bluuebunny/crossref_metadata_2025 huggingface dataset:
History of Evolutionary Thought Since 1930
Authors: Millstein Roberta , Dietrich Michael , Skipper Robert A.
Published: February 2019

Evolutionary biology underwent several significant transformations in the period after 1930. While mid-century was dominated by the evolutionary synthesis and the professionalization of evolutionary biology, the second half of the 20th century saw evolutionary research diversifying and the domain of evolutionary phenomena expanded, especially in response to the rise of molecular biology. While what happened in 1950 may seem ancient to a contemporary evolutionary biologist, to a historian of biology the last half of the 20th century is recent history. Where the literature on Darwin could fill a bibliography by itself, the history of modern evolutionary biology is neither as extensive nor as comprehensive. Some topics such as the evolutionary synthesis and molecular evolution have a rich historical literature. Others such as cultural evolution or quantitative genetics still await further historical analysis: not because they are undeserving, but because they are just now becoming ripe for historical investigation. For the purposes of this article, we selected significant pieces of historical and some philosophical scholarship that address major developments in the history of evolutionary biology. We did not select so-called classic papers by evolutionary biologists or review papers written by biologists. Instead our focus was on evolutionary biology as it has been contextualized and discussed by historians who have often been seeking to address a range of non-biological issues regarding the nature and practice of science, and how different aspects of evolutionary biology reflect the time and place of their development.
Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?
Authors: van Lunteren Miranda , van der Heijde Désirée , Sepriano Alexandre , Berg Inger J , Dougados Maxime , Gossec Laure , Jacobsson Lennart , Ramonda Roberta , Rudwaleit Martin , Sieper Joachim , Landewé Robert , van Gaalen Floris A
Published: February 2019

Objectives

A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known.

Methods

In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis.

Results

In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis.

Conclusion

In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.
Evaluation of the effects of biochar on diet digestibility and methane production from growing and finishing steers
Authors: Winders Thomas M , Jolly-Breithaupt Melissa L , Wilson Hannah C , MacDonald James C , Erickson Galen E , Watson Andrea K
Published: February 2019

The objectives of these studies were to evaluate the effects of biochar (0%, 0.8%, or 3% of diet dry matter) on diet digestibility and methane and carbon dioxide production from cattle on growing and finishing diets. The growing diet consisted of 21% brome hay, 20% wheat straw, 30% corn silage, 22% wet distillers grains plus solubles, and 7% supplement. The finishing diet consisted of 53% dry-rolled corn, 15% corn silage, 25% wet distillers grains plus solubles, and 7% supplement. In both trials biochar replaced fine ground corn in the supplement. Six crossbred steers (initial body weight [BW] 529 kg; SD = 16 kg) were used in both the growing and finishing trial. The growing diets were evaluated over 6 periods followed by the finishing trial with 3 periods. Digestibility measures were taken over 4 d after at least 8 d of adaptation to diets followed by 2 d of gas emission measurements using headbox calorimeters. Dry matter intake (DMI) was not affected (P ≥ 0.43; 7.91 kg/d) by biochar inclusion in the growing study and increased quadratically (P = 0.07) in the finishing study with 0.8% biochar inclusion having the greatest DMI (12.9 kg/d). Organic matter (OM) and neutral detergent fiber (NDF) digestibility increased quadratically (P = 0.10) in the growing study whereas OM digestibility tended to linearly decrease (P = 0.13) and NDF digestibility was not affected (P ≥ 0.39) by biochar inclusion in the finishing diet. Digestible energy intake (Mcal/d) was not affected (P ≥ 0.25) by biochar inclusion in the growing or finishing study. Methane production (g/d) tended to decrease quadratically (P = 0.14) in the growing study and was decreased 10.7% for the 0.8% biochar treatment relative to the control. There were no statistical differences in methane production (g/d) in the finishing study (P ≥ 0.32) but cattle on the 0.8% biochar treatment produced numerically less (9.6%) methane than the control. Methane production as g/kg DMI of the 0.8% biochar treatment relative to the control was numerically reduced 9.5% and 18.4% in the growing and finishing studies, respectively (P ≥ 0.13). Carbon dioxide production (g/d and g/kg of intake) quadratically decreased (P ≤ 0.06) in the growing study but was not affected by treatment in the finishing study (P ≥ 0.34). Although biochar is not a U.S. Food and Drug Administration -approved feed for cattle, the initial research shows potential as a methane mitigation strategy in both growing and finishing diets.
Role Transition of Clinical Nurse Educators Employed in Both Clinical and Faculty Positions
Authors: Wenner Teresa A. , Hakim Amy Cooper
Published: February 2019

AIM

The aim of this study was to explore how nurses experienced the role transition from clinical expert to part-time clinical faculty member when they worked in both a clinical and academic setting.

BACKGROUND

In response to the current nurse faculty shortage and the anticipated return of a nationwide shortage of registered nurses, the use of part-time clinical nurse educators has been increasing.

METHOD

Fourteen RNs were interviewed using online video conferencing for this qualitative phenomenological study.

RESULTS

Study findings revealed seven key themes: different background-different experiences, guidance and support, challenges along the way, maintaining two work roles, influences of prior work experience, influence of personal attributes, and recommendations for successful transition.

CONCLUSION

This work-role transition was found to be highly individualized and multifactorial. Results of the study may be beneficial in future administrative decision-making.
Using Virtual Interactive Digital Simulator to Enhance Simulation Experiences for Undergraduate Nursing Students
Authors: Betts Lorraine , Schmid Jacqueline , Sivaramalingam Suba , Verkuyl Margaret
Published: February 2019

It is increasingly difficult to find quality clinical placements that allow nursing students to work with high acuity patients. To address this need, simulation is recommended; however, human patient simulation is costly from a human and resource perspective. In a search for alternatives, we offered a simulation experience using a virtual interactive digital simulator and evaluated student outcomes. This emerging technology, although not intended to replace human patient simulation, shows promise in enabling easier, more self-directed access to simulation for students.
Measured Emotional Intelligence in Baccalaureate Nursing Education: A Longitudinal Study
Authors: Cheshire Michelle H. , Strickland Haley P. , Ewell Patrick J.
Published: February 2019

Emotional intelligence (EI) includes the ability to perceive, facilitate, understand, and manage emotions. EI impacts the quality of care nurses provide to patients as members of the health care team. The purpose of this study was to determine if measured EI of nursing students changed during a professional nursing program. A quantitative longitudinal correlational design was used to measure EI scores of nursing students at the beginning and end of a baccalaureate nursing program. Findings include a statistically significant decrease of total EI scores over time, as well as a significant decrease in two of the ability subscales.
Impact of Anesthesia on Long-term Outcomes in Patients With Supratentorial High-grade Glioma Undergoing Tumor Resection: A Retrospective Cohort Study
Authors: Dong Jia , Zeng Min , Ji Nan , Hao Shuyu , Zhou Yang , Gao Zhixian , Gu Hongqiu , Zhang Li , Ma Daqing , Peng Yuming , Han Ruquan
Published: February 2019

Background:

Intravenous and inhalational anesthesia might have different associations with long-term outcome in cancer patients, with reports of adverse effects of inhalation anesthesia. However, the effects of anesthesia in patients with high-grade glioma (HGG) are not known.

Methods:

This study investigated 154 patients who received propofol and 140 patients who received sevoflurane for maintenance of anesthesia during HGG tumor resection. The primary outcomes were progression-free survival and overall survival.

Results:

Median progression-free survival was 10 months (interquartile range [IQR], 6 to 18) versus 11 months (IQR 6 to 20; P=0.674), and median overall survival was 18 months (IQR, 11 to 39) versus 18 months (IQR, 10 to 44; P=0.759) in patients maintained with propofol and sevoflurane, respectively. Higher preoperative Karnofsky performance status and postoperative chemotherapy were associated with a reduced hazard of tumor progression or death, whereas higher age-adjusted Charlson comorbidity index and longer duration of anesthesia were associated with an increased hazard of progression or death. World Health Organization tumor classification IV and incomplete tumor resection were associated with an increased hazard of tumor progression but not death. Anesthesia maintenance with sevoflurane increased the risk of death in patients with Karnofsky performance status <80 compared with propofol (hazard ratio, 1.66; 95% confidence interval, 1.08-2.57; P=0.022).

Conclusions:

Compared with maintenance of anesthesia with propofol, sevoflurane did not worsen progression-free or overall survival in patients with HGG undergoing tumor resection. However, propofol might be beneficial in patients with poor preoperative Karnofsky performance status.
Effectiveness of school scoliosis screening and the importance of this method in measures to reduce morbidity in an Italian territory
Authors: Aulisa Angelo G. , Giordano Marco , Guzzanti Vincenzo , Falciglia Francesco , Pizzetti Paolo , Toniolo Renato M.
Published: February 2019

Although several procedures for treating scoliosis have been developed, the most effective treatment is still based on early detection. For early diagnosis of idiopathic scoliosis, many authors have proposed methods of school screening; however, there is still no standardized screening program. The aim of this study was to evaluate a school screening method and the prevalence and distribution of scoliosis in Italian school children, aged 9–14 years, and to determine if the screening method can reduce morbidity in an Italian territory. The screening program consisted of three steps: the first step was a clinical examination carried out by the school physician and two specialists. In the second step, doubtful cases (presence of a hump between the two sides of the torso, in the thoracic or thoracolumbar region, measured using a hump meter) were evaluated by an orthopedic specialist and subsequently controlled every 6 months either clinically or by radiographic examination. The third step was the classification of the scoliosis and procedures for treatment. All patients were scheduled for a follow-up program and were evaluated during the subsequent 3 years. Statistical analyses were performed with GraphPad Prism 6. A total of 8995 children were screened for scoliosis. Of these, 487 showed clinical signs of scoliosis, and 181 were referred for anteroposterior radiographs because of a positive result on the forward-bending test (hump>5 mm). No significant statistical difference was observed by the three clinical examiners. Of the 181 patients who were referred, 69 were radiographed, and the clinical diagnosis was confirmed in 94.2% of the cases. The prevalence of scoliosis (defined as a curve of ≥10°) was 0.76% (65 of 8995 children), and most of the curves (44; prevalence 67.69%) were small (<20°). The overall ratio of boys to girls was 1 : 3.3, but varied according to the magnitude of the curve (1 : 3 for curves of <20°, 1 : 3.25 for curves of 20–29°, and 1 : 4 for curves of ≥30°). Double curves were the most common type identified, followed by thoracolumbar curves; specifically, of the 65 children who had a curve, 21 (32.30%) had a double curve, 18 (27.6%) had a thoracolumbar curve, 17 (26.1%) had a lumbar curve, and nine (13.84%) had a thoracic curve. In the following 3 years, only four patients were found to have curves more than 20° and none more than 30°. Our results show that the school screening program was accurate and repeatable. Moreover, screening children for scoliosis using a simple test appears to be an effective means of early detection. Above all, the screening process effectively decreased morbidity in the territory at a negligible cost.
Peroneal Tendon Tears: When to Use an Allograft
Authors: Hanselman Andrew E. , Easley Mark E.
Published: February 2019

Allograft reconstruction of chronic peroneal tendon tears is a safe and effective option to help restore patient function and limit pain. Both the author’s experience, along with cadaveric and clinical studies, have shown that this technique can restore function and stability. The authors provide step-by-step instruction of their preferred allograft reconstruction technique for chronic peroneal attritional injuries, while limiting the comorbidities that may be seen with autograft reconstruction.

Level of Evidence: Level IV—review article, expert opinion, operative technique.
Management of Chronic Hypertension Following Intracerebral Hemorrhage
Authors: Van Matre Edward T. , Cook Aaron M. , Shah Samarth P. , Rydz Alexandria C. , Smetana Keaton S.
Published: February 2019

Acute blood pressure control after a cerebrovascular event is integral in the immediate care of these patients to preserve perfusion to ischemic areas and prevent intracerebral bleeding. The majority of patients with ischemic stroke or intracerebral hemorrhage (ICH) present with preexisting hypertension and therefore require a treatment plan after the acute phase. The presence of chronic hypertension after ICH has often been discussed as a modifiable risk factor for recurrent events. Clinical evidence is relatively lacking for clinicians to understand the extent of blood pressure lowering and the optimal agents to use in this setting. Limited data exist describing the long-term management of hypertension in patients after cerebrovascular events. This review provides nurses with a summary of the available literature on long-term blood pressure management to minimize the risk of secondary ICH and ischemic stroke. It focuses on oral antihypertensive medications available in the United States that may be utilized to manage chronic hypertension immediately after the postacute phase of care to lower blood pressure and to improve long-term outcomes.
Porphyria
Authors: Hudgins Kerstin
Published: February 2019

Diagnosis of porphyria is often difficult due to the range of symptoms, which are common in many other disorders, hence frequently leading to misdiagnosis. Attacks can be triggered through sunlight and contact with diverse substances, including medications. Signs are severe, appear quickly, and tend to last from days to weeks, affecting the skin, mentation, the digestive, cardiovascular, nervous, and muscular system. Neuropathy signifies a severe and potentially life-threatening attack. Porphyria is mainly an inherited disorder, but can be acquired, and emerges in adults and children. The exact rates of porphyria are unknown and vary around the world. Diagnosis, clinical presentation, treatment, and disease management are introduced.
Alvimopan Significantly Reduces Length of Stay and Costs Following Colorectal Resection and Ostomy Reversal Even Within an Enhanced Recovery Protocol
Authors: Hyde Laura Z. , Kiely James Mark , Al-Mazrou Ahmed , Zhang Haiqing , Lee-Kong Steven , Kiran Ravi Pokala
Published: February 2019

BACKGROUND:

Alvimopan accelerates GI recovery after colorectal resection. Data on real-world cost-effectiveness have been mixed.

OBJECTIVE:

This study aimed to evaluate if adding alvimopan to an enhanced recovery pathway reduces length of stay.

DESIGN:

Patients undergoing colorectal resection or ostomy reversal for the year before and after the introduction of alvimopan were evaluated.

SETTING:

This study was conducted at a single academic medical center.

PATIENTS:

Patients undergoing elective colorectal resection (488) or ostomy reversal (148) were included.

MAIN OUTCOME MEASURES:

The primary outcomes measured were length of stay and prolonged length of stay defined as >75th percentile for each procedure.

RESULTS:

Two hundred eighty-six patients (45%) received alvimopan. Alvimopan and no-alvimopan groups had similar demographics, comorbidities, operative indication, and case mix. In the alvimopan group, more of the colorectal resections were laparoscopic (87% vs 79%, p = 0.015). Length of stay was reduced with alvimopan (6.2 vs 4.9 days, p = 0.003), and this effect persisted when controlling for procedure type, approach, and ASA class (decreased length of stay by 1.0 day, p = 0.014). The alvimopan group had lower risk of prolonged length of stay (14.7% vs 23.1%, p = 0.007) and ileus (10.8% vs 16.2%, p = 0.05). On multivariable analysis, no alvimopan use (OR, 1.8; 95% CI, 1.2–2.7), ASA ≥3 (OR, 2.0; 95% CI, 1.3–3.1), and history of cardiac surgery (OR, 2.8; 95% CI, 1.2–6.5) were significant predictors of prolonged length of stay. Alvimopan use was associated with a lower risk of infectious complications other than surgical site infection (2.8% vs 6.7%, p = 0.025), and did not increase risk of any adverse outcomes. The addition of alvimopan to the protocol resulted in cost savings of $708.39 per patient.

LIMITATIONS:

Data collected from a single center limit external validity.

CONCLUSIONS:

The introduction of alvimopan to a postoperative protocol following elective colorectal resection or ostomy reversal significantly reduces length of stay and is associated with cost savings even within an enhanced recovery protocol. See Video Abstract at http://links.lww.com/DCR/A911.
SINGLE NUCLEOTIDE POLYMORPHISMS IN RETINAL DETACHMENT PATIENTS WITH AND WITHOUT PROLIFERATIVE VITREORETINOPATHY
Authors: Lumi Xhevat , Jelen Mateja M. , Zupan Andrej , Boštjančič Emanuela , Ravnik-Glavač Metka , Hawlina Marko , Glavač Damjan
Published: February 2019

Purpose:

To investigate differences in genotype distributions of single nucleotide polymorphisms within genes, encoding inflammatory mediators, among patients with rhegmatogenous retinal detachment (RRD) and patients with proliferative vitreoretinopathy (PVR).

Methods:

A genetic association study was performed on 191 Slovenian patients, divided into 2 groups: 113 RRD patients with PVR and 78 RRD patients without PVR. Genotype distributions were investigated within the following 13 single nucleotide polymorphisms: rs3760396 (CCL2), rs9990554 (FGF2), rs17561 (IL1A), rs2069763 (IL2), rs1800795 (IL6), rs1800871 (IL10), rs3008 (JAK3), rs2229094 (LTA), rs1042522 (TP53), rs7656613 (PDGFRA), rs7226855 (SMAD7), rs1800471 (TGFB1), and rs1800629 (TNF).

Results:

Differences in genotype distributions between patients with RRD with or without PVR were detected in rs1800795 (IL6) (P = 0.04), rs1800871 (in the vicinity of the IL10) (P = 0.034), and rs1800471 (TGFB1) (P = 0.032). After adjustment none of the 13 analyzed single nucleotide polymorphisms showed statistically significant associations in single nucleotide polymorphism genotype distributions between patients with RRD with and without PVR.

Conclusion:

Further research is needed, particularly expanded multicentric population-based studies, to clarify the issue of genetic contribution to PVR from different genetic, clinical, and population-based aspects.
Neuropsychiatric Safety and Efficacy of Varenicline, Bupropion, and Nicotine Patch in Smokers With Psychotic, Anxiety, and Mood Disorders in the EAGLES Trial
Authors: Evins A. Eden , Benowitz Neal L. , West Robert , Russ Cristina , McRae Thomas , Lawrence David , Krishen Alok , St Aubin Lisa , Maravic Melissa Culhane , Anthenelli Robert M.
Published: February 2019

Background

Neuropsychiatric safety and relative efficacy of varenicline, bupropion, and transdermal nicotine patch (NRT) in those with psychiatric disorders are of interest.

Methods

We performed secondary analyses of safety and efficacy outcomes by psychiatric diagnosis in EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study), a 12-week, randomized, double-blind, triple-dummy, placebo- and active (NRT)–controlled trial of varenicline and bupropion with 12-week follow-up, in a subset population, n = 4092, with a primary psychotic (n = 390), anxiety (n = 792), or mood (n = 2910) disorder. Primary end-point parameters were incidence of prespecified moderate and severe neuropsychiatric adverse events (NPSAEs) and weeks 9 to 12 continuous abstinence rates (9–12CAR).

Results

The observed NPSAE incidence across treatments was 5.1% to 6.3% in those with a psychotic disorder, 4.6% to 8.0% in those with an anxiety disorder, and 4.6% to 6.8% in those with a mood disorder. Neither varenicline nor bupropion was associated with significantly increased NPSAEs relative to NRT or placebo in the psychiatric cohort or any psychiatric diagnostic subcohort. There was a significant effect of treatment on 9–12CAR (P < 0.0001) and no significant treatment-by-diagnostic subcohort interaction (P = 0.24). Abstinence rates with varenicline were superior to bupropion, NRT, and placebo, and abstinence with bupropion and NRT was superior to placebo. Within-diagnostic subcohort comparisons of treatment efficacy yielded estimated odds ratios for 9–12CAR versus placebo of greater than 3.00 for varenicline, greater than 1.90 for bupropion, and greater than 1.80 for NRT for all diagnostic groups.

Conclusions

Varenicline, bupropion, and nicotine patch are well tolerated and effective in adults with psychotic, anxiety, and mood disorders. The relative effectiveness of varenicline, bupropion, and NRT versus placebo did not vary across psychiatric diagnoses.
Decisional Balance for Insulin Injection: Scale Development and Psychometric Testing
Authors: HSU Hui-Chun , CHEN Shi-Yu , HUANG Yu-Chi , WANG Ruey-Hsia , LEE Yau-Jiunn , AN Ling-Wang
Published: February 2019

Background

Insulin-naive patients are often reluctant to receive insulin treatment, and even insulin-treated patients frequently have poor rates of adherence to their prescribed insulin injection regimes. Assessing attitudes toward insulin injection may help in the design of interventions that improve the insulin injection behaviors of patients with type 2 diabetes (T2DM). The concept of decisional balance has been associated with behavior in many studies and may be useful in assessing the attitude of patients with T2DM toward insulin injection. Decisional balance for insulin injection (DBII) has not been widely assessed in patients with T2DM.

Purpose

The aim of this study was to develop an insulin injection (DBII) scale that is valid for insulin-naive and insulin-treated patients and to test the psychometric characteristics of this scale based on the concept of decisional balance.

Methods

This cross-sectional study administered an 18-item DBII scale, including pro and con subscales, to 95 insulin-naive and 237 insulin-treated patients in Taiwan. The decisional balance score was calculated as the mean score of the pro subscale minus the mean score of the con subscale. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis; concurrent validity was assessed by examining the association between the score of the DBII scale and the stages of behavioral change and of hemoglobin A1c for, respectively, insulin-naive patients and insulin-treated patients; and reliability was assessed using internal consistency and test–retest reliability.

Results

A 13-item DBII scale supported by exploratory factor analysis and confirmatory factor analysis was developed. The stages of behavioral change and hemoglobin A1c levels were found to be significantly associated with the scores of decisional balance of the 13-item DBII scale for both insulin-naive and insulin-treated patients. The Cronbach's α ranged between .78 and .92.

Conclusions

The 13-item DBII scale is appropriately short and possesses satisfactory validity and reliability for both insulin-naive and insulin-treated patients with T2DM. Healthcare providers may use this scale as a checklist to guide clinical discussions related to insulin therapy with both insulin-naive and insulin-treated patients with T2DM across time.
Surgical Outcomes on Hearing and Vestibular Symptoms in Barotraumatic Perilymphatic Fistula
Authors: Ahn Jungmin , Son Se-Eun , Choi Ji Eun , Cho Young Sang , Chung Won-Ho
Published: February 2019

Objective:

To analyze surgical results on hearing and vestibular symptoms in patients with barotraumatic perilymphatic fistula (PLF) according to diagnostic criteria.

Methods:

A total of 39 patients (41 ears) who underwent surgery on suspicion of barotraumatic PLF from January 2005 to December 2017 were included. Pure tone audiometry and videonystagmography (VNG) recording for spontaneous nystagmus and positional tests were performed preoperatively and postoperatively at 1 week and 1 month. Surgical outcomes were analyzed based on hearing results, subjective dizziness, and change of nystagmus.

Results:

Preoperative hearing level was 75.5 ± 28.7 dB for definite PLF and 88.5 ± 22.8 dB for probable PLF, and levels were not significantly different between groups. Preoperatively, subjective dizziness was present in 18 (94.7%) and 19 (95%) in each group. Among 39 patients, 24 had VNG recordings. Positional nystagmus was recorded in 87.5% (7/8) and 87.5% (14/16) of the definite and probable PLF groups, respectively. Postoperatively, hearing was improved in 65% (13/20 ears) of definite PLF and 61.9% (13/21 ears) of probable PLF. There was no significant difference between the two groups. Hearing gain was significantly correlated with the time interval between symptom onset and surgical timing. Subjective dizziness was improved immediately after surgical repair in 97.4% (17/18) of definite PLF patients and 100% (19/19) of probable PLF patients. Even though dizziness was improved in most patients, some had persistent positional nystagmus and recurrent dizziness.

Conclusions:

Surgical sealing of both windows in suspected barotraumatic PLF is an effective treatment to improve hearing and subjective dizziness.
Improvement or Recovery From Sudden Sensorineural Hearing Loss With Steroid Therapy Does Not Preclude the Need for MRI to Rule Out Vestibular Schwannoma
Authors: Puccinelli Cassandra , Carlson Matthew L.
Published: February 2019

Objective:

There is a common misconception that improvement in sudden sensorineural hearing loss (SSNHL) after treatment with steroid therapy effectively excludes the diagnosis of a vestibular schwannoma (VS) and such cases do not warrant an MRI. Paralleling this, steroids are commonly withheld for SSNHL in patients with an existing diagnosis of VS, believing that this condition is not steroid-responsive. This study seeks to underscore that improvement or recovery of SSNHL with steroid therapy does not exclude the diagnosis of VS and does not preclude the need for magnetic resonance imaging.

Methods:

A retrospective chart review was performed (2002–2017) of patients with previously untreated sporadic VS who developed SSNHL that improved after steroid treatment. A clinically significant audiometric improvement was defined as an increase of more than or equal to 15% in word recognition score (WRS) and/or decrease of more than or equal to 15 dB in 4-frequency pure-tone average (PTA). To supplement these data, a separate population of patients with incomplete or missing audiometric data, who reported unequivocal subjective improvement in hearing after steroid treatment, were also described to reinforce the study objective. Patient demographics, tumor characteristics, steroid regimen, and data regarding treatment response were recorded.

Results:

A total of 29 patients (55% women; median age of 47 yr) met inclusion criteria. Fourteen (48%) cases had objective audiometric documentation of SSNHL, while 15 (52%) had either subjective report only or incomplete audiometric data available. Eighteen (62%) had a single event, while 11 (38%) had more than one episode of SSNHL that was treated with steroids. For all patients, the median time between SSNHL and diagnosis of VS was 1.3 months (range, 0.13–148.4 mo). At the time of diagnosis, 15 tumors were purely intracanalicular, while 15 tumors had cerebellopontine angle extension. Of the latter, the median cisternal tumor size was 15.9 mm (range, 5.3–33). Twenty-six (90%) cases received oral steroid therapy alone, two (9%) had intratympanic steroid therapy alone, and one (3%) required combination therapy. The median PTA improvement with steroid therapy was 21 dB HL (range, –10–101.2) and the median WRS improvement was 40% (range, 4–100%).

Conclusion:

A therapeutic response to steroid therapy for SSNHL does not exclude the diagnosis of VS. All patients with SSNHL should undergo appropriate diagnostic imaging to prevent delays in diagnosis and potential treatment.
Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data
Authors: Bustamante Ranier , Earles Ashley , Murphy James D. , Bryant Alex K. , Patterson Olga V. , Gawron Andrew J. , Kaltenbach Tonya , Whooley Mary A. , Fisher Deborah A. , Saini Sameer D. , Gupta Samir , Liu Lin
Published: February 2019

Background:

Aspirin impacts risk for important outcomes such as cancer, cardiovascular disease, and gastrointestinal bleeding. However, ascertaining exposure to medications available both by prescription and over-the-counter such as aspirin for research and quality improvement purposes is a challenge.

Objectives:

Develop and validate a strategy for ascertaining aspirin exposure, utilizing a combination of structured and unstructured data.

Research Design:

This is a retrospective cohort study.

Subjects:

In total, 1,869,439 Veterans who underwent usual care colonoscopy 1999–2014 within the Department of Veterans Affairs.

Measures:

Aspirin exposure and dose were obtained from an ascertainment strategy combining query of structured medication records available in electronic health record databases and unstructured data extracted from free-text progress notes. Prevalence of any aspirin exposure and dose-specific exposure were estimated. Positive predictive value and negative predictive value were used to assess strategy performance, using manual chart review as the reference standard.

Results:

Our combined strategy for ascertaining aspirin exposure using structured and unstructured data reached a positive predictive value and negative predictive value of 99.2% and 97.5% for any exposure, and 92.6% and 98.3% for dose-specific exposure. Estimated prevalence of any aspirin exposure was 36.3% (95% confidence interval: 36.2%–36.4%) and dose-specific exposure was 35.4% (95% confidence interval: 35.3%–35.5%).

Conclusions:

A readily accessible approach utilizing a combination of structured medication records and query of unstructured data can be used to ascertain aspirin exposure when manual chart review is impractical.
Development of Secondary Osteosarcoma After TBI and Allogeneic Bone Marrow Transplant: A Case Series of 3 Patients
Authors: Scheuermann Amanda , Phelan Rachel , Browning Meghen
Published: February 2019

Osteosarcoma can rarely occur as a subsequent malignant neoplasm after cancer therapy. Children who underwent treatment for cancer and received an allogeneic hematopoietic cell transplant are at a higher risk to develop secondary malignancies. Radiation is also a known risk factor, but estimating the quantitative risk is difficult due to the rarity of the condition and long latency period between primary and secondary cancer. In this report, we present 3 patients diagnosed with leukemia as young children who received hematopoietic cell transplants with total body irradiation as part of the conditioning regimen, and later went on to develop secondary osteosarcoma.
Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study*
Authors: Abe Toshikazu , Aoki Makoto , Deshpande Gautam , Sugiyama Takehiro , Iwagami Masao , Uchida Masatoshi , Nagata Isao , Saitoh Daizoh , Tamiya Nanako
Published: February 2019

Objectives:

We aimed to investigate whether whole-body CT for children with trauma is associated with a different mortality than only selective CT.

Design:

A multicenter, retrospective cohort study.

Setting:

Nationwide trauma registry from 183 tertiary emergency medical centers in Japan.

Patients:

We enrolled pediatric trauma patients less than 16 years old who underwent whole-body CT or selective CT from 2004 to 2014.

Interventions:

We classified the patients into a whole-body CT group if they underwent head, chest, abdomen, and pelvis CT and a selective CT group if they underwent at least one, but not all, of the above scans.

Measurements and Main Results:

We analyzed data from 9,170 eligible patients (males, 6,362 [69%]; median age, 9 yr [6–12 yr]). Of these, 3,501 (38%) underwent whole-body CT. The overall in-hospital mortality was 180 of 9,170 (2.0%), that of patients who underwent whole-body CT was 102 of 3,501 (2.9%), and that of patients who underwent selective CT was 78 of 5,669 (1.4%). After adjusted multilevel logistic regressions and propensity score matching, the whole-body CT group demonstrated no significant difference in terms of in-hospital mortality compared with the selective CT group. The adjusted odds ratios (whole-body CT vs selective CT) for in-hospital mortality were as follows: multilevel logistic regression model 1 (1.05 [95% CI, 0.70–1.56]); multilevel logistic regression model 2 (0.72 [95% CI, 0.44–1.17]); propensity score-matched model 1 (0.98 [95% CI, 0.65–1.47]); and propensity score-matched model 2 (0.71 [95% CI, 0.46–1.08]). Subgroup analyses also revealed similarities between CT selection and in-hospital mortality.

Conclusions:

In this nationwide study, whole-body CT was frequently used among Japanese children with trauma. However, compared with the use of selective CT, our results did not support the use of whole-body CT to reduce in-hospital mortality. Selective use of imaging may result in less radiation exposure and provide more benefits than whole-body CT to pediatric trauma patients.
Acute Respiratory Failure With a Rare, Rapidly Progressing Pediatric Desmoid Tumor Anterior Mediastinal Mass
Authors: McAninch Scott A. , Glenn Jared W. , Quinn Kellie , Barney Jacob K.
Published: February 2019

We present an unusual case of a 6-year-old boy who presented with the sudden presence of left neck mass and acute hypoxemic respiratory failure, whose subsequent imaging demonstrated a previously undiagnosed anterior mediastinal mass (AMM) extending into the left neck. Biopsy of the mass was consistent with a desmoid tumor, which is a rare cause of AMM in children. Desmoid tumors are locally aggressive, often invading and enveloping surrounding tissues, but overall slow growing. The sudden growth of the neck mass suggests a very aggressive desmoid tumor, causing an unexpected respiratory compromise. Anterior mediastinal masses may cause symptoms by compressing the heart, great vessels, and airways. However, the patient may adapt and develop compensatory mechanisms to counter the compressive effects. Emergency care of the patient with an AMM who presents with acute respiratory distress includes optimizing oxygenation through promoting a calm environment, oxygenating while minimizing positive end-expiratory pressure, maintaining the patient's compensatory mechanisms by minimizing sedation and muscle relaxation, positioning the patient to minimize compressive effects of the mass on the vital thorax structures, and early consultation with pediatric specialists to develop a shared-emergency treatment strategy and to secure an expedited disposition to the appropriate venue of care.
Regional Differences in Pediatric Firearm-Related Emergency Department Visits and the Association With Firearm Legislation
Authors: Patel Shilpa J. , Badolato Gia M. , Parikh Kavita , Iqbal Sabah F. , Goyal Monika K.
Published: February 2019

Objective

The objective of this study was to describe regional and temporal trends in pediatric firearm-related emergency department (ED) visits and investigate association with regional firearm legislation.

Methods

We conducted a cross-sectional analysis using the Nationwide Emergency Department Sample from 2009 to 2013 for children aged 21 years or younger. We calculated national estimates of firearm-related visits using annual census data and measured trends. We used state-level gun law scores to derive regional scores to measure strictness of firearm legislation. We used multivariable logistic and linear regression to measure regional differences in visits and their association with regional gun law scores, respectively.

Results

There were 111,839 (95% confidence interval, 101,248–122,431) ED visits for pediatric firearm-related injuries. Rates of visits varied by region, with the lowest rate in the Northeast and highest rate in the South (40.0 [34–45]; 70.8 [63.7–76.9] per 100,000 ED visits, respectively). Compared with the Northeast, odds of firearm-related ED visits were higher in the Midwest (adjusted odds ratio [aOR], 1.8; 1.4–2.3), West (aOR, 2.5; 2.0–3.2), and South (aOR, 1.9; 1.5–2.4). Firearm-related visits remained consistent over time. A higher (stricter) regional median Brady gun law score was associated with a lower rate of firearm-related visits (β = −0.8; R
2 = 0.9; P = 0.03).

Conclusions

Rates of pediatric firearm-related ED visits vary by region. Stricter regional gun laws were associated with lower rates of ED visits for pediatric firearm-related injuries. Further study of the social and cultural regional differences in gun ownership and the role of legislation in the prevention of pediatric firearm-related morbidity and mortality is warranted.
Magnetic Resonance-Guided Focused Ultrasound
Authors: Griffin Michael O. , Kulkarni Naveen M. , O'Connor Stacy D. , Sudakoff Gary S. , Lea William B. , Tutton Sean M.
Published: February 2019

Magnetic resonance–guided focused ultrasound (MRgFUS) utilizes high-intensity focused ultrasound to noninvasively, thermally ablate lesions within the body while sparing the intervening tissues. Magnetic resonance imaging provides treatment planning and guidance, and real-time magnetic resonance thermometry provides continuous monitoring during therapy. Magnetic resonance–guided focused ultrasound is ideally suited for the treatment of extra-abdominal desmoid fibromatosis due to its noninvasiveness, lack of ionizing radiation, low morbidity, and good safety profile. Conventional treatments for these benign tumors, including surgery, radiation, and chemotherapy, can carry significant morbidity. Magnetic resonance–guided focused ultrasound provides a safe and effective alternative treatment in this often-young and otherwise healthy patient population. While there is considerable experience with MRgFUS for treatment of uterine fibroids, painful bone lesions, and essential tremor, there are few reports in the literature of its use for treatment of benign or malignant soft tissue tumors. This article reviews the principles and biologic effects of high-intensity focused ultrasound, provides an overview of the MRgFUS treatment system and use of magnetic resonance thermometry, discusses the use of MRgFUS for the treatment of extra-abdominal desmoid tumors, and provides several case examples.
Effects of Granulocyte–Macrophage Colony-Stimulating Factor on Neuronal Senescence in Ultraviolet Irradiated Skin
Authors: Moon Kyung-Chul , Lee Hyun-Su , Son Seung-Tae , Lee Jae-Sun , Dhong Eun-Sang , Jeong Seong-Ho , Han Seung-Kyu
Published: February 2019

Ultraviolet (UV) irradiation affects neuronal structures of the skin and accelerates skin aging. Cytokine cascades in keratinocytes after UV irradiation may result in a paracrine inhibitory effect on nerve cells. The purpose of the present study was to determine the direct effect of cytokines induced by UV radiation on nerve cells in terms of neuronal senescence. Our group performed a preliminary study to determine cytokines induced in UV-irradiated keratinocytes. Among 40 cytokines studied, granulocyte–macrophage colony-stimulating factor (GM-CSF) was increased 4-fold in inflammation antibody array. The GM-CSF was added to cultured human neuroblastoma cells. To evaluate the effect of cellular senescence, the authors performed real-time polymerase chain reaction (RT-PCR), western blot, immunocytochemical, and phase-contrast microscopic evaluations. Expression levels of matrix metallopeptidase-9 (MMP-9), nuclear factor kappa-light-chain-enhancer of activated B cells 1 (NF-κB1), inducible nitric oxide synthase (iNOS), and interleukin β1 (IL-β1) were assessed by RT-PCR. Expression levels of AAP and beta-site amyloid precursor protein cleaving enzyme 1 (BACE1) related to formation of beta-amyloid were evaluated by western blot analysis. Expression levels of MMP-9, NF-κB1, iNOS, and IL-β1 after treatment with GM-CSF were significantly higher than those in the control group. Enhanced expression of AAP and BACE1 was also observed in the treatment group. Thus, GM-CSF might have a provocative effect on nerve cells in terms of neuronal senescence.
Critical Stenosis of the Internal Carotid Artery: Variability in Vertebral Artery Diameters and Areas of Cerebral Chronic Infarction in Computed Tomography
Authors: Şahan Mehmet Hamdi , Asal Neşe , Bayar Muluk Nuray , Inal Mikail , Doğan Adil
Published: February 2019

Objectives:

We investigated unilateral and bilateral cervical internal carotid artery (ICA) stenosis according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST).

Methods:

We retrospectively investigated ICA stenosis on Head&Neck Computed Tomography Angiography (CTA); and their simultaneous brain computed tomography images were also evaluated. In unilateral ICA stenosis group (n=36), 17 of them had right ICA stenosis and 19 left ICA stenosis. In bilateral stenosis group, there were 24 patients. ICA stenosis was evaluated according to NASCET and ECST methods. We also evaluated vertebral artery dimension, plaque density and cerebral infarct (Cerebral kortex, white matter, basal ganglion-thalamus).

Results:

Unilateral ICA stenosis according to the NASCET was 70.64% to 73.68% (right-left) and according to the ECTS was 65.52% to 71.15% (right–left). For bilateral stenosis, ICA stenosis according to the NASCET was 67.70 to 67.91 (right–left); according to the ECTS was 62.45% to 62.15% (right–left). Vertebral artery dimensions were 3.26 to 3.72 mm (right-left) in unilateral ICA stenosis; and 3.52 to 3.71 mm (right–left) in bilateral ICA stenosis. In bilateral stenosis group, mixt plaque; and in unilateral stenosis group, hard plaque was detected. In unilateral stenosis, white matter and basal ganglion-thalamus infarcts; in bilateral ICA stenosis, cerebral cortical infarct was detected. Left-vertebral artery diameter increased in higher L-ECTS ICA stenosis (unilateral) group.

Conclusion:

Increase in left vertebral artery diameter in unilateral L-ECTS ICA stenosis may be related to increase of the collateral flow by vertebral arteries to support brain blood-flow.
Evaluation of the Relationship Between Nasal Septum Deviation and Oxidative Stress Markers
Authors: Düzenli Ufuk , Bozan Nazim , Sonkaya Yasin , Çetin Yaser Said , Demir Halit
Published: February 2019

Introduction:

Nasal septum deviation (NSD) may lead to chronic hypoxia and increased oxidative stress.

The main goal of this study was to investigate the effect of NSD on malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and glutathione (GSH) levels.

Methods:

There were 30 patients with NSD and 30 healthy subjects in this study. Malondialdehyde, CAT, SOD, and GSH levels were determined in the control and study groups. The measurements were done preoperatively and postoperatively. Study group patients completed the Nasal Obstruction Symptom Evaluation questionnaire preoperatively and postoperatively to determine the success of the septoplasty.

Results:

Higher CAT, SOD, and GSH levels and lower MDA levels were found in the control group compared with the study group (P < 0.05). After septoplasty, Nasal Obstruction Symptom Evaluation scores improved significantly and CAT, SOD, and GSH levels increased significantly (all,P < 0.05). Malondialdehyde levels did not decrease significantly after surgery (P > 0.05).

Conclusions:

Nasal obstruction due to nasal septal deviation led to lower antioxidant enzyme levels, and correction of the septum led to an increase in antioxidant levels.