bluuebunny/crossref_metadata_2025 huggingface dataset:
Auch betagte Patienten profitieren von einer Induktionstherapie bei ANCA-assoziierter Vaskulitis
Authors: von Vietinghoff Sibylle
Published: July 2020

Background: The benefits of treating anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) in advancing age remains unclear with most published studies defining elderly as ≥65 years. This study aims to determine outcomes of induction immunosuppression in patients aged ≥75 years. Methods: A cohort of patients aged ≥75 years with a diagnosis of AAV between 2006 and 2018 was constructed from 2 centres. Follow-up was to 2 years or death. Analysis included multivariable Cox regression to compare mortality and end-stage renal disease (ESRD) based on receipt of induction immunosuppression therapy with either cyclophosphamide or rituximab. A systematic review of outcome studies was subsequently undertaken amongst this patient group through Pubmed, Cochrane and Embase databases from inception until October 16, 2019. Results: Sixty-seven patients were identified. Mean age was 79 ± 2.9 years and 82% (n = 55) received induction immunosuppression. Following systematic review, 4 studies were eligible for inclusion, yielding a combined total of 290 patients inclusive of our cohort. The aggregated 1-year mortality irrespective of treatment was 31% (95% CI 25–36%). Within our cohort, induction immunosuppression therapy was associated with a significantly lower 2-year mortality risk (hazard ratio [HR] 0.29 [95% CI 0.09–0.93]). The pooled HR by meta-analysis confirmed this with a significant risk reduction for death (HR 0.31 [95% CI 0.16–0.57], I2 = 0%). Treated patients had a lower pooled rate of ESRD, but was not statistically significant (HR 0.71 [95% CI 0.15–3.35]). Conclusion: This meta-analysis suggests that patients ≥75 years with AAV do benefit from induction immunosuppression with a significant survival benefit. Age alone should not be a limiting factor when considering treatment.
Genomic Signatures in Luminal Breast Cancer
Authors: Puppe Julian , Seifert Tabea , Eichler Christian , Pilch Henryk , Mallmann Peter , Malter Wolfram
Published: July 2020

Background: Breast cancer is a very heterogeneous disease and luminal breast carcinomas represent the hormone receptor-positive tumors among all breast cancer subtypes. In this context, multigene signatures were developed to gain further prognostic and predictive information beyond clinical parameters and traditional immunohistochemical markers. Summary: For early breast cancer patients these molecular tools can guide clinicians to decide on the extension of endocrine therapy to avoid over- and undertreatment by adjuvant chemotherapy. Beside the predictive and prognostic value, a few genomic tests are also able to provide intrinsic subtype classification. In this review, we compare the most frequently used and commercially available molecular tests (OncotypeDX®, MammaPrint®, Prosigna®, EndoPredict®, and Breast Cancer IndexSM). Moreover, we discuss the clinical utility of molecular profiling for advanced breast cancer of the luminal subtype. Key Messages: Multigene assays can help to de-escalate systemic therapy in early-stage breast cancer. Only the Oncotype DX® and MammaPrint®test are validated by entirely prospective and randomized phase 3 trials. More clinical evidence is needed to support the use of genomic tests in node-positive disease. Recent developments in high-throughput sequencing technology will provide further insights to understand the heterogeneity of luminal breast cancers in early-stage and metastatic disease.
Necessity of Antiaggregation and Anticoagulation and Its Prognostic Impact: A Cardiologist’s View
Authors: Hink Ulrich , Voigtländer Thomas
Published: July 2020

Background: In modern cardiology, anticoagulation and antiaggregation are key components of current treatment strategies. However, in patients treated with anticoagulation and antiplatelet substances, bleeding is a major risk. Findings: In all major cardiovascular diseases, a multitude of studies have shown a positive impact of antithrombotic treatment on cardiovascular death. In patients with higher bleeding risks, recent studies showed the safety of reducing the period of dual antiplatelet therapy (DAPT), i.e., after percutaneous coronary intervention. In patients with coronary artery disease and atrial fibrillation (AF), triple therapy including DAPT and anticoagulation is associated with very high bleeding risks. However, recently published data showed the safety of direct oral anticoagulants (DOACs) and P2Y12 inhibitors only compared to vitamin K antagonist (VKA) and DAPT. Anticoagulation in nonvalvular AF reduces major cerebrovascular ischemic events. However, the inherent cerebrovascular bleeding risk is an important concern of this treatment. With the advent of DOACs, this risk could be reduced compared to VKA. Furthermore, anticoagulation and antiaggregation are crucial after treatment of valve disease, both after surgical and interventional procedures. Even in heart failure, new data show benefits using antithrombotic substances. Conclusions: Anticoagulation and antiaggregation are of major prognostic relevance in cardiovascular diseases. However, the inherent bleeding risk has to be considered.
Impact of Local Alloimmunity and Recipient Cells in Transplant Arteriosclerosis
Authors: Cai Jingjing , Deng Jiacheng , Gu Wenduo , Ni Zhichao , Liu Yuanyuan , Kamra Yogesh , Saxena Alka , Hu Yanhua , Yuan Hong , Xiao Qingzhong , Lu Yao , Xu Qingbo
Published: July 2020

Rationale:

Transplant arteriosclerosis is the major limitation to long-term survival of solid organ transplantation. Although both immune and nonimmune cells have been suggested to contribute to this process, the complex cellular heterogeneity within the grafts, and the underlying mechanisms regulating the disease progression remain largely uncharacterized.

Objective:

We aimed to delineate the cellular heterogeneity within the allografts, and to explore possible mechanisms underlying this process.

Methods and Results:

Here, we reported the transcriptional profiling of 11 868 cells in a mouse model of transplant arteriosclerosis by single-cell RNA sequencing. Unbiased clustering analyses identified 21 cell clusters at different stages of diseases, and focused analysis revealed several previously unknown subpopulations enriched in the allografts. Interestingly, we found evidence of the local formation of tertiary lymphoid tissues and suggested a possible local modulation of alloimmune responses within the grafts. Intercellular communication analyses uncovered a potential role of several ligands and receptors, including
Ccl21a
and
Cxcr3
, in regulating lymphatic endothelial cell-induced early chemotaxis and infiltration of immune cells. In vivo mouse experiments confirmed the therapeutic potential of CCL21 and CXCR3 neutralizing antibodies in transplant arteriosclerosis. Combinational use of genetic lineage tracing and single-cell techniques further indicate the infiltration of host-derived c-Kit
+
stem cells as heterogeneous populations in the allografts. Finally, we compared the immune response between mouse allograft and atherosclerosis models in single-cell RNA-seq analysis. By analyzing susceptibility genes of disease traits, we also identified several cell clusters expressing genes associated with disease risk.

Conclusions:

Our study provides a transcriptional and cellular landscape of transplant arteriosclerosis, which could be fundamental to understanding the initiation and progression of this disease. CCL21/CXCR3 was also identified as important regulators of immune response and may serve as potential therapeutic targets in disease treatment.
Association Between the Gut Microbiota and Blood Pressure in a Population Cohort of 6953 Individuals
Authors: Palmu Joonatan , Salosensaari Aaro , Havulinna Aki S. , Cheng Susan , Inouye Michael , Jain Mohit , Salido Rodolfo A. , Sanders Karenina , Brennan Caitriona , Humphrey Gregory C. , Sanders Jon G. , Vartiainen Erkki , Laatikainen Tiina , Jousilahti Pekka , Salomaa Veikko , Knight Rob , Lahti Leo , Niiranen Teemu J.
Published: July 2020

Background

Several small‐scale animal studies have suggested that gut microbiota and blood pressure (BP) are linked. However, results from human studies remain scarce and conflicting. We wanted to elucidate the multivariable‐adjusted association between gut metagenome and BP in a large, representative, well‐phenotyped population sample. We performed a focused analysis to examine the previously reported inverse associations between sodium intake and
Lactobacillus
abundance and between
Lactobacillus
abundance and BP.

Methods and Results

We studied a population sample of 6953 Finns aged 25 to 74 years (mean age, 49.2±12.9 years; 54.9% women). The participants underwent a health examination, which included BP measurement, stool collection, and 24‐hour urine sampling (N=829). Gut microbiota was analyzed using shallow shotgun metagenome sequencing. In age‐ and sex‐adjusted models, the α (within‐sample) and β (between‐sample) diversities of taxonomic composition were strongly related to BP indexes (
P
<0.001 for most). In multivariable‐adjusted models, β diversity was only associated with diastolic BP (
P
=0.032). However, we observed significant, mainly positive, associations between BP indexes and 45 microbial genera (
P
<0.05), of which 27 belong to the phylum
Firmicutes
. Interestingly, we found mostly negative associations between 19 distinct
Lactobacillus
species and BP indexes (
P
<0.05). Of these, greater abundance of the known probiotic
Lactobacillus paracasei
was associated with lower mean arterial pressure and lower dietary sodium intake (
P
<0.001 for both).

Conclusions

Although the associations between overall gut taxonomic composition and BP are weak, individuals with hypertension demonstrate changes in several genera. We demonstrate strong negative associations of certain
Lactobacillus
species with sodium intake and BP, highlighting the need for experimental studies.
Functional strengthening through synaptic scaling upon connectivity disruption in neuronal cultures
Authors: Estévez-Priego Estefanía , Teller Sara , Granell Clara , Arenas Alex , Soriano Jordi
Published: July 2020

An elusive phenomenon in network neuroscience is the extent of neuronal activity remodeling upon damage. Here, we investigate the action of gradual synaptic blockade on the effective connectivity in cortical networks in vitro. We use two neuronal cultures configurations—one formed by about 130 neuronal aggregates and another one formed by about 600 individual neurons—and monitor their spontaneous activity upon progressive weakening of excitatory connectivity. We report that the effective connectivity in all cultures exhibits a first phase of transient strengthening followed by a second phase of steady deterioration. We quantify these phases by measuring GEFF, the global efficiency in processing network information. We term hyperefficiency the sudden strengthening of GEFF upon network deterioration, which increases by 20–50% depending on culture type. Relying on numerical simulations we reveal the role of synaptic scaling, an activity–dependent mechanism for synaptic plasticity, in counteracting the perturbative action, neatly reproducing the observed hyperefficiency. Our results demonstrate the importance of synaptic scaling as resilience mechanism.
Rethinking Public Theology in Ethiopia: Politics, Religion, and Ethnicity in a Declining National Harmony
Authors: Sonessa Wondimu Legesse
Published: July 2020

Ethiopia is a country of multi-ethnic and multi-religious society. Almost all of its citizens claim affiliation with either Christianity, Islam, or African traditional religions. Adherents of these religions have been coexisting in respect and peace. However, there is a growing tension between the citizens since the downfall of the dictatorial military government of Ethiopia, which was displaced by the Ethiopian People’s Revolutionary Democratic Front (EPRDF), in 1991. Politics, religion, and ethnicity are the major causes of the declining national harmony under the current government. My claim is that addressing the declining national harmony caused by the religious, political, and ethnic tensions in Ethiopia requires of the EECMY to rethink its public theology in a way that promotes a national harmony that values peace, equality, justice, democracy, and human flourishing.
Wind Profile Satellite Observation Requirements and Capabilities
Authors: Stoffelen Ad , Benedetti Angela , Borde Régis , Dabas Alain , Flamant Pierre , Forsythe Mary , Hardesty Mike , Isaksen Lars , Källén Erland , Körnich Heiner , Lee Tsengdar , Reitebuch Oliver , Rennie Michael , Riishøjgaard Lars-Peter , Schyberg Harald , Straume Anne Grete , Vaughan Michael
Published: July 2020

The Aeolus mission objectives are to improve numerical weather prediction (NWP) and enhance the understanding and modeling of atmospheric dynamics on global and regional scale. Given the first successes of Aeolus in NWP, it is time to look forward to future vertical wind profiling capability to fulfill the rolling requirements in operational meteorology. Requirements for wind profiles and information on vertical wind shear are constantly evolving. The need for high-quality wind and profile information to capture and initialize small-amplitude, fast-evolving, and mesoscale dynamical structures increases, as the resolution of global NWP improved well into the 3D turbulence regime on horizontal scales smaller than 500 km. In addition, advanced requirements to describe the transport and dispersion of atmospheric constituents and better depict the circulation on climate scales are well recognized. Direct wind profile observations over the oceans, tropics, and Southern Hemisphere are not provided by the current global observing system. Looking to the future, most other wind observation techniques rely on cloud or regions of water vapor and are necessarily restricted in coverage. Therefore, after its full demonstration, an operational Aeolus-like follow-on mission obtaining globally distributed wind profiles in clear air by exploiting molecular scattering remains unique.
Cultural Influences on Hermeneutical Frameworks in the Debate on Same-Sex Relationships
Authors: Keen Karen R.
Published: July 2020

Socio-cultural changes in the West have influenced interpretation and use of scriptural texts among both those who oppose and support same-sex relationships. Cultural distance from the values of antiquity on matters of family structures and perceptions of people attracted to the same sex have led to greater attention to theological reflection beyond the standard biblical prohibition texts, particularly among conservative evangelicals. This article looks at two key areas of discussion: theological anthropology (sex difference) and sanctification.
Coming Out and the Bible
Authors: West Mona
Published: July 2020

Mona West shares her journey with the Bible as a feminist and a lesbian to articulate an approach to reading the Bible that claims it as a text to be trusted by queer people of faith. Drawing parallels with the ancient practice of lectio divina, she develops a method for praying the Scriptures using the process of coming out.
Optimization of injection parameters to obtain selected properties on foamed PP with hollow glass microspheres and thermally expandable microspheres using Taguchi method
Authors: Contreras Vicente , Maturana Francisco J , Poveda Jesús , Núñez Karina C , Merino Juan C , Pastor José M
Published: July 2020

A foaming system composed by hollow glass microspheres (HGM) and thermally expandable microspheres (EM) was used to achieve a balance between selected properties of foamed polypropylene (PP) by injection molding, combining the higher flexural properties and lower density required on automotive interior parts. Taguchi’s L16 (44.23) was employed for the experimental plan and signal to noise ratio (S/N) for the optimization of the system raised. The two important injection molding parameters affecting selected properties were melt and mold temperature. The most important effect on flexural modulus was the amount of HGM, and for density the amount of EM.
The Societal Consequences of Higher Education
Authors: Schofer Evan , Ramirez Francisco O. , Meyer John W.
Published: July 2020

The advent of mass schooling played a pivotal role in European societies of the later nineteenth century, transforming rural peasants into national citizens. The late-twentieth-century global expansion of higher education ushered in new transformations, propelling societal rationalization and organizing, and knitting the world into a more integrated society and economy. We address four key dynamics: (1) Higher education sustains the modern professions and contributes to the rationalization of society and state. (2) The supranational and universalistic orientation of higher education provides elites with shared global cultural frames and identities, facilitating globalization. (3) Consequently, tertiary education provides a foundation for major global movements and sociopolitical change around diverse issues, such as human rights and environmental protection as well as potentially contentious religious and cultural solidarities. (4) Higher education contributes to the reorganization of the economy, creating new monetarized activities and facilitating the reconceptualization of activities distant from material production as economic. In short, many features of the contemporary world arise from the growing legions of people steeped in common forms of higher education. Panel regression models of contemporary cross-national longitudinal data examine these relationships. We find higher-education enrollments are associated with key dimensions of rationalization, globalization, societal mobilization, and expansion of the service economy. Central features of modern society, often seen as natural, in fact hinge on the distinctive form of higher education that has become institutionalized worldwide.
1976 The limitations of William Temple
Authors: Vidler A. R.
Published: July 2020

Dr Alec Vidler (1899–1991) wrote this deliberately provocative article seven years after retiring as editor of Theology. An influential former Dean of King’s College, Cambridge, by this stage he had retired to his home town of Rye in Sussex, where, like his forebears, he served as mayor. In this article he looks back in 1976 at the strengths and weaknesses of Archbishop William Temple, who died in 1944. While acknowledging at the outset that Temple was ‘a giant among men, a great and a good man’, Vidler regards him as too privileged and comfortable in his Christian faith to ‘disturb and shake your mind, baffle and bewilder you, at once repel and draw you, as the greatest theologians do’. For him, ‘Temple was a theologian for Christmas rather than for Passiontide’. Ironically, Temple’s article included in this centenary issue, spurred by the crisis of a looming war, somewhat undermines this judgement. Editor.
A case of concomitant intussusception and appendicitis managed at a regional hospital in Guyana
Authors: Algu Tameshwar K
Published: July 2020

Appendicitis and intussusception are two potentially fatal surgical pathologies occurring at different peak age groups. Simultaneous presentation of both is rare. We present such a case in an eight-month-old infant who required successful emergency laparotomy with right hemicolectomy and primary anastomosis. Appendicitis was confirmed histologically.
Toward Integrated Processual Theories of Crime: Assessing the Developmental Effects of Executive Function, Self-Control, and Decision-Making on Offending
Authors: Altikriti Sultan
Published: July 2020

Research on executive function indicates that self-control stems partially from normative brain development. Extant research has also provided evidence of an association between self-control and offender decision-making. Yet, to date, there has been no attempt to account for these associations within one model. The current study used structural equation modeling to estimate the links between executive function, self-control, moral disengagement, and perceptions of risk and reward in a sample of male offenders ( n = 1,170) from the Pathways to Desistance data. The results indicated that executive function affects self-control, which subsequently influences perceptions of offending and offending behavior, supporting the integration of these concepts under one processual model. Moreover, moral disengagement, certainty of punishment, and rewards of offending mediated the majority of the effects of self-control on offending. The results from the current study advance theories in the life-course/developmental perspective and inform policy toward a developmentally oriented juvenile justice system.
Assessment of wind energy potential for Tuvalu with accurate estimation of Weibull parameters
Authors: Talama Fatonga , Kutty Saiyad S , Kumar Ajal , Khan MGM , Ahmed M Rafiuddin
Published: July 2020

Wind resource assessments are carried out for two sites in Tuvalu: Funafuti and Nukufetau. The wind speeds at 34 and 20 m above ground level were recorded for approximately 12 months and analyzed. The averages of each site are computed as the overall, daily, monthly, annual, and seasonal averages. The overall average wind speeds for Funafuti and Nukufetau at 34 m above ground level were estimated to be 6.19 and 5.36 m/s, respectively. The turbulence intensities at the two sites were also analyzed. The turbulence intensity is also computed for windy and low-wind days. Wind shear analysis was carried out and correlated with temperature variation. Ten different methods: median and quartiles method, the empirical method of Lysen, the empirical method of Justus, the moments method, the least squares method, the maximum likelihood method, the modified maximum likelihood method, the energy pattern factor method, method of multi-objective moments, and the wind atlas analysis and application program method were used to find the Weibull parameters. From these methods, the best method is used to determine the wind power density for the site. The wind power density for Funafuti is 228.18 W/m2 and for Nukufetau is 145.1 W/m2. The site maps were digitized and with the WAsP software, five potential locations were selected for each site from the wind resource map. The annual energy production for the sites was computed using wind atlas analysis and application program to be 2921.34 and 1848.49 MWh. The payback periods of installing the turbines for each site are calculated by performing an economic analysis, which showed payback periods of between 3.13 and 4.21 years for Funafuti and between 4.83 to 6.72 years for Nukufetau.
An Evaluation of Oxidative Stress With Thiol/Disulfide Homeostasis in Patients With Persistent Allergic Rhinitis
Authors: Göker Ayse E. , Alagöz Maide H. , Kumral Tolgar L. , Karaketir Semih , Yilmazer Ayça B. , Tutar Belgin , Ahmed Esmail A. , Biçer Cemile , Uyar Yavuz
Published: July 2020

Background:

We evaluated the efficacy of medical treatment on thiol–disulfide balance despite ongoing allergic stimulation.

Methods:

The research design was a prospective observational study that included 35 persistent allergic rhinitis (AR) patients. All patients who were diagnosed with persistent AR were included. A skin prick test was applied to all patients, and the Sino-nasal Outcome Test-22 was used to evaluate sinonasal symptoms. Thiol/disulfide homeostasis balance parameters were measured using a novel automatic and spectrophotometric method and compared statistically. Serum total thiol (TT), native thiol (SH), disulphide (SS), disulphide/native thiol (SS/SH), disulphide/total thiol (SS/TT), and native thiol/total thiol (SH/TT) ratios were measured after the second month of the treatment.

Results:

The 35 patients included 20 (58%) females and 15 (42%) males. The mean age of the patients was 33.17 ± 9.9 years. Disulphide, SS/SH, and SS/TT ratios decreased significantly after the treatment ( P < .05), while SH and SH/TT increased significantly ( P < .05). The mean SH measurement increased significantly in the second month ( P = .001), but TT mean measurements showed no difference after the treatment ( P = .058). The mean SS measurements, on the other hand, decreased significantly in the second month ( P = .003).

Conclusion:

Thiol/disulfide homeostasis may be used as a marker to evaluate the efficacy of persistent AR treatments. After the treatment, the increase in SH levels suggested the decrease in oxidative stress, even though allergen exposure continued.
The Association Between Vitamin D Deficiency and Recurrent Tonsillitis: A Systematic Review and Meta‐analysis
Authors: Mirza Ahmad A. , Alharbi Abdulrahman A. , Marzouki Hani , Al‐Khatib Talal , Zawawi Faisal
Published: July 2020

Objectives

The role of vitamin D deficiency has been linked with recurrent upper respiratory tract infections, but its impact on the frequency of tonsillitis is not yet fully understood. The objective of this study is to determine the association between vitamin D deficiency and recurrent tonsillitis based on current literature.

Data Source

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. Data were collected from online medical databases (PubMed, MEDLINE, EMBASE, and Cochrane Collaboration Registry of Controlled Trials).

Review Methods

All studies addressing the association of vitamin D deficiency and recurrent tonsillitis prior to March 2019. The data were collected in different phases: screening review using search words and controlled vocabularies followed by detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles.

Results

Fifty‐three studies were potentially eligible; of these, 4 publications met the inclusion criteria and were included in the quantitative synthesis. There was a statistically significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy controls (mean difference, −10.71; 95% CI, −19.12 to −2.31; P =. 01). The odds of vitamin D insufficiency were significantly higher in patients with recurrent tonsillitis as compared to the control group (odds ratio, 4.37; 95% CI, 2.78‐6.88; P <. 001).

Conclusion

Vitamin D deficiency was present in patients with recurrent tonsillitis and might be associated with an increase in the risk of recurrent tonsillitis. There is a need to explore these findings via clinical trials based on large populations.
Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI‐RADS
Authors: Xiao Juan , Xiao Qiang , Cong Wei , Li Ting , Ding Shouluan , Shao Chunchun , Zhang Yuan , Liu Jianing , Wu Mei , Jia Hongying
Published: July 2020

Objective

To develop an easy‐to‐use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI‐RADS).

Study Design

Retrospective diagnostic study.

Setting

The Second Hospital of Shandong University.

Subjects and Methods

From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI‐RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated.

Results

The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI‐RADS (0.826, P =. 008) and the ACR TI‐RADS (0.810, P <. 001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI‐RADS (0.852, P <. 001) and the ACR TI‐RADS (0.853, P <. 001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI‐RADS (P <. 05), each in the whole series and separately for nodules >1 or ≤1 cm.

Conclusions

When compared with the Kwak and ACR TI‐RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.
Clinical Implications of the Submental and Sublingual Arteries in Relation to the Mylohyoid Boutonnière
Authors: Zdilla Matthew J. , Bender‐Heine Adam N. , Lambert H. Wayne , Hunter Dawn D.
Published: July 2020

Objective

Mylohyoid musculature may be included in the submental artery flap to protect perforators. However, blood vessels may pass through the mylohyoid muscle and therefore cause bleeding and risk to pedicle or perforator injury when a mylohyoid‐containing flap is lifted. The objectives of this study were to identify the prevalence of the submental and sublingual arteries that traverse the mylohyoid and to assess relationships between vasculature transmitted through mylohyoid muscles and mylohyoid boutonnières.

Study Design

Cross‐sectional human cadaveric study.

Setting

The West Virginia University School of Medicine human gross anatomic laboratories.

Subjects and Methods

A total of 43 intact mylohyoid muscles from 22 cadavers were dissected. The prevalence of submental vasculature perforating the mylohyoid was recorded in addition to the prevalence and contents of mylohyoid boutonnières.

Results

Of 43 mylohyoid muscles, 21 (48.8%) transmitted the submental or sublingual arteries, and 30 (69.1%) possessed boutonnières. One muscle had 2 boutonnières. Of 31 mylohyoid boutonnières, 21 transmitted blood vessels (67.7%). Specifically, 9 transmitted an artery and a vein (29.0%), and 12 transmitted an artery (38.7%). Ten boutonnières (32.3%) were exclusively occupied by fascia.

Conclusion

This report identifies the importance of identifying and carefully ligating branches of the submental artery that pierce the mylohyoid during elevation of the submental island flap. This report also identifies that a boutonnière is often present where a submental or sublingual artery is traversing the mylohyoid to supply sublingual glands, tongue, and anterior mandible.
Development and Validation of the Short Version of the Reflux Symptom Score: Reflux Symptom Score–12
Authors: Lechien Jerome R. , Bobin Francois , Rodriguez Alexandra , Dequanter Didier , Muls Vinciane , Huet Kathy , Harmegnies Bernard , Crevier‐Buchman Lise , Hans Stéphane , Saussez Sven , Carroll Thomas L.
Published: July 2020

Objective

To develop and validate a short version of the Reflux Symptom Score—the 12‐question Reflux Symptom Score–12 (RSS‐12)—for patients with laryngopharyngeal reflux disease (LPR).

Study Design

Prospective study.

Setting

Multicenter academic hospitals.

Methods

Patients with LPR diagnosed via multichannel intraluminal impedance pH monitoring were enrolled from 3 European hospitals. Healthy individuals completed the study. Individuals completed the Reflux Symptom Score, Reflux Symptom Index (RSI), and Voice Handicap Index (VHI) at baseline and 3 months posttreatment. The Reflux Symptom Score was completed twice within a 7‐day period to assess test‐retest reliability. Cronbach’s α was used for assessing internal consistency. The RSS‐12 was developed and validity assessed through a comparison of the RSS‐12, RSI, and VHI. Responsiveness to change was evaluated through the pre‐ to posttreatment evolution of the RSS‐12 total score. Receiver operating characteristic analysis was used to determine the RSS‐12 threshold that is suggestive of LPR.

Results

The RSS‐12 was characterized by high test‐retest reliability (rs = 0.956) and adequate internal consistency reliability (α = 0.739). The RSS‐12 was significantly correlated with the RSI (rs = 0.845), suggesting high external validity. The RSS‐12 total and item scores were significantly higher in patients with LPR as compared with healthy individuals (P =. 001), supporting high internal validity. RSS‐12, VHI, and RSI significantly improved throughout treatment. Regarding the receiver operating characteristic curve, an RSS‐12 score >11 is suggestive of LPR, exhibiting a sensitivity of 94.5% and a specificity of 86.2%.

Conclusion

The RSS‐12 is a shorter, reliable, and valid self‐administered patient‐reported outcome measure questionnaire that can be used in the outpatient setting to suggest and monitor LPR.
An Analysis of the US News & World Report Methodology for Attribution of Specialty Care in Otolaryngology and Urology
Authors: Shah Ankur A. , Carey Ryan M. , Brant Jason A. , Tasian Gregory E. , Ziemba Justin B.
Published: July 2020

US News & World Report (USNWR) rankings can assist patients with choosing where to receive their specialty care. USNWR methodology assumes that the specialty caring for hospitalized patients is equivalent to the specialty assigned by administrative coding. We examined the frequency of discordance between USNWR methodology‐assigned specialty and the actual specialty care received for 2 surgical specialties, otolaryngology (ENT) and urology (GU). Our analysis included inpatient deaths identified by USNWR coding for these specialties from 2013 to 2017 at a single academic tertiary care center. We found that a minority of patients with deaths attributed by USNWR to these 2 specialties were actually cared for by ENT (6/14; 43%) or GU (3/19; 16%). Only 5 of 14 (36%) and 2 of 19 (11%) deaths were potentially associated with ENT and GU care, respectively. We identified a significant discordance between USNWR‐assigned specialty and the actual specialty care received.
With the Incidence of Otosclerosis Declining, Should Stapedectomy Remain a Key‐Indicator Case for Otolaryngology Residents?
Authors: Totten Douglas J. , Marinelli John P. , Spear Samuel A. , Bowe Sarah N. , Carlson Matthew L.
Published: July 2020

Stapedectomy remains a joint key‐indicator case with ossiculoplasty for otolaryngology residents in the United States. Yet, residents consistently report feeling inadequately prepared to perform stapes surgery following graduation. Applying recently described age‐ and sex‐standardized incidence rates of surgically confirmed cases of otosclerosis to the US populace, upper and lower estimates of residents’ case exposure to stapedectomy can be approximated. With this, uppermost projections estimate 6484 new cases of stapes surgery are performed annually nationwide. With approximately 1424 otolaryngology residents nationally, the average case exposure is 7.8 stapedectomies throughout their training, with upper and lower estimates of 17.1 and 4.2 cases, respectively. As such, proficiency in stapedectomy is no longer a realistic expectation for US graduating residents. This reality supports the removal of “stapedectomy” from the list of 14 key‐indicator case requirements, leaving ossiculoplasty as its own key‐indicator case, thereby reinforcing true competence in this fundamental procedure for the graduating otolaryngologist.
An Analysis of Otolaryngology Medical Malpractice Payments From the National Practitioner Data Bank
Authors: Breen Christopher T. , Mehra Saral
Published: July 2020

Objective

To describe malpractice payments made on behalf of otolaryngologists, analyze trends over time, and test the association of payment amount with severity of alleged malpractice and patient age.

Study Design

Retrospective cross‐sectional analysis.

Setting

National Practitioner Data Bank.

Subjects and Methods

This study comprised all payments made on behalf of otolaryngologists from 1991 to 2018 that were reported to the National Practitioner Data Bank. Descriptive statistics were calculated within and across years. Trends in payments were analyzed with the Mann‐Kendall test. Generalized linear regression was utilized to test for association of payment amount with severity of the alleged injury and patient age.

Results

From 1991 to 2018, there was a significant decrease in the number of payments (272 to 81) and number of otolaryngologists on whose behalf payments were made (250 to 77). Mean and median payments increased significantly from $248,848 to $420,386 and from $96,813 to $275,000, respectively. By severity of alleged injury, mean payments ranged from $39,755 (95% CI, $20,957‐$75,412) for insignificant injury to $754,349 (95% CI, $624,847‐$910,692) for patients who were left quadriplegic, sustained brain damage, or required lifelong care. By patient age, mean payments for patients ≥60 years old were $191,465 (95% CI, $159,880‐$229,292) versus $247,878 (95% CI, $209,416‐$293,402) for patients aged 20 to 39 years and $232,225 (95% CI, $197,691‐$272,793) for patients aged 40 to 59 years.

Conclusion

The annual number and total value of malpractice payments decreased, while the annual mean and median payments increased. Payment amount was associated with severity of alleged malpractice and patient age.
Systematic Review and Meta‐analysis of the Change in Pharyngeal Bacterial Cultures After Pediatric Tonsillectomy
Authors: Brietzke Scott E. , Andreoli Steven M.
Published: July 2020

Objective

To review all available biomedical literature to assess published data regarding the effect of pediatric tonsillectomy on the culture results of potentially pathogenic respiratory pharyngeal bacteria before and after surgery.

Data Sources

Biomedical literature databases (PubMed, Embase, Web of Science) from January 1970 to December 2019.

Review Methods

A systematic review of the literature was performed with the assistance of a medical librarian. Inclusion criteria consisted of pediatric patients and extractable data regarding respiratory bacteria culture data before and after tonsillectomy. Meta‐analysis with random effects modeling was used on a limited basis.

Results

Only 5 studies met the inclusion criteria. The grand mean age was 5.9 years; the sample size range was 31 to 134; and the range of follow‐up was 1 to 12 months. Group A beta hemolytic Streptococcus was generally the least commonly cultured pathogenic bacteria on preoperative cultures. Qualitative culture data generally showed an overall decrease in potentially pathogenic bacteria and some increase in nonpathologic respiratory flora after tonsillectomy. Meta‐analysis showed significant reductions in postoperative culture rates for group A beta hemolytic Streptococcus (positive post‐ vs preoperative culture: risk ratio [RR], 0.144; 95% CI, 0‐0.342), Haemophilus influenzae (RR, 0.437; 95% CI, 0.266‐0.608), and Streptococcus pneumoniae (RR, 0.268; 95% CI, 0‐0.567) and mixed results for Moraxella catarrhalis (0.736; 95% CI, 0.446‐1.03) but no significant reduction for Staphylococcus aureus (RR, 0.774; 95% CI, 0.157‐1.39).

Conclusion

The majority of published evidence shows that pediatric tonsillectomy appears to reduce the quantity of most cultured potentially pathogenic respiratory bacteria in the pharynx after surgery. The implications and possible benefits of this favorable change in the microbiologic environment after surgery require further study.
Thoracic aortic aneurysm gene dictionary
Authors: Rohde Stefanie , Zafar Mohammad A , Ziganshin Bulat A , Elefteriades John A
Published: July 2020

Thoracic aortic aneurysm is typically clinically silent, with a natural history of progressive enlargement until a potentially lethal complication such as rupture or dissection occurs. Underlying genetic predisposition strongly influences the risk of thoracic aortic aneurysm and dissection. Familial cases are more virulent, have a higher rate of aneurysm growth, and occur earlier in life. To date, over 30 genes have been associated with syndromic and non-syndromic thoracic aortic aneurysm and dissection. The causative genes and their specific variants help to predict the disease phenotype, including age at presentation, risk of dissection at small aortic sizes, and risk of other cardiovascular and systemic manifestations. This genetic “dictionary” is already a clinical reality, allowing us to personalize care based on specific causative mutations for a substantial proportion of these patients. Widespread genetic sequencing of thoracic aortic aneurysm and dissection patients has been and continues to be crucial to the rapid expansion of this dictionary and ultimately, the delivery of truly personalized care to every patient.
Adrenal failure and antiphospholipid syndrome
Authors: Mlekuš Kozamernik Katarina , Jensterle Mojca , Ambrožič Aleš , Pfeifer Marija
Published: July 2020

We herein report two cases of primary adrenal insufficiency (AI) associated with antiphospholipid syndrome (APS). In both patients, the main finding that led to the diagnosis was hyponatraemia. The major difference between the two cases was the time at which AI evolved during the course of APS. In the first patient, AI developed acutely along with other presenting features of APS. In the second patient, the AI was unmasked during a stressful situation induced by severe inflammation that occurred 7 years after the first APS manifestation and had probably evolved slowly during the previous few years. These cases emphasise the importance of considering AI in patients with either suspected or newly diagnosed APS as well as in patients who have long been known to have APS. The symptoms and signs alerting the clinician to possible AI are general abdominal complaints, fever, hypotension, and hyponatraemia. Conversely, patients with primary AI should be questioned about the signs and symptoms of APS.
Establishment and assessment of a nomogram for predicting adverse outcomes of preterm preeclampsia
Authors: Chen Rongxin , Han Qing , Zheng Lianghui , Jiang Lingling , Yan Jianying
Published: July 2020

Objective

This prospective study was designed to develop and internally validate an accurate prognostic nomogram model with which to predict the adverse outcomes of preterm preeclampsia.

Methods

Pregnant women with preeclampsia were divided into the adverse outcome group and the no adverse outcome group. The Kaplan–Meier method, univariate Cox regression analysis, and calculation of the concordance index (C-index) were applied to predictive evaluation of the nomogram. Calibration curves were drawn to test the nomogram prediction and actual observation of the adverse outcome rate.

Results

After 1000 internal validations of bootstrap resampling, the C-index of the nomogram for predicting adverse outcomes within 48 hours was 0.74 and the cut-off value was 0.53, with a sensitivity of 61.57% and a specificity of 76.93%. The C-index of the nomogram for predicting adverse outcomes within 7 days was 0.76 and the cut-off value was 0.37, with a sensitivity of 58.17% and a specificity of 84.82%. The calibration curves showed good concordance of incidence of adverse outcomes between nomogram prediction and actual observation.

Conclusion

Cox regression has certain guiding significance in preventing and treating adverse outcomes, choosing the time of termination of pregnancy, and improving the prognosis of the mother and child.
Branchial cleft fistula to branchio-oto-renal syndrome: A case report and literature review
Authors: Li Hong-Xia , Zhou Peng , Tong Min , Zheng Yan
Published: July 2020

Branchial cleft abnormality is a common congenital neck malformation in children, which is caused by the abnormal development of the gill sac or gill groove. It is mainly manifested as a cyst in the sinus tract and fistula in the neck, as well as branchio-oto-renal syndrome (BORS). As a rare autosomal dominant genetic disease, the typical manifestations of BORS are hearing loss, abnormal branchial cleft development and renal dysplasia. In this paper, a patient was admitted to the hospital for bilateral branchial cleft fistulas combined with bilateral anterior auricular fistulas, auricular appendix, auricle dysplasia, external auditory canal stenosis, and hearing loss. The patient was diagnosed with BORS, and underwent fistulectomy of the neck and anterior ear, external auditory canal formation, and tympanoplasty. The aim of this report is to strengthen clinicians’ understanding of BORS and reduce the rate of clinical missed diagnosis through our case report and literature review.
Improved cardiovascular autonomic function and decreased protein-bound uremic toxins in patients with end-stage renal disease after peritoneal dialysis
Authors: Cheng Ben-Chung , Lai Yun-Ru , Huang Chih-Cheng , Lu Cheng-Hsien
Published: July 2020

Objective

Cardiovascular autonomic neuropathy is highly prevalent in patients with end-stage renal disease (ESRD), and it has a high fatality rate. This study aimed to determine whether peritoneal dialysis (PD) improves cardiovascular autonomic function (CAF) and decreases protein-bound uremic toxin (indoxyl sulfate [IS], p-cresyl sulfate [PCS]) levels.

Methods

IS and PCS levels, and parameters of CAF (heart rate response to deep breathing [HR_DB], the Valsalva ratio, baroreflex sensitivity, and the frequency domain) were prospectively evaluated in 26 patients with ESRD undergoing PD at two time points (pre-PD and 6 months post-PD). For comparison, 19 consecutive patients with pre-dialysis chronic kidney disease and 30 age- and sex-matched healthy volunteers were included as the disease and control groups, respectively.

Results

Baroreflex sensitivity, HR_DB, and the Valsalva ratio were significantly lower in the ESRD and disease groups than in the control group. IS and PCS levels were significantly higher in the ESRD group than in the control group. Sympathetic/parasympathetic activity was improved after PD. IS levels were significantly decreased after PD and IS level changes were correlated with the frequency domain.

Conclusions

IS may play a role in cardiovascular autonomic neuropathy, and decreased IS levels after dialysis are associated with sympathetic/parasympathetic activity imbalance.
Plasma levels of IL-1β and IL-37 in patients with severe haemophilia
Authors: Lin Pei-Chin , Chiou Shyh-Shin , Hsu Wan-Yi , Liao Yu-Mei , Tsai Shih-Pien , Su Hsiu-Lan , Lu Ping-Tao , Tseng Yu-Hsin
Published: July 2020

Objective

Haemophilia A and B are disorders caused by the lack of clotting factors VIII and IX, respectively. Repeated bleeding into the same joint leads to haemophilic arthropathy (HA). Interleukin (IL)-1β is responsible for the pro-inflammatory response and IL-37 is induced by IL-1β stimuli to have an anti-inflammatory response and prevent uncontrolled inflammation and tissue damage. Our objective was to investigate plasma levels of IL-1β and IL-37 in patients with severe haemophilia with different severities of HA.

Methods

Peripheral blood samples were collected from 14 patients with severe haemophilia A and 6 with severe haemophilia B, and 18 healthy individuals. Plasma levels of IL-1β and IL-37 were detected by immunoassay, and severity of HA was evaluated using the Pettersson scoring system. Plasma levels of IL-1β and IL-37 were analysed in patients with severe haemophilia grouped by Pettersson score and in healthy individuals.

Results

Plasma levels of IL-1β and IL-37 were significantly higher in patients with severe haemophilia compared with healthy individuals and significantly lower in those with moderate to severe HA than in those with no or mild HA.

Conclusions

Plasma levels of IL-1β and IL-37 may be useful to track HA progression in patients with severe haemophilia.