bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival of Women With Type I and II Epithelial Ovarian Cancer Detected by Ultrasound Screening
Authors: van Nagell John R. , Burgess Brian T. , Miller Rachel W. , Baldwin Lauren , DeSimone Christopher P. , Ueland Frederick R. , Huang Bin , Chen Quan , Kryscio Richard J. , Pavlik Edward J.
Published: October 2018

OBJECTIVE:

To estimate the effect of ultrasound screening on stage at detection and long-term disease-specific survival of at-risk women with epithelial ovarian cancer.

METHODS:

Eligibility included all asymptomatic women 50 years of age or older and women 25 years of age or older with a documented family history of ovarian cancer. From 1987 to 2017, 46,101 women received annual ultrasound screening in a prospective cohort trial. Women with a persisting abnormal screen underwent tumor morphology indexing, serum biomarker analysis, and surgery.

RESULTS:

Seventy-one invasive epithelial ovarian cancers and 17 epithelial ovarian tumors of low malignant potential were detected. No women with a low malignant potential tumor experienced recurrent disease. Stage distribution for screen-detected invasive epithelial ovarian cancers was stage I—30 (42%), stage II—15 (21%), stage III—26 (37%), and stage IV—0 (0%). Follow-up varied from 9.2 months to 27 years (mean 7.9 years). Disease-specific survival at 5, 10, and 20 years for women with invasive epithelial ovarian cancer detected by screening was 86±4%, 68±7%, and 65±7%, respectively, vs 45±2%, 31±2%, and 19±3%, respectively, for unscreened women with clinically detected ovarian cancer from the same geographic area who were treated at the same institution by the same treatment protocols (P<.001). Twenty-seven percent of screen-detected malignancies were type I and 73% were type II. The disease-specific survival of women with type I and type II screen-detected tumors was significantly higher than that of women with clinically detected type I and type II tumors and was related directly to earlier stage at detection.

CONCLUSION:

Annual ultrasound screening of at-risk asymptomatic women was associated with lower stage at detection and increased 5-, 10-, and 20-year disease-specific survival of women with both type I and type II epithelial ovarian cancer.

CLINICAL TRIAL REGISTRATION:

OnCore Clinical Trials Management System, NCI-2013-01954.
Elagolix Alone or With Add-Back Therapy in Women With Heavy Menstrual Bleeding and Uterine Leiomyomas
Authors: Carr Bruce R. , Stewart Elizabeth A. , Archer David F. , Al-Hendy Ayman , Bradley Linda , Watts Nelson B. , Diamond Michael P. , Gao Jingjing , Owens Charlotte D. , Chwalisz Kristof , Duan W. Rachel , Soliman Ahmed M. , Dufek Matthew B. , Simon James A.
Published: October 2018

OBJECTIVE:

To evaluate elagolix, an oral gonadotropin-releasing hormone receptor antagonist, alone or with add-back therapy, in premenopausal women with heavy menstrual bleeding (greater than 80 mL per month) associated with uterine leiomyomas.

METHODS:

This double-blind, randomized, placebo-controlled, parallel-group study evaluated efficacy and safety of elagolix in cohorts 1 (300 mg twice daily) and 2 (600 mg daily) with four arms per cohort: placebo, elagolix alone, elagolix with 0.5 mg estradiol/0.1 norethindrone acetate, and elagolix with 1.0 mg estradiol/0.5 mg norethindrone acetate. A sample size of 65 per group was planned to compare elagolix with add-back to placebo on the primary end point: the percentage of women who had less than 80 mL menstrual blood loss and 50% or greater reduction in menstrual blood loss from baseline to the last 28 days of treatment. Safety assessments included changes in bone mineral density.

RESULTS:

From April 8, 2013, to December 8, 2015, 571 women were enrolled, 567 were randomized and treated (cohort 1=259; cohort 2=308), and 80% and 75% completed treatment, respectively. Participants had a mean±SD age of 43±5 years (cohort 2, 42±5 years), and 70% were black (cohort 2, 74%). Primary end point responder rates in cohort 1 (cohort 2) were 92% (90%) for elagolix alone, 85% (73%) for elagolix with 0.5 mg estradiol/0.1 mg norethindrone acetate, 79% (82%) for elagolix with 1.0 mg estradiol/0.5 mg norethindrone acetate, and 27% (32%) for placebo (all P<.001 vs placebo). Elagolix groups had significant decreases compared with placebo in lumbar spine bone mineral density, which was attenuated by adding 1.0 mg estradiol/0.5 mg norethindrone acetate.

CONCLUSION:

Elagolix with and without add-back significantly reduced menstrual blood loss in women with uterine leiomyomas. Add-back therapy reduced hypoestrogenic effects on bone mineral density.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01817530; EU Clinical Trial Register, 2013-000082-37.
Prospective Validation of a Standardized Ultrasonography-Based Ovarian Cancer Risk Assessment System
Authors: Suh-Burgmann Elizabeth , Flanagan Tracy , Osinski Todd , Alavi Mubarika , Herrinton Lisa
Published: October 2018

OBJECTIVE:

To evaluate the performance of a system that standardizes ovarian cancer risk assessment and reporting on ultrasonography.

METHODS:

We conducted a prospective community-based cohort study of average-risk women undergoing ultrasonography in 2016 using a reporting system that requires adnexal masses to be categorized as 1, 2, 3, or X based on standardized ultrasound criteria including size, presence of solid components, and vascularity assessed by Doppler. With a median follow-up of 18 months, the risk of ovarian cancer or borderline tumor diagnosis for each category was determined.

RESULTS:

Among 43,606 women undergoing ultrasonography, 6,838 (16%) had an abnormal adnexal mass reported: 70% were category 1, 21% category 2, 3.7% category 3, and 5.4% category X. Among these women, 89 (1.3%) were subsequently diagnosed with ovarian cancer and 59 (0.9%) with borderline tumors. The risks of ovarian cancer diagnosis associated with masses reported as categories 1, 2, 3, and X were 0.2% (95% CI 0.05–0.3%), 1.3% (95% CI 0.7–1.9%), 6.0% (95% CI 3.0–8.9%), and 13.0% (95% CI 9.5–16.4%), respectively; risks of either ovarian cancer or borderline tumor were 0.4% (95% CI 0.2–0.6%), 2.3% (95% CI 1.6–3.1%), 10.4% (95% CI 6.6–14.1%), and 18.9% (95% CI 14.9–23.0%) respectively. Among 36,768 (84%) women with normal or benign adnexal findings reported, 38 women were diagnosed with ovarian cancer, for a risk of 0.1% (95% CI 0.07–0.14%).

CONCLUSION:

In a community-based setting with low ovarian cancer prevalence, our standardized reporting system differentiated adnexal masses into four categories with distinct levels of risk with 9–10% of women having higher risk masses and 70% of women having masses associated with a risk of cancer similar to that of normal ultrasound findings. The system supports risk-based management by providing clinicians a more consistent assessment of risk based on ultrasound characteristics.
Female Physician Leadership During Cardiopulmonary Resuscitation Is Associated With Improved Patient Outcomes*
Authors: Meier Angela , Yang Jenny , Liu Jinyuan , Beitler Jeremy R. , Tu Xin M. , Owens Robert L. , Sundararajan Radhika L. , Malhotra Atul , Sell Rebecca E.
Published: October 2018

Objectives:

A recently published simulation study suggested that women are inferior leaders of cardiopulmonary resuscitation efforts. The aim of this study was to compare female and male code leaders in regard to cardiopulmonary resuscitation outcomes in a real-world clinical setting.

Design:

Retrospective cohort review.

Setting:

Two academic, urban hospitals in San Diego, California.

Subjects:

One-thousand eighty-two adult inpatients who suffered cardiac arrest and underwent cardiopulmonary resuscitation.

Interventions:

None.

Measurements and Main Results:

We analyzed whether physician code leader gender was independently associated with sustained return of spontaneous circulation and survival to discharge and with markers of quality cardiopulmonary resuscitation. Of all arrests, 327 (30.1%) were run by female physician code leaders with 251 (76.8%) obtaining return of spontaneous circulation, and 122 (37.3%) surviving to discharge. Male physicians ran 757 codes obtaining return of spontaneous circulation in 543 (71.7%) with 226 (29.9%) surviving to discharge. When adjusting for variables, female physician code leader gender was independently associated with a higher likelihood of return of spontaneous circulation (odds ratio, 1.36; 95% CI, 1.01–1.85; p = 0.049) and survival to discharge (odds ratio, 1.53; 95% CI, 1.15–2.02; p < 0.01). Additionally, the odds ratio for survival to discharge was 1.62 (95% CI, 1.13–2.34; p < 0.01) for female physicians with a female code nurse when compared with male physician code leaders paired with a female code nurse. Gender of code leader was not associated with cardiopulmonary resuscitation quality.

Conclusions:

In contrast to data derived from a simulated setting with medical students, real life female physician leadership of cardiopulmonary resuscitation is not associated with inferior outcomes. Appropriately, trained physicians can lead high-quality cardiopulmonary resuscitation irrespective of gender.
Immunotherapy With Antiprogrammed Cell Death 1 Antibody Improves Outcome in a Mouse Model of Spinal Cord Injury Followed by Staphylococcus aureus Pneumonia
Authors: Ruggeri Tiphaine , Jacqueline Cédric , Ambrosi Xavier , Broquet Alexis , Desfrançois Juliette , Roquilly Antoine , Altare Frédéric , Asehnoune Karim
Published: October 2018

Objectives:

In patients with spinal cord injury, spinal cord injury-immune depression syndrome induces pneumonia. We aimed to develop a new spinal cord injury-immune depression syndrome mouse model and to test antiprogrammed cell death 1 therapy.

Design:

Experimental study.

Setting:

Research laboratory.

Subjects:

RjOrl: SWISS and BALB/cJ mice.

Interventions:

Mouse model of spinal cord injury-immune depression syndrome followed by a methicillin-susceptible Staphylococcus aureus pneumonia. Lung injuries were assessed by histologic analysis. Membrane markers and intracytoplasmic cytokines were assessed by flow cytometry. Cytokine production was assessed by quantitative polymerase chain reaction (messenger RNA) and enzyme-linked immunosorbent assay (protein). Animals were treated with blocking antiprogrammed cell death 1 antibodies (intraperitoneal injection).

Measurements and Main Results:

Spinal cord injury mice were more susceptible to methicillin-susceptible S. aureus pneumonia (increased mortality rate). An early inflammatory response was observed in spinal cord injury mice characterized in lungs by a decreased percentage of aerated tissue, an increased production of proinflammatory cytokines (tumor necrosis factor-α). In spleen, an increased expression of major histocompatibility complex class II molecules on dendritic cells, and an increased production of proinflammatory cytokines (interleukin-12, interferon-γ) was observed. Following this pulmonary and systemic inflammation, spinal cord injury-immune depression syndrome was observed in spleens as acknowledged by a decrease of spleen’s weight, a lymphopenia, a decrease of major histocompatibility complex class II expression on dendritic cells. An increase of interleukin-10 production and the increase of a cell exhaustion marker expression, programmed cell death 1 receptor on T-cell were also observed. Blockade of programmed cell death 1 molecules, improved survival of spinal cord injury infected mice and enhanced interferon-γ production by natural killer T cells as well as number of viable CD4+ T cells.

Conclusions:

This model of spinal cord injury in mice mimics a clinical scenario rendering animals prone to a secondary pneumonia. We show for the first time an acute T-cell exhaustion-like phenomenon following an initial inflammatory response. Finally, inhibition of exhaustion pathway should be considered as a new therapeutic option to overcome spinal cord injury-immune depression syndrome and to decrease the rate of nosocomial pneumonia.
Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors
Authors: Tsai Min-Shan , Chuang Po-Ya , Huang Chien-Hua , Tang Chao-Hsiun , Yu Ping-Hsun , Chang Wei-Tien , Chen Wen-Jone
Published: October 2018

Objectives:

To evaluate the ramifications of steroid use during postarrest care.

Design:

Retrospective observational population-based study enrolled patients during years 2004–2011 with 1-year follow-up.

Setting:

Taiwan National Health Insurance Research Database.

Patients:

Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission.

Interventions:

These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status.

Measurements and Main Results:

There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70–0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70–0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest.

Conclusions:

In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.
Predicting the Risk of Readmission From Dehydration After Ileostomy Formation: The Dehydration Readmission After Ileostomy Prediction Score
Authors: Chen Sophia Y. , Stem Miloslawa , Cerullo Marcelo , Canner Joseph K. , Gearhart Susan L. , Safar Bashar , Fang Sandy H. , Efron Jonathan E.
Published: October 2018

BACKGROUND:

All-cause readmission rates in patients undergoing ileostomy formation are as high as 20% to 30%. Dehydration is a leading cause. No predictive model for dehydration readmission has been described.

OBJECTIVE:

The purpose of this study was to develop and validate the Dehydration Readmission After Ileostomy Prediction scoring system to predict the risk of readmission for dehydration after ileostomy formation.

DESIGN:

Patients who underwent ileostomy formation were identified using the American College of Surgeons National Surgical Quality Improvement Program data set (2012–2015). Predictors for dehydration were identified using multivariable logistic regression analysis and translated into a point scoring system based on corresponding β-coefficients using 2012–2014 data (derivation). Model discrimination was assessed with receiver operating characteristic curves using 2015 data (validation).

SETTINGS:

This study used the American College of Surgeons National Surgical Quality Improvement Program.

PATIENTS:

A total of 8064 (derivation) and 3467 patients (validation) were included from the American College of Surgeons National Surgical Quality Improvement Program.

MAIN OUTCOME MEASURES:

Dehydration readmission within 30 days of operation was measured.

RESULTS:

A total of 8064 patients were in the derivation sample, with 2.9% (20.1% overall) readmitted for dehydration. Twenty-five variables were queried, and 7 predictors were identified with points assigned: ASA class III (4 points), female sex (5 points), IPAA (4 points), age ≥65 years (5 points), shortened length of stay (5 points), ASA class I to II with IBD (7 points), and hypertension (9 points). A 39-point, 5-tier risk category scoring system was developed. The model performed well in derivation (area under curve = 0.71) and validation samples (area under curve = 0.74) and passed the Hosmer–Lemeshow goodness-of-fit test.

LIMITATIONS:

Limitations of this study pertained to those of the American College of Surgeons National Surgical Quality Improvement Program, including a lack of generalizability, lack of ileostomy-specific variables, and inability to capture multiple readmission International Classification of Diseases, 9th/10th edition, codes.

CONCLUSIONS:

The Dehydration Readmission After Ileostomy Prediction score is a validated scoring system that identifies patients at risk for dehydration readmission after ileostomy formation. It is a specific approach to optimize patient factors, implement interventions, and prevent readmissions. See Video Abstract at http://links.lww.com/DCR/A746.
INCIDENCE AND RISK FACTORS FOR HYPOTONY AFTER 25-GAUGE PARS PLANA VITRECTOMY WITH NONEXPANSILE ENDOTAMPONADE
Authors: Mimouni Michael , Abualhasan Hamza , Derman Laura , Feldman Assaf , Mazzawi Fares , Barak Yoreh
Published: October 2018

Purpose:

The purpose of this study was to assess the incidence and risk factors for early postoperative hypotony after 25-gauge pars plana vitrectomy with nonexpansile endotamponade.

Methods:

A retrospective study of consecutive patients who underwent 25-G pars plana vitrectomy. Hypotony was defined as an intraocular pressure of 5 mmHg or less after surgery and ocular hypertension as an intraocular pressure greater than 21 mmHg.

Results:

Overall, 307 eyes of 307 patients with a mean age of 61.7 ± 14.3 of which 56.7% were males were included. Hypotony was identified in 5.2% of cases (n = 16) at Day 1 and 0.7% (n = 2) at Week 1 with no hypotony-related complications. The hypotony group had a higher number of previous vitreoretinal surgeries (1.5 ± 1.1 vs. 0.4 ± 0.7, P < 0.001) and a higher prevalence of preoperative ocular hypertension (22.2% vs. 4.8%, P = 0.02), pseudophakia (77.8% vs. 48.4%, P = 0.01), silicone oil removal (61.1% vs. 8.3%, P < 0.001), and external diathermy performed (55.6% vs. 20.1%, P = 0.001). In stepwise multivariate analysis, significant parameters were silicone oil removal (R2 = 16.34%, odds ratio 13.45, P < 0.001), pseudophakia (R2 = 5.69%, odds ratio 3.65, P = 0.03), and younger age (R2 = 2.68%, odds ratio 0.96, P = 0.04).

Conclusion:

Silicone oil removal is a significant risk factor for early postoperative hypotony after 25-G pars plana vitrectomy.
Descemet's Membrane Biomimetic Microtopography Differentiates Human Mesenchymal Stem Cells Into Corneal Endothelial-Like Cells
Authors: Gutermuth Angela , Maassen Jessika , Harnisch Emely , Kuhlen Daniel , Sauer-Budge Alexis , Skazik-Voogt Claudia , Engelmann Katrin
Published: October 2018

Purpose:

Loss of corneal endothelial cells (CECs) bears disastrous consequences for the patient, including corneal clouding and blindness. Corneal transplantation is currently the only therapy for severe corneal disorders. However, the worldwide shortages of corneal donor material generate a strong demand for personalized stem cell–based alternative therapies. Because human mesenchymal stem cells are known to be sensitive to their mechanical environments, we investigated the mechanotransductive potential of Descemet membrane–like microtopography (DLT) to differentiate human mesenchymal stem cells into CEC-like cells.

Methods:

Master molds with inverted DLT were produced by 2-photon lithography (2-PL). To measure the mechanotransductive potential of DLT, mesenchymal stem cells were cultivated on silicone or collagen imprints with DLT. Changes in morphology were imaged, and changes in gene expression of CEC typical genes such as zonula occludens (ZO-1), sodium/potassium (Na/K)-ATPase, paired-like homeodomain 2 (PITX2), and collagen 8 (COL-8) were measured with real-time polymerase chain reaction. At least immunofluorescence analysis has been conducted to confirm gene data on the protein level.

Results:

Adhesion of MSCs to DLT molded in silicone and particularly in collagen initiates polygonal morphology and monolayer formation and enhances not only transcription of CEC typical genes such as ZO-1, Na/K-ATPase, PITX2, and COL-8 but also expression of the corresponding proteins.

Conclusions:

Artificial reproduction of Descemet membrane with respect to topography and similar stiffness offers a potential innovative way to bioengineer a functional CEC monolayer from autologous stem cells.
Symptom Perception, Evaluation, Response to Symptom, and Delayed Care Seeking in Patients With Acute Heart Failure
Authors: Okada Akiko , Tsuchihashi-Makaya Miyuki , Kang JungHee , Aoki Yoshiyuki , Fukawa Mariko , Matsuoka Shiho
Published: October 2018

Background:

Exacerbation of heart failure (HF) requires early intervention to prevent hospital admission and to reduce mortality. Early care seeking requires that patients perceive symptoms, accurately evaluate perceived symptoms, and respond appropriately. How perception, evaluation, and response to symptoms are associated with delay in seeking care for worsening symptoms has rarely been studied.

Objective:

The aims of this study were to investigate the associations of perception of symptoms, evaluation of symptoms, and response to symptoms with delayed care seeking in patients with HF and to identify factors associated with delayed care seeking.

Methods:

Patients admitted for acute exacerbation of HF were enrolled in this cross-sectional observational study. We used structured interviews, questionnaires, and medical record review to collect data. Factors related to delayed care seeking were identified using nonlinear regression.

Results:

Analysis was performed in 109 patients with HF. The median delay time was 124 hours. Delayed care seeking was associated with younger age and perception of fatigue, whereas evaluation of and response to symptoms were not associated with delay.

Conclusions:

Few characteristics of the symptom experience are associated with delayed care seeking among patients with HF who experience an exacerbation of symptoms. Further research is needed to determine why early care seeking is difficult among patients with HF.
Effectiveness of antibiotics versus ibuprofen in relieving symptoms of nosocomial urinary tract infection: A comparative study
Authors: Aloush Sami M. , Al-Awamreh Khetam , Abu Sumaqa Yasmeen , Halabi Marwa , Al Bashtawy Mohammed , Salama Fatima Bani
Published: October 2018

Background and purpose:

Antibiotic therapy has been the mainstay of treatment in the management of hospitalized patients with nosocomial urinary tract infection (UTI); however, its use is associated with an increase in resistance and high cost. Ibuprofen showed effectiveness in relieving symptoms of UTI, but its superiority is questionable. The goal of this study was to compare the effectiveness of antibiotics against ibuprofen in relieving symptoms of UTI and to identify factors that affect symptom relief.

Methods:

This study was conducted in three public hospitals in Jordan. Patients with nosocomial UTI were assigned to either antibiotics or ibuprofen. Symptoms of UTI were assessed at the time of initiation of treatment and 5 days later.

Conclusions:

Antibiotics were more effective in relieving symptoms of UTI than Ibuprofen. Comorbidity and length of hospitalization affected symptom relief during the treatment of UTI.

Implication for practice:

Nurse practitioners in the clinical settings can take an active role in helping patients with UTI to achieve relief of symptoms by supporting the use of antibiotics over ibuprofen in symptom resolution.
Surgical Management for Dysplastic or Congenitally Absent Oval Window
Authors: Seidman Michael D. , Manning Drue
Published: October 2018

Objective:

To evaluate surgical findings and hearing results for patient's undergoing the described surgical approach for congenitally absent or dysplastic oval window (OW).

Study Design:

The Institutional Review Board approved retrospective review of patients with conductive hearing loss (CHL) operated on from 1992 to 2016.

Setting:

Academic tertiary center.

Patients:

Patients with CHL, an intact tympanic membrane (TM), and without history of chronic infection underwent middle ear exploration. Eleven patients and 13 ears underwent an oval window drill-out (OWD) procedure.

Intervention:

Eleven patients presented, all with dysplastic or congenitally absent oval window (CAOW). CHL was identified using audiometry and tuning forks, many patients also had preoperative computed tomography temporal bones. A transcanal approach was used and an OWD was performed with a variety of prostheses placed.

Main Outcome Measure:

Audiometric studies before and after intervention were compared with 12 month and long-term follow-up (1–22 yr).

Results:

Preoperative air-bone gaps ranged from 40 to 60 dB and averaged 55.1 dB. Postoperative air-bone gaps ranged from 0 to 60 dB and averaged 24.1 dB. The preoperative pure-tone average (PTA) ranged from 55 to 99 dB and averaged 71.3 dB. Postoperative PTA ranged from 21 to 108 dB and averaged 49.6 dB.

Conclusion:

Dysplastic and CAOW are uncommon congenital major ear anomalies. OWD is a viable treatment option, though careful counseling is critical, as significant complications are possible, especially with facial nerve (FN) abnormalities. This series demonstrates successful closure of the air-bone gap for many patients with this technique.
Superiority of Second Stage Ossiculoplasty
Authors: Lim Ji Hyung , Park Jung Mee , Han Jung Ju , Kim Seon Ik , Park So Young , Park Shi Nae
Published: October 2018

Objective:

To compare hearing results of single stage ossiculoplasty with second stage ossiculoplasty, and to provide a proper indication of operation options (single stage or second stage ossiculoplasty) according to patients’ clinical conditions.

Study Design:

Retrospective case review study.

Setting:

Tertiary referral center.

Patients:

A total of 175 patients with chronic otitis media.

Interventions:

Tympanoplasty or mastoidectomy with tympanoplasty (M&T) as well as ossiculoplasty of either single or second stage between January 2009 and March 2016 by one surgeon (S.N.P.).

Main Outcome Measures:

Hearing outcomes evaluated by mean postoperative air-bone gap (ABG) and success rates in various subgroups of middle ear surgeries and different types of ossiculoplasty were analyzed.

Results:

Among 175 patients, 120 underwent single stage ossiculoplasty, and 55 underwent second stage ossiculoplasty. The benefit of second stage ossiculoplasty in hearing results both at 3 months visit (p < 0.001) and 2 years visit (p = 0.003) were observed. The superiority of second stage ossiculoplasty was found in 20 dBHL cut off value with a statistical significance. The subgroups of canal wall down mastoidectomy and the first, non-revision middle ear surgery showed statistically significant benefits with second stage ossiculoplasty.

Conclusion:

Second stage ossiculoplasty has overall advantage in hearing results compared with single stage ossiculoplasty and could be more advantageous to the patient who needs canal wall down mastoidectomy or whose operation is the first middle ear surgery.
The Effect of a Distributed Virtual Reality Simulation Training Program on Dissection Mastoidectomy Performance
Authors: Andersen Steven Arild Wuyts , Foghsgaard Søren , Cayé-Thomasen Per , Sørensen Mads Sølvsten
Published: October 2018

Objective:

To investigate the effect on final-product performance of a distributed, virtual reality (VR) simulation training program on cadaveric dissection performance and learning curves compared with standard VR simulation training during a temporal bone course.

Study Design:

Educational interventional cohort study.

Setting:

The national Danish temporal bone courses of 2016 and 2017.

Subjects:

Postgraduate year 2 to 5 residents in otorhinolaryngology.

Intervention:

Nine participants volunteered for additional VR simulation training (intervention) before the temporal bone course, with training blocks distributed (i.e., separated). The remaining 28 participants received standard VR simulation training during the temporal bone course (control).

Main Outcome Measure:

VR simulation and cadaveric dissection final-product performances were analyzed by blinded raters using a 26-item modified Welling Scale.

Results:

Distributed VR simulation training before the temporal bone course (intervention) significantly increased dissection final-product performance by 25% compared with standard VR simulation training during the course (control) (mean scores 12.8 points versus 10.3 points, p < 0.01). Distributed and repeated VR simulation practice markedly decreased drilling time. Guidance by the simulator-integrated tutor-function significantly increased final-product performance by 2.3 points compared with nontutored procedures but at the cost of increased drilling time.

Conclusion:

Skills acquired in a VR simulation environment translate to cadaveric dissection skills and repeated and distributed VR simulation can be used to further increase performance compared with standard VR simulation training during a temporal bone course. Further dissemination of inexpensive VR simulators would allow all future temporal bone course participants to train locally before attending future centralized courses.
Perioperative renal protection
Authors: Canet Emmanuel , Bellomo Rinaldo
Published: October 2018

Purpose of review

The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI).

Recent findings

AKI occurs in 1 in every 10 surgical patients, with cardiac, orthopedic, and major abdominal surgeries being the procedures associated with the highest risk. Overall, complex operations, bleeding, and hemodynamic instability are the most consistent procedure-related risk factors for AKI. AKI increases hospital stay, mortality, and chronic kidney disease, gradually with severity. Furthermore, delayed renal recovery negatively impacts on patients’ outcomes. Cell cycle arrest biomarkers seem promising to identify high-risk patients who may benefit from the bundles recommended by the Kidney Disease: Improving Global Outcomes guidelines. Hemodynamic management using protocol-based administration of fluids and vasopressors helps reducing AKI. Recent studies have highlighted the benefit of personalizing the blood pressure target according to the patient's resting reference, and avoiding both hypovolemia and fluid overload. Preliminary research has reported encouraging renoprotective effects of angiotensin II and nitric oxide, which need to be confirmed. Moreover, urinary oxygenation monitoring appears feasible and a fair predictor of postoperative AKI.

AKI remains a frequent and severe postoperative complication. A personalized

multicomponent approach might help reducing the risk of AKI and improving patients’ outcomes.
Effect of combined parenteral and enteral nutrition versus enteral nutrition alone for critically ill patients
Authors: Shi Jialing , Wei Liying , Huang Rongzhi , Liao Liang
Published: October 2018

Background and aim:

The increased mortality rate and other poor prognosis make malnutrition a serious issue for adult critically ill patients in intensive care unit care. This study was to compare outcomes between combined parenteral and enteral nutrition and enteral nutrition alone for adult critically ill patients.

Materials and methods:

The PubMed (June 30st, 2018), EMBASE (June 30st, 2018), and Cochrane library databases (June 30st, 2018) were searched systematically. Randomized controlled trials (RCTs) of comparing combined PN and EN with EN alone were eligible. Relative risks (RRs), mean differences (MDs), and 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes.

Results:

Eight RCTs involving 5360 patients met the inclusion criteria. Compared with combined PN and EN, fewer respiratory infections (RR, 1.13 [95% CI 1.01–1.25]) and shorter length of days at hospital (MD, 1.83 [95% CI 1.05–2.62]) were observed in EN alone group. And no significant differences were found on hospital mortality (RR, 0.91 [95% CI 0.74–1.12]), length of days in ICU (MD, −0.23 [95% CI −1.79 to 1.32]), duration of ventilatory support (MD, −1.10 [95% CI −3.15 to 0.94]), albumin (MD, −0.04 [95% CI, −0.12 to 0.21]), or prealbumin (MD, −0.77 [95% CI −0.22 to 1.75]) between theses 2 groups.

Conclusion:

Receiving EN alone decreased the respiratory infections and length of days at hospital for critically ill patients. Combined PN and EN did not add up the potential risk from PN and EN on hospital mortality, length of days in ICU, duration of ventilatory support, albumin, and prealbumin.
Percutaneous nerve electrical stimulation for fatigue caused by chemotherapy for cervical cancer
Authors: Fu Ting , Guang Hui-juan , Gao Xiang-zhuan
Published: October 2018

This retrospective study investigated the effectiveness of percutaneous nerve electrical stimulation (PNES) for fatigue caused by chemotherapy for cervical cancer survivors.

Totally, 83 cases of fatigue caused by chemotherapy for cervical cancer survivors were analyzed. All these cases were assigned to a treatment group (n = 43), and a control group (n = 40). Patients in the treatment group received PNES, while the subjects in the control group were on waiting list. The treatment was applied once daily for a total of 6 weeks. The primary endpoint was fatigue. It was evaluated by the Multidimensional Fatigue Inventory (MFI), and Fatigue Questionnaire (FQ). The secondary endpoints consisted of anxiety and depression. They were measured by the Hospital Anxiety and Depression Scale (HADS). All outcomes were measured before and after 6-week treatment.

After treatment, PNES did not show significant difference in fatigue relief, measured by MFI (General fatigue, P = .31; Physical fatigue, P = .44; Activity, P = .36; Motivation, P = .55; Mental fatigue, P = .49), and FQ (Mental fatigue, P = .29; Physical fatigue, P = .35); and the reduction of anxiety and depression, measured by the HADS (Anxiety, P = .21; Depression, P = .17) after 6 weeks treatment between 2 groups.

This study demonstrated that PNES may not benefit for cervical cancer survivors with fatigue caused by chemotherapy after 6-week treatment.
Prognostic and clinical significance of metastasis-associated gene 1 overexpression in solid cancers
Authors: Ma Ke , Fan Yangwei , Hu Yuan
Published: October 2018

Background:

In the past 2 decades, metastasis-associated gene 1 (MTA1) has attracted attention for its close association with cancer progression and its roles in chromatin remodeling processes, making it a central gene in cancer. The present meta-analysis was performed to assess MTA1 expression in solid tumors.

Materials and methods:

This analysis identified studies that evaluated the relationship between MTA1 expression and clinical characteristics or prognosis of patients with solid tumors via the PubMed, Cochrane Library, and Embase electronic databases. Fixed-effect and random-effect meta-analytical techniques were used to correlate MTA1 expression with outcome measures. The outcome variables are shown as odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI).

Results:

Analysis of 40 cohort studies involving 4564 cancer patients revealed a significant association of MTA1 overexpression with tumor patient age (>50 vs. <50 years: combined OR 0.73, 95% CI 0.57–0.94), tumor grade (G3/4 vs. G1/2: combined OR 1.94, 95% CI 1.48–2.53), tumor size (>3 cm vs. <3 cm: combined OR 2.35, 95% CI 1.73–3.19), T stage (T3/4 vs. T1/2: combined OR 2.11, 95% CI 1.74–2.56), lymph node metastasis (yes vs. no: combined OR 2.92, 95% CI 2.26–3.75), distant metastasis (yes vs. no: combined OR 2.26, 95% CI 1.42–3.59), TNM stage (III/IV vs. I/II: combined OR 2.50, 95% CI 1.84–3.38), vascular invasion (yes vs. no: combined OR 2.26, 95% CI 1.92–3.56), and poor overall survival time (HR 1.83; 95% CI: 1.53–2.20; P = .000).

Conclusions:

Our analyses demonstrate that MTA1 was an effective predictor of a worse prognosis in tumor patients. Moreover, MTA1 may play important role in tumor progression and outcome, and targeting MTA1 may be a new strategy for anti-cancer therapy.
Diagnostic value of carotid artery ultrasound and hypersensitive C-reactive protein in Type 2 diabetes mellitus patients with acute myocardial infarction in Chinese population
Authors: Li Juan , Wang Liangliang , Wang Qian , Xin Zhaoqin , Liu Yilin , Zhao Qinghua
Published: October 2018

Hypersensitive C-reactive protein (hs-CRP) is reported to be significant risk indicators not only for the development of cardiovascular disease, but also for the development or progression of type 2 diabetes. The objective of this study was to analyze the significance of hs-CRP in type 2 diabetes mellitus (T2DM) combined with acute myocardial infarction (AMI).

Fifty patients with both T2DM and AMI, 50 patients with T2DM alone, and 50 healthy subjects (control group) were selected.

Operating characteristic (ROC) analysis revealed that the sensitivity, specificity, accuracy, and critical value in the diagnosis of T2DM combined with AMI using hs-CRP level were 84.6%, 75.9%, 0.856, and 7.34 mg/L, respectively. For using vulnerable plaque rate, these were 92.7%, 95.3%, 0.923, and 0.52, respectively.

hs-CRP play a significant role in the early diagnosis of T2DM combined with AMI.
MRI findings of AIDS-related giant facial Kaposi's sarcoma
Authors: Guan Chun-Shuang , Wang Xue-Mei , Lv Zhi-Bin , Yan Shuo , Sun Lei , Xie Ru-Ming
Published: October 2018

Rationale:

Kaposi's sarcoma (KS) is the most common malignant tumor in HIV-infected people and occurs mainly in the skin, mucous membranes, and lymph nodes. Approximately 33% of the initial skin manifestations of AIDS and approximately 35% to 79% of KS occur during disease progression. Otherwise, AIDS-related facial KS that was simultaneously examined by magnetic resonance imaging (MRI) is rare.

Patient concerns:

This case was a 30-year-old male homosexual, with left facial nodule for 14 months, and HIV infection was diagnosed 1 month previously. The patient was admitted to hospital because the nodule gradually expanded from 0.2 to 10.0 cm in diameter. Ultrasound examination showed edema of the subcutaneous tissue of the left facial mass, and the boundary was not clear between lesion and normal tissues. Magnetic resonance imaging (MRI) indicated that the left facial mass showed low signal intensity on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI), and a small amount of high signal intensity was seen in it. Diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) showed low signal intensity. After enhanced scan, the tumor showed uneven enhancement.

Diagnoses:

The pathological biopsy indicated KS.

Interventions:

The patient began chemotherapy with the intravenous drip infusion of Doxorubicin Hydrochloride Liposome.

Outcomes:

The facial KS decreased and the facial swelling was relieved.

Lessons:

MRI could not only provide the diagnostic basis of KS for the therapy, but also could accurately determine the scope of the disease.
Infliximab versus cyclosporine for severe ulcerative colitis refractory to steroids
Authors: Wu Dongjie , Yang Zhen , Zhao Chen , Yao Liang
Published: October 2018

Background:

Infliximab and cyclosporine are two main therapies in treating acute severe ulcerative colitis (ASUC), our objective is to assess the effectiveness and safety of cyclosporine (CSA) versus infliximab (IFX) as rescue agents in patients with steroid-refractory ulcerative colitis (UC).

Methods:

We will search three databases from inception to May 2018, and 19 studies are identified that infliximab and cyclosporine as a treatment in steroid-refractory UC patients. The primary outcome was short-term response to treatment. Secondary outcomes included the rates of colectomy at 3 months, 12 months, 36 months, adverse drug reactions and mortality in those who received rescue therapy.

Results:

This update review will provide a high quality synthesis of current evidence of two treatment for steroid-refractory ulcerative colitis. The definition of severe colitis is according to Truelove and Witts’ criteria.

Conclusions:

In the treatment of steroid-resistant ulcerative colitis with infliximab and cyclosporine, there is no difference between the two treatments on short-term and long-term results.
Relationship between ultrasonographic and pathologic calcification patterns in papillary thyroid cancer
Authors: Kim Bu Kyung , Lee Eun Mi , Kim Jeong Hoon , Oak So Young , Kwon Su Kyoung , Choi Young Sik , Kim Young Ok
Published: October 2018

Ultrasonographic microcalcification is highly related to papillary thyroid cancer (PTC) and pathologic psammoma body is a poor prognostic factor. However, it is little known about whether the microcalcifications seen on ultrasonography are consistent with the pathologic psammoma bodies. We evaluated the relationship between ultrasonographic (US) calcification types and pathologic calcification features, and the consistency between observed pathologic and US calcifications.

US calcifications were classified into microcalcification (MC) and nonmicrocalcification (non-MC) types, and pathologic calcifications were classified into 3 types: psammoma bodies, stromal calcifications, and ossifications.

Among the 411 nodules that were reviewed by a pathologist, 38.9% (n = 160) had any type of US calcification. The larger the size of pathologic calcification, the more calcification was present in US (psammoma 46.1% < stromal 53.7% < ossification 73.3%). Psammoma bodies occurred in all US MC type. Ossification nodules occurred in nearly all (92.3%) non-MC type. The stromal-only nodules were 36.8% MC-type and 63.2% non-MC type. MC-type had a significantly higher odds ratio than non-MC type for predicting psammoma bodies according to the logistic regression.

The presence of MC in ultrasonography was consistent with the presence of psammoma bodies. This study suggests that US identification of MC may be a useful prognostic indicator of PTC aggressiveness.
Long-term effects and quality of life following definitive bile duct reconstruction
Authors: Otto Włodzimierz , Sierdziński Janusz , Smaga Justyna , Dudek Krzysztof , Zieniewicz Krzysztof
Published: October 2018

The study covered a cohort of 236 patients with transection of hepatic duct. It aimed to assess the long-term outcome of the reconstruction and a patient's quality of life.

The literature contains many controversies over timing of biliary reconstruction and who ought to repair the injury but just few reports on the long-term outcomes and patient's quality of life.

The bile duct system was reconstructed by hepaticojejunostomy in 236 patients. Of these, 139 patients were initially repaired at a public hospital and referred because of stricture (Group A, N = 59) or of an anastomosis dehiscence (Group B, N = 80); 97 were unrepaired and referred because of a surgical clip occluding the duct (Group C, N = 39) or bile leakage from an open duct (Group D, N = 58). All patients were surveyed in 2015 for quality of life using WHOQOL-BREF.

The mean time of follow-up was 150 months. The time without symptoms amounted to >5 years in 78.6% of patients. The mean time before anastomosis renewal ranged from 8.9 to 4.7 years (P < .04). Multivariate analysis showed infection, failure of reconstruction in public hospital, and female sex as factors responsible for poor long-term outcome.

Patients in Group C had better quality of life than the others (P < .001) with respect to physical health (median 67.85) and psychological condition (median 79.16). The overall mortality was 15.2%.

The long-term result of reconstruction depends on the cause of referral which, in turn, arises from subsequent intervention taken in local hospitals.
Association of MMP-8 rs2012390 and rs11225394 polymorphisms with osteonecrosis of the femoral head risks
Authors: Jiang Liangbin , Zhang Chungang , Wei Biaofang
Published: October 2018

Background:

The association of MMP-8 rs2012390 and rs11225394 polymorphisms with osteonecrosis of the femoral head (ONFH) risks was investigated in several studies with conflicting results. We performed the meta-analysis to evaluate the association between them.

Methods:

Potentially relevant literatures were searched from the electronic databases of PubMed, Web of Science, and Cochrane Library. All databases were searched up to May 6, 2018. The strength of associations of the MMP-8 rs2012390 and rs11225394 polymorphisms with ONFH risk was assessed by crude odds ratios (ORs) with their 95% confidence intervals (CIs) under different genetic models.

Results:

A total of 1469 cases diagnosed with ONFH and 1211 healthy controls were included in the current meta-analysis. A remarkable association between rs11225394 in the MMP-8 gene and an increased risk of ONFH was found (allele model: OR = 1.33, 95% CI = 1.09–1.61, P = .005; heterozygote model: OR = 1.39, 95% CI = 1.13–1.71, P = .002; dominant model: OR = 1.40, 95% CI = 1.14–1.73, P = .002, respectively). Meanwhile, a significant association between MMP-8 rs2012390 and the decreased risk of ONFH was found in heterozygote model (OR = 0.63, 95% CI = 0.51–0.77, P < .00001).

Conclusion:

The meta-analysis results showed a remarkable association between rs11225394 in MMP-8 gene and an increased risk of ONFH and a significant association between MMP-8 rs2012390 and the decreased risk of ONFH.
Impact of surgical ventricular restoration on early and long-term outcomes of patients with left ventricular aneurysm
Authors: Yan Jun , Jiang Shu-Lin
Published: October 2018

Left ventricular aneurysm (LVA) is a common complication of myocardial infarction. However, the optimal treatment for LVA remains controversial.

In this retrospective study, we analyzed the early and long-term clinical consequences of surgical ventricular restoration on 102 patients who had undergone repair between January, 2005 and January, 2015. The LVA repair approaches comprised of patch plasty (n = 28), linear repair (n = 40), and plication repair (n = 34).

Patient demographics were 60.8% male, and the mean age was 60.5 ± 7.2 years. The in-hospital mortality rate was 7.8% (8/102), including 6 patients who died from low cardiac output and 2 from multiorgan failure. During the early postoperative period, left ventricular sizes significantly decreased in the patch plasty and linear repair groups compared with the plication group. In addition, all 3 repair techniques greatly ameliorated left ventricular ejection fraction (P < .05), and there was no significant difference in survival rate between groups (P = .25).

Surgical ventricular restoration (linear repair, plication repair, and patch plasty) obtained equivalently appreciable outcomes for cardiac function improvement, perioperative mortality, and survival. Selection of a surgical technique for LVA patients should be optimized to individual patient conditions including the morphological characteristics of the aneurysm and ischemic scar.