bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous Orbital Hemorrhage Related to the Extraocular Muscles
Authors: Chan Helen H. L. , Hardy Thomas G. , McNab Alan A.
Published: October 2018

Purpose:

The authors present the largest series of patients to date of spontaneous hemorrhage in relation to extraocular muscles (EOMs).

Methods:

Observational retrospective case series. Institutional review board approval was obtained.

Results:

Eighteen patients with a mean age of 71 years presented with 20 episodes of spontaneous orbital hemorrhage closely related to an EOM. Most patients woke with unilateral proptosis, pain, and diplopia. Vision was impaired in 25%. Imaging identified a characteristic well-circumscribed hematoma arising within the muscle sheath or intermuscular septum. Three episodes required surgical drainage. All patients had good recovery of vision.

Discussion:

The authors describe a distinct clinical entity of idiopathic hemorrhages related to EOMs. No patient had an underlying vascular malformation or other lesion. The authors demonstrate that a proportion of these patients have vascular risk factors, namely, hypertension, hyperlipidemia, and antiplatelet use. This study suggests that inferior rectus is the most commonly affected EOM and shows that it is the muscle sheath or intermuscular septum of inferior rectus that is involved, rather than the muscle belly. Most patients can be managed conservatively with good visual outcomes. However, there were 3 exceptional cases that required surgical intervention.

Conclusions:

The findings that spontaneous orbital hemorrhages related to EOMs have certain predisposing factors, a characteristic radiological appearance, and a typically benign course will be helpful for clinicians in the management of this condition.
Subcutaneous Dirofilariasis in a Returning Traveler From Costa Rica
Authors: Olivo Christian A. , Gundacker Nathan D. , Murillo Jorge , Weiss Steven D. , Suarez Desiree , Suarez Jose Antonio
Published: October 2018

Dirofilaria genus is the most common cause of zoonotic filariasis. It typically causes cardiopulmonary disease in canines, but in humans, it can cause pulmonary, subcutaneous, and ocular disease. In this report, we present a case of a young woman who traveled to Costa Rica and subsequently developed a subcutaneous nodule. A biopsy performed in our patient showed dirofilariasis, possibly Dirofilaria tenuis. Most human dirofilariases are caused by Dirofilaria immitis and Dirofilaria repens. This is the first case of possible D. tenuis in Central America. The animal reservoir (North American raccoon) has been described in Costa Rica, highlighting the importance of reservoir distribution in human disease.
A Swollen Leg
Authors: Xu Anthony Ang , Hyman David , Cortes-Penfield Nicolas , D'Souza Jessica , Mao Tiffany , Lu Lee Bach
Published: October 2018

We report a patient with a rheumatic overlap syndrome on hydroxychloroquine and prednisone who developed tuberculous pyomyositis shortly after receiving 9 months of treatment of miliary tuberculosis. Her only presenting symptom was swelling of the left lower extremity without any systemic manifestation, despite extensive radiographic evidence of disseminated abscess formation. Acid-fast bacilli stains and cultures of the purulent material were negative for Mycobacterium tuberculosis (MTB), but polymerase chain reaction confirmed the diagnosis. To our knowledge, this is the first case report of tuberculous pyomyositis that developed shortly after the patient completed a full course of antituberculous therapy. We believe that the concurrent therapy of her rheumatic overlap syndrome with hydroxychloroquine likely led to her treatment failure for MTB and will discuss the possible pathogenesis. Our case also illustrates that MTB can cause significant soft tissue disease without systemic manifestations and that polymerase chain reaction is a valuable diagnostic study.
Failure Mechanisms of Polymeric Medical Devices
Authors: Block Frank E. , Ortega Ryan A. , Brown Cedric W.
Published: October 2018

Medical devices manufactured today typically require a number of different components and materials. Commonly, mass-produced devices utilize biocompatible polymers for their external surfaces. In this article, we discuss common failure mechanisms of polymers and a number of contributing factors, related to both the use and manufacturing of these devices. Reprocessing and cleaning of reusable medical devices can also contribute to their failures when incompatible substances or techniques are used. Thorough postmarket reporting of any medical device failure can allow enhancements of the device to be made and will ultimately improve patient safety.
Using a Valid and Reliable Measure to Assess Clinical Instructor Self-perception of Teaching Behaviors
Authors: Wormley Michelle E. , Romney Wendy , Schweizer Kristin , Fein Beverly , LaFay Vicki , Martin Rebecca , Greer Anna E.
Published: October 2018

Introduction.

The purpose of this study was to 1) use the Clinical Teaching Effectiveness Questionnaire (CTEQ) to determine the self-perception of clinical teaching effectiveness (CTE) with a current sample of clinical instructors (CIs) and 2) determine if a relationship exists between CI characteristics and self-perceived ratings.

Methods.

A cross-sectional study was completed with a convenience sample of 194 physical therapists who served as CIs for 2 universities in the Northeast. Participants completed demographic data and the 30-item CTEQ, a valid and reliable tool, consisting of 4 sections with 8 subscales. Data were reported descriptively, and Mann–WhitneyUtests were completed to determine significant relationships between CI characteristics and the CTEQ subscales.

Results.

Overall, CIs agreed they were effective clinical teachers. Analysis revealed significant differences in scoring on the subscales of the CTEQ based on curricular model of the program from which the CI graduated, American Physical Therapy Association (APTA) membership, number of students supervised, APTA Advanced CI Credentialing, experience in a teaching role, highest degree earned, and Center Coordinator of Clinical Education role.

Discussion and Conclusion.

The CTEQ provides a preliminary valid measure for assessing CTE in physical therapy practice. Multiple factors were discovered to have an influence on CI's self-perception of clinical teaching using the CTEQ. Notably, the long-term impact of problem-based learning curricula were associated with identification of student learning domains and total score on the CTEQ, adding new information regarding curricular influence on CIs' self-perception of CTE. The CTEQ can be used by academic programs and clinical sites to develop strategies to better prepare CIs delivery of high-quality clinical education experiences.
Effects of a Safety-Awareness–Promoting Program Targeting Mothers of Children Aged 0–6 Years to Prevent Pediatric Injuries in the Home Environment: Implications for Nurses
Authors: Kahriman I·lknur , Karadeniz Havva
Published: October 2018

Pediatric injuries pose a significant problem, both in Turkey and worldwide, because they lead to death or disability in a number of children each year. This quasi-experimental study aimed to identify the effects of the training provided to mothers with children aged 0–6 years about the hazards that lead to pediatric injuries. The population of the research comprised mothers with children aged 0–6 years, living in the city center. Considering the educational and socioeconomic levels of the individuals registered in the family health centers (FHC), the FHCs were divided into 3 groups of high, moderate, and low socioeconomic level. Subsequently, 1 FHC was selected from each level using simple random sampling. The study was conducted with 300 volunteer mothers registered in these FHCs. The tools used for data collection included the “0–6-year-old Children's Mothers' Identification Scale of Safety Precautions for the Prevention of Pediatric Injuries,” the “Risk Assessment Form for Pediatric Injuries” (RAF), and a 33-item questionnaire. After the training on the prevention of pediatric injuries, the mothers' scores on the identification of safety precautions for pediatric injuries increased significantly (p = 000). In addition, there was a significant difference between the pre- and posttest scores of the mothers (p < .05) on all dimensions of the RAF (choking, burns, poisoning, sharp object injuries, and falling; all p values <.05). Thus, the training provided to mothers to prevent pediatric injuries was effective in improving the awareness of the mothers.
The Social Determinants of Trauma: A Trauma Disparities Scoping Review and Framework
Authors: Mikhail Judy N. , Nemeth Lynne S. , Mueller Martina , Pope Charlene , NeSmith Elizabeth G.
Published: October 2018

The drivers of trauma disparities are multiple and complex; yet, understanding the causes will direct needed interventions. The aims of this article are to (1) explore how the injured patient, his or her social environment, and the health care system interact to contribute to trauma disparities and examine the evidence in support of interventions and (2) develop a conceptual framework that captures the socioecological context of trauma disparities. Using a scoping review methodology, articles were identified through PubMed and CINAHL between 2000 and 2015. Data were extracted on the patient population, social determinants of health, and interventions targeting trauma disparities and violence. Based on the scoping review of 663 relevant articles, we inductively developed a conceptual model, The Social Determinants of Trauma: A Trauma Disparities Framework, based on the categorization of articles by: institutional power (n = 9), social context—place (n = 117), discrimination experiences (n = 59), behaviors and comorbidities (n = 57), disparities research (n = 18), and trauma outcomes (n = 85). Intervention groupings included social services investment (n = 54), patient factors (n = 88), hospital factors (n = 27), workforce factors (n = 31), and performance improvement (n = 118). This scoping review produced a needed taxonomy scheme of the drivers of trauma disparities and known interventions that in turn informed the development of The Social Determinants of Trauma: A Trauma Disparities Framework. This study adds to the trauma disparities literature by establishing social context as a key contributor to disparities in trauma outcomes and provides a road map for future trauma disparities research.
Human Trafficking: Clinical Assessment Guideline
Authors: Leslie Jennifer
Published: October 2018

Approximately 18,000 people are trafficked into the United States each year and forced into commercial sex work. Up to 80% of victims are seen by a health care provider. In the health care setting, they rarely identify themselves as victims of human trafficking (HT), making it difficult to recognize them. Only a few health care professionals know how to identify victims of trafficking among their patients. The purpose of this article was to review the process used in health care settings to identify victims of traffickers. The author conducted a search to locate current scholarly articles addressing HT identification in health care settings. Each article was reviewed for its significance in victim identification. To address the problem of identifying and assisting patients who are being trafficked, some hospitals developed their own protocols. However, the wide variation in what is included on these assessment protocols makes it difficult to hold up any particular protocol as a national model. The author concludes that until more effective standardized national protocols for the identification of the HT victim within the health care settings are developed, National Human Trafficking Resource Center's method of screening should be used to help increase the degree at which patient victims are identified within the health care setting.
The Role of Trauma Video Review in Optimizing Patient Care
Authors: McNicholas Amanda Renee , Reilly Eugene Francis
Published: October 2018

Trauma video review allows for monitoring of performance improvement initiatives, leadership skills, system process issues, and guideline compliance. Despite the well-documented benefits, there are persistent barriers to its use including patient privacy concerns, cost, and provider anxiety. Optimizing implementation by ensuring that informed consent processes are in place, as well as a structured peer review process, can help trauma centers overcome these hurdles. Trauma video review is a unique and beneficial tool that helps tie patient care to quantifiable data, as well as serves as a platform for education opportunities.
Evaluating the Effectiveness of the Translated “A Matter of Balance” Fall Prevention Program Materials for Non-English-Speaking Participants
Authors: Wolfe Elizabeth Suzanne , Arabian Sandra Strack , Breeze Janis L. , Bugaev Nikolay
Published: October 2018

A Matter of Balance (MOB) is an evidence-based fall prevention program shown to reduce fear of falling (FOF) in English-speaking participants. The effectiveness of translated (Chinese and Spanish) MOB materials in reducing FOF is unknown. The objective of this study was to evaluate whether MOB was associated with reduced FOF in Chinese- and Spanish-speaking participants and included an English-speaking comparison group. Participants were recruited from MOB classes in Massachusetts and Illinois. Investigators used the Falls Efficacy Scale–International (FES-I) and a demographic questionnaire to survey the participants at the first class (baseline), the last class, and 6 months after the MOB course. Of the 90 participants who enrolled, 77 (85.6%) completed the course (Chinese: n = 37; Spanish: n = 19; and English: n = 21) and 54 (60%) completed the 6-month survey (Chinese: n = 33; English: n = 21). Chinese FES-I scores significantly increased (FOF worsened) at the end of the course (+7.1, p = .009), and 6-month survey scores were also significantly above the baseline score (+6.7, p = .0088). FES-I scores decreased (FOF declined) in both the Spanish (−6.6, p = .016) and English groups (−2.7, p = .14) at the last class, and English 6-month FES-I scores were slightly lower than baseline scores (−0.4, p = .8). Participation in the MOB program did not reduce FOF in the Chinese population, but MOB did show promise in reducing FOF in both the Spanish and English groups. Future studies are warranted to explore the cultural, social, and education-related factors that may influence effectiveness of the MOB program.
2015 Beers criteria medication review in assisted living facilities
Authors: Chun Jessica C. , Appel Susan J. , Simmons Steven
Published: October 2018

Background and purpose:

The elderly population is expected to double by 2050 with falls and hospitalizations due to adverse drug events having a major effect on health and quality of life. With the release of the revised 2015 American Geriatrics Society (AGS) Beers criteria, usage of potentially inappropriate medications (PIMs) should be studied to determine their effect on falls and hospitalizations in frail populations such as those in assisted living facilities.

Methods:

This quality improvement project used a retrospective chart review on residents from a purposive sample of two assisted living facilities in Northern Virginia. Residents were aged ≥65 and lived at the facility for at least 6 months and were not enrolled in hospice and/or palliative care or living in the dementia unit. The 2015 AGS Beers criteria were used to evaluate the effect of PIMs on falls and hospitalization rates.

Conclusions:

This project did not find statistical significance between PIMs and falls (p = .276). A favorable, but not statistically significant trend, was noted between PIMs and hospitalizations (p = .079).

Implications for practice:

Understanding the effect of PIMs on falls and hospitalizations could help providers improve prescribing practices for the elderly population who are at the greatest risk for potential adverse effects from polypharmacy.
I Serve 2: Identifying and caring for military-connected children in civilian primary care settings
Authors: Rossiter Alicia Gill , Patrician Patricia A. , Dumas Mary Anne , Ling Catherine Gaines , Johnson Heather L. , Wilmoth Margaret C.
Published: October 2018

Military children make tremendous sacrifices in support of a parent(s) military service. More than two million children have a parent who is serving or has served in the Armed Forces. Research shows that military-connected children are at higher risk of physical, psychological, and behavioral health issues. While “resilient” is the word used to describe most military children, it is important to recognize the stresses/stressors of military life— that military children serve too—to support and care for them.
Sudden Sensorineural Hearing Loss in Hemodialysis Patients Could be a Marker of Pathogenic Progression in the Mortality and Atherosclerotic Events: A National Cohort Study
Authors: Chou Chu-Lin , Hsieh Tsung-Cheng , Chen Jin-Shuen , Fang Te-Chao
Published: October 2018

Objectives:

There are higher incidence of sudden sensorineural hearing loss (SSHL) in hemodialysis (HD) patients than in the general population. Long-term outcomes of HD patients with new-onset SSHL have yet to be investigated although SSHL is considered as an independent risk of cardiovascular diseases in the general population. We examined the risks of mortality and atherosclerotic events in HD patients with new-onset SSHL in Taiwan.

Study Design:

Cohort study.

Methods:

Using the Taiwan National Health Institutes Research Database, 105,243 HD patients were identified between 1997 and 2008. In total, 288 HD patients with a new diagnosis of idiopathic SSHL were enrolled and matched with 1,728 HD patients without SSHL by using propensity score matching at a ratio of 1:6.

Main Outcome Measures:

A multivariate Cox regression and a competing risk regression were used to evaluate mortality and atherosclerotic events.

Results:

Results revealed a risk of mortality in HD patients with SSHL than in HD patients without SSHL (adjusted hazard ratios [aHRs] 2.22, 95% confidence interval [CI] 1.71–2.89). HD patients with SSHL had higher risks of hemorrhagic stroke (competing risk aHR 4.08, 95% CI 1.93–8.61), ischemic stroke (competing risk aHR 2.34, 95% CI 1.45–3.78), acute coronary syndrome, and peripheral arterial occlusive disease than did the HD patients without SSHL.

Conclusion:

This study is the first to signify that the risks of mortality and atherosclerotic complications in HD patients with new-onset SSHL are increased. Therefore, we should pay attention to risks of mortality and atherosclerotic events in HD patients with new-onset SSHL.
The Medial Canthus Reference Electrode Is not Electrically Indifferent to the Ocular Vestibular Evoked Myogenic Potential
Authors: Piker Erin G. , Jacobson Gary P. , Makowiec Kathryn F. , Atabek Paris M. , Krolewicz Sara
Published: October 2018

Objective:

To determine whether a reference electrode placed over the contralateral medical canthus is electrically indifferent to the ocular vestibular evoked myogenic potential (oVEMP).

Study Design:

Prospective observational study.

Setting:

Tertiary academic center.

Participants:

Nineteen otologically normal subjects.

Methods:

oVEMPs were recorded using a 500 Hz tone burst at 125 dB pSPL using both a conventional dual infra-orbital derivation and contralateral infraorbital electrode referenced to a medial canthus electrode known as the “belly-tendon” derivation.

Results:

The belly-tendon derivation produced significantly larger oVEMP amplitudes. This appears to be due to a polarity inversion of the first negative peak that occurs when the reference electrode is placed over the medial canthus. Thus, the belly-tendon derivation was associated with reference contamination, but in this instance the reference contamination produced an augmented oVEMP amplitude.

Conclusions:

Neither the dual infra-orbital nor belly-tendon electrode montages are electrically neutral. Reference contamination is the source of both a decrease in amplitude using conventional recording techniques and increased amplitude using the belly-tendon montage. The results support the contention that the belly-tendon montage generates a reversed polarity response, i.e., algebraically subtracted (i.e., added in the differential amplifier) from the response recorded at the infraorbital midline enhancing the oVEMP amplitude. It should be noted that the amplitude gained when using the belly-tendon montage may also be due to electromyographic (EMG) generated by extraocular muscles other than the inferior oblique generator, resulting in a loss of specificity. The authors recommend the belly-tendon montage be used in clinical situations where the oVEMP is absent or low in amplitude.
Causes of Persistent Positional Vertigo Following Posterior Semicircular Canal Occlusion for Benign Paroxysmal Positional Vertigo
Authors: Luryi Alexander L. , Schutt Christopher A. , Bojrab Dennis I. , LaRouere Michael , Zappia John , Sargent Eric W. , Babu Seilesh
Published: October 2018

Objective:

To report causes of persistent recalcitrant positional vertigo (PRPV) after posterior semicircular canal occlusion (PSCO) for benign paroxysmal positional vertigo (BPPV).

Study Design:

Retrospective chart review.

Setting:

Single high-volume otology practice.

Patients:

Patients diagnosed with BPPV from 2007 to 2017.

Intervention:

PSCO and follow-up care including diagnostic and particle repositioning maneuvers for recurrent BPPV.

Main Outcome Measures:

PRPV, defined as recalcitrant positional vertigo for any reason following PSCO.

Results:

Twenty seven PSCO operations were performed in 26 patients. Twenty five patients (96.2%) had resolution of the Dix–Hallpike test in the operated ear. Eleven patients (42.3%) developed BPPV postoperatively, three (11.5%) in the operated ear and eight (30.8%) in the contralateral ear. Five of eight patients (62.5%) who developed contralateral BPPV had unilateral BPPV preoperatively. Eight patients (30.8%) developed BPPV at least twice after surgery or did not resolve, qualifying as PRPV, and all but one of these events occurred in the nonsurgical ear. No instances of cerebrospinal fluid leak, postoperative infection, facial palsy, clinically significant hearing loss, or death occurred.

Conclusions:

PSCO is a safe and effective option for recalcitrant BPPV. However, 30.8% of patients, including patients with initially unilateral BPPV, had recalcitrant positional vertigo postoperatively, usually due to contralateral BPPV. Patients considering PSCO should be counseled regarding this risk to ensure realistic expectations.
Relationship of a “Fundal Fluid Cap” and Vestibular Schwannoma Volume: Analysis of Preoperative Radiographic Findings and Outcomes
Authors: Sullivan Christopher Blake , Sun Daniel Q. , Al-Qurayshi Zaid , Bathla Girish , Policeni Bruno , Gantz Bruce J. , Hansen Marlan R.
Published: October 2018

Objective:

To evaluate the relationship between radiographic fundal fluid cap in the lateral internal auditory canal, preoperative clinical characteristics, and postoperative outcomes in patients with vestibular schwannoma who underwent microsurgical excision.

Study Design:

Retrospective chart review.

Setting:

Academic tertiary referral center.

Patients:

Thirty-six consecutive patients (mean age 49.4 yr [range 29–74]) who underwent microsurgical vestibular schwannoma excision.

Interventions:

Microsurgical excision.

Main Outcome Measures:

Linear fundal fluid size and tumor size calculated using volumetric analysis were measured on preoperative magnetic resonance imaging, and correlated to hearing status and postoperative facial nerve function.

Results:

Mean fundal fluid size was 2.18 mm (range 0–7.32). Mean tumor volume was 5.58 cm3 (range, 0.210–40.3 cm3). Short- and long-term postoperative House–Brackmann scores were 2.4 and 1.4, respectively. Fundal fluid size was associated with tumor volume (r

s
 = 0.488, p = 0.003) but not preoperative hearing status (p = 0.333). The presence of fundal fluid and larger tumor volumes were statistically associated with poorer short-term and long-term postoperative facial nerve function (p < 0.05).

Conclusions:

Radiographic fundal fluid size is correlated to tumor volume.
Noninvasive Registration Strategies and Advanced Image Guidance Technology for Submillimeter Surgical Navigation Accuracy in the Lateral Skull Base
Authors: Schneider Daniel , Hermann Jan , Gerber Kate A. , Ansó Juan , Caversaccio Marco D. , Weber Stefan , Anschuetz Lukas
Published: October 2018

Hypothesis:

Combining novel registration strategies and advanced image guidance technology enable submillimeter accurate and noninvasive navigation for middle ear and lateral skull base surgery.

Background:

Surgery in the internal auditory canal and the petrous apex present a cognitive and motoric challenge for the surgeon. To date, image guidance rarely assists these procedures, mainly due to the lack of navigation solutions providing submillimeter accuracy associated with low cost in terms of invasiveness, radiation, and time.

Methods:

This study proposes an approach to clinically viable image guidance by using a combination of advanced image guidance technology and noninvasive registration strategies. Based on accuracy-optimized optical tracking hardware (accuracy: 0.05 ± 0.025 mm), 14 novel registration strategies were investigated. In human cadaveric temporal bone specimens n = 36 registration attempts per strategy were conducted. Target registration errors at 10 anatomical targets were measured.

Results:

The most accurate registration strategies were identified as paired-point-matching using eight landmarks located in the external auditory canal and middle ear and surface matching using combined surfaces of the middle ear, the external auditory canal and the mastoid cortex yielding target registration errors of 0.51 ± 0.28 mm and 0.36 ± 0.13 mm respectively.

Conclusions:

This study demonstrates submillimeter TREs achieved with noninvasive, anatomy-based registration strategies in combination with advanced image guidance technology. Clinically viable LSB and ME navigation is realized without additional invasiveness, radiation and time associated with artificial fiducials. The appropriate registration strategy can be chosen by the surgeon depending on the pathology and surgical approach.
Temporal Bone CT Scan for Malleal Ligaments Assessment
Authors: Vaisbuch Yona , Hosseini Davood K. , Lanzman Bryan , Marcott Stephen C. , Ma Yifei , Song Yohan , Alyono Jennifer C. , Blevins Nikolas H.
Published: October 2018

Objective:

To determine the feasibility of using temporal bone computed tomography (CT) scans to identify malleal ligaments and the prevalence of calcification in malleal ligaments.

Study Design:

Retrospective case review. CT scans were blindly and retrospectively reviewed by two physicians (a radiologist and a nonradiologist). Scans differed by slice thickness, and included both conventional CT and cone beam CT (CBCT).

Setting:

Ambulatory tertiary referral center.

Patients:

One hundred fifty-one temporal bone CT scans, obtained between the years 2014 and 2017, were initially screened, which included 302 ears. Patients with previous tympanomastoid surgery or middle ear opacification were excluded, leaving 187 ears in the study.

Intervention:

Diagnostic.

Main Outcome Measure:

Percentage of visible normal and calcified malleal ligaments.

Results:

Scans with submillimeter slice thickness were more likely to demonstrate all three malleal ligaments than those with 1 ml and larger slices (83.7% versus 50.0% for nonradiologist, p < 0.0001; 59.6 versus 34.8% for radiologist, p < 0.0001). Calcification was seen in 11.8% of ears reviewed. The ability to detect malleal ligaments with cone beam CT was 86.2%, while the rate with conventional CT was 71.1%, a difference that persisted when controlling for slice thickness. Interobserver agreement for the detection of malleal ligaments was 65% with a Cohen's kappa coefficient of κ = 0.27.

Conclusion:

Visualization of the malleal ligaments using CT scans is feasible in a majority of aerated ears. Detection of malleal ligaments improves with thinner slice thickness and cone-beam technique. Low interobserver agreement suggests the importance of experience and a need for standardized review.
Case Report of a New Coupler for Round Window Application of an Active Middle Ear Implant
Authors: Lenarz Thomas , Zimmermann Denise , Maier Hannes , Busch Susan
Published: October 2018

Objectives:

To evaluate feasibility, surgical handling, audiological outcome, and coupling efficiency of a new coupler (custom-made device) for an active middle ear implant.

Patient:

Revision surgery after implantation of an active middle ear implant in a 66-year-old male patient with mixed hearing loss.

Intervention:

Prosthetic hearing rehabilitation with a new coupler for round window application.

Main Outcome and Results:

The patient obtained good speech perception in quiet (word recognition scores 80%; Freiburg monosyllables) and noise (−3.3 dB SNR; Oldenburg Sentence Test). The effective gain with the Hannover coupler improved at frequencies > 0.5 kHz compared with the values reported for other round window (RW)-coupling modalities.

Conclusion:

The coupler provides a feasible option for the RW application of the middle ear implant actuator. The spring concept of the coupler needs to be improved to further standardize RW-coupling and improve coupling efficiency at low frequencies (0.5 kHz).
Microstructural Alterations in the Brains of Adults With Prelingual Sensorineural Hearing Loss: a Diffusion Kurtosis Imaging Study
Authors: Zou Yan , Yang Yan , Fan Wenliang , Yu Qun , Wang Miao , Han Ping , Ma Hui
Published: October 2018

Objective:

To investigate the alterations in microstructural gray matter (GM) and white matter (WM) in adults with prelingual sensorineural hearing loss (SNHL) using diffusion kurtosis imaging (DKI) and explore whether the clinical data are associated with the whole brain structure changes in SNHL subjects.

Study Design:

Prospective case study.

Setting:

Tertiary class A teaching hospital.

Patients:

Eighty adults with prelingual SNHL.

Intervention:

Diagnostic.

Main Outcome Measure:

DKI-derived metrics, including mean kurtosis, radial kurtosis, axial kurtosis, fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity were applied to explore the differences in GM and WM between the groups across the whole brain with voxel-based analysis.

Results:

Compared with the control group, adults with prelingual SNHL exhibited significantly decreased fractional anisotropy, mean kurtosis, radial kurtosis, and axial kurtosis in the bilateral superior temporal gyrus in both the GM and WM. No correlations were detected between these alterations and clinical data.

Conclusions:

These findings suggest that DKI can provide comprehensive characteristics to demonstrate reductions in the auditory cortical GM and hypomyelination of WM fibers in the auditory pathway caused by auditory deprivation early in life.
Tinnitus Impacts on Speech and Non-speech Stimuli
Authors: Omidvar Shaghayegh , Mahmoudian Saeid , Khabazkhoob Mehdi , Ahadi Mohsen , Jafari Zahra
Published: October 2018

Objective:

To investigate how tinnitus affects the processing of speech and non-speech stimuli at the subcortical level.

Study Design:

Cross-sectional analytical study.

Setting:

Academic, tertiary referral center.

Patients:

Eighteen individuals with tinnitus and 20 controls without tinnitus matched based on their age and sex. All subjects had normal hearing sensitivity.

Intervention:

Diagnostic.

Main Outcome Measures:

The effect of tinnitus on the parameters of auditory brainstem responses (ABR) to non-speech (click-ABR), and speech (sABR) stimuli was investigated.

Results:

Latencies of click ABR in waves III, V, and Vn, as well as inter-peak latency (IPL) of I to V were significantly longer in individuals with tinnitus compared with the controls. Individuals with tinnitus demonstrated significantly longer latencies of all sABR waves than the control group. The tinnitus patients also exhibited a significant decrease in the slope of the V-A complex and reduced encoding of the first and higher formants. A significant difference was observed between the two groups in the spectral magnitudes, the first formant frequency range (F1) and a higher frequency region (HF).

Conclusions:

Our findings suggest that maladaptive neural plasticity resulting from tinnitus can be subcortically measured and affects timing processing of both speech and non-speech stimuli. The findings have been discussed based on models of maladaptive plasticity and the interference of tinnitus as an internal noise in synthesizing speech auditory stimuli.
The Viability of Percutaneous Bone-Anchored Hearing Systems in the HIV Population
Authors: Kuschke Silva , Honnet Simon , Scott Alex J. , Labuschagne Sherene , Pithey Sharon , Solomons Zane , Meyer Estie
Published: October 2018

Objective:

To determine the viability of percutaneous bone-anchored hearing systems (BAHS), in terms of local soft tissue complications, in the HIV population.

Study Design:

Retrospective folder review.

Setting:

Two tertiary-level academic state hospitals in Cape Town, South Africa.

Patients:

Twenty patients, of which six (30%) were HIV-positive. All HIV-positive patients had CD4 counts greater than 200, and were on highly-active antiretroviral therapy (HAART).

Intervention:

Percutaneous BAHS implantation surgery was performed on all patients.

Main Outcome Measure:

Comparisons were made between HIV-positive and HIV-negative patients in terms of incidence of local soft tissue complications post-implantation.

Results:

Soft tissue complications occurred in 50% of patients, and most were easily managed with topical treatment. No significant differences were found when comparing incidence of local soft tissue complications between HIV-positive and HIV-negative patients (p = 0.314). Similarly, surgical technique did not influence soft tissue complication incidence (p = 0.143).

Conclusions:

No significant differences in incidence of local soft tissue complications after percutaneous BAHS implantation were found between HIV-positive and HIV-negative patients. In a resource-constrained country like South Africa, where cost and time management are vital, these results indicate that the use of percutaneous BAHS implantation is a viable option, even in HIV-positive patients.
Esophageal neuroendocrine carcinoma complicated with unexpected hyperprocalcitonin
Authors: Hu Qida , Jin Piaopiao , Zhao Xinyu , Wu Wangteng , Huang Bingfeng , Shao Shiyi , Que Risheng , Liang Tingbo
Published: October 2018

Rationale:

Neuroendocrine tumors (NETs) with hyperprocalcitonin are relatively rare with a low incidence rate.

Patient concerns:

An afebrile 63-year-old male with persistent low back pain unexpectedly presented with an extreme hyperprocalcitonin. Radiological assessment revealed thickening of the esophageal wall with vertebral bone destruction and liver lesions. Endoscopy showed an irregular-shaped esophageal lesion which turned out to be poorly-differentiated NETs.

Diagnosis:

Esophageal NETs with multiple metastases.

Interventions:

The patient was treated with chemotherapies, and was evaluated by procalcitonin level and radiology within follow-up.

Outcome:

The procalcitonin levels were altered in line with the therapeutic response and disease progression during the treatment course.

Lessons:

Increased procalcitonin occurs in several malignancies with neuroendocrine components, such as NETs of the digestive system.
Normal pregnancy induced glucose metabolic stress in a longitudinal cohort of healthy women
Authors: Wang Mu , Xia Wei , Li Han , Liu Fang , Li Yuanyuan , Sun Xiaojie , Lu Songfeng , Xu Shunqing
Published: October 2018

During normal pregnancy, mothers face a unique physiological challenge in the adaptation of glucose metabolism in preparation for the metabolic stress presented by fetal development. However, the responsible mechanism remains elusive. The purpose of this study is to investigate the mechanism of the metabolic stress of glucose metabolism in pregnant women using metabolomics method.

A Ultra Performance Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometer-based untargeted metabolomics study was performed to investigate the dynamic urinary signature of the intermediates of glucose metabolism in a longitudinal cohort of 232 healthy pregnant women in their first, second, and third trimesters.

Twelve glucose metabolic intermediates were screened out from hundreds of candidate metabolites using partial least squares discriminant analysis models. These 12 markers were mainly involved in the metabolic pathways of insulin resistance, glycolysis/gluconeogenesis, tricarboxylic acid cycle, nonabsorbable carbohydrate metabolism, and N-glycan biosynthesis. In particular, l-acetylcarnitine, a metabolite that is beneficial for the amelioration of insulin resistance, decreased in a time-dependent manner during normal pregnancy. Moreover, thiamine pyrophosphate, an intermediate product of glycolysis/gluconeogenesis, significantly increased in the second trimester, and argininosuccinic acid and oxalosuccinic acid, intermediates involved in the tricarboxylic acid cycle, significantly decreased in the third trimester, suggesting an increased glucose demand in the maternal body during fetal development.

These findings provide novel insight into the normal pregnancy-induced elevation of insulin resistance and glycolysis/gluconeogenesis, as well as the observed reduction in the aerobic oxidation of glucose.
Pain monitoring and management in a rehabilitation setting after total joint replacement
Authors: De Luca Maria Laura , Ciccarello Marcello , Martorana Manfredi , Infantino Davide , Letizia Mauro Giulia , Bonarelli Stefano , Benedetti Maria Grazia
Published: October 2018

Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.
Everolimus-induced pulmonary toxicity
Authors: Dejust Sebastien , Morland David , Bruna-Muraille Claire , Eymard Jean-Christophe , Yazbek Gabriel , Savoye Aude-Marie , Papathanassiou Dimitri
Published: October 2018

The everolimus–exemestane combination is indicated in advanced breast cancer treatment and usually well tolerated. The objective of the study was to determine the frequency of everolimus lung side effects and investigate their imaging characteristics on positron emission tomography with 18F-fluoro-deoxy-glucose combined with computerized tomography (18F-FDG PET/CT).

Our single-center retrospective descriptive study systematically included all patients with metastatic breast cancer treated by this combination (n = 29 representing 57 18F-FDG PET/CT). Number of segments involved was quantified. Maximum standardized uptake value (SUVmax), average standardized uptake value (SUVmean), metabolic target volume (MTV), and total lesion glycolysis (TLG) were measured. Severe pneumopathy was studied by subgroup analysis.

Pleuroparenchymal anomalies rate detected on 18F-FDG PET/CT was 62%. Alveolar-interstitial lesions were mainly observed (89%) and affected 2.8 segments (0.5–11.5) with a median of 2 segments. S7 and S10 were the most involved segments with SUVmax 3.9 (1.3–8.8) and SUVmean 2.2 (0.7–4.9). Statistically significant difference (P = .02) was found with number of segment involved to characterize severe pneumopathy (average of 6.3 segments [2.5–11.5] vs 1.9 segments [0.5–8] for interstitial lung disease) but not with SUVmax, SUVmean, MTV, TLG (P = .14, 0.22, 0.22, and 0.17, respectively).

The 18F-FDG PET/CT could highlight pulmonary everolimus side effects, with a typical imaging pattern: alveolar-interstitial opacities associated with moderate uptake, more or less extensive, mainly affecting the lower lobes. Rarely, a pseudotumoral aspect may be detected, corresponding to a pitfall. MTV or TLG showed a tendency to differentiate severe pneumopathy vs interstitial lung disease but no statistically significant differences was observed contrarily to the number of segments involved. Further studies are necessary to determine if the 18F-FDG PET/CT could early predict adverse effects of mTOR inhibitors.
Splenic cystic lymphangiomatosis in association with omental varices and portal hypertension
Authors: Hsu Wei-Fan , Yu Cheng-Ju , Yeh Chun-Chieh , Huang Wen-Hsin , Peng Cheng-Yuan
Published: October 2018

Rational:

Lymphangiomatosis is rare and benign, and slowly proliferating lymphatic vessels of unknown etiology and visceral lymphangiomatosis involving the spleen is rare. Since lymphangiomatosis may be asymptomatic or present as a sense of fullness, splenic cystic lymphangiomatosis is a disease of little concern.

Patient concerns:

A 34-year-old woman suffering from progressive epigastric fullness after oral intake for two weeks.

Diagnoses:

Physical examination showed a palpable mass which was more than 10 cm in size over the left hypochondrium. An abdominal computed tomography disclosed marked splenomegaly with multiple cystic lesions in the spleen, causing external compression with right-sided deviation of the adjacent organs and varices in the upper abdomen. Esophagogastroduodenoscopy revealed portal hypertensive gastropathy.

Interventions:

Conventional total splenectomy was performed in this patient because of an enlarged spleen and unknown etiology, preoperatively. Upon surgery, splenomegaly with polycystic content and varicose vessels over the omentum were noted. Autologous spleen transplantation was not performed because of limited orthotopic and vascularized spleen.

Outcomes:

The patient is doing well 18 months after splenectomy.

Lessons:

This was a rare case presenting with splenic cystic lymphangiomatosis in association with omental varices and portal hypertension. Splenic cystic lymphangiomatosis should be considered in the differential diagnosis of patients with a palpable painless mass over the left hypochondrium.
Early post-operative cognitive dysfunction after closed-loop versus manual target controlled-infusion of propofol and remifentanil in patients undergoing elective major non-cardiac surgery
Authors: Besch Guillaume , Vettoretti Lucie , Claveau Melanie , Boichut Nathalie , Mahr Nicolas , Bouhake Yannis , Liu Ngai , Chazot Thierry , Samain Emmanuel , Pili-Floury Sebastien
Published: October 2018

Introduction:

Post-operative cognitive dysfunction (POCD) is frequent in patients older than 60 years undergoing major non-cardiac surgery, and increases both morbidity and mortality. Anesthetic drugs may exert neurotoxic effects and contribute to the genesis of POCD. The hypothesis of the POCD-ELA trial was that closed-loop target-controlled infusion of propofol and remifentanil could reduce the occurrence of POCD by decreasing the risk of excessive depth of anesthesia and the dose of anesthetic drugs.

Methods and analysis:

We designed a single-center, single-blind, randomized, controlled, parallel trial and aim to include 204 patients aged >60 years undergoing elective major non-cardiac surgery. Patients will be randomized to receive closed-loop versus manual target-controlled infusion of propofol and remifentanil guided by bispectral index monitoring. Cognitive assessment will be performed the day before surgery (baseline) and within 72 hours after surgery, using a battery of validated neuropsychological tests. The primary outcome is the incidence of POCD within 72 hours after surgery. POCD is defined as a Z-score value > 1.96 for at least 2 different tests or a Z-score composite value >1.96. The calculation of the Z-score is based on data from an age-matched control population who did not undergo surgery or general anesthesia.

Ethics and dissemination:

This study was approved by the Ethics Committee (Comité de Protection des Personnes Est-II) and authorized by the French Health Products Agency (Agence Nationale de Sécurité des Médicaments, Saint-Denis, France). The University Hospital of Besancon is the trial sponsor and the holder of all data and publication rights. Results of the study will be submitted for publication in a peer-review international medical journal and for presentation in abstract (oral or poster) in international peer-reviewed congresses.

Registration:

The trial is registered with ClinicalTrials.gov (Identifier: NCT02841423, principal investigator: Prof Emmanuel Samain, date of registration: July 22, 2016). Last amendment of protocol: version 8.0 April 2018.
Efficacy and safety of PDE5 inhibitors in the treatment of diabetes mellitus erectile dysfunction
Authors: Li Xiao , Zhao Qi , Wang Jingshang , Wang Jisheng , Dai Hengheng , Li Haisong , Wang Bin
Published: October 2018

Introduction:

Diabetes mellitus erectile dysfunction (DMED) is a common complication of long-term hyperglycemia. With the increasing of diabetic patients, the number of DMED patients is gradually growing up, which has a serious impact on the quality of life of patients. PDE5 inhibitors have good clinical efficacy in DMED patients. This study is designed to evaluate the efficacy and safety of PDE5 inhibitors in DMED patients.

Methods and analysis:

We will systematically search all randomized controlled trials (RCTs) by electronic and manual search. Electronic retrieval of the database includes Pubmed, EMBASE, The Cochrane Library, the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Journal database (VIP) and the Wanfang database. Manual search will retrieve gray literature, including dissertations, ongoing experiments, grey literature, conference and unpublished documents. We use the IIEF-5 scale as the primary outcome of DMED. We also need to pay attention to the following outcomes: the sexual satisfaction of patients and their partners, like IIEF Q3 Q4; SEP 2, 3; GAQ. More importantly, the adverse reactions of patients during medication will also be taken seriously. Two reviewers will independently read the articles, extract the data information, and give the assessment of risk of bias. Data analysis will be used the special software like RevMan (version 5.3.5), ENDNOTE X7 and STATA 13.

Results:

This study will provide a comprehensive assessment based on current evidence of PDE5 inhibitors for DMED, especially its impacts on International Index of Erectile Function, the sexual satisfaction of patients and their partners and safety.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of PDE5 inhibitors on DMED. This review does not require ethical approval and will be reported in a peer-reviewed journal.

Trial registration number:

PROSPERO CRD42018095185.