bluuebunny/crossref_metadata_2025 huggingface dataset:
The Abdominal Aortic Intima-Media Thickness Increases in Patients with Primary Hyperparathyroidism
Authors: Sumbul Hilmi Erdem , Koc Ayse Selcan
Published: August 2018

Background We aimed to determine whether there is an increase in aortic intima-media thickness values measured from the abdominal aorta in addition to the traditional carotid intima-media thickness in patients with primary hyperparathyroidism and to determine the parameters closely related to aortic intima-media thickness.

Methods This perspective study included 65 primary hyperparathyroidism patients and 30 healthy-controls. Routine laboratory tests for the diagnosis of hyperparathyroidism and vascular ultrasound examinations were performed. Common carotid, internal carotid, and abdominal aortic intima media thickness were measured. The participants of the study was divided into 3 groups as the control (Group–I), the medical treatment (Group–II) due to primary hyperparathyroidism, and the planned surgery (group–III).

Results Aortic intima-media thickness, serum urea, creatinine, glucose, uric acid, hs-CRP, parathyroid hormone, calcium and urine calcium levels increased significantly from Group–I to Group–III and T–scores and serum phosphorus in levels decreased significantly. Carotid intima-media thicknesses were not significantly different between the groups. Serum and urinary calcium levels were independently associated with aortic intima-media thickness. Aortic intima-media thickness, serum phosphorus, parathyroid hormone, T-scores, serum and urinary calcium levels are independent indicators for Group–III. When the cut-off value of aortic intima-media thickness was taken as 1.5 mm, 80.6% sensitivity and 89.1% specificity were determined for patients who would go to surgery.

Conclusion Serum and urine calcium levels were independently associated with aortic intima-media thickness. Aortic intima-media thickness is more useful than carotid intima-media thickness in showing vascular organ involvement in patients with primary hyperparathyroidism.
Synthesis of Thiophosphates by Coupling of Phosphates with Bunte Salts under Mild Conditions
Authors: Lin Sen , Yan Zhaohua , Min Cong , Zhang Rongxing , Liu Qian
Published: August 2018

A simple, green, and efficient method has been developed for the preparation of thiophosphates with sodium S-benzyl thiosulfates. The method uses an NaBr-catalyzed coupling reaction of Bunte salts with phosphonates in the presence of an acid and hydrogen peroxide (30%), and the desired products were obtained in good yields.
The Use of a Game-Based Decision Aid to Educate Pregnant Women about Prenatal Screening: A Randomized Controlled Study
Authors: Johnson Erin , Wong Bob , Rose Nancy , Latendresse Gwen , Altizer Roger , Zagal Jose , Smid Marcela , Watson Abby , Botkin Jeffrey , Rothwell Erin
Published: August 2018

Purpose This project developed and evaluated the efficacy of a game decision aid among pregnant women about prenatal screening in a randomized controlled study.

Study Design Participants were recruited from an obstetric clinic of an academic urban medical center and randomized (n = 73) to one of two study groups: the control group (n = 39) that used a brochure or the intervention group (n = 34) that also used a game decision aid.

Result Participants who played the game had higher knowledge scores (m = 21.41, standard deviation [SD] = 1.74) than participants in the control group (m = 19.59; SD = 3.31), p = 0.004. The median time of game playing was 6:43 minutes (range: 2:17–16:44). The groups were similar in frequency of completing screening after the study, control = 6 (15%) versus intervention = 11 (32%), p = 0.087. However, the more interaction with the game resulted in more positive attitudes toward screening.

Conclusion The addition of a game decision aid was effective in educating pregnant women about prenatal screening. As other genetic testing decisions continue to increase within clinical care, game-based decision tools may be a constructive method of informed decision-making.
Electrical and spectral characterization of an atmospheric pressure He/CF4 plasma jet
Authors: Chen Sile , Chen Xingyu , Yao Congwei , Xu Guimin , Chang Zhengshi , Zhang Guan-Jun
Published: August 2018

Surface modification of polymeric materials based on non-equilibrium plasma fed with helium (He) and tetrafluoromethane (CF4) has gained much attention. In this paper, an atmospheric pressure plasma jet (APPJ) generated in He/CF4 mixtures is developed, and it is characterized systematically by electrical and optical methods. It is found that the He/CF4 APPJ presents three kinds of discharge modes, i.e., glow discharge, unstable glow discharge, and filamentary discharge under different operation parameters including applied voltage and gas composition. With the increase in applied voltage, the discharge mode transits from glow to filamentary discharge gradually, while the gas composition has significant influences on ignition/extinction voltages and excited species. The discharge modes under different parameters are obtained, and the applied voltage is regarded as the main reason for discharge mode transition. The excited species in the He/CF4 APPJ mainly include the excited helium atoms, the fluorine groups, and the impurities originated from air, whose generation reactions are discussed. The evolution of excited species under different parameters and discharge modes is acquired. The discharge modes and excited species of the He/CF4 APPJ can be well modulated by changing applied voltage and CF4 volume fraction.
Spatial symmetry breaking in single-frequency CCP discharge with transverse magnetic field
Authors: Sharma Sarveshwar , Kaganovich Igor D. , Khrabrov Alexander V. , Kaw Predhiman , Sen Abhijit
Published: August 2018

An independent control of the flux and energy of ions impacting on an object immersed in a plasma is often desirable for many industrial processes such as microelectronics manufacturing. We demonstrate that a simultaneous control of these quantities is possible by a suitable choice of a static magnetic field applied parallel to the plane electrodes in a standard single frequency capacitively coupled plasma device. Our particle-in-cell simulations show a 60% reduction in the sheath width (that improves control of ion energy) and a fourfold increase in the ion flux at the electrode as a consequence of the altered ion and electron dynamics due to the ambient magnetic field. A detailed analysis of the particle dynamics is presented, and the optimized operating parameters of the device are discussed. The present technique offers a simple and attractive alternative to conventional dual frequency based devices that often suffer from undesirable limitations arising from frequency coupling and electromagnetic effects.
Full-waveform inversion and least-squares reverse-time migration imaging of collimated ultrasonic-beam data for high-resolution wellbore integrity monitoring
Authors: Chen Yu , Gao Kai , Davis Eric S. , Sinha Dipen N. , Pantea Cristian , Huang Lianjie
Published: August 2018

Los Alamos National Laboratory (LANL) has recently developed an ultrasonic side-lobe suppressed Bessel collimated beam transducer for low-frequency imaging through highly attenuating materials. We study the effectiveness of using such a collimated ultrasonic-beam transducer for imaging concrete heterogeneities outside borehole casing for high-resolution borehole imaging and wellbore integrity monitoring. We obtain detailed concrete heterogeneities including a low-velocity zone using ultrasound data acquired with a 3D imaging prototype and our recently developed full-waveform inversion and least-squares reverse-time migration methods. Full-waveform inversion fits synthetic ultrasonic waveforms with recorded waveforms to build a high-resolution velocity model. Least-squares reverse-time migration produces a high-resolution structural image showing material discontinuities. Our results demonstrate that LANL's 3D imaging system with a collimated ultrasonic-beam transducer together with full-waveform inversion and least-squares reverse-time migration imaging has great potential for high-resolution single-well borehole imaging and non-destructive evaluation.
Jet amplification and cavity formation induced by penetrable fabrics in hydrophilic sphere entry
Authors: Watson Daren A. , Stephen Jeremy L. , Dickerson Andrew K.
Published: August 2018

Studies of solid impact with fluid surfaces have traditionally considered splashing in the context of impactor shape and surface texture. However, it is not always possible to tune impactor properties for desired splash characteristics. In this experimental study, smooth, hydrophilic, free-falling spheres are allowed to impact a quiescent liquid surface for Weber numbers in the range of 400–1580. The liquid surface is modified by the inclusion of a thin fabric upon which a falling sphere strikes and penetrates at water entry. With respect to clean water, inclusion of a single layer of fabric on the surface increases the Worthington jet height across all entry speeds tested. As the sphere penetrates, the fabric is drawn inward, providing a fabric funnel through which a Worthington jet subsequently passes. We show that the presence of fabric increases the drag at entry and enables air-entraining cavities otherwise unattainable by hydrophilic spheres for the impact speeds tested. Such cavity formation is made possible by alteration of the flow separation angle, analogous to greater values of the advancing contact angle.
Oceanographic boundaries constrain microbial diversity gradients in the South Pacific Ocean
Authors: Raes Eric J. , Bodrossy Levente , van de Kamp Jodie , Bissett Andrew , Ostrowski Martin , Brown Mark V. , Sow Swan L. S. , Sloyan Bernadette , Waite Anya M.
Published: August 2018

Significance

High-resolution data covering marine microbes and microeukaryotes are sparse, even though these organisms control global biogeochemical cycles. Here we present a dataset describing the microbial pro- and eukaryotic diversity along a 7,000-km transect from the Antarctic ice edge to the equator in the South Pacific Ocean. We show that (
i
) temperature is not a primary driver of richness gradients, (
ii
) prokaryotic richness increases with productivity, and (
iii
) oceanographic features can structure the diversity of pro- and eukaryotes. Our data have given us a better understanding of how diversity relates to dissolved inorganic nitrogen and productivity as well as insights into the potential shifts in the geographical range of marine microbe communities in light of the rapidly changing climate.
Crystal Structure of a ligand-bound LacY–Nanobody Complex
Authors: Kumar Hemant , Finer-Moore Janet S. , Jiang Xiaoxu , Smirnova Irina , Kasho Vladimir , Pardon Els , Steyaert Jan , Kaback H. Ronald , Stroud Robert M.
Published: August 2018

Significance

The lactose permease of
Escherichia coli
(LacY), a model Major Facilitator Superfamily transporter, catalyzes galactoside/H
+
symport by an alternating access mechanism that involves multiple conformational transitions. Nanobodies (Nbs) generated against a double mutant (LacY
WW
) that exists in an outward-open conformation stabilize the periplasmic-open conformer of wild-type LacY, block lactose transport, and lead to a 5–50-fold increase in the on-rate for galactoside binding to WT LacY. The galactoside-binding site in galactoside/LacY
ww
/Nb9047 is superimposable with other sugar-bound LacY
ww
structures and therefore is not perturbed due to crystal contacts or nanobody; thus, comparison with apo-LacY
ww
Nb demonstrates that it most likely represents a transport intermediate primarily seen on the periplasmic side in response to the initial galactoside-binding.
“Behave yourself, woman!”
Authors: Ilie Cornelia
Published: August 2018

After a record number of women were elected to the House of Commons in 1997, many incidents of sexism and abusive behaviour were reported. The aim of this article is twofold: on the one hand, to scrutinize the mechanisms and effects of sexist discrimination and stereotyping of women MPs in the House of Commons; on the other, to identify the strategies used by female (and male) MPs to subvert discriminatory representations, and to counteract gender-biased and sexist treatment. The focus of the multi-level analysis is on three recurrent strategies: objectifying women MPs through fixation on personal appearance rather than professional performance (e.g. making trivialising comments about women’s hair and dressing style); patronizing women MPs through the use of derogatory forms of address (e.g. directly addressing them by the terms of endearment “honey”, “dear”, “woman”); and stigmatizing women MPs through abusive and discriminatory labelling (e.g. ascribing to them stereotypically insulting names.
Natural killers shed attachments to kill again
Authors: Felce James H. , Dustin Michael L.
Published: August 2018

Natural killer cells target antibody-bound cells following engagement of the Fc receptor CD16. Srpan et al. (2018. J. Cell Biol. https://doi.org/10.1083/jcb.201712085) reveal that activation-induced shedding of CD16 leads to more motile behavior, allowing more targets to be engaged and killed in a given time.
A Legally Constructed Underclass of Workers? The Deportability and Limited Work Rights of International Students in Australia and the United Kingdom
Authors: Howe Joanna
Published: August 2018

International students have not traditionally been the focus of labour law scholarship, in part because their central purpose in a foreign country is to study rather than work. It is also generally accepted that there is no special reason to focus on international students as a distinct category of workers. This article attests to the particular vulnerability of international students in domestic labour markets, drawing on a comparative study of government policy and practice in relation to international students in Australia and the UK. Immigration rules in both jurisdictions frame the manner in which international students engage in the labour market during their studies. These rules restrict the hours in which international students can engage in paid work during semester, and if breached can result in the international students being deported from the host country. This has the effect of limiting the job market for international students, increasing the power of employers and reducing the likelihood international students will report exploitative work. Instead of strict work hour limits and deportation for breach, governments should rely on other regulatory mechanisms for ensuring international students are present in the host country for the purpose of education rather than work.
Impact of a tailored training on advanced electronic medical records use for providers in a Veterans Health Administration Medical System
Authors: Lopez Christopher A , Omizo Reese K , Whealin Julia M
Published: August 2018

This quality improvement project evaluated the impact of a tailored, evidence-based training strategy on advanced electronic medical record (EMR) use for Veterans Administration (VA) clinicians experienced in using the EMR. After developing the curriculum, an online needs assessment tool evaluated 20 clinicians’ competency gaps. Responses were used to prioritize clinicians’ training needs. Clinician informaticists then provided 2–4 h of tailored training to groups of 1–5 clinicians. Compared with baseline scores (M = 3.59), scores on EMR Task Comfort showed a large improvement in the week following training (M = 4.60; t = 5.41; P <.000, r = 0.58) regardless of baseline level of computer anxiety. Assessment and tailored training methods can help maximize the benefits of resources for EMR training. This formative evaluation suggests that tailored, hands-on training led by clinician informaticists effectively improved clinicians’ EMR comfort and confidence in only 2–4 h.
Nuclear localized Raf1 isoform alters DNA‐dependent protein kinase activity and the DNA damage response
Authors: Nixon Benjamin R. , Sebag Sara C. , Glennon Michael S. , Hall Eric J. , Kounlavong Emily S. , Freeman Michael L. , Becker Jason R.
Published: August 2018

Raf1/c‐Raf is a well‐characterized serine/threonine–protein kinase that links Ras family members with the MAPK/ERK signaling cascade. We have identified a novel splice isoform of human Raf1 that causes protein truncation and loss of the C‐terminal kinase domain (Raf1‐tr). We found that Raf1‐tr has increased nuclear localization compared with full‐length Raf1, and this finding was secondary to reduced binding of Raf1‐tr to the cytoplasmic chaperone FK506 binding protein 5. We show that Raf1‐tr has increased binding to DNA‐dependent protein kinase (DNA‐PK), which inhibits DNA‐PK function and causes amplification of irradiation‐ and bleomycin‐induced DNA damage. We found that the human colorectal cancer cell line, HCT‐116, displayed reduced expression of Raf1‐tr, and reintroduction of Raf1‐tr sensitized the cells to bleomycin‐induced apoptosis. Furthermore, we identified differential Raf1‐tr expression in breast cancer cell lines and showed that breast cancer cells with increased Raf1‐tr expression become sensitized to bleomycin‐induced apoptosis. Collectively, these results demonstrate a novel Raf1 isoform in humans that has a unique noncanonical role in regulating the double‐stranded DNA damage response pathway through modulation of DNA‐PK function.—Nixon, B. R., Sebag, S. C., Glennon, M. S., Hall, E. J., Kounlavong, E. S., Freeman, M. L., Becker, J. R. Nuclear localized Raf1 isoform alters DNA‐dependent protein kinase activity and the DNA damage response. FASEB J. 33, 1138–1150 (2019). www.fasebj.org
Noninvasive measures in atopic dermatitis
Authors: Fluhr Joachim W. , Zuberbier Torsten , Darlenski Razvigor
Published: August 2018

Purpose of review

To summarize the current knowledge on the morphology, functionality and biochemical composition of the skin in allergic reactions. We address novel noninvasive techniques that promise to disclose intimate mechanisms of skin allergy in vivo. Epidermal barrier is not just a static wrap of the organism but rather a dynamic field for immunological, biophysical and biochemical processes and serves as a bio-sensor for exogenous danger signals.

Recent findings

Classical biophysical methods are amended by novel in-vivo techniques, such as Raman spectroscopy, analysing the skin microcomposition and develop epidermal profiles. Visualization techniques, such as reflectance spectroscopy and optical coherence tomography (OCT) are employed in studying the micro-morphological changes in the skin of allergic patients.

The noninvasive assessment of skin functions, micro-morphology and biochemical as well as immunological pathways will help to better understand skin allergies. They will allow to detect subtypes, for example in atopic dermatitis and to develop specific treatment modalities.
Stage-specific incidence trends of melanoma in an English region, 1996–2015: longitudinal analyses of population-based data
Authors: Herbert Annie , Koo Minjoung M. , Barclay Matthew E. , Greenberg David C. , Abel Gary A. , Levell Nick J. , Lyratzopoulos Georgios
Published: August 2018

The aim of this study was to examine temporal trends in overall and stage-specific incidence of melanoma. Using population-based data on patients diagnosed with melanoma in East Anglia, England, 1996–2015, we estimated age-standardized time trends in annual incidence rates for each stage at diagnosis. Negative binomial regression was used to model trends over time adjusted for sex, age group and deprivation, and to subsequently examine variation in stage-specific trends by sex and age group. The age-standardized incidence increased from 14 to 29 cases/100 000 persons (i.e. 4% annually). Increasing incidence was apparent across all stages but was steepest for stage I [adjusted annual increase: 5%, 95% confidence interval (CI): 5–6%, and more gradual for stage II–IV disease (stage II: 3%, 95% CI: 2–4%; stage III/IV: 2%, 95% CI: 1–3%)]. Stage II–IV increase was apparent in men across age groups and in women aged 50 years or older. Increases in incidence were steeper in those aged 70 years or older, and in men. The findings suggest that both a genuine increase in the incidence of consequential illness and a degree of overdiagnosis may be responsible for the observed increasing incidence trends in melanoma in our population during the study period. They also suggest the potentially lower effectiveness of public health awareness campaigns in men and older people.
Intraocular Pressure Lowering Effect of Latanoprost as First-line Treatment for Glaucoma
Authors: Aspberg Johan , Heijl Anders , Jóhannesson Gauti , Lindén Christina , Andersson-Geimer Sabina , Bengtsson Boel
Published: August 2018

Purpose:

The purpose of this study was to assess the intraocular pressure (IOP) - reducing effect of latanoprost in treatment-naïve patients with newly detected open-angle glaucoma with no restriction of the level of untreated IOP.

Methods:

Eighty-six patients (105 eyes) with a diagnosis of open-angle glaucoma received IOP-lowering therapy with latanoprost. The IOP reduction 1 and 3 months after initiation of treatment was recorded.

Results:

Mean untreated IOP for all eyes was 26.2 mm Hg (ranging from 10 to 51 mm Hg). The mean pressure reduction was 7.9 mm Hg (28%), with equivalent average levels at 1 and 3 months. The reduction in IOP ranged from −2.3 to 25.3 mm Hg after 1 month, and from −1.3 to 33.3 mm Hg after 3 months. The pressure-lowering effect was considerably more pronounced in eyes with higher untreated IOP; the reduction increased by 0.55 mm Hg per mm Hg higher untreated IOP. Four eyes, with untreated IOP within statistically normal limits, had no or negative IOP-reduction. A regression model predicted that IOP reduction ended at untreated IOP≤16 mm Hg. Multiple regression analysis showed that an additional IOP-lowering effect of 1.28 mm Hg was achieved in eyes with pseudoexfoliation glaucoma.

Conclusions:

To the best of our knowledge, this paper is the first to report the IOP-reducing effect of latanoprost treatment at all untreated IOP levels in newly detected glaucoma patients. The effect was proportional to the untreated IOP at all levels above 16 mm Hg and better at higher untreated IOP levels, also in relative terms. Our results further confirm the indication of latanoprost as a first-line therapy for glaucoma.
Efficacy of Sertraline in Patients With Major Depressive Disorder Naive to Selective Serotonin Reuptake Inhibitors
Authors: Valle-Cabrera Roselin , Mendoza-Rodríguez Yudexi , Robaina-García Maytee , Ballesteros Javier , Cordero-Jiménez Juan Rafael , Espinosa-Rodríguez Nadia B. , Sotolongo-Garcia Yenia , Lauria-Horner Bianca
Published: August 2018

Purpose

The aim of this study was to assess the efficacy and safety of sertraline compared with placebo in a good clinical practice trial conducted with major depressive disorder patients naive to selective serotonin reuptake inhibitors.

Methods

This was a 10-week randomized, multicenter, placebo-controlled, double blind, superiority trial. Adult patients diagnosed with major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria), total score of 19 to 36 in the 17-item Hamilton Depression Rating Scale (HAMD-17), were randomly allocated to sertraline (n = 39) or placebo (n = 38). Each patient received a fixed dose of sertraline 50 mg/d or placebo for 4 weeks. Afterward a flexible dose up to 200 mg/d was allowed if needed. The primary efficacy end point was clinical response defined as 50% score reduction in HAMD-17 at 10 weeks relative to baseline. Supplementary analysis was performed on HAMD-17 score change from baseline.

Findings

The clinical response favored sertraline (72% vs 32%; relative risk, 2.27; 95% confidence interval, 1.37–3.78; P = 0.0006). A linear mixed model showed arm × time interaction was significant (likelihood ratio test χ2 on 7 df = 48.42, P < 0.0001). The HAMD-17 change score favored sertraline from week 8 onwards. The most frequent adverse events in the sertraline arm were headache, diarrheas, and weight loss.

Implications

In this trial, the benefit of sertraline compared with placebo appeared later than usual. The therapeutic process with a close doctor-patient relationship throughout the trial and the effect expectancy due to a new treatment might explain the response delay.

Trial registration: RPCEC, ID no. 00000128.
Next Generation Sequencing of Sporadic Vestibular Schwannoma: Necessity of Biallelic NF2 Inactivation and Implications of Accessory Non-NF2 Variants
Authors: Carlson Matthew L. , Smadbeck James B. , Link Michael J. , Klee Eric W. , Vasmatzis George , Schimmenti Lisa A.
Published: August 2018

Objectives:

1) Describe the genetic alterations discovered in a series of sporadic vestibular schwannomas (VS). 2) Identify if more clinically aggressive variants possess different genetic alterations compared to more indolent-behaving VS.

Methods:

Fresh frozen tumor and matched peripheral blood leukocytes from 23 individuals with sporadic VS were analyzed using whole-exome sequencing, tumor whole transcriptome expression profiling (mRNA-Seq), and tumor mate-pair analysis. Source cases included tumors with fast preoperative growth, giant tumors in young patients, tumors with macrocystic change, recurrent tumors following radiation or microsurgery, and indolent small tumors with minimal or no growth before surgery. Somatic and germ-line alterations of the NF2 gene and beyond the NF2 locus were identified and analyzed using complementing analyses.

Results:

Biallelic somatic events involving the NF2 gene were discovered in every analyzed tumor specimen with no concurrent NF2 variants identified in matching peripheral blood specimens. Thirteen tumors showed loss of one chromosome 22 (ch22), 4 tumors showed copy-neutral 22q loss of heterozygosity, and 31 unique small variants in the NF2 gene were discovered. Of the latter, 10 were essential splice site, 11 frame shift, 7 stop gain, 2 missense, and 1 in-frame mutation. No other common or recurring NF2 mutations were identified. However, several other notable large chromosomal aberrations were discovered including 2 tumors with loss of a chromosome 21, 3 with loss of an X or Y chromosome, 1 with copy-neutral loss of heterozygosity in chromosome 15, and 1 with loss of 18p and 16q. All of these other major chromosomal abnormalities only occurred in tumors demonstrating a more aggressive phenotype.

Conclusions:

To date, few studies have used whole-exome sequencing, mate-pair analysis, and RNA-seq to profile genome-wide alterations in sporadic VS. Using high-throughput deep sequencing, “two-hit” alterations in the NF2 gene were identified in every tumor and were not present in peripheral blood supporting that all events were somatic. Type of NF2 gene alteration and accessory mutations outside the NF2 locus may predict phenotypic expression and clinical course.
Cochlear Implantation in Organ Transplant Recipients
Authors: Suhling Marie-Charlot , Lenarz Thomas , Teschner Magnus
Published: August 2018

Objective:

Immunosuppressed individuals who have undergone organ transplants, especially children, pose particular challenges in terms of treatment. The aim of this study was to analyze the postoperative complication rate of organ transplant recipients who have also received a cochlear implant (CI).

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Intervention:

The case series includes 13 kidney, liver, lung, and heart transplant patients. Age at treatment ranged from 2 to 71 years, with a total of 17 CIs.

Main Outcome Measures:

Postoperative complications were classified into major and minor, early (within 3 mo postoperatively) and late (>3 mo postoperatively). The results were compared with those for 13 1:1 matched pairs obtained and from our database and a healthy patient collective from our department.

Results:

The global postoperative complication rate was 29.4%. The proportion of patients suffering major complications was 17.6%, with 17.6% having minor complications. Complications that occurred early accounted for 13.3%, and late for 26.7%. No adults, and 33.0% of children, showed any complications after cochlear implantation. The global complication rate (29.4%) was significantly increased compared with the matched pairs (0%, p = 0.013) and department data (13.8%, p = 0.006; Cramers v = 0.102).

Conclusion:

This study demonstrates that organ transplant recipients, and especially children, are at increased risk of postoperative complications after cochlear implantation in comparison with healthy CI recipients.
Electronic Health Record Use Among American Neurotology Society Members
Authors: Kamil Rebecca J. , Giddings Neil , Hoffer Michael , Ying Yu-Lan Mary , Kwartler Jed , Brookler Kenneth , Arriaga Moises , Agrawal Yuri
Published: August 2018

Objective:

To describe the use of electronic health records (EHR) among members of the American Neurotology Society (ANS).

Study Design:

Cross-sectional.

Setting:

Active ANS members in November 2017.

Intervention:

Internet-based survey.

Main Outcome Measure:

Survey that assessed the use of EHR in practice, types of EHR programs, different elements of EHR employed, and respondents’ satisfaction and efficiency with EHR.

Results:

One hundred twenty-seven ANS members responded to the survey with 67 (52.8%) respondents working in academic practice and 60 (47.2%) respondents working in private practice. Epic was the most commonly used EHR with 89 (70.1%) respondents using this system. Among all respondents, 84 (66.1%) respondents reported their efficiency was reduced by EHR use, and there was an even split between respondents who reported they were satisfied versus dissatisfied with their EHR (∼40% each). We found that younger members were more likely to feel EHR increased their efficiency compared with the older members (p = 0.04). In all other analyses, we found no significant difference in efficiency and satisfaction between age groups, practice settings, presence of residents or fellows, or specific EHR used. The main challenges reported by ANS members related to the EHR were increased time burden, poor user interface, lack of customizability, and the focus away from patients.

Conclusions:

The majority of ANS members felt their efficiency decreased as a result of EHR. These findings provide specific changes to the EHR that would improve efficiency and satisfaction among neurotologists.
Evaluation of Outcome Variability Associated With Lateral Wall, Mid-scalar, and Perimodiolar Electrode Arrays When Controlling for Preoperative Patient Characteristics
Authors: Fabie Joshua E. , Keller Robert G. , Hatch Jonathan L. , Holcomb Meredith A. , Camposeo Elizabeth L. , Lambert Paul R. , Meyer Ted A. , McRackan Theodore R.
Published: August 2018

Objective:

Determine the impact of electrode array selection on audiometric performance when controlling for baseline patient characteristics.

Study Design:

Retrospective evaluation of a prospective cochlear implant (CI) database (January 1, 2012–May 31, 2017).

Setting:

Tertiary Care University Hospital.

Patients:

Three hundred twenty-eight adult CI recipients.

Interventions/Main Outcomes Measured:

Hearing outcomes were measured through unaided/aided pure tone thresholds and speech recognition testing before and after cochlear implantation. All reported postoperative results were performed at least 6 months after CI activation. All device manufacturers were represented.

Results:

Of the 328 patients, 234 received lateral wall (LW) arrays, 46 received perimodiolar (PM) arrays, and 48 received mid-scalar (MS) arrays. Patients receiving PM arrays had significantly poorer preoperative earphone and aided PTAs and SRTs, and aided Consonant-Nucleus-Consonant(CNC) word and AzBio +10 SNR scores compared with patients receiving LW arrays (all p ≤ 0.04), and poorer PTAs and AzBio +10 SNR scores compared with MS recipients (all p ≤ 0.02). No preoperative audiological variables were found to significantly differ between MS and LW patients. After controlling for preoperative residual hearing and speech recognition ability in a hierarchical multiple regression analysis, no statistically significant difference in audiological outcomes was detected (CNC words, AzBio quiet, or AzBio +10 SNR) among the three electrode array types (all p > 0.05).

Conclusion:

While previous studies have demonstrated superior postoperative speech recognition scores in LW electrode array recipients, these differences lose significance when controlling for baseline hearing and speech recognition ability. These data demonstrate the proclivity for implanting individuals with greater residual hearing with LW electrodes and its impact on postoperative results.
Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics
Authors: Govil Nandini , DeMayo William M. , Hirsch Barry E. , McCall Andrew A.
Published: August 2018

Objective:

The purpose of this study was to evaluate the impact of patient positioning on physician ergonomics during in-office otologic procedures. A previous simulation study suggested that placing patients supine during in-office otology procedures is ergonomically favorable. This study aims to substantiate these findings during the routine care of patients in an otolaryngology practice setting.

Study Design:

Observational study.

Setting:

Outpatient otology clinic within tertiary care facility.

Study Subjects:

Two neurotology attending physicians.

Interventions:

Physicians performed cerumen removal procedures in the office with patients either in the seated position (n = 24) or supine position (n = 24).

Main Outcome Measures:

The rapid upper limb assessment (RULA), a validated instrument that measures body positioning with a focus on the upper arm, was used to measure ergonomic positioning. RULA scores correlate occupational body positioning with a numeric representation of musculoskeletal injury risk ranging from 1 (minimal risk) to 7 (very high risk).

Results:

Overall median RULA scores were 4.5 (medium risk) with patients in the seated position, and 2 (low risk) with patients in the supine position (p < 0.0001). Similarly, RULA scores were significantly lower with patients in the supine position when each physician was evaluated independently (p < 0.0001, for both).

Conclusions:

Placing patients in a supine position for cerumen removal results in more favorable ergonomic positioning for the physician, thus reducing risk for work-related musculoskeletal disorders. This suggests that physicians should consider placing patients in the supine position for in-office otologic procedures. Further study is needed to investigate optimal ergonomic positioning for other common otolaryngology procedures.
Spontaneous Vestibular Schwannoma Regression: A Case-Control Study
Authors: Tikka Theofano , Yiannakis Constantina P. , Stapleton Emma , Locke Richard , Crowther John A. , Taylor William A. S. , Kontorinis Georgios
Published: August 2018

Objective:

To explore the nature of spontaneously regressing vestibular schwannomas (VS) and identify possible predictive factors for such behavior.

Study Design:

Retrospective case control study.

Setting:

Tertiary referral center, university teaching hospital.

Patients:

Patients with sporadic VS demonstrating spontaneous regression compared with a control group of patients with growing VS.

Interventions:

Review of serial magnetic resonance imaging of the internal auditory meatus (MRI IAM) and case notes and direct comparison of possible related factors between the two groups using univariate analysis.

Main Outcome Measures:

Presenting symptoms, VS size and consistency, patients’ age and sex, tumor laterality and location, and the neutrophil-to-lymphocyte ratio between the two groups.

Results:

Of the 540 patients on the database 28 (5.2%) showed spontaneous regression with a mean follow-up of 122 months. Mean absolute and relative regression was 3.9 mm and 25.7%, respectively. 60% of tumors showed gradual regression while 25% showed growth followed by regression. Regressing VS had a significantly larger size than the control group; while the regressing tumors were located further from the fundus than the control group. The remaining examined factors did not reach a statistical level of significance.

Conclusion:

This is, to our knowledge, the first study comparing a cohort of regressing tumors with a control group of growing VS. The finding that the location of tumors around the porous, is more common in regressing VS has implications for patients’ counselling.
Resource Utilization and Outcomes of Medicare Recipients With Chronic Hepatitis B in the United States
Authors: Kim Min , Paik James , Golabi Pegah , Jeffers Thomas , Mishra Alita , Younossi Zobair M.
Published: August 2018

Goals:

To assess the outcomes and resource utilization of chronic hepatitis B (CH-B) among Medicare beneficiaries.

Background:

CH-B is highly prevalent among immigrants from endemic areas. Although incidence of CH-B is stable in the United States, CH-B patients have become Medicare eligible.

Study:

We used the inpatient and outpatient Medicare database (2005 to 2014). Adult patients with CH-B diagnosis were included. One-year mortality and resource utilization were assessed. Independent associations with resource utilization and mortality were determined using multivariate analysis.

Results:

Study cohort included 18,603 Medicare recipients with CH-B. Between 2005 and 2014, number of Medicare beneficiaries with CH-B increased by 4.4% annually. The proportion of beneficiaries with CH-B who were whites decreased while those who were Asians increased (P<0.05). Furthermore, 7.4% of CH-B Medicare cohort experienced decompensated cirrhosis, 2.9% hepatocellular carcinoma (HCC) and 11.9% 1-year mortality. Although the number of inpatients with CH-B remained stable, the number of outpatient encounters increased. Annual total inpatient charges increased from $66,610 to $94,221 while these charges for outpatient increased from $9257 to $47,863. In multivariate analysis, age [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.04-1.05], male gender [OR, 1.24 (95% CI, 1.12-1.38)], decompensated cirrhosis [OR, 3.02 (95% CI, 2.63-3.48)], HCC [OR, 2.64 (95% CI, 2.10-3.32)], and higher Charlson comorbidity index [OR, 1.24 (95% CI, 1.21-1.27)] were independently associated with increased 1-year mortality. HCC and higher Charlson comorbidity index were also associated with higher inpatient and outpatient charges, and inpatient length of stay (all P<0.001).

Conclusions:

CH-B infection has been rising in Medicare population and is responsible for significant mortality and resource utilization.
Nonalcoholic fatty liver disease: current concepts, epidemiology and management strategies
Authors: Tomic Dunya , Kemp William W. , Roberts Stuart K.
Published: August 2018

Nonalcoholic fatty liver disease (NAFLD) is now the most prevalent liver disease in the world. It involves a spectrum of conditions from hepatic steatosis to nonalcoholic steatohepatitis and liver fibrosis, and is a major cause of cirrhosis and hepatocellular carcinoma. It is defined by presence of steatosis in 5% of hepatocytes or more in the absence of other causes of fatty liver. The metabolic syndrome is the major known risk factor for NAFLD. Dietary contributors such as high fructose intake and coffee consumption appear to increase and decrease the risk of disease respectively, but these links are unclear. Genetic associations have also been identified. The estimated prevalence of the disease varies according to diagnostic method and population demographics. It appears to be a major issue in Europe with population studies showing up to 50% of the individuals are affected while in the USA one in three adults are estimated to have NAFLD. Laboratory investigations and ultrasound are typically first-line investigations. Fibrosis may be assessed noninvasively through transient elastography and biomarkers but liver biopsy remains the gold standard to quantify hepatic damage. Associated comorbidities include cardiovascular disease and chronic kidney disease. Weight loss, dietary changes and exercise are recommended in management. Medications should be considered to manage underlying risk factors including insulin resistance. Surgical options include bariatric procedures and liver transplantation. The combination of rising prevalence and significant potential complications warrant further research into NAFLD, particularly in areas with research gaps including Eastern Europe.
Alternatively spliced tissue factor levels are elevated in the plasma of patients with chronic liver diseases
Authors: Caversaccio Nathalie I. , Reina Caro Maria D. , Prince Raja , Müller Martin , Lewis Clayton S. , Bogdanov Vladimir Y. , Dufour Jean-François , Angelillo-Scherrer Anne
Published: August 2018

Objectives

In patients with chronic liver diseases, hypercoagulability can contribute to the progression of fibrosis and complications of cirrhosis. Tissue factor (TF) is a transmembrane glycoprotein that initiates the extrinsic pathway of blood coagulation. Recent investigations have established that TF is elevated in patients with pancreatic cancer, blood disorders, diabetes, and cardiovascular disease. Alternatively spliced tissue factor (asTF), a secreted form of TF, induces angiogenesis and exhibits low-level procoagulant activity. The aim of this study was to investigate whether the circulating levels of asTF are elevated in the plasma of patients with liver disease.

Materials and methods

In a single-center study, we retrospectively analyzed asTF plasma levels in healthy participants and patients having stage F0–F3 liver fibrosis, liver cirrhosis, as well as hepatocellular carcinoma (HCC). AsTF plasma levels were measured using a sandwich enzyme-linked immunosorbent assay. Values were expressed as median with interquartile range (IQR).

Results

The lowest median plasma asTF concentration (94 pg/ml, IQR: 33–275) was found in the healthy control group. The patients with low-grade liver fibrosis (F0–F1 group) displayed the highest median asTF concentration (404 pg/ml, IQR: 277–789). Significant differences between the asTF levels in the plasma of healthy participants and those in patients with grade F0–F1 fibrosis (P<0.001), patients with grade F2–F3 fibrosis (P=0.019), patients with cirrhosis (P=0.004), and patients with HCC (P<0.001) were found using a Wilcoxon rank-sum test. Treatment-naive patients with HCC had significantly higher asTF levels (P=0.018) than those receiving treatment. AsTF levels were found to increase with worsening Child–Pugh scores and heightened liver disease activity.

Conclusion

AsTF levels are elevated in patients with chronic liver diseases, which increase with worsening Child–Pugh scores and decrease following HCC therapy.
Clinical and pathological profile of eosinophilic gastroenteritis
Authors: Sato Hiroki , Honma Terasu , Owaki Takashi , Tominaga Kentaro , Yokoyama Junji , Terai Shuji
Published: August 2018

Background

Eosinophilic gastroenteritis (EoGE) can be diagnosed on the basis of histologic criteria; however, the pathology is considered to be heterogeneous. There is no consensus on the management of this enigmatic disorder with an unknown etiology.

Patients and methods

Data for patients diagnosed with EoGE and followed up over a 1-year period were analyzed. Their symptoms, patterns of flares, and type of treatment were documented. The shift in peripheral blood eosinophil levels was also examined.

Results

A total of 10 (mean age, 44 years; range: 31–70 years; women, 5) patients were diagnosed with EoGE. The most frequent presenting symptom was abdominal pain, and eight patients were classified with mucosal type of EoGE. Chronic disease or multiple flares were observed in seven out of 10 (70.0%) patients, and all of them had a history of allergy. Four were corticosteroid dependent (three relapsed during corticosteroid tapering and one following corticosteroid withdrawal). One of them received anti-IL5 monoclonal antibody that enabled corticosteroid dose tapering. In four patients with highly elevated initial eosinophil levels at diagnosis, the peripheral eosinophil level correlated with the amelioration and deterioration of their symptoms. The remaining three patients had a single flare without relapse. Two had no history of allergy.

Conclusion

EoGE is a unique disorder with a variable clinical course. Although further studies are required to confirm our observations, the presence of other allergic disorders is associated with chronicity or multiple flares. Peripheral eosinophil level may be an effective biomarker for recurrence in patients with severe systemic disorders at diagnosis.
Assessing Trends in Hospital System Structures From 2008 to 2015
Authors: Walker Daniel M. , Mora Arthur M. , Hogan Tory H. , Diana Mark L. , McAlearney Ann Scheck
Published: August 2018

Background:

The Affordable Care Act introduced a major systematic change aimed to promote coordination across the care continuum. Yet, it remains unknown the extent to which hospital system structures have changed following the Affordable Care Act. The structure of hospital systems has important implications for the cost, quality, and accessibility of health services.

Objectives:

To assess trends in the structures of hospital systems.

Research Design:

We aggregated data from the American Hospital Association (AHA) Annual Survey to the system level. Using a panel of hospital systems from 2008 to 2015, we assessed trends in the number of hospital systems, their size, ownership characteristics, geospatial arrangements, and integration with outpatient services.

Results:

In the period 2008–2015, there was an increasing percentage of hospitals that were system affiliated as well as growth in the number of hospital systems. A greater percentage of hospital systems that were organized as moderately centralized systems transitioned to centralized systems than to decentralized systems (19.8% vs. 4.7%; P<0.001). In terms of geospatial arrangement, a greater percentage of hub-and-spoke systems moved to a regional design than to national systems (20.0% vs. 8.2%; P<0.05). An increasing trend over time toward greater integration with outpatient services was found in a measure of total system level integration with outpatient services.

Conclusions:

Our findings suggest that hospital systems may be moving toward more regional designs. In addition, the trend of increasing integration offered across hospital systems overall, and as portion of total integration, suggests that systems may be increasing their services along the continuum of care.