.01). The final OSATS and ICSAD scores did not differ from experts (P = 0.1) and were significantly different from untrained residents (P = 0.02).

Conclusions

Simulated training of Chevron, Akin, and triple Weil osteotomies in orthopedic residents improved procedural proficiency, enabling successful skill transfer to a surgical scenario in cadavers.

Level of Evidence

II (Prospective Cohort Study)
Long-Term Oncological Outcomes After Colorectal Anastomotic Leakage
Authors: Arron Melissa N.N. , Greijdanus Nynke G. , Bastiaans Sarah , Vissers Pauline A.J. , Verhoeven Rob H.A. , ten Broek Richard P.G. , Verheul Henk M.W. , Tanis Pieter J. , van Goor Harry , de Wilt Johannes H.W.
Published: August 2022

Objective:

The aim was to evaluate the impact of anastomotic leak (AL) after colon cancer (CC) and rectal cancer (RC) surgery on 5-year relative survival, disease-free survival (DFS), and disease recurrence.

Background:

AL after CC and RC resection is a severe postoperative complication with conflicting evidence whether it deteriorates long-term outcomes.

Methods:

Patients with stage I to IV CC and RC who underwent resection with primary anastomosis were included from the Netherlands Cancer Registry (2008–2018). Relative survival, measured from day of resection, and multivariable relative excess risks (RERs) were analyzed. DFS and recurrence were evaluated in a subset with stage I to III patients operated in 2015. All analyses were performed with patients who survived 90 days postoperatively.

Results:

A total of 65,299 CC and 22,855 RC patients were included. Five-year relative survival after CC resection with and without AL was 95% versus 100%, 89% versus 94%, 66% versus 76%, and 28% versus 25% for stage I to IV disease. AL was associated with a significantly higher RER for death in stage II and III CC patients. Stage-specific 5-year relative survival in RC patients with and without AL was 97% versus 101%, 90% versus 95%, 74% versus 83%, and 32% versus 41%. AL was associated with a significantly higher RER for death in stage III and IV RC patients. DFS was significantly lower in CC patients with AL, but disease recurrence was not associated with AL after colorectal cancer resection.

Conclusion:

AL has a stage-dependent negative impact on survival in both CC and RC, but no independent association with disease recurrence.