bluuebunny/crossref_metadata_2025 huggingface dataset:
The situation in media and communication research
Authors: Schnauber-Stockmann Anna , Bayer Joseph B , Harari Gabriella M , Karnowski Veronika
Published: November 2024

Communication researchers have long sought to situate or contextualize media behaviors in their natural settings. However, the many approaches taken to understand media behavior in context have varied considerably. This article proposes a metatheoretical framework for theorizing media behavior at the situational level, encompassing the entirety of circumstances surrounding a media behavior at a given moment. The framework describes how psychological states, environmental context, and media context combine to shape moment-to-moment media behavior. We then describe how situational factors have the potential to interact with the three phases of media behavior—i.e., selection, processing, and disengagement—in distinctive ways. We argue that communication researchers only gain the ability to explain the variability in media behavior by taking the situational level into account. We conclude by providing future theoretical and empirical directions to guide the field in building a more generalizable and durable understanding of situated media behavior.
The WIPO Treaty on Intellectual Property, Genetic Resources and Associated Traditional Knowledge: Situating a Landmark Development in International Intellectual Property Governance
Authors: Vásquez Callo-Müller María , Ortega Sanabria Diego F , Matsuno Remigio Alejandro
Published: November 2024

This article analyses the recently adopted World Intellectual Property Organization Treaty on Intellectual Property, Genetic Resources and Associated Traditional Knowledge. The result of over two decades of discussions, the WIPO Treaty represents a landmark achievement in international intellectual property law and governance, establishing a mandatory disclosure requirement for patent applicants who utilize genetic resources and/or associated traditional knowledge in their inventions. This article dissects the key provisions of the Treaty, focusing on the mandatory Disclosure Requirement for patent applicants and the associated sanctions for non-compliance. The relationship between the WIPO Treaty and other international instruments is also addressed. Finally, the article considers how the Treaty is positioned within the broader landscape of intellectual property developments at the bilateral and regional level, particularly within Free Trade Agreements.
Effect of Esketamine Nasal Spray on Cognition in Patients With Treatment-Resistant Depression: Results From Four Phase 3 Studies
Authors: Morrison Randall L , Singh Jaskaran , Daly Ella , Fedgchin Maggie , Ochs-Ross Rachel , Karcher Keith , Lane Rosanne , Cooper Kim , Sanacora Gerard , Maruff Paul , Drevets Wayne C
Published: November 2024

Background

While esketamine is effective in treatment-resistant depression (TRD), detailed information about the effect of esketamine on cognition is relatively scarce. This analysis assessed the effect of short-term (3 double-blind [DB] studies: DB1, DB2, and DB4) or long-term maintenance treatment (DB3) with esketamine nasal spray (ESK) compared with a placebo (PBO) combined with active-comparator, on cognition in patients with TRD.

Methods

Patients (DB1/DB2/DB3: [18–64 years, n = 747]; DB4: [65 years or older, n = 137]) with TRD received ESK (DB1/DB2/DB3: 56/84 mg; DB4: 28/56/84 mg) or PBO+newly initiated oral antidepressant (OAD) as per treatment schedules. Cognitive assessments—Cogstate battery and Hopkins Verbal Learning Test-Revised—were administered at baseline, Day 28/early withdrawal, and follow-up visits in DB1/DB2/DB4 and at 12-week intervals in the DB3 maintenance phase. Descriptive statistics were used to analyze ESK effects on cognition with effect sizes and 95% confidence intervals to express the nature and magnitude of treatment effects relative to active-comparator+PBO. Correlation between depression severity (Montgomery-Ǻsberg Depression Rating Scale scores [MADRS]) and cognition was assessed at baseline and endpoint(s).

Results

At baseline, mild-to-moderate impairment in psychomotor function, attention, and memory (working and episodic) were evident. For each DB1/DB2/DB4, group mean performance in Z-scores for ESK+OAD and OAD+PBO groups on all cognitive tests remained similar or slightly improved from baseline at endpoint (Day 28) and follow-up assessments. Similarly, in DB3 (maintenance phase), both groups generally showed improvement in cognitive performance at endpoint(s). Correlations between MADRS scores and performance on the cognitive test battery were small at baseline and endpoint(s).

Conclusions

This analysis did not identify evidence of negative effects on cognition following short-term or long-term maintenance treatment with ESK+OAD in patients with TRD.
Prevalence of Trypanosoma cruzi Infection in Solid Organ Transplant Recipients: A Neglected Disease in America
Authors: Contreras German A , Golovko George
Published: November 2024

This study investigates the prevalence of Trypanosoma cruzi infection among solid organ transplant recipients in the United States from 2019 to 2023 before transplantation. Utilizing data from a large multicenter network, we identified a rising seroprevalence of 4.8% from 1523 solid organ transplant recipients at the time of the evaluation for transplantation, particularly among lung and heart transplant recipients. The findings highlight the need for improved screening protocols to address this neglected tropical disease in transplant populations.
Major-Element Geochemistry and Fe3+/ΣFe of Metabasites
Authors: Forshaw Jacob B , Dominguez Hugo , Markmann Thorsten A , Tamblyn RenÉe , Hermann Jörg , Riel Nicolas , Lanari Pierre
Published: November 2024

Metabasites (metamorphosed mafic rocks) are crucial for understanding metamorphic and tectonic processes. Their preservation in exhumed orogenic belts from throughout Earth’s history and the diverse mineral assemblages they form under different pressure–temperature conditions make them valuable for studying metamorphic processes. This work compiles a database of 6186 major-element whole-rock analyses of metabasites from different metamorphic facies (low-grade, greenschist, blueschist, amphibolite, granulite, and eclogite). These are used to explore the range and variability in their composition and assess geochemical differences among metamorphic facies. To mitigate the impact of outliers, median values and median absolute deviations (MAD) are used as measures of central tendency and dispersion. Metabasites show decreased volatile content with increasing metamorphic grade and generally consistent major-element contents across facies, with subtle differences interpreted to result from sampling bias. The median worldwide metabasite is as follows (anhydrous, normalised values in wt %, ±MAD): SiO2 = 51.36±3.40, TiO2 = 1.33±0.82, Al2O3 = 15.47±1.97, FeOtotal = 11.48±2.50, MnO 0.20±0.06, MgO = 6.83±2.25, CaO = 9.84±2.34, Na2O = 2.82±1.05, K2O = 0.50±0.61, and P2O5 = 0.18±0.16. The median XMg = MgO/(MgO+FeOtotal) is 0.51±0.09. The median Fe3+/ΣFe was measured by titration in 3153 samples and is 0.26±0.12, comparable to values in altered oceanic crust or arc basalts. Future research must carefully examine the distribution of Fe3+ amongst minerals in metabasites, allowing for a better evaluation of the median whole-rock Fe3+/ΣFe and its potential susceptibility to analytical interferences.
Association of the benzoxazinoid pathway with boron homeostasis in maize
Authors: Chu Liuyang , Shrestha Vivek , Schäfer Cay Christin , Niedens Jan , Meyer George W , Darnell Zoe , Kling Tyler , Dürr-Mayer Tobias , Abramov Aleksej , Frey Monika , Jessen Henning , Schaaf Gabriel , Hochholdinger Frank , Nowak-Król Agnieszka , McSteen Paula , Angelovici Ruthie , Matthes Michaela S
Published: November 2024

Both deficiency and toxicity of the micronutrient boron lead to severe reductions in crop yield. Despite this agricultural importance, the molecular basis underlying boron homeostasis in plants remains unclear. To identify molecular players involved in boron homeostasis in maize (Zea mays L.), we measured boron levels in the Goodman-Buckler association panel and performed genome-wide association studies. These analyses identified a benzoxazinless (bx) gene, bx3, involved in the biosynthesis of benzoxazinoids, such as 2,4-dihydroxy-7-methoxy-1,4-benzoxazin-3-one (DIMBOA), which are major defense compounds in maize. Genes involved in DIMBOA biosynthesis are all located in close proximity in the genome, and benzoxazinoid biosynthesis mutants, including bx3, are all DIMBOA deficient. We determined that leaves of the bx3 mutant have a greater boron concentration than those of B73 control plants, which corresponded with enhanced leaf tip necrosis, a phenotype associated with boron toxicity. By contrast, other DIMBOA-deficient maize mutants did not show altered boron levels or the leaf tip necrosis phenotype, suggesting that boron is not associated with DIMBOA. Instead, our analyses suggest that the accumulation of boron is linked to the benzoxazinoid intermediates indolin-2-one (ION) and 3-hydroxy-ION. Therefore, our results connect boron homeostasis to the benzoxazinoid plant defense pathway through bx3 and specific intermediates, rendering the benzoxazinoid biosynthesis pathway a potential target for crop improvement under inadequate boron conditions.
Original Research: Improving Pain Assessment After Inpatient Orthopedic Surgery: A Comparison of Two Scales
Authors: Boggs Lauryn , Fleming Jennifer , Geamanu Andreea , Vaidya Rahul
Published: November 2024

Purpose:

In pain assessment, the commonly used Numeric Rating Scale (NRS) offers an incremental 0-to-10 range of response options. But this broad range often leads to discordant evaluations between nurses and their patients. This study aimed to compare the NRS to the three-category Interventional Pain Assessment (IPA) scale, validate the IPA scale in an inpatient setting, and determine RN and patient scale preferences.

Methods:

This prospective study enrolled 122 postoperative orthopedic patients and their designated 104 RNs at a level 1 trauma center in the midwestern United States. Patients were asked to verbally rate their pain from 0 to 10 using the NRS and from 0 to 2 on the IPA scale. Patients were also asked which scale best conveyed their pain. The RNs were asked which scale best informed them of their patient's pain situation and which scale they preferred. To establish a correlation between the two scales, we considered NRS values of 0 to 7 (signifying no pain to moderate pain) to correspond to IPA scale values of 0 to 1 (signifying no pain to tolerable pain). NRS values of 8 to 10 (signifying severe pain) were considered to correspond to IPA scale values of 2 (signifying intolerable pain). Responses in which patients reported IPA scores indicating no pain to tolerable pain but NRS scores above 7 or IPA scale scores indicating intolerable pain but NRS scores of 7 or below were defined as discordant answers.

Results:

Data analysis revealed a strong significant correlation between the NRS and IPA scale (τ = 0.597), with an 82.7% concordance rate. Once an NRS score rose above 7, more discordance between the two scales became increasingly prevalent, as evidenced by the 45% of patients who also reported tolerable pain on the IPA scale. Significantly more patients (89.3%) preferred the IPA scale to communicate their pain level than the NRS (10.7%). Significantly more RNs (76%) felt the IPA scale best informed them of their patient's pain and was a better guide for treatment than felt the NRS did so (24%).

Conclusions:

The IPA scale asks about pain tolerability and thus has a direct role in the management of pain medications. Both patients and nurses felt they were better able to convey and understand pain when using the IPA scale than when using the NRS. There was consensus regarding pain scale preference among patients and their RNs, with both groups preferring the IPA scale due to its simplicity and, among the RNs, its usefulness in guiding treatment. The IPA scale may be a much better tool for accurately assessing a patient's pain experience and needs, with the potential to change practice and improve pain management.
Buprenorphine Administration and Prescribing at Emergency Departments: A National Analysis from 2014–2021
Authors: Ramdin Christine , McGowan Tanner , Perrone Jeanmarie , Mazer-Amirshahi Maryann , Nelson Lewis S.
Published: November 2024

Background

Emergency department (ED)–initiated buprenorphine provides a low barrier access point and safety net to mitigate opioid overdose risk and increase treatment engagement. We sought to describe trends and patterns of buprenorphine utilization from the ED using national data.

Methods

This is a retrospective review of the National Hospital Ambulatory Medical Care Survey between 2014 and 2021. Our primary outcomes were trends in ED buprenorphine utilization. We described patient demographics, visit characteristics, and conducted trend analyses. We utilized logistic regression to determine predictors of buprenorphine prescribing.

Results

Between 2014 and 2021, there were 341,875 ED visits in which buprenorphine was administered, with no change over time (P = 0.08). There were 392,031 visits where buprenorphine was prescribed at ED discharge, with an increase over time (P = 0.01). The largest rise in rate for discharge prescriptions occurred between 2019 and 2020 (37,737 [0.03%] visits vs 126,041 [0.10%]) (233% increase in rate, P < 0.0001).

Conclusions

Although there was an increase in buprenorphine prescribing at ED discharge, there was no increase in administration. The acceleration in prescribing between 2019 and 2020 suggests that the ED may have been a safety net for patients who lost access to addiction care during COVID-19. Future studies should explore reasons for disparities and barriers to buprenorphine utilization.
Prevalence of BRCA1 and BRCA2 mutations in ovarian cancer patients from Yunnan Province in southwest China
Authors: Peng Yongmei , Liao Jiaqian , He Xian , Zhou Yongchun , Zhang Lei , Jia Yue , Yang Hongying
Published: November 2024

Carriers with germline breast cancer 1/2 gene mutations (BRCAm) are likely to develop ovarian cancer (OC). Therefore, identifying these mutations may enable individualized therapy for OC and preventive measures to reduce OC risk in BRCAm carrier families. Thus, we investigated the prevalence of BRCAm in OC patients from Yunnan Province in Southwest China. In total, 674 unselected OC patients were enrolled and tested for BRCAm via next-generation sequencing. Data on clinicopathological characteristics and personal/family history of cancer were collected. The prevalence rates of pathogenic/likely pathogenic BRCAm were 26.6% overall, 20.8% among BRCA1m carriers, 5.5% among BRCA2m carriers, and 0.3% among carriers of both BRCA1m and BRCA2m. The most common pathogenic mutation in the BRCA1 gene was c.5114T>C (n = 9). The number of BRCAm carriers was significantly greater among patients with serous cancer, a personal tumor history, a family history of hereditary breast and ovarian cancer (HBOC)-related tumors, and bilateral tumors. The most common pathogenic mutation in this cohort was c.5114T>C (n = 9) in BRCA1. The prevalence and spectrum of BRCAm in OC patients from Yunnan Province are different from those in other groups. BRCA status testing is advised for all OC patients, particularly those with a family history of HBOC.
Anomalous origin of right coronary artery from left anterior descending coronary artery presenting with syncope – a case report
Authors: Hanif Kiran , Ali Tooba , Akhtar Parveen , Haque Md Ariful
Published: November 2024

Introduction and importance:

Non-dominant right coronary artery (RCA) is supposed to be benign as it does not result in large myocardial infarction. Still, in this case, non-dominant RCA from left anterior descending (LAD) artery not only produces ischemia but also results in incessant ventricular tachycardia, which is a life-threatening arrhythmia because of compromised blood flow. However, RCA is free of atherosclerotic plaque, which is the main cause of ischemia/infarction and subsequent arrhythmia.

Case presentation:

A 21-year-old male was admitted to the emergency cardiology ward of the National Institute of Cardiology following an episode of syncope. The patient reported a sudden loss of consciousness without preceding symptoms.

Clinical discussion:

The present case highlights the importance of a comprehensive evaluation and diagnosis in the management of syncope in young patients. The case presented here revealed a rare finding of a single coronary artery with a left main origin and an anomalous RCA emerging from the LAD artery. This is a very unusual presentation, with less than 50 occurrences recorded in the medical literature. This abnormality is classified as a single coronary artery anomaly (CAA), which means that the coronary arteries arise from a single coronary ostium within the aorta.

Conclusion:

In conclusion, CAA is an uncommon cause of SCA that can easily be overlooked without a systematic approach. In this report, we discuss the case of a patient who was discovered to have an anomalous RCA that branched off from the LAD artery.
PLASMA RICH IN GROWTH FACTORS MEMBRANE IN THE TREATMENT OF MACULAR HOLES ASSOCIATED WITH MACTEL TYPE 2
Authors: Arias Juan D. , Córdoba-Ortega Carlos M. , Martinez-Pulgarín Dayron F. , Viteri Eduardo J. , Parra Maria M. , Rangel Carlos M.
Published: November 2024

Purpose:

To demonstrate the regenerative effects of Plasma membrane rich in growth factors (PRGFm) as an adjuvant in the surgical treatment of Full-thickness macular holes (FTMH) associated with MacTel type 2 (MacTel).

Methods:

Observational study of a consecutive case series. Type 2 MacTel patients with FTMH. Best-corrected visual acuity, optical coherence tomography (OCT) data, anatomic closure rates, and duration of follow-up were documented.

Results:

3 patients who met the inclusion criteria were enrolled, 2 are naïve and one is already operated with silicon oil in situ. Median follow-up was 6 months (range 6-18 months), anatomic closure rate was 100%, and median visual acuity change was 20/60 (range 20/40 - 20/100). No complications related to PRGFm were found.

Conclusion:

PRGFm is a valuable option for the treatment of FTMH associated with MacTel type 2. Its application promotes tissue regeneration and facilitates anatomical closure. The technique is reproducible and does not require manipulation of the internal limiting membrane.
The Protective Function of αKlotho in Chronic Kidney Disease: Evidence and Therapeutic Implications
Authors: Wang Yue , Zhao Jinghong
Published: November 2024

Chronic kidney disease (CKD) is a prevalent global health problem, resulting in a considerable health burden, with renal fibrosis its principal pathological process. Recent studies have indicated that acute kidney injury (AKI) significantly increases the risk of CKD development. As renal function deteriorates, various complications, including cardiovascular and cerebrovascular diseases and mineral bone disorders, progress rapidly, adversely affecting the long-term survival of CKD patients. αKlotho is an anti-aging protein primarily expressed in renal tubules, exhibiting significant renal protective properties. The reduction of αKlotho expression is common in various kidney diseases, leading to AKI-to-CKD progression, renal fibrosis, and CKD complications through diverse mechanisms. Additionally, αKlotho deficiency may serve as a potential biomarker in the clinical assessment of CKD and its complications, although the research findings in this area are inconclusive. Addressing the reduction of αKlotho levels is crucial for CKD prevention and management. In this paper, we provide an overview of the impact of αKlotho in the progression of AKI to CKD, the upstream and downstream pathways of αKlotho in renal fibrosis, and the role of αKlotho in CKD complications. In addition, potential therapeutic strategies for restoring αKlotho in CKD are explored, including the stimulation of endogenous αKlotho production, αKlotho gene delivery, and the administration of αKlotho protein. Further studies are essential for a better understanding of the role of αKlotho and discovering therapeutic strategies targeted at recovering αKlotho in CKD.
Clinical Effectiveness of Multimodal Exercise Combined With Supportive Music and Imagery in the Management of Poststroke Mood Disorders
Authors: Mao Yu-Cui , Li Hui-Hua , Tao Sheng , Zhang Wei-Wei , Zhang Liu-Hong , Geng De-Qin , Ren Neng , Gao Li-Yan
Published: November 2024

BACKGROUND: The objective of this study is to investigate the clinical effectiveness of the combination of multimodal exercise (MME) with supportive music and imagery in the management of poststroke mood disorders (PSMD). METHODS: A total of 200 PSMD patients treated in the neurology department of a tertiary hospital in Jiangsu Province were enrolled. They were assigned to either a control group or the observation group using a random number table at a 1:1 ratio, with 100 patients in each group. The control group received conventional nursing care, and the observation group received both MME and music and imagery in addition to the conventional nursing interventions. The scores of the 10-item Kessler Psychological Distress Scale (K10), Hospital Anxiety and Depression Scale (HADS), and Well-being Index Scale (WBIS) were recorded before and 3, 6, and 9 months after the interventions and compared between the 2 groups. RESULTS: Changes in K10, HADS, and WBIS scores significantly differed between the 2 groups after interventions (all P < .05) and among different time points (all P < .05). There were interactions between the time points of the K10, HADS, and WBIS assessments and the intervention methods in both groups (P < .05). The improvements in anxiety or depression and psychological distress in the observation group were significantly superior to those in the control group. CONCLUSION: MME combined with music and imagery can effectively improve anxiety and depression, reduce symptoms of psychological distress, and improve well-being in PSMD patients.
When Things Go South, It Does Affect You
Authors: Gould Caitlin A. , Frattaroli Shannon , Williams D’Ann L. , Bulzacchelli Maria T. , Barnett Daniel J. , Davis Meghan F.
Published: November 2024

Commercial fishing is a dangerous profession with known hazards for musculoskeletal injuries, yet minimal examination of microbiological or attendant psychosocial hazards from water- and food-borne pathogens like Vibrio vulnificus and V. parahaemolyticus exists. Improving knowledge of Vibrio-related hazards addresses Total Worker Health® concerns for commercial fisheries workers.

Methods

Following a grounded theory approach, we conducted semistructured interviews with watermen and related workers who fish and harvest shellfish in the Chesapeake Bay, USA, to investigate risk perceptions and understanding, and compliance with regulations intended to reduce worker and consumer illnesses and injuries from pathogen exposures.

Results

Worker and consumer illnesses and injuries, and threat of fishery closures—with regulatory and organizational factors—influence this workforce.

Conclusions

Our findings support interventions that promote monitoring, surveillance, and awareness of Vibrio-related risk among watermen, regulatory officials, medical professionals, and the public.
Robotic-Assisted Adrenalectomy of a Giant Dopamine-Only Secreting Pure Adrenal Ganglioneuroma: A Case Report and Operative Video
Authors: Khalil Ibrahim A. , Alhyari Abdelkareem , Younes Nagy , Badawi Alaeddin , Mansour Abdulhamed , Taha Noheir M. , Al Rumaihi Khalid
Published: November 2024

Introduction:

Ganglioneuromas (GNs) are rare, differentiated tumors that originate from neural crest cells and can occasionally develop in the adrenal medulla. Adrenal GNs (AGNs) are typically hormonally silent and asymptomatic. Hormone-secreting pure AGNs in adults are uncommon; however, dopamine-secreting pure AGNs are extremely rare, with only a few cases reported in the literature. Giant AGNs are usually managed with open surgical intervention.

Case Presentation:

We present a case of a giant dopamine-secreting pure AGN in a 19-year-old woman who complained of mild left flank pain with no other symptoms. On physical examination, a mass was felt in left upper abdomen. MRI showed a left retroperitoneal mass extending from the left suprarenal region inferiorly, anterior to and compressing the left kidney, measuring 9 × 7.5 × 14 cm. Hormonal investigations ruled out Cushing syndrome, and catecholamine studies were negative for metanephrines, normetanephrines, adrenaline, and noradrenaline but were positive for dopamine levels more than 3 times the upper normal level. The patient underwent robotic-assisted adrenalectomy with minimal morbidity.

Conclusion:

Robotic-assisted adrenalectomy is a feasible and effective treatment option for rare dopamine-secreting pure AGNs. Careful patient selection and thorough preoperative preparation are essential to minimize risks and ensure favorable outcomes.
Comparing Cochlear Implant Outcomes in 100 Patients With Sporadic Vestibular Schwannoma Managed With Observation, Radiosurgery, or Microsurgery: A Multi-Institutional Review
Authors: Dornhoffer James R. , Marinelli John P. , Lohse Christine M. , Cottrell Justin , McMenomey Sean O. , Roland J. Thomas , Thompson Nicholas J. , Brown Kevin D. , Lucas Jacob C. , Babu Seilesh C. , Lindquist Nathan R. , Perkins Elizabeth L. , Rahne Torsten , Plontke Stefan K. , Tan Donald , Hunter Jacob B. , Harvey Erin , Deep Nicholas L. , Cerasiello Samantha Y. , Kircher Matthew L. , Espahbodi Mana , Tooker Evan L. , Lloyd Simon K.W. , Carlson Matthew L.
Published: November 2024

Objective

To compare cochlear implant (CI) speech perception outcomes in patients with sporadic vestibular schwannoma (VS) managed with observation, radiosurgery, or microsurgery.

Study Design

Retrospective review.

Setting

Eleven tertiary academic medical centers.

Patients

One hundred patients with sporadic VS who received an ipsilateral CI.

Interventions

Ipsilateral cochlear implantation.

Main Outcome Measures

Pure-tone thresholds, monosyllabic speech perception testing scores, and rates of open-set speech acquisition.

Results

Of the 100 patients studied, 54 underwent microsurgery, 26 underwent radiosurgery, 19 continued observation, and 1 underwent multimodal therapy. Among all patients, the median post-implantation pure-tone average was 31 dB (interquartile range [IQR] 25–39 dB) and the median monosyllabic speech perception score was 30% (IQR 0–60%) at a median of 12 months (IQR 5–25 months) post-implantation. Patients who were managed with microsurgery (median speech perception score 11%, IQR 0–52%) exhibited poorer implant outcomes overall compared with those managed with observation (median speech perception score 52%, IQR 40–72%) or radiosurgery (median speech perception score 30%, IQR 16–60%). Open-set speech perception was achieved in 61% of patients managed with microsurgery, 100% with observation, and 80% with radiosurgery. In a multivariable setting, those managed with observation (p = 0.02) or who underwent radiosurgery (p = 0.04) were significantly more likely to achieve open-set speech perception compared with patients who underwent microsurgery.

Conclusions

Cochlear implants offer benefit in selected patients with sporadic VS. Although achieved in over half of people after microsurgery, open-set speech perception is more reliably attained in patients who are treated with observation or radiosurgery compared with microsurgical resection. These data may inform patient counseling and VS tumor management in people who may benefit from implantation.
The Relationship Between eSRTs and Upper Stimulation Levels in a Large Cohort of Adult Cochlear Implant Recipients
Authors: Holder Jourdan T. , Hoffman Jennifer , Williams Haley , Gifford René H.
Published: November 2024

Objective

To compare electrically evoked stapedial reflex thresholds (eSRTs) measured at 1 month post-activation to upper stimulation levels used for programming adult cochlear implant (CI) recipients over time in a large clinical population.

Study Design

Review of prospectively collected clinical database.

Setting

Large CI program at an academic medical center.

Patients

Postlingually deafened adult CI recipients (n = 439).

Main Outcome Measure(s)

eSRTs recorded in the medical record and upper stimulation levels derived from the programming software at 1 and 6 months post-activation.

Results

The correlation between eSRTs and upper stimulation levels was strong for all three manufacturers (r = 0.80–0.86). On average, upper stimulation levels were set 15.4 clinical levels below eSRT for Cochlear using a pulse width of 25 microseconds, 13.4 clinical levels below eSRT for Cochlear using a pulse width of 37 microseconds, 11.3 clinical units below eSRT for Advanced Bionics, and 0.1 charge unit above eSRT for MED-EL. eSRTs were found to be elicited at similar levels for different electrodes/frequencies across the array. After upper stimulation levels were set based on eSRT at 1 month post-activation, there was no significant change in upper stimulation levels between 1 and 6 months post-activation.

Conclusions

eSRTs and upper stimulation levels are highly correlated. Average differences between eSRTs and upper stimulation levels reported herein can be used to guide programming in the clinic. Further, when eSRTs are used to program upper stimulation levels, upper stimulation levels should be relatively similar across channels and stable over time.
Automatic Final-Product Assessment of Virtual Reality Mastoidectomy Performance: A Validity and Reliability Study
Authors: Mikkelsen Peter Trier , Sørensen Mads Sølvsten , Senn Pascal , Frithioff Andreas , Andersen Steven Arild Wuyts
Published: November 2024

Objective

Assessment is key in modern surgical education to monitor progress and document sufficient skills. Virtual reality (VR) temporal bone simulators allow automated tracking of basic metrics such as time, volume removed, and collisions. However, adequate performance assessment further includes compound rating of the stepwise bony excavation, and exposure and preservation of soft tissue structures. Such complex assessment requires further development of automated assessment routines in the VR simulation environment. In this study, we present the integration of automated mastoidectomy final-product assessment with validation against manual rating.

Methods

At two international temporal bone courses, 33 ORL trainees performed anatomical mastoidectomies in the Visible Ear (VR) Simulator with automatic performance assessment using a newly implemented rating routine based on the modified Welling Scale. Automated assessment was compared with manual ratings by experts using absolute agreement, intraclass correlation, and generalizability analysis to establish validity and reliability.

Results

The overall average agreement between manual and automatic assessment was 83.9% compared with the inter-rater agreement of 88.9%. A majority of items (15 out of 26) showed high agreement between automated and manual rating (>85%). Intraclass correlation coefficients were found to be high. Generalizability analysis with D-studies found that five repetitions per participant are needed for a G coefficient >0.8, which is considered necessary for high-stakes assessments.

Conclusion

We have demonstrated the feasibility, validity, and reliability of an automatic assessment system integrated into a VR temporal bone simulator. This can prove to be an important tool for future self-directed training with skills certification.
Safety Outcomes of Balloon Dilation Eustachian Tuboplasty in Pediatric Patients: A Follow-Up Study
Authors: Ahluwalia Jatin , Babu Seilesh , Haupert Michael , Thottam Prasad
Published: November 2024

Objectives

Balloon dilation eustachian tuboplasty (BDET) has gained popularity as a treatment modality for chronic eustachian tube dysfunction (ETD) in both adults and children. Although its safety and efficacy in the adult population have been well described, very few large-sample studies assessing its safety profile have been performed in the pediatric population. This study serves as a follow-up to a previously published analysis assessing the safety of BDET in the pediatric population.

Methods

Retrospective chart review of 71 pediatric patients (139 ears) aged 11 ± 7 years who underwent BDET from 2019 to 2023. Medical records were reviewed from the extended postoperative period. A standardized grading scale that assesses severity of surgical complications was used.

Results

A total of five minor complications (7%) were noted. These included transient postoperative tinnitus, hyperacusis, otalgia, nausea, and epistaxis. There were no major complications requiring repeat intervention or need for imaging or hospital admission. In all cases, these symptoms had resolved in the postoperative time frame, with majority of them demonstrating complete resolution before the first postoperative visit.

When combining these findings with the previously published paper by the same institution, the overall complication rate is 6.1% with 114 total patients. All complications between both papers are considered minor with no long-term effects

Conclusions

In this retrospective analysis, BDET is shown to be a relatively safe procedure when performed in the pediatric population. Upon review of the literature, this is the largest safety analysis of exclusively pediatric patients who underwent BDET.

Level of evidence

4.
Management of Massive Iatrogenic Temporal Lobe Meningoencephalocele and Bacterial Meningitis Following Pediatric Cochlear Implant Surgery
Authors: Shave Samantha M. , Saber Camelia N. , David Abel P. , Lee Daniel J.
Published: November 2024

Objective

To review the management of meningitis, large lateral skull base defect, and meningoencephalocele following pediatric cochlear implant (CI) surgery.

Study Design

Case report.

Methods

Patient demographics, medical and surgical history, computed tomography (CT).

Results

An 8-year-old male with congenital severe to profound sensorineural hearing loss underwent uncomplicated right CI surgery at 18 months of age. He returned to his home country and received a bilateral sequential left ear CI at age 2. Five years following his second CI surgery, he presented to his local emergency room with worsening fever, headache, back pain, and vomiting. Lumbar puncture confirmed bacterial meningitis, and he was managed with intravenous antibiotics. The hospital course was complicated by a right-sided facial nerve paresis, prompting a temporal bone CT. Imaging demonstrated a tegmen defect measuring 15 mm × 10 mm with soft tissue opacification involving the entire mastoid and CI harness. He was then referred by family back to our institution. Intraoperatively, we identified a massive temporal lobe meningoencephalocele involving the entire mastoid cavity and engulfing the entire proximal electrode harness. Following middle cranial fossa craniotomy and revision mastoidectomy, proximal and distal array were separated, encephalocele transected, and remaining temporal lobe reduced. The lateral skull base was reconstructed with calvarial bone, temporalis fascia, and bovine collagen graft. The remnant electrode array was removed, a new CI receiver stimulator was fixed postero-superiorly to the cranial defect, and a new multichannel array inserted. A titanium cranioplasty completed the repair. A lumbar drain was placed for 3 days. Recovery and CI activation occurred uneventfully.

Conclusion

Risk of encephalocele and meningitis underscores the importance of early identification, adequate repair, and long-term radiologic follow-up of iatrogenic tegmen defects during pediatric CI surgery.
Sensitivity and Costs of Intraoperative Trans-Impedance Matrix Recordings, Spread of Excitation Functions, and X-ray Imaging in Detecting Cochlear Implant Tip Foldovers
Authors: Tejani Viral , Piper Robin , Murray Gail , Manzoor Nauman F. , Mowry Sarah , Semaan Maroun , Rivas Alejandro
Published: November 2024

Objective

Evaluate the sensitivity and financial costs of Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays in detecting cochlear implant tip foldovers

Setting

Tertiary academic medical center

Patients

113 ears of 108 patients

Interventions

Following cochlear implantation and before concluding surgery, intraoperative Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays were conducted to evaluate presence of tip foldover.

Main Outcome Measures

Presence of tip foldover; recording time necessary for and costs of Trans-Impedance Matrix, spread of excitation, and x-rays.

Results

There were six tip foldovers. Trans-Impedance Matrix showed 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predicative value in detecting tip foldovers. Spread of excitation showed 29% sensitivity, 99% specificity, 67% positive predictive value, and 95% negative predicative value. Trans-Impedance Matrix recordings were completed significantly faster than spread of excitation and x-rays. Elimination of x-rays from our intraoperative workflow results in a twofold cost reduction.

Conclusion

Trans-Impedance Matrix recordings have potential great clinical utility in evaluating proper CI placement intraoperatively and reducing costs of surgery while not compromising patient care. Given the low tip foldover rate, a multicenter study is in progress to evaluate the sensitivity, specificity, positive predictive value, and negative predicative value of Trans-Impedance Matrix in a larger dataset. This can provide better guidance to cochlear implant clinics interested in evaluating the impact of using Trans-Impedance Matrix on patient care as well as the economics of reducing use of intraoperative imaging.
Morphometric Measurements of the Incomplete Partition Type II (IP-II) Cochlea and Implications on Cochlear Implantation
Authors: Xiao Adam Y. , Saad Miryam , Fujiwara Rance J.T. , Wong Emily C. , Korte Grant O. , Sennaroglu Levent , Lopez Ivan A. , Ishiyama Gail , Ishiyama Akira
Published: November 2024

Hypothesis

The objective of this study is to obtain comprehensive morphometric measurements of the incomplete partition type II (IP-II) cochlea to provide a better understanding of intracochlear anatomy and important considerations for electrode selection and insertion.

Background

IP-II is the most common bony inner ear malformation that often requires cochlear implantation. Currently, there is significant controversy on electrode selection due to a lack of research that can provide reliable, high-resolution measurements.

Methods

Three-dimensional reconstructions of the cochlea were made from hematoxylin and eosin–stained slides from 11 archival human temporal bones from 8 adult IP-II patients (one paired) and 2 fetuses. Detailed measurements of the angular and linear length of the spiral ganglion neurons and cochlear duct at the modiolar and lateral wall of the scala tympani as well as cross-sectional areas and vertical height measurements of the scala tympani at 90-degree intervals were measured.

Results

The spiral ganglia neurons terminated at 540.5 ± 45.4 degrees, which corresponded to the beginning of the interscalar septal defect. The corresponding Rosenthal's canal length was 12.75 ± 0.82 mm, and the lateral wall length was 23.95 ± 1.04. The average cochlear duct length was 32.44 mm ± 1.58 mm, corresponding to an average angular distance of 951.6 ± 80 degrees. The modiolar height demonstrated less variation within the scala tympani but was significantly smaller at 0 and 90 degrees compared with the normal cochlea. The lateral wall height was also significantly smaller at 0, 180, and 540 degrees. There was a drastic decrease in lateral wall height at 540 degrees to 0.4 mm, which is smaller than the apical dimension of many electrodes.

Conclusion

This is the first study to provide detailed morphometric measurements of the IP-II cochlea including spiral ganglion neuron length and scala tympani height. These measurements directly relate to electrode selection for cochlear implantation.
Perioperative nutrition in older patients: what are the priorities?
Authors: Gumuskaya Oya , Skendri Sahnoun , Birkenhead Karen , Sarkies Mitchell N.
Published: November 2024

Purpose of review

This review aimed to synthesize recent literature on perioperative nutritional interventions for older patients.

Recent findings

This review underscores the role of comprehensive preoperative optimization, strategic use of nutritional supplements focusing on calorie, protein, and fluid intake, and active involvement of health consumers in co-designing solutions. Tools like the Geriatric Nutritional Risk Index offer a prediction value for nutrition-related complications in preoperative patients, guiding management strategies. Oral nutritional supplements, particularly those rich in protein and carbohydrates, prevent weight loss and improve functional outcomes postsurgery. However, patient satisfaction with these interventions is inconsistent and often unmeasured. Evidence suggests that prolonged fluid deprivation is harmful and preoperative hydration protocols reduce surgical stress and improve recovery outcomes. Yet, the benefit of preoperative hydration remains under-researched. Multimodal interventions for frail older adults are increasingly considered more effective than single-aspect interventions, which involve combining prehabilitation programs targeting malnutrition with smoking cessation and stabilization of preexisting conditions.

Comprehensive preoperative nutritional assessment, evidence-based interventions, and health consumer involvement are crucial for improving perioperative care for elderly patients. Implementing multimodal interventions, including nutritional support and proper hydration, can enhance recovery, reduce complications, and improve the quality of life for older surgical patients.
Competency-based medical education in interventional pulmonology: current state and future opportunities
Authors: Hostetter Logan J. , Nelson Darlene R.
Published: November 2024

Purpose of review

This chapter examines the evolution and current status of competency-based medical education (CBME) in interventional pulmonology, focusing on procedural skills assessment and training.

Recent findings

Traditionally, interventional pulmonology training has used an apprenticeship model with case logs and director attestation, leading to inconsistent outcomes due to a lack of standardized curricula. CBME, established to address these issues, relies on outcome-based assessments to ensure trainees achieve necessary competencies. The chapter reviews various assessment tools, including global rating scales, checklists, and simulation-based methods, and their effectiveness in skill acquisition and clinical evaluation. It also covers specific procedures such as EBUS-TBNA, electromagnetic navigation bronchoscopy, and rigid bronchoscopy, discussing their assessment tools and learning curves. The chapter emphasizes the need for standardized assessment tools and suggests using entrustable professional activities (EPAs) to improve competency evaluation. Future directions include integrating real-time artificial intelligence feedback, addressing high-risk low-volume procedures, and enhancing workplace-based assessments to improve interventional pulmonology training and patient care quality.

This chapter reviews the transition from traditional apprenticeship models to CBME in interventional pulmonology, highlighting advancements in procedural skills assessment, the effectiveness of various assessment tools, and future directions for improving training and patient care.
Sarcopenia is associated with new-onset acute biliary infection within 1 year in patients with hepatitis B virus-related decompensated cirrhosis
Authors: Zhang Shuangshuang , Zhou Tian , Wu Mingbo , Xiong Xuanxuan
Published: November 2024

Backgrounds:

Malnutrition and sarcopenia are prevalent complications in cirrhosis. The relationship between sarcopenia and biliary infection in cirrhotic patients is not well understood. Our study aims to clarify this association.

Methods:

In this study, we leveraged data from a tertiary care hospital, enrolling patients with hepatitis B virus (HBV)-induced cirrhosis from 2022. An acute biliary tract infection was defined as the onset of acute cholecystitis or cholangitis within a year. Sarcopenia was identified based on established criteria and assessed using the L3 skeletal muscle index (SMI). A multivariate logistic regression model was constructed to analyze the relationship between sarcopenia and acute biliary tract infection. Receiver operating characteristic (ROC) curve analysis and smooth curve fitting were also conducted.

Results:

This study enrolled a total of 262 patients with HBV-related cirrhosis, with an average age of 60 years and including 173 males. The primary causes for hospital admission were ascites and hepatic encephalopathy. Within the group with biliary infection, patients typically presented with higher white blood cell counts, lower platelet levels, and poorer indicators of liver and kidney function. In the multivariate analysis, after adjusting for various confounding factors, sarcopenia was associated with an odds ratio of 1.55 (P = 0.002) for acute biliary infection. Smooth curve fitting revealed an approximately linear positive relationship between L3 SMI and acute biliary infection, with the area under the ROC curve for L3 SMI reaching 0.89, indicating a strong predictive value.

Conclusion:

Sarcopenia is associated with acute biliary infection in patients with HBV-related cirrhosis.
Evaluating the Impact of a Peer Support Program on Participants’ Well-Being
Authors: Galovski Tara E. , Street Amy E. , Cooney Caroline C. , Winters Michael R.
Published: November 2024

Background:

Loss of belongingness may be particularly pronounced for women veterans, representing a threat to long-term well-being. Improvements in social support through engagement in a structured peer support program may mitigate the negative effects of loss of belongingness on well-being.

Objective:

We assessed the impact of participation in a peer-led, structured, social support group-based network on outcomes related to well-being [i.e., belongingness, social support, quality of life, posttraumatic stress disorder (PTSD), depression]. Subgroup analyses examined relative impact among those who completed the intervention and those reporting clinical levels of PTSD and depression symptoms.

Methods:

We analyzed survey data consisting of reliable and valid measures collected at baseline, postgroup and 3-month follow-up among 393 participants in the Woven Veterans Network’s (WoVeN) group program.

Results:

We observed improvements in posttraumatic stress disorder (PTSD) symptoms over time. We observed additional benefits among those who received an adequate dose of the intervention (significant improvements on PTSD, belongingness) and those with clinical levels of mental health symptoms (significant improvements on PTSD, depression, belongingness, quality of life).

Conclusions:

Impacts on social support may have been masked due to ceiling effects given wide dispersion baseline social support in this sample. This social support network had particularly profound impacts on well-being for those veterans who suffered from conditions for which isolation and loneliness are particularly salient.