bluuebunny/crossref_metadata_2025 huggingface dataset:
No Differences in Renal Function between Balanced 6% Hydroxyethyl Starch (130/0.4) and 5% Albumin for Volume Replacement Therapy in Patients Undergoing Cystectomy
Authors: Kammerer Tobias , Brettner Florian , Hilferink Sebastian , Hulde Nikolai , Klug Florian , Pagel Judith-Irina , Karl Alexander , Crispin Alexander , Hofmann-Kiefer Klaus , Conzen Peter , Rehm Markus
Published: October 2017

Background

The use of artificial colloids has declined in critical care, whereas they are still used in perioperative medicine. Little is known about the nephrotoxic potential in noncritically ill patients during routine surgery. The objective of this trial was to evaluate the influences of albumin 5% and balanced hydroxyethyl starch 6% (130/0.4) on renal function and kidney injury.

Methods

One hundred urologic patients undergoing elective cystectomy were randomly assigned for this prospective, single-blinded, controlled study with two parallel groups to receive either albumin 5% or balanced hydroxyethyl starch 6% (130/0.4) as the only perioperative colloid. The primary endpoint was the ratio of serum cystatin C between the last visit at day 90 and the first preoperative visit. Secondary endpoints were estimated glomerular filtration rate and serum neutrophil gelatinase-associated lipocalin until the third postoperative day and risk, injury, failure, loss, and end-stage renal disease criteria at postoperative days 3 and 90.

Results

The median cystatin C ratio was 1.11 (interquartile range, 1.01 to 1.23) in the albumin and 1.08 (interquartile range, 1.00 to 1.20) in the hydroxyethyl starch group (median difference = 0.03; 95% CI, –0.09 to 0.08; P = 0.165). Also, there were no significant differences concerning serum cystatin C concentrations; estimated glomerular filtration rate; risk, injury, failure, loss, and end-stage renal disease criteria; and neutrophil gelatinase-associated lipocalin. Infusion requirements, transfusion rates, and perioperative hemodynamics were similar in both groups.

Conclusions

With respect to renal function and kidney injury, this study indicates that albumin 5% and balanced hydroxyethyl starch 6% have comparable safety profiles in noncritically ill patients undergoing major surgery.
Biomechanical Evaluation of Pediatric Anterior Cruciate Ligament (ACL) Reconstruction Techniques With and Without the Anterolateral Ligament (ALL)
Authors: Trentacosta Natasha , Pace James L. , Metzger Melodie , Michalski Max , Nelson Trevor , Polakof Landon , Mandelbaum Bert
Published: October 2017

Background:

Two popular physeal-sparing procedures used in the management of anterior cruciate ligament (ACL) injuries in skeletally immature patients are the iliotibial band (ITB) ACL reconstruction (ACLR) and the all-epiphyseal (AE) ACLR. Although there has been concern for overconstraint of the lateral compartment of the knee with the ITB ACLR technique, rotational stability, as provided by the anterolateral ligament (ALL) and ACL, has not been assessed in the setting of pediatric ACLR techniques. Our hypothesis is that the ITB ACLR and AE ACLR with ALL reconstruction (ALLR) will best replicate the biomechanical profile of the intact ACL that is lost with transection of the ACL and ALL.

Methods:

Eight cadaveric legs were statically loaded with an anterior drawer force and varus, valgus, internal and external rotational moments at 0, 30, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: intact ACL/intact ALL, ACL-deficient/intact ALL, ITB ACLR/intact ALL, ITB ACLR/ALL-deficient, ACL-deficient/ALL-deficient, AE ACLR/ALL-deficient, AE ACLR/ALLR.

Results:

Both ACLR techniques reduced anterior tibial translation from the ACL-deficient state, but neither restored it to the intact state (P<0.05), except in full extension. ALL deficiency increased anterior tibial translation in the ACL-deficient state (P<0.05). In rotational testing, no significant increase was seen with transection of the ACL, but the ACL-deficient/ALL-deficient state had a significant increase in internal rotation (P<0.05). This was significantly restored to the intact state at most flexion angles with the ITB ACLR without rotational overconstraint of the lateral compartment. The AE ACLR/ALL-deficient state and AE ACLR/ALLR improved rotational stability at lower flexion angles, but not at 60 and 90 degrees. There were no significant changes in varus/valgus moments.

Conclusions:

In this model, the ITB ACLR provided the superior biomechanical profile between our tested reconstructions. It best corrected both AP and rotatory stability without overconstraining the knee. The AE ACLR and AE ACLR/ALLR improved both parameters but not at all flexion angles and not as robustly. ACL deficiency in the knee increased anterior tibial translation, but did not affect rotatory stability. ALL deficiency in the knee increased anterior displacement and rotational moments in the ACL-deficient state.

Clinical Relevance:

Cadaveric Laboratory Study. The ITB ACLR seems to be the biomechanically superior pediatric ACLR technique to regain translational and rotational stability.
Best Practice Guidelines for Surgical Site Infection Prevention With Surgical Treatment of Early Onset Scoliosis
Authors: Glotzbecker Michael P. , St Hilaire Tricia A. , Pawelek Jeff B. , Thompson George H. , Vitale Michael G.
Published: October 2017

Background:

Postoperative surgical site infection (SSI) is unfortunately a commonly encountered complication in the surgical treatment of children with Early Onset Scoliosis (EOS). There is documented variation in the treatment of this patient population. Previous work building consensus for the approach to high risk patients (eg, neuromuscular etiology) has been promising. The goal of the current study is to apply similar principles to develop consensus-based guidelines for the treatment of patients with EOS.

Methods:

A focus group from 2 multicenter pediatric spine deformity study groups developed a list of statements to be distributed to a larger group of EOS experts. Using the Delphi process, participants were presented with a systematic review of the literature as well as a review of current practices in growth friendly surgery. The first round was conducted using an electronic survey. Results of this survey were then discussed face-to-face and the statements were further refined. A final round was conducted using the Audience Response System, allowing participants to vote for each statement (strongly agree or agree). Agreement >80% or disagreement <20% was considered consensus.

Results:

A total of 29 of 57 statements reached consensus. Negative statements (statements of disagreement) were excluded, so the final consensus guidelines included 22 statements. The number of statements from the previously published Best Practice Guidelines (BPG) approved for insertion and lengthening growth friendly procedures were 12 of 14 and 11 of 14, respectively. The high risk BPG therefore does not cover all of the issues specific to the EOS population, and explains why 22 statements reached consensus in the current guideline. Upon completion of the surveys, 100% of the participants agreed to support its publication.

Conclusions:

Using the Delphi process several “best practices” were developed for growth friendly surgical treatment of EOS.

Level of Evidence:

Level V.
Correction of Paradoxical Ribcage Motion in Scoliosis by Noninvasive Ventilation
Authors: Kinnear William J.M. , Sovani Milind , Khanna Arun , Colt Juliet
Published: October 2017

Study Design.

Observational study of ribcage motion in scoliosis.

Objective.

To see whether noninvasive ventilation corrected paradoxical inward motion of the ribs during inspiration.

Summary of Background Data.

Paradoxical inward motion of the ribs is observed after rib fractures, low cervical cord injury, and in chronic obstructive pulmonary disease. It is not well recognized in scoliosis and the mechanism in this group has not been studied.

Methods.

Linearized magnetometers were used to measure the diameter of the ribcage. Changes in diameter during tidal breathing were recorded during spontaneous ventilation and noninvasive ventilation in 10 subjects with idiopathic or congenital thoracic scoliosis.

Results.

During spontaneous breathing, the median change in ribcage diameter during inspiration was −1.5 (range −2.3 to −0.8) cm. The median change in ribcage diameter during noninvasive ventilation was +0.5 (range −1.1 to +1.2) cm. Noninvasive ventilation improved paradoxical motion in all subjects, completely correcting it in six.

Conclusion.

Paradoxical inward motion of the ribcage is seen in some subjects with severe scoliosis. This abnormal motion is improved or abolished by noninvasive ventilation. Since noninvasive ventilation takes over the work of breathing from the respiratory muscles, we suggest that inspiratory muscle contraction causes distortion of part of the ribcage in scoliosis, probably because of the abnormal orientation of diaphragmatic muscle fibers.

Level of Evidence: 2
Sex differences in the association between a previous cancer diagnosis and the use of medication
Authors: Costa Ana Rute , Pacheco-Figueiredo Luís , Alves Luís , Lunet Nuno
Published: October 2017

We aimed to quantify the association between a previous cancer diagnosis and medication use, depicting possible sex differences. We analysed data from a representative sample of the Portuguese adult population (n=32 610), which was collected through face-to-face interviews, using a structured questionnaire. The effect of a previous diagnosis of cancer was quantified through prevalence ratios (PR), adjusted for age, education and region of residence. Cancer survivors (CS) reported higher use of prescribed medication, with greater adjusted PR among men (1.25 vs. 1.13, P for interaction=0.001). Compared with the general population, male CS reported higher use of drugs for sleep problems, allergies and antibiotics, whereas female CS reported greater consumption of drugs for depression, anxiety, sleep problems and pain. This study contributes towards understanding sex disparities in the impact of cancer survival on medication use.
Antiarrhythmic Effects of Combining Dofetilide and Ranolazine in a Model of Acutely Induced Atrial Fibrillation in Horses
Authors: Carstensen Helena , Kjær Line , Haugaard Maria Mathilde , Flethøj Mette , Hesselkilde Eva Zander , Kanters Jørgen K. , Pehrson Steen , Buhl Rikke , Jespersen Thomas
Published: October 2017

Background:

Antiarrhythmic compounds against atrial fibrillation (AF) often have reduced efficacy and may display cardiac and/or noncardiac toxicity. Efficacy can be improved by combining 2 compounds with distinct mechanisms, and it may be possible to use lower doses of each compound, thereby reducing the likelihood of adverse side effects. The purpose of this study was to investigate whether the effective doses of dofetilide and ranolazine can be reduced if the drugs are combined.

Methods:

Dofetilide, ranolazine, and a combination of these were administered in 4 incremental dosing regimens to horses with acutely pacing-induced AF. Time to cardioversion, atrial effective refractory period, and AF vulnerability and duration were assessed.

Results:

Of 8 horses, 6 cardioverted to sinus rhythm after infusion with a combination of 0.889 μg/kg dofetilide and 0.104 mg/kg ranolazine. Two horses cardioverted with 0.104 mg/kg ranolazine alone, and 3 cardioverted with 0.889 μg/kg dofetilide alone. The combination therapy decreased AF vulnerability (P < 0.05) and AF duration (P < 0.05). No change in atrial effective refractory period was detected with any of the drugs.

Conclusions:

The combination of dofetilide and ranolazine showed increased antiarrhythmic effects on acutely induced AF in horses, affecting time to cardioversion, AF vulnerability, and AF duration.
A New Modified Method of Correcting Cryptotia with a Subcutaneous Pedicled Flap
Authors: Hikiami Rina , Kakudo Natsuko , Morimoto Naoki , Hihara Masakatsu , Kusumoto Kenji
Published: October 2017

We developed a surgical technique to correct cryptotia using a subcutaneous pedicled flap raised from the retroauricular region. A skin paddle over the caudal part of the auricular sulcus is designed and transferred to the skin defect of the upper posterior surface of the auricle. This procedure has been performed on 17 ears in 14 patients with cryptotia since 1992. There were no postoperative complications, such as necrosis of the flaps or deformities, and cryptotia did not recur in any patient. A satisfactory auricular contour with a sufficiently deep auriculotemporal sulcus was preserved in all cases. The intraoperative procedure to correct cryptotia and outcomes obtained are presented herein and compared with other procedures.
CORRELATION BETWEEN INNER-RETINAL CHANGES AND OUTER-RETINAL DAMAGE IN PATIENTS WITH IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Cho Kwan Hyuk , Park Sang Jun , Woo Se Joon , Park Kyu Hyung
Published: October 2017

Purpose:

To investigate correlations between the inner-retinal irregularity index and interdigitation zone (IZ) defects preidiopathic and postidiopathic epiretinal membrane (ERM) surgery.

Methods:

The authors retrospectively assessed ophthalmic parameters in 89 eyes of 89 patients with ERM. They divided patients into the no-IZ defect (51, 57%) and IZ defect (38, 43%) groups. The IZ defect group was subdivided into recovered (22, 58%) and remaining IZ defect (16, 42%) subgroups, according to IZ recovery status at final examination. The inner-retinal irregularity index of each group was measured before and 1-, 3-, and 6-month postsurgery.

Results:

Clinical characteristics were similar in both groups. The IZ defect group had a statistically significant higher inner-retinal irregularity index than the no-IZ defect group before (P = 0.023), but not after ERM surgery. The inner-retinal irregularity index of the recovered and remaining IZ defect subgroups was similar before surgery, but differed markedly 6 months after surgery (P = 0.048). Changes in the inner-retinal irregularity index quantitatively correlated with IZ defect size before and after ERM surgery (P < 0.001).

Conclusion:

The inner-retinal irregularity index differed significantly according to the IZ status and also correlated with the IZ defect before and after ERM surgery. The inner-retinal irregularity index may reflect the outer-retinal damage in ERM.
INTRARETINAL HYPERREFLECTIVE FOCI IN BEST VITELLIFORM MACULAR DYSTROPHY
Authors: Parodi Maurizio Battaglia , Romano Francesco , Sacconi Riccardo , Casati Stefano , Marchini Giorgio , Bandello Francesco , Iacono Pierluigi
Published: October 2017

Purpose:

To report on the presence of hyperreflective foci (HF) on spectral domain optical coherence tomography in patients with Best vitelliform macular dystrophy (BVMD), and to describe the relationship between HF and stages of the disease.

Methods:

Consecutive patients diagnosed with BVMD were enrolled in a prospective cross-sectional study. All patients and control subjects underwent a complete ophthalmologic examination, including best-corrected visual acuity and spectral domain optical coherence tomography. Main outcome measure: identification of HF in BVMD. Secondary outcome: assessment of the HF in each stage and correlation with best-corrected visual acuity.

Results:

Overall, 75 eyes of 39 patients were included in the study (Stage 1: 13%, Stage 2: 43%, Stage 3: 15%, Stage 4: 21%, and Stage 5: 8%). On spectral domain optical coherence tomography assessment, intraretinal HF were present in 83% of all eyes, in 91% of eyes affected by clinical BVMD (Stages 2–5) and in 100% of patients in Stages 4 and 5. In 46% of clinically diseased eyes, HF were localized in the fovea and in correspondence with the BVMD lesions at the level of the outer nuclear layer and outer plexiform layer. Hyperreflective foci were present in 16% of control eyes. Mean number of HF in eyes affected by clinical BVMD stood at 7.67 ± 7.35. These were predominantly small HF (6.23 ± 6.14, P < 0.001) localized in the outer nuclear layer (5.19 ± 5.38, P = 0.001) and presented largely in the extrafoveal, rather than the foveal area (5.21 ± 5.57 vs 2.46 ± 2.73, P = 0.001). Analysis of HF distribution revealed that the control group and Stage 1 eyes had the fewest HF; Stage 4 displayed a significant increase in the number of HF compared with Stages 2 and 3; Stage 5 also showed an increased number of HF, although this difference was statistically significant only with Stage 3 eyes. The best-corrected visual acuity was negatively related to the number of HF, with best-corrected visual acuity deteriorating as the number of HF increased in Stages 2 to 5 (P < 0.001).

Conclusion:

This study describes the presence of HF in BVMD using spectral domain optical coherence tomography. Our data suggest that HF identification is correlated with the progression of the disease and could represent a useful biomarker of BVMD.
OCULAR MANIFESTATIONS OF SYSTEMIC AMYLOIDOSIS
Authors: Reynolds Margaret M. , Veverka Kevin K. , Gertz Morie A. , Dispenzieri Angela , Zeldenrust Steven R. , Leung Nelson , Pulido Jose S.
Published: October 2017

Purpose:

To describe ophthalmic manifestations of systemic amyloidosis, a group of devastating conditions.

Methods:

A retrospective chart review including patients who had ocular examinations at Mayo Clinic between January 1, 1985, and April 1, 2014, and a diagnosis of light-chain (AL), secondary (AA), or nontransthyretin familial amyloidosis was undertaken. Sixty-eight patients with AL amyloidosis, eight patients with AA amyloidosis, and five patients with nontransthyretin familial amyloidosis were included.

Results:

Of 68 patients, 8 patients (14 eyes) with AL amyloidosis had ocular involvement secondary to conjunctiva, temporal artery, extraocular muscle, trabecular meshwork, and cranial nerve deposition. One of the five patients with nontransthyretin familial amyloidosis had gelsolin-related corneal dystrophy. No patients with AA amyloidosis (n = 8) had ophthalmic manifestations.

Conclusion:

Systemic amyloidosis can lead to ocular morbidity. Patients with AL amyloidosis had involvement of the temporal artery, conjunctiva, extraocular muscles, trabecular meshwork, and cranial nerves. Those with gelsolin nontransthyretin familial amyloidosis were susceptible to corneal dystrophy. Patients with AA amyloidosis did not manifest ophthalmic involvement. Finally, if ocular amyloidosis is detected, patients should be referred for systemic workup.
TO PEEL OR NOT TO PEEL THE INTERNAL LIMITING MEMBRANE IN IDIOPATHIC EPIRETINAL MEMBRANES
Authors: Díaz-Valverde Andrea , Wu Lihteh
Published: October 2017

Background:

Epiretinal membranes (ERMs) have been described for more than 150 years. Currently, they are a common indication for vitreoretinal surgery. Recently, there has been an increasing trend to peel the internal limiting membrane (ILM). Although ILM peeling has generally been accepted as a fundamental step in macular hole repair, its current role in ERM remains controversial.

Methods:

Literature review.

Results:

Proponents of ILM peeling argue that peeling of the ILM reduces the recurrence rate and facilitates a greater resolution of retinal folds. Opponents of ILM peeling show that the visual outcomes between eyes that undergo ILM peeling and those that do not have their ILM peeled are the same. Stripping of the ILM removes the Müller cell footplates, so it is reasonable to expect some Müller cell dysfunction. Adverse events such as eccentric paracentral macular holes, macular microscotomata, and retinal dimpling have been associated with ILM peeling.

Conclusion:

Internal limiting membrane peeling does not improve the functional outcomes after ERM surgery. Internal limiting membrane peeling reduces ERM recurrences, but many recurrences are not clinically significant. It remains unclear what the long-term effects of ILM peeling are. We should err on the side of caution and avoid routine ILM peeling in primary idiopathic ERM cases and should reserve it for recurrent and high risk of recurrence cases.
ABNORMAL QUIESCENT NEOVASCULARIZATION IN A PATIENT WITH LARGE COLLOID DRUSEN VISUALIZED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Carnevali Adriano , Sacconi Riccardo , Querques Lea , Corbelli Eleonora , Rabiolo Alessandro , Chiara Giuffrè , Scorcia Vincenzo , Bandello Francesco , Querques Giuseppe
Published: October 2017

Purpose:

We report a case of large colloid drusen complicated by extensive quiescent choroidal neovascularization in both eyes.

Methods:

Case report.

Results:

A 46-year old woman was referred to our department with diagnosis of early-onset retinal drusen. Review of examinations performed 16 years before along with current multimodal imaging evaluation showed the presence of numerous large colloid drusen, subsequently replaced by quiescent choroidal neovascularization in both eyes, nicely visualized by optical coherence tomography angiography.

Conclusion:

This case suggests progressive development of quiescent neovascularization beneath the drusen as a possible late evolution of degenerating large colloid drusens.
CLINICAL COURSE OF INFLAMMATORY CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH FOCAL CHOROIDAL EXCAVATION
Authors: Corbelli Eleonora , Sacconi Riccardo , Querques Lea , Carnevali Adriano , Giuffrè Chiara , Rabiolo Alessandro , Bandello Francesco , Querques Giuseppe
Published: October 2017

Purpose:

To report the clinical course of focal choroidal excavation associated with choroidal neovascularization in a case of choroidal inflammation.

Methods:

Case report.

Results:

A 41-year-old man presented with blurred vision and metamorphopsia in his left eye. Multimodal imaging including optical coherence tomography angiography showed nonconforming focal choroidal excavation in the setting of choroidal inflammation and the presence of choroidal neovascularization at the border of the excavation, nicely visualized by optical coherence tomography angiography. Pattern alteration from nonconforming to conforming focal choroidal excavation and choroidal neovascularization involution were observed after treatment with oral steroids.

Conclusion:

Multimodal imaging, including optical coherence tomography angiography, allowed to detect and monitor pattern focal choroidal excavation transformation and choroidal neovascularization reduction after treatment with oral steroids.
Global Voyeurism or Sustainable Ethical Practice?
Authors: Finn Cris , Coast Mary Jo
Published: October 2017

This is a conceptual article exploring global voyeurism and service, overlaying ethical considerations in service within the profession of forensic nursing. Key elements considered include examining and reflecting on personal motivations, benefits, and consequences of service when viewed through an ethical perspective. Through this article we seek to examine the relationships between poverty tourism and service, while better supporting individual forensic nurses in their quest to align their actions with the ethical and practice comportment standards within the profession of nursing service globally. We include definition of terms, including professional identity, ethics and social justice, poverty tourism and voyeurism, global and professional service, cultural humility, partnerships, and trusting relationships. We conclude with implications, and considerations for forensic nursing.
Stress and Unusual Events Exacerbate Symptoms in Menière's Disease: A Longitudinal Study
Authors: Yeo Nicola L. , White Mathew P. , Ronan Natalie , Whinney David J. , Curnow Alison , Tyrrell Jessica
Published: October 2017

Hypothesis:

Stress and unusual events are associated with a higher likelihood of attacks and increased symptom severity in Menière's disease (MD).

Background:

MD is an unpredictable condition which severely impacts the quality of life of those affected. It is thought that unusual activity and stress may act as an attack trigger in MD, but research in this area has been limited to date.

Methods:

This was a longitudinal study conducted over two phases. A mobile phone application was used to collect daily data on Menière's attacks and individual symptoms (aural fullness, dizziness, hearing loss, and tinnitus), as well as prevalence of unusual events (phase I), and stress levels (phase II). There were 1,031 participants (730 women, mean age 46.0 yr) in phase I and 695 participants (484 women, mean age 47.7 yr) in phase II. Panel data regression analyses were employed to examine for associations between unusual events/stress and attacks/symptoms, including the study of 24 hours lead and lag effects.

Results:

Unusual events and higher stress levels were associated with higher odds of Menière's attacks and more severe symptoms. The odds of experiencing an attack were 2.94 (95% confidence interval [CI] 2.37, 3.65) with reporting of unusual events and increased by 1.24 (95% CI 1.20, 1.28) per unit increase in stress level. Twenty-four hour lead (OR 1.10 [95% CI 1.07, 1.14]) and lag (OR 1.10 [95% CI 1.06, 1.13]) effects on attacks were also found with increases in stress.

Conclusion:

This study provides the strongest evidence to date that stress and unusual events are associated with attacks and symptom exacerbation in MD. Improving our understanding of stress and unusual events as triggers in Menière's may reduce the uncertainty associated with this condition and lead to improved quality of life for affected individuals.
Morphological Characteristics of Osseous External Auditory Canal and Its Relationship With External Auditory Canal Cholesteatoma in Patients With Congenital Aural Stenosis
Authors: Yin Dongming , Li Chenlong , Juan Hong , Li Jieying , Yang Lin , Zhang Tianyu , Dai Peidong
Published: October 2017

Objective:

To investigate the characteristics of stenotic external auditory canal (EAC) (e.g., shape, length, orientation, and curvature) and to compare them with those of the cholesteatoma and no cholesteatoma groups, which may help to explain cholesteatoma formation to a certain degree.

Methods:

Computed tomography scans of two groups of patients (with and without EAC cholesteatoma) were analyzed. We determined the degree of microtia, the stenosis of EAC, radius and curvature of osseous EAC bending (abbreviated as OEB-r and OEB-c, respectively), and other anatomic parameters of EAC by using Mimics and Matlab.

Results:

There was no significant difference in the degree of microtia between the cholesteatoma and no cholesteatoma groups using the Marx grading system. Additionally, no significant difference was found in the stenosis of EAC between the two groups. The OEB-r was smaller in the cholesteatoma group (4.62 ± 0.62 mm) than in the no cholesteatoma group (7.41 ± 0.50 mm), and the OEB-c was found to be larger in the cholesteatoma group (1.55 ± 0.05 × 10 mm−1) than in the no cholesteatoma group (1.10 ± 0.10 × 10 mm−1). Moreover, the OEB-c (OR, 8.60; 95% CI, 2.67–27.75) was associated with EAC cholesteatoma formation.

Conclusion:

The curvature of osseous EAC in the cholesteatoma group was significantly larger than that in the no cholesteatoma group. It is suggested that the curvature of osseous EAC was a risk factor for EAC cholesteatoma formation.
Preventing Facial Nerve Stimulation by Triphasic Pulse Stimulation in Cochlear Implant Users: Intraoperative Recordings
Authors: Bahmer Andreas , Adel Youssef , Baumann Uwe
Published: October 2017

Hypothesis:

Triphasic pulse stimulation of the auditory nerve can prevent unintended facial nerve stimulation (FNS) due to a different electromyographic (EMG) input–output function compared with biphasic pulses.

Background:

FNS is sometimes observed in cochlear implant (CI) users as an unpleasant side effect of electrical stimulation using biphasic pulse patterns (BPP). Clinical remedies to alleviate FNS are 1) to extend stimulus phase duration or 2) to completely deactivate the electrode. In some cases, these options do not provide sufficient FNS reduction or are detrimental to subject performance. Stimulation using triphasic pulse patterns (TPP) has been shown to prevent FNS more effectively, yet the underlying mechanism remains unclear.

Methods:

EMG potentials of muscles innervated by the facial nerve (orbicularis oculi and oris muscles) were recorded to quantitatively compare the effect of BPP and TPP stimulation on FNS. Recordings were conducted in five subjects during CI surgery. In two exemplary cases, different leading phase polarities in alternating and non-alternating order were tested.

Results:

Compared with our previous study in awake patients using surface electrodes (Bahmer and Baumann, 2016), intraoperative recordings using subdermal electrodes showed lower noise content and allowed higher sampling resolution. While inter-subject variation remained high, intra-subject results for different electrode positions were comparable: FNS was strongly reduced for cathodic-first TPP stimulation. In contrast, exemplary cases showed little reduction for anodic-first TPP as well as for alternating stimulation.

Conclusion:

FNS in CI users can be reduced using TPP stimulation, but the ameliorative effect appears to be dependent on the leading stimulus polarity.
Do Measurements of Inner Ear Structures Help in the Diagnosis of Inner Ear Malformations? A Review of Literature
Authors: D’Arco Felice , Talenti Giacomo , Lakshmanan Rahul , Stephenson Kate , Siddiqui Ata , Carney Olivia
Published: October 2017

Objective:

We conducted an extensive review of the literature relevant to inner ear measurements in normal and malformative conditions to select reproducible methods and normative ranges that may be used in clinical practice.

Data Sources and Study Selection:

A review of the published literature was performed in the English language using PubMed with appropriate keywords. We selected only those articles containing normative values of inner ear structures.

Data Extraction and Data Synthesis:

The following measurements were identified as reproducible and sensitive for the diagnosis of inner malformations: cochlear height in coronal plane; maximal diameter of bony island of lateral semicircular canal; width of vestibular aqueduct: 1) at midpoint; 2) at operculum in axial plane; cochlear canal and cochlear width in multiplanar reconstructions (MPR)/axial; cochlear length. The following cutoffs for normal inner ears are proposed based on the comparative analysis of the literature: cochlea height: >4.3 mm; lateral semicircular canal bony island: >3 mm; vestibular aqueduct: <0.9 (midpoint) and <1.9 mm (operculum); cochlear canal (axial MPR): >1.4 mm and <2.5 mm; cochlear width (MPR): >5.4 mm.

Conclusion:

Measurements of inner ear structures can help in the interpretation of computed tomography images. They increase the sensitivity in detecting inner ear malformations, especially cochlear hypoplasia now considered more common than previously thought.
Changes in Serum Prestin Concentration After Exposure to Cisplatin
Authors: Liba Benjamin , Naples James , Bezyk Elizabeth , Campbell Charlene , Mei Michael , Parham Kourosh
Published: October 2017

Hypothesis:

There are temporal changes in the outer-hair-cell-specific protein, prestin, in the blood after administration of low-dose cisplatin.

Methods:

Two rodent models of ototoxicity were used. After control and baseline data collection, mice (n = 30) and guinea pigs (n = 10), respectively, were treated with cisplatin at 8 mg/kg. Auditory brainstem responses were recorded on Days 1, 3, 7, and 14 after treatment. Five mice were sacrificed at each time point and serum samples were obtained. A group of 10 guinea pigs were tested and serum samples were collected at each time point. Serum prestin concentrations were measured using separate enzyme-linked immunosorbent assays for each species.

Results:

Auditory brainstem responses thresholds changed relatively little in mice, but gradually increased in guinea pigs, as a function of time after cisplatin exposure. In contrast, serum prestin concentrations rose, reaching a peak on Days 3 and 7 after cisplatin treatment in mouse and guinea pig, respectively, before declining back to or below baseline/control levels 14 days after treatment.

Conclusion:

There was a time-dependent pattern of change in serum prestin after exposure to low-dose cisplatin in a resistant (mouse) and sensitive (guinea pig) rodent models. These comparative results suggest prestin may serve as a biomarker for cisplatin ototoxicity.
The association between physical activity and the risk of symptomatic Barrett’s oesophagus: a UK prospective cohort study
Authors: Lam Stephen , Alexandre Leo , Luben Robert , Hart Andrew R.
Published: October 2017

Background

Physical activity affects the functioning of the gastrointestinal system through both local and systemic effects and may play an important role in the aetiology of gastroesophageal reflux disease, Barrett’s oesophagus and oesophageal adenocarcinoma. We investigated, for the first time in a large prospective cohort study, associations between recreational and occupational levels of physical activity and the incidence of Barrett’s oesophagus.

Participants and methods

The European Prospective Investigation of Cancer-Norfolk recruited 30 445 men and women between 1993 and 1997. Occupational and recreational levels of physical activity were measured using a baseline questionnaire. The cohort was followed up until 2015 to identify symptomatic cases of Barrett’s oesophagus. Cox proportional hazard regression estimated hazard ratios (HR) for physical activity and the development of disease.

Results

Two hundred and three participants developed Barrett’s oesophagus (mean age: 70.6 years) the majority of whom were men (70.9%). There was an inverse association between standing occupations and disease risk [HR: 0.50, 95% confidence interval (CI): 0.31–0.82, P=0.006] when compared with sedentary jobs. Heavy manual occupations were positively associated with disease risk (HR: 1.66, 95% CI: 0.91–3.00), but conventional statistical significance was not reached (P=0.09). No associations were found between recreational activity and the risk of Barrett’s oesophagus (HR: 1.34, 95% CI: 0.72–2.50, P=0.35, highest vs. lowest levels of activity).

Conclusion

Our study suggests that occupational levels of physical activity may be associated with the risk Barrett’s oesophagus. However, further work is required to confirm and describe specific occupations that may be protective.
Quality of life of hepatitis B virus surface antigen-positive patients with suppressed viral replication: comparison between inactive carriers and nucleot(s)ide analog-treated patients
Authors: Simonetti Giulia , Gitto Stefano , Golfieri Lucia , Gamal Nesrine , Loggi Elisabetta , Taruschio Gianfranco , Cursaro Carmela , Nunzella Serena , Grandi Silvana , Andreone Pietro
Published: October 2017

Objective

Hepatitis B virus infection is a relevant health problem with more than 400 million infected people worldwide. Our aim was to analyze quality of life of hepatitis B virus surface antigen-positive patients in inactive status or treated with antivirals.

Patients and methods

Patients referred to our center between February and October 2016 were prospectively enrolled. Half-structured interview was used for examining psychological symptoms and Illness Behavior Questionnaire for exploring attitudes toward illness. We used World Health Organization Quality of Life-short version survey for studying quality of life and logistic regression to find possible predictors of nonadequate quality of life.

Results

The study involved 102 patients. At Illness Behavior Questionnaire test, psychological perception of illness (21.6%), and denial of illness itself (13.7%) were the most frequent conditions. Inactive and treated subgroups were comparable for almost all variables and scores, but patients on treatment were significantly more often male, older, and cirrhotic. Sleep disturbance emerged as an independent predictor of inadequate quality of life in Physical health, anxiety in Social relationship, and both anxiety and hostility in Environmental health domain.

Conclusion

Inactive carriers and patients on treatment showed the same global quality of life, but the second group was older and more frequently with an advanced liver disease. Further studies might specifically evaluate the impact of antiviral therapy on quality of life.
Rhabdomyolysis: a 10-year retrospective study of patients treated in a medical department
Authors: Vangstad Marie , Bjornaas Mari A. , Jacobsen Dag
Published: October 2017

Background

Rhabdomyolysis is a common and potentially life-threatening syndrome, and acute kidney injury (AKI) is a serious complication. We performed a 10-year retrospective study that included all patients treated for rhabdomyolysis in a medical clinic. We examined the relationships between the levels of creatine kinase (CK), myoglobin, and creatinine (as a marker of renal function and thereby AKI), and whether the myoglobin/CK ratio could be a valuable tool in the clinical evaluation of this patient group. Clinical characteristics were noted.

Patients and methods

The study included all patients treated for rhabdomyolysis in the Department of Medicine, Oslo University Hospital Ulleval, from 2003 to 2012. Rhabdomyolysis was defined as a serum CK activity more than five times the upper reference limit.

Results

A total of 341 patients were included in the study; 51% developed AKI, and 20% of those required dialysis. Logistic regression showed that myoglobin concentration [P < 0.001, odds ratio (OR) = 6.24] was a better predictor than CK activity (P = 0.001, OR = 3.45) of the development of AKI. The myoglobin/CK ratio was a good predictor of AKI (P < 0.001, OR = 5.97). The risk of developing AKI increased with increasing myoglobin/CK ratio (P < 0.001); a ratio more than 0.2 was associated with an increased likelihood of developing AKI.

Conclusion

Serum myoglobin concentration was a better predictor of AKI than was serum CK activity. The myoglobin/CK ratio may be useful for assessing the likelihood of developing AKI.
Regional Medicare Expenditures and Survival Among Older Women With Localized Breast Cancer
Authors: Tannenbaum Sara , Soulos Pamela R. , Herrin Jeph , Mougalian Sarah , Long Jessica B. , Wang Rong , Ma Xiaomei , Gross Cary P. , Xu Xiao
Published: October 2017

Background:

Despite evidence on large variation in breast cancer expenditures across geographic regions, there is little understanding about the association between expenditures and patient outcomes.

Objectives:

To examine whether Medicare beneficiaries with nonmetastatic breast cancer living in regions with higher cancer-related expenditures had better survival.

Research Design:

A retrospective cohort study of women with localized breast cancer from the Surveillance, Epidemiology, and End Results-Medicare linked database. Hospital referral regions (HRR) were categorized into quintiles based on risk-standardized per patient Medicare expenditures on initial phase of breast cancer care. Hierarchical generalized linear models were estimated to examine the association between patients’ HRR quintile and survival.

Subjects:

In total, 12,610 Medicare beneficiaries diagnosed with stage II–III breast cancer during 2005–2008 who underwent surgery.

Measures:

Outcome measures for our analysis were 3- and 5-year overall survival.

Results:

Risk-standardized per patient Medicare expenditures on initial phase of breast cancer care ranged from $13,338 to $26,831 across the HRRs. Unadjusted 3- and 5-year survival varied from 66.7% to 92.2% and 50.0% to 84.0%, respectively, across the HRRs, but there was no significant association between HRR quintile and survival in bivariate analysis (P=0.08 and 0.28, respectively). After adjustment for sociodemographic and clinical characteristics, quintiles of regional cancer expenditures remained unassociated with patients’ 3-year (P=0.35) and 5-year survival (P=0.20). Further analysis adjusting for treatment factors (surgery type and receipt of radiation and systemic therapy) and stratifying by cancer stage showed similar results.

Conclusions:

For Medicare beneficiaries with nonmetastatic breast cancer, residence in regions with higher breast cancer–related expenditures was not associated with better survival. More attention to value in breast cancer care is warranted.
What Role Does Efficiency Play in Understanding the Relationship Between Cost and Quality in Physician Organizations?
Authors: Paddock Susan M. , Damberg Cheryl L. , Yanagihara Dolores , Adams John L. , Burgette Lane , Escarce José J.
Published: October 2017

Background:

The belief that there is inefficiency, or the potential to improve patient health at current levels of spending, is driving the push for greater value in health care. Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs).

Data and Methods:

We used data on quality of care and total cost of care from 129 California POs participating in a statewide value-based pay-for-performance program. We estimated a production function with quality as the output and cost as the input, using a stochastic frontier model, to develop a measure of relative efficiency for each PO. To validate the efficiency measure, we examined correlations of PO efficiency estimates with indicators representing overuse of services.

Results:

The estimated production function showed that PO quality was positively associated with costs, although there were diminishing marginal returns to spending. A certain minimum level of spending was associated with high quality even among efficient POs. Most strikingly, however, POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.

Conclusions:

Differences among POs in the efficiency with which they produce quality suggest opportunities for improvements in care delivery that increase quality without increasing spending.
Alanine aminotransferase blood levels and rehabilitation outcome in older adults following hip fracture surgery
Authors: Gringauz Irina , Weismann Jonathan , Justo Dan , Adunsky Abraham , Segal Gad
Published: October 2017

Low alanine aminotransferase (ALT) blood levels are associated with frailty and poor outcome in older adults. Therefore, we studied the association between ALT blood levels before rehabilitation and rehabilitation outcome in older adults following hip fracture surgery. A total of 490 older adults (age>60 years, mean age: 82.9±6.7 years, 82.0% women) admitted to rehabilitation following hip fracture surgery were included. The rehabilitation outcome was assessed by Functional Independence Measure (FIM) scores. ALT blood levels were documented between 1 and 6 months before rehabilitation. Patients with ALT blood levels over 40 IU/l possibly consistent with liver injury were excluded. The cohort was divided into two groups: patients with ALT more than 10 IU/l and patients with ALT less than or equal to 10 IU/l. Upon rehabilitation discharge, the FIM outcome measures (motor, cognitive, gain, efficiency) were significantly higher in patients with ALT more than 10 IU/l relative to patients with ALT less than or equal to 10 IU/l (P<0.05). A logistic regression analysis adjusted for age and sex showed that patients with ALT more than 10 IU/l were more likely to have higher (second to fourth upper quartiles) total FIM scores (>50), cognitive FIM scores (>16), and FIM efficiency (>0.228) upon rehabilitation discharge (odds ratio=1.56–1.78). However, this association was no longer significant following adjustment also for admission total FIM score, cognitive impairment, cancer, and albumin serum levels. High-normal ALT blood levels before rehabilitation are associated with a better rehabilitation outcome in older adults following hip fracture surgery. It may be used when data on admission FIM score, cognitive impairment, cancer, and albumin serum levels are not available.
Use of pain medication before and after inpatient musculoskeletal rehabilitation: longitudinal analysis of a nationwide cohort
Authors: Saltychev Mikhail , Laimi Katri , Pentti Jaana , Kivimäki Mika , Vahtera Jussi
Published: October 2017

The objective of this study was to identify subgroups among the participants in inpatient multidisciplinary musculoskeletal rehabilitation based on the differences in the shapes of trajectories of pain medication consumption during the 9 years around the time of intervention. A register-based study among 4578 public sector employees was conducted. Group-based trajectory analysis was done on the purchase of prescribed pain medications during the 9 years around the time of rehabilitation. The participants were on an average 50.7 (SD=6.6) years of age, and 2955 (86%) were women. Average yearly purchase of pain medications increased during the follow-up period from 73.4 (SD=193.0) to 163.3 (SD=295.7) defined daily doses. The analysis suggested six-cluster model. The shapes of the trajectories of three clusters did not show any steep slopes, one trajectory demonstrated nonstop rising through the entire follow-up, and one trajectory was closed to the trajectory average of medication use. One trajectory (11% of the sample) demonstrated a steep growth before the intervention and steep drop after it. When comparing this cluster with all other clusters combined, odds ratios were 0.40 [95% confidence interval (CI): 0.19–0.85] for age group (older vs. younger), 0.78 (95% CI: 0.61–1.01) for sex (women vs. men), and 1.44 (95% CI: 1.09–1.90) for occupational status (lower vs. higher). In other words, the participants belonged to this cluster were younger employees with a lower occupational grade. It seems that younger employees in manual jobs benefitted of the studied multidisciplinary musculoskeletal rehabilitation the most, especially when the timing of intervention is bounded to the substantial rise of pain severity.
Intra-Abdominal Hemorrhage Complicating Electrothermal Arterial Injury During Pelvic Surgery
Authors: Tingey Paul , Krizova Adriana , Little D’Arcy , Ross Joel , Forse Catherine , Pollanen Michael S.
Published: October 2017

Iatrogenic vascular injury is a potentially serious complication of surgical procedures. Here we report a case of delayed fatal intra-abdominal hemorrhage because of electrocautery injury of a right external iliac artery. The decedent, a 31-year-old woman, died suddenly on postoperative day 1 after a laparoscopic staging operation for an ovarian tumor. Her past medical history included a recent diagnosis of a microinvasive carcinoma in the background of a mucinous cystic neoplasm of the right ovary. Postmortem examination revealed a young woman with evidence of emergency intervention, recent laparoscopic pelvic surgery, and pale hypostasis limited to the back surfaces of the body. The internal examination confirmed the postmortem computed tomography findings of a large amount of blood in the pelvic and abdominal cavities and evidence of recent surgical intervention. The soft tissues around the aorta and major pelvic vessels showed electrocautery change and marked perivascular hemorrhage preferentially surrounding the right external iliac artery. Histological examination of the vascular bundle showed an electrocautery injury of the arterial wall: transmural necrosis, acute inflammation, and hemorrhage. In this report, we offer an approach to a postmortem examination in postoperative deaths with emphasis on deaths due to iatrogenic vascular injuries and discuss the rationale for determining the manner of death.