bluuebunny/crossref_metadata_2025 huggingface dataset:
Size matters: diatom establishment and extirpation timing in the Laurentian Great Lakes has been influenced by cell size
Authors: Bramburger Andrew J , Reavie Euan D , Sgro Gerald V , Estepp Lisa R , Shaw Chraïbi Victoria L , Pillsbury Robert W
Published: March 2020

The Laurentian Great Lakes are among the planet’s fastest-warming lakes. Recent paleolimnological studies have shown changes in the diatom community of the system, including shifts towards taxa characteristic of strongly stratified systems and ongoing cell-size diminution. Relationships between species’ cell size and establishment in—or extirpation from—the system have not been addressed. Examining patterns of establishment and extirpation provides insight into the effects of multiple stressors at the ecosystem scale. We evaluate the timing of the establishment or extirpation of diatom taxa from fossil records post-European settlement within the Great Lakes as a function of cell size. Relationships between establishment or extirpation date and cell size were not random, and were best expressed as cubic curves. Generally, large taxa became established early in the record, while establishments of smaller taxa continued apace until the late 20th century. Extirpations of taxa of all sizes accelerated in the late 20th and early 21st centuries, and large-celled taxa were disproportionately extirpated over the last two decades. We discuss the implications of these relationships on the overall cell-size characteristics of the community, and consider the influences of propagule pressure, nutrient status, species invasions, and climate change upon diatom establishment and extirpation.
Use of Surface Electromyography to Measure Muscle Fatigue in Patients in an Acute Care Hospital
Authors: Skrzat Julie M , Carp Stephen J , Dai Ting , Lauer Richard , Hiremath Shivayogi V , Gaeckle Nathaniel , Tucker Carole A
Published: March 2020

Background

Functional outcomes with early rehabilitation in the acute care setting have improved; however, an improved understanding of muscle fatigue using surface electromyography (sEMG) is warranted to better guide patient-centered exercise prescription.

Objectives

The objectives of this study were to assess the safety and feasibility of collecting sEMG at the acute care bedside and to determine differences in muscle fatigue during isometric and dynamic submaximal contractions among patients in the hospital, healthy younger participants, and healthy older participants.

Design

The study used an observational cohort design.

Methods

There were 37 participants. Median frequency (Fmed) of the myoelectric signal of the quadriceps femoris muscles and time to task failure (TTTF) were measured using sEMG during an isometric and dynamic fatiguing contraction. Primary analysis compared TTTF between groups for both types of contractions. Secondary analysis compared Fmed at initiation and termination of fatiguing contraction.

Results

High-quality sEMG measures were safe and feasible to collect at the acute care bedside with no adverse events. There was a statistically significant difference in TTTF between groups after isometric and dynamic contractions; hospitalized patients fatigued faster than healthy younger and healthy older participants after both contractions. With the exception of the vastus lateralis during a dynamic contraction in healthy younger and hospitalized patients, there was a statistically significant difference between Fmed at initiation and termination of contraction, indicating that subjects’ muscles did truly fatigue.

Limitations

A limitation of the study was the small sample size of patients who were hospitalized without matched controls.

Conclusions

sEMG is a lab quantitative technique that was found to be safe and feasible to assess muscle fatigue in the acute care environment. The protocol yielded similar results to previously published literature for healthy younger and healthy older people. Further research is needed to better understand how to integrate sEMG findings into patient-centered exercise prescriptions.
Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Yoshii Toshitaka , Morishita Shingo , Inose Hiroyuki , Yuasa Masato , Hirai Takashi , Okawa Atsushi , Fushimi Kiyohide , Fujiwara Takeo
Published: March 2020

Study Design.

A retrospective comparative study.

Objective.

To compare the perioperative complications and costs of anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data.

Surgical treatment of cervical OPLL has a high risk of various complications. ADF and PDF are effective for the treatment of cervical OPLL; however, few studies have compared the two procedures in terms of the perioperative surgical complications.

Methods.

Patients undergoing ADF and PDF for cervical OPLL from 2010 to 2016 were identified in a nation-wide inpatient database. We investigated systemic and local complications, length of hospital stay, costs for hospitalization, reoperation, and mortality. Propensity score was calculated from patients’ characteristics and preoperative comorbidities, and one to one matching was performed.

Results.

Propensity score-matching produced 854 pairs of patients who underwent ADF and PDF. The rate of at least one systemic complication was significantly higher in the ADF group (P = 0.004). The incidence rates of postoperative respiratory failure (P = 0.034) and dysphagia (P = 0.008) were significantly higher in the ADF group. The rates of pneumonia (P = 0.06) and hoarseness (P = 0.08) also tended to be higher in the ADF group. However, no difference was found in the mortality rate (P = 0.22). In the local complications, spinal fluid leakage was significantly higher in the ADF group (P < 0.001). However, blood transfusion rate was significantly higher in the PDF group (P = 0.001). Hospital stay was significantly longer in the PDF group (P < 0.001) and the cost for hospitalization was greater in the PDF group (P < 0.001).

Conclusion.

The present study demonstrated that perioperative complications, such as respiratory failure, dysphagia, and spinal fluid leakage, were more common in the ADF group. However, hospital stay was longer in the PDF group, and the cost for hospitalization was greater in the PDF group.

Level of Evidence: 3.
Post-traumatic ACL Tear With Oxford Mobile Bearing UKA In Situ: Management Tips and Pearls
Authors: Kumar Vijay , Panthee Rajan , Yadav Rahul , Nayak Mayur , Malhotra Rajesh
Published: March 2020

A 59-year-old female individual with bilateral unicompartmental knee arthroplasty (UKA) in situ suffered post-traumatic left anterior cruciate ligament (ACL) tear. She was managed with an arthroscopic ACL reconstruction with an autologous hamstring graft. The outside-in technique was used with a suspensory method of fixation. Currently, the patient has completed 2 years of follow-up with an improvement of the functional scores to the preinjury levels. Given the paramount importance of the integrity of ACL to a well-functioning UKA, the present case shows a suitable treatment option for patients with ACL injury post-UKA and highlights the surgical technique.
Increasing Trauma-Informed Awareness and Practice in Higher Education
Authors: Doughty Kristen
Published: March 2020

Background:

Traumatic experiences across the lifespan can affect an individual's physical, social, and emotional health and cognitive development. There has been an increased focus on trauma-informed initiatives in various public and health care sectors, but these initiatives are lacking in higher education.

Method:

A pre-post survey design was used in a trauma-informed professional development session. The survey evaluated educator's knowledge and perceptions of trauma-informed care (TIC) and trauma-informed educational strategies (TIES). Select interviews were then conducted to further analyze knowledge and perception related to TIC and TIES.

Results:

The results demonstrated an increase in knowledge of TIC and TIES, as well as an improved ability to support students. P values were statistically significant at <.05.

Conclusion:

The integration of a trauma-informed professional development session for all educators is the first step in the integration of TIC in higher education and a transition to a trauma-sensitive culture.
Creating and Presenting an Effective Lecture
Authors: Babik Jennifer M. , Luther Vera P.
Published: March 2020

Lectures are a key tool for large group teaching in continuing professional development and continuing medical education within the health care professions. However, many practitioners who deliver lectures have not had the time or opportunity to participate in formal training on how to give an effective presentation. In this article, we will provide a comprehensive guide for creating and presenting an effective lecture. We will discuss evidence-based principles of effective teaching, slide organization and design, active learning, and public speaking.
Intracoronary pressure gradient measurement in acute myocardial infarction patients with the no-reflow phenomenon during primary percutaneous coronary intervention
Authors: Gao Ming-Dong , Zhang En-Yuan , Liu Yuan-Ying , Li Xiao-Wei , Xiao Jian-Yong , Sun Gen-Yi , Liu Yin
Published: March 2020

Background

Various experimental and clinical studies have reported on coronary microcirculatory dysfunction (“no-reflow” phenomenon). Nevertheless, pathogenesis and effective treatment are yet to be fully elucidated. This study aimed to measure the intracoronary pressure gradient in the no-reflow artery during emergent percutaneous coronary intervention and explore the potential mechanism of no-reflow.

Methods

From September 1st, 2018 to June 30th, 2019, intracoronary pressure in acute myocardial infarction patient was continuously measured by aspiration catheter from distal to proximal segment in the Department of Coronary Care Unit, Tianjin Chest Hospital, respectively in no-reflow arteries (no-reflow group) and arteries with thrombolysis in myocardial infarction-3 flow (control group). At least 12 cardiac cycles were consecutively recorded when the catheter was pulled back. The forward systolic pressure gradient was calculated as proximal systolic pressure minus distal systolic pressure. Comparison between groups was made using the Student t test, Mann-Whitney U-test or Chi-square test, as appropriate.

Results

Intracoronary pressure in 33 no-reflow group and 26 in control group were measured. The intracoronary forward systolic pressure gradient was −1.3 (−4.8, 0.7) and 3.8 (0.8, 8.8) mmHg in no-reflow group and control group (Z = −3.989, P < 0.001), respectively, while the forward diastolic pressure gradient was −1.0 (−3.2, 0) and 4.6 (0, 16.5) mmHg in respective groups (Z = −3.851, P < 0.001). Moreover, the intracoronary forward pressure gradient showed significant difference between that before and after nicorandil medication (Z = −3.668, P < 0.001 in systolic pressure gradient and Z = −3.530, P < 0.001 in diastolic pressure gradient).

Conclusions

No reflow during emergent coronary revascularization is significantly associated with local hemodynamic abnormalities in the coronary arteries. Intracoronary nicorandil administration at the distal segment of a coronary artery with an aspiration catheter could improve the microcirculatory dysfunction and resume normal coronary pressure gradient.

Clinical trial registration

www.ClinicalTrials.gov
(No. NCT 03600259).
Reflections on the Spiritual Lives of Caregivers of Spouses with Dementia
Authors: Shim Bomin
Published: March 2020

Observations from research on the spiritual lives of persons caring for their spouses with dementia provide insight into the spirituality of caregivers. The author relates her personal journey of spirituality with findings from narratives of caregivers and the results of grace, joy, and trust. The lived experiences of caregivers who express faith in Jesus enable them to rest and love amid their caregiving. These insights can be useful when applied to nursing care and nursing education.
SEROLOGY NEGATIVE BARTONELLA NEURORETINITIS IN AN IMMUNOCOMPROMISED PATIENT
Authors: Wu Annie M. , Zhao Peter Y. , Wubben Thomas J. , Hyde Robert A. , Paulus Yannis M. , Johnson Mark W.
Published: March 2020

Background/Purpose:

To report a case of serology-negative severe disseminated Bartonella neuroretinitis in an immunocompromised patient in which diagnosis was made by detection of B. henselae DNA by universal polymerase chain reaction of brain tissue.

Methods:

Case report.

Results:

A 57-year-old man with immunoglobulin A vasculitis on immunosuppressive therapy presented with lethargy, weight loss, and bilateral decreased vision. Fundus examination revealed bilateral mild vitritis, marked optic disc edema, vascular sheathing, and numerous white inner retinal and preretinal lesions. Brain magnetic resonance imaging revealed multiple foci of restricted diffusion and a ring-enhancing focus in the left parietal lobe. Serologies, cerebrospinal fluid, and vitreous biopsies were all negative for Bartonella. A brain biopsy was performed and B. henselae DNA was detected by universal polymerase chain reaction of the specimen. The patient demonstrated resolution of fundus findings with antibiotic treatment. Repeat serological testing demonstrated seroconversion.

Conclusion:

In immunocompromised patients, infection by Bartonella henselae can present as severe disseminated disease. Establishing the diagnosis can be challenging as serologic testing is often unrevealing in the setting of a blunted immune response. Polymerase chain reaction has been used in select cases to establish the diagnosis.
Visual Field Cluster Map Corresponding to Bruch Membrane Opening-minimum Rim Area Sectors in Open-angle Glaucoma
Authors: Choi Hyun Sup , Park Sung Pyo , Na Kyeong Ik
Published: March 2020

Précis:

We generated a new visual field (VF) cluster map corresponding to Bruch membrane opening-minimum rim area (BMO-MRA) sectors, which described in detail the structure-function relationships between the optic nerve head and VF in patients with open-angle glaucoma.

Purpose:

The purpose of this study was to investigate the structure-function relationship between BMO-MRA and VF in patients with open-angle glaucoma.

Materials and Methods:

We retrospectively reviewed 67 eyes of 50 patients with open-angle glaucoma who underwent spectral-domain optical coherence tomography for BMO-MRA and the Humphrey VF test. BMO-MRA of the glaucomatous optic nerve head was divided into 12 sectors. The correlation between BMO-MRA sectors and the VF points was analyzed to generate a new VF cluster map.

Results:

Forty-three of the 52 VF points showed a significant correlation with at least 1 BMO-MRA sector. The VF cluster map was generated using the BMO-MRA sectors and each VF point that showed the most correlation. The superior hemifield correlated with 5, 6, 7, and 8 o’clock positions (ρ=0.312 to 0.710), whereas the inferior hemifield correlated with 10, 11, 12, and 2 o’clock positions (ρ=0.241 to 0.483). The VF cluster maps of superior and inferior hemifields showed different configurations of VF clusters and topographical relationships with the glaucomatous optic nerve head.

Conclusion:

The newly generated VF cluster map corresponding to BMO-MRA sectors showed a significant structure-function relationship and could be useful in the diagnosis and evaluation of glaucoma.
Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children
Authors: Ericson Jessica E. , McGuire John , Michaels Marian G. , Schwarz Adam , Frenck Robert , Deville Jaime G. , Agarwal Swati , Bressler Adam M. , Gao Jamie , Spears Tracy , Benjamin Daniel K. , Smith P. Brian , Bradley John S. ,   on behalf of the Best Pharmaceuticals for Children Act—Pediatric Trials Network Steering Committee and the Clinical Trials Transformation Initiative
Published: March 2020

Background:

Clinical trials for antibiotics designed to treat hospital-acquired and ventilator-associated bacterial pneumonias (HABP/VABP) are hampered by making these diagnoses in a way that is acceptable to the United States Food and Drug Administration and consistent with standards of care. We examined laboratory and clinical features that might improve pediatric HABP/VABP trial efficiency by identifying risk factors predisposing children to HABP/VABP and describing the epidemiology of pediatric HABP/VABP.

Methods:

We prospectively reviewed the electronic medical records of patients <18 years of age admitted to intensive and intermediate care units (ICUs) if they received qualifying respiratory support or were started on antibiotics for a lower respiratory tract infection or undifferentiated sepsis. Subjects were followed until HABP/VABP was diagnosed or they were discharged from the ICU. Clinical, laboratory and imaging data were abstracted using structured chart review. We calculated HABP/VABP incidence and used a stepwise backward selection multivariable model to identify risk factors associated with development of HABP/VABP.

Results:

A total of 862 neonates, infants and children were evaluated for development of HABP/VABP; 10% (82/800) of those receiving respiratory support and 12% (103/862) overall developed HABP/VABP. Increasing age, shorter height/length, longer ICU length of stay, aspiration risk, blood product transfusion in the prior 7 days and frequent suctioning were associated with increased odds of HABP/VABP. The use of noninvasive ventilation and gastric acid suppression were both associated with decreased odds of HABP/VABP.

Conclusions:

Food and Drug Administration-defined HABP/VABP occurred in 10%–12% of pediatric patients admitted to ICUs. Risk factors vary by age group.
Specific liver volume parameters in cirrhotic patients with peribiliary cysts
Authors: Hwang Hsuen-En , Chiu Nai-Chi , Liu Chien-An , Chou Yi-Hong , Lee Rheun-Chuan
Published: March 2020

Background:

The presence of peribiliary cysts and morphological changes in the volumes of lobes in the livers of patients with cirrhosis are both related to the alteration of portal flow. Our study explored the relationship between these two features in patients with cirrhosis.

Methods:

We retrospectively selected 150 computed tomography (CT) images of cirrhotic livers and 105 CT images of healthy livers. The cirrhotic livers were further classified according to the presence of peribiliary cysts (peribiliary cysts group) or the absence of peribiliary cysts (control cirrhotic group). The characteristic features of liver cirrhosis, including modified caudate-right lobe ratio (mCR ratio), splenomegaly, ascites, and collateral shunts, were reviewed. Liver volume calculations included the sum of the left hepatic volume (LHV) and right hepatic volume (RHV; LHV + RHV) and the ratio of LHV to RHV (LHV/RHV).

Results:

The two groups did not differ in the presence of splenomegaly, ascites, or collateral shunts. The control cirrhotic group exhibited a significantly higher mCR ratio and LHV/RHV ratio than the peribiliary cysts group did (p < 0.001). The healthy liver group exhibited a significantly higher LHV + RHV value than either the peribiliary cysts group or the control cirrhotic group did (p < 0.001). The peribiliary cysts group and the control cirrhotic group did not differ significantly for LHV + RHV (p > 0.05).

Conclusion:

The control cirrhotic group exhibited a significantly higher mCR ratio and LHV/RHV ratio than the peribiliary cysts group did, but the two groups were similar for most measurements. Peribiliary cysts might result in reduction of portal flow, causing cirrhotic liver with peribiliary cysts with left-sided dominance not to demonstrate the typical morphological appearance of the common cirrhotic liver.
First-line combination immunotherapy for metastatic non-small cell lung cancer
Authors: Chen Yuh-Min
Published: March 2020

Immunotherapy has recently become an important treatment modality, especially for non-small cell lung cancer (NSCLC) and melanoma patients. Several large-scale phase III trials of first-line treatments for metastatic NSCLC have documented prolonged patient survival, including progression-free survival and overall survival for immune checkpoint inhibitors (ICIs) used alone or in combination with chemotherapy. However, a significant proportion of patients experienced disease progression shortly after starting single-agent ICI treatment even after biomarker selection, such as programmed cell death-ligand 1 and tumor mutation burden. The present review was performed to identify ways to enhance ICI efficacy in the first-line treatment of metastatic NSCLC patients. At least four effective ways of combination treatment modalities are currently available, namely, immune therapy in combination with radiotherapy, chemotherapy, antiangiogenesis, or other immunotherapeutic agents.
Evaluation of factors associated with the risk stratification of survivorship for stage IV squamous cell carcinoma of the oral cavity: A 10-year retrospective study
Authors: Cheng Han-Chieh , Yang Cheng-Chieh , Kao Shou-Yen , Wu Tzu-Ying , Wu Cheng-Hsien
Published: March 2020

Background:

Oral squamous cell carcinoma (OSCC) leads to thousands of deaths every year in Taiwan. Nearly 40% of OSCC patients are diagnosed with stage IV disease, which has a poor prognosis. Multimodality treatments including surgery and adjuvant therapy have been utilized, but their treatment outcomes are generally poor. In this study, we sought to identify possible clinical impact factors that may contribute to the survival of stage IV OSCC.

Methods:

Data for patients with malignant neoplasms of the oral cavity registered in the Cancer Registry Database of Taipei Veterans General Hospital between 2002 and 2011 were retrieved. The study patients consisted of OSCC patients with clinical stage IV disease who had undergone a surgery and adjuvant therapy. The primary endpoints were the 5-year disease-free survival (DFS) and overall survival (OS) rates. The clinicopathological characteristics of the patients were also stratified and compared.

Results:

A total of 191 OSCC patients were included for retrospective analysis. The different subgroups of stage IV disease presented different treatment outcomes. The 5-year OS versus DFS rates of each subgroup were as follows: T4N0: 70.9% versus 52.6%; T1-3N23: 66.1% versus 49.8%; T4N1: 49.6% versus 31.6%; and T4N23: 40.9% versus 31.0% (p< 0.01). Patients with diabetes, moderate or poor cell differentiation, perineural invasion, and extracapsular spread presented lower 5-year OS rates (hazard ratio [HR] = 1.87, 1.65, 2.42, and 2.14, respectively), and patients with perineural invasion, positive cut margin, and extracapsular spread presented lower 5-year DFS rates (HR = 1.57, 1.62, and 1.71, respectively).

Conclusion:

In this study, we elucidated the different survival rates of different subgroups of stage IV OSCC following the same treatment scheme. The results of the study provide clinical physicians with references by which to evaluate prognosis and determine post-operative disease monitoring timetables based upon different characteristics.
The Association Between Unit-Level Workplace Social Capital and Intention to Leave Among Employees in Health Care Settings: A Cross-Sectional Multilevel Study
Authors: Iida Mako , Watanabe Kazuhiro , Ando Emiko , Tsuno Kanami , Inoue Akiomi , Kurioka Sumiko , Kawakami Norito
Published: March 2020

Objective:

The aim of this study was to investigate the multilevel association between workplace social capital and intention to leave among employees in health care settings in Japan.

Methods:

This study was a secondary data analysis of the cross-sectional data. A sample of 658 Japanese employees in health care settings with 17 facilities were recruited using a self-administered questionnaire. Multilevel linear regression analysis of intention to leave on unit-level workplace social capital (average score for each unit) was conducted.

Results:

Among 317 respondents from 49 units, after adjusting for demographic and work-related variables, both unit-level and individual-level workplace social capital were significantly negatively associated with intention to leave (P < 0.001).

Conclusions:

The current study found that there was a significant negative association between unit-level workplace social capital and intention to leave in the health care field.
Human Temporal Bone Study of Vestibular Histopathology in Cochlear Implant Patients With Cochlear Hydrops
Authors: Su-Velez Brooke M. , Lopez Ivan A. , Ishiyama Akira , Ishiyama Gail
Published: March 2020

Hypothesis:

Endolymphatic hydrops (EH) associated with cochlear implantation are associated with vestibular dysfunction.

Background:

Vestibular dysfunction is a known risk after cochlear implantation (CI). CI has been shown to cause cochlear hydrops due to fibrosis surrounding the ductus reuniens. However, the association of cochlear hydrops with vestibular hydrops and the relationship to vestibular symptoms remain unknown.

Methods:

Histopathological analysis and clinical evaluation of the vestibular end organs of 17 human temporal bones (HTB)s exhibiting cochlear hydrops from 15 CI recipients.

Results:

Eight of 15 patients with cochlear hydrops due to CI had complaints of dizziness, vertigo, or imbalance following CI. In all 17 HTBs with cochlear hydrops, there was fibrosis, atrophy, or obstruction of the ductus reuniens, and all had straight electrode CI via cochleostomy. In one of the eight reporting postoperative dizziness, labyrinthitis ossificans was deemed causative. Six of the seven remaining patients had EH of both the saccule and utricle. Fifteen of 17 HTBs (88.2%) had saccular EH. In contrast, 8 of 17 HTBs (47.0%) in 7 patients had utricular EH, of which 6 patients had postoperative vertigo spells. It seems that hydrops of the utricle closely corresponds to postoperative vertigo spells and vestibular complaints.

Conclusion:

Implantation of the CI, when complicated by ductus reuniens fibrosis, may cause both cochlear hydrops and vestibular endolymphatic hydrops. Hydrops of the vestibular periphery when involving the utricle seems to be more likely associated with disabling vertigo symptoms. This study supports the round window technique of insertion rather than cochleostomy.
In Vitro Investigation of the Dependency Between Abutment Length and Implant Stability Quotient (ISQ) for Stability Measurements on Bone Anchored Hearing Implant Systems
Authors: Høgsbro Morten , Agger Andreas , Johansen Lars Vendelbo , Gaihede Michael
Published: March 2020

Hypothesis:

The investigation aimed at measuring the relation between abutment length and Implant Stability Quotient (ISQ) for stability measurements on two types of bone-anchored hearing implant systems.

Background:

Measuring bone-anchored hearing implant stability using the ISQ has the inherent limitation that the measurement is dependent on the length of the abutment used on the implant. This dependency has not earlier been analyzed in depth. Therefore, ISQ measurements for different abutment lengths cannot be directly compared if a patient needs a change of abutment or when evaluating different patients in a scientific setting.

Methods:

The dependency of ISQ on abutment length for Cochlear BI300 (Cochlear Nordic AB, Mölnlycke, Sweden) and Ponto Wide Implant (Oticon Medical AB, Askim, Swden) was measured using a temporal bone model and a plaster model. ISQ at abutment level was compared with the corresponding ISQ at implant level and results were analyzed by multiple linear regression.

Results:

The ISQ dependency on abutment length was −3.5 ISQ/mm (95% CI: −3.7 to −3.4) (Cochlear BI300 implant) and −2.9 ISQ/mm (95% CI: −3.0 to −2.7) (Oticon Wide Implant).

Conclusion:

The dependency of ISQ on abutment length for two types of bone-anchored hearing implant systems has been established empirically. This knowledge enables clinicians to continue monitoring the ISQ for a patient after a change of abutment and enables researchers to compare ISQ between patients in a clinical study.
Long-term Hearing Preservation in Electric Acoustic Cochlear Implant Candidates
Authors: Sprinzl Georg Mathias , Schoerg Philipp , Edlinger Stefan Herwig , Magele Astrid
Published: March 2020

Objectives:

To evaluate long-term stability and residual hearing preservation after cochlear implantation with electric acoustic stimulation (EAS).

Study Design:

Retrospective chart-analysis.

Setting:

University clinic.

Methods:

Long- and short-term hearing preservation (HP) of 18 EAS subjects (21 ears) was evaluated. Short-term was defined as follow-ups less than 12 months after surgery versus long-term outcomes longer than 12 months postsurgery.

Results:

Mean period of observation in the short-term group was 4 ± 3.0 months (range 0–7). In the long-term group the mean follow-up was 28.4 ± 15.0 months (range 12–58). Full insertion was possible in all 18 implanted subjects. In the short-term group, complete HP was achieved in 50%, partial HP in 33.3%, and minimal HP in 8.3% of the investigated subjects. One subject lost hearing completely. In the long-term group, complete HP was achieved in 50%, partial HP was observed in 40%, and minimal HP in 10% of the ears. No subject lost hearing completely. Subjects using EAS showed better word recognition scores after surgery (mean at 65 dB 55.3 ± 18.4; mean at 80 dB 68.1 ± 12.2) than subjects using electric stimulation only (mean at 65 dB 38.3 ± 18.1; mean at 80 dB 60.0 ± 16.4) with nonfunctional low-frequency hearing.

Conclusion:

The study confirms that hearing can be preserved to a large extent. As a result, most subjects benefitted from EAS. Subjects with postoperative functional low-frequency hearing showed greater benefit in word speech tests. Furthermore, the outcomes show that EAS implantation is a safe, effective, and most importantly stable treatment option (longest follow-up with 58 mo).
Will They Show? Predictors of Nonattendance for Scheduled Screening Colonoscopies at a Safety Net Hospital
Authors: O’Neil Jessica , Winter Ethan , Hemond Colin , Fass Ronnie
Published: March 2020

Background:

Colonoscopy can reduce colorectal cancer–related mortality by up to 90% through early detection and polyp removal. Despite this, nonattendance rates for scheduled colonoscopies have been reported ranging from 4.1% to as high as 67% depending on the population studied.

Aim:

The aim of the study was to measure the nonattendance rate for scheduled screening colonoscopy at a large safety net hospital and identify predictors of nonattendance within this patient population.

Materials and Methods:

This was a population-based study of 1186 adults who were scheduled to undergo screening colonoscopy at a safety net hospital as part of their routine preventative health program. Health systems variables were assessed including procedure time and scheduling patterns as well as patient-centered variables such as socioeconomic indicators and specific comorbid diagnoses. Associations with nonattendance were examined by univariate and multivariate logistic regression.

Results:

The overall rate of nonattendance for scheduled screening colonoscopy was 33%. A multivariate model was constructed to predict nonattendance revealing that private payer status [odds ratio (OR)=0.368, 95% confidence interval (CI): 0.225, 0.602] and prior colonoscopy (OR=0.371, 95% CI: 0.209, 0.656) were associated with greater attendance rates. Chronic obstructive pulmonary disease (OR=2.034, 95% CI: 1.239, 3.341), afternoon procedure time (OR=1.807, 95% CI: 1.137, 2.871), and a greater interval time between the date the colonoscopy was ordered and the date the colonoscopy was scheduled to occur (OR=1.005, 95% CI: 1.001, 1.009) were independently associated with nonattendance when controlling for age, sex, and race.

Conclusions:

Specific predictors for scheduled screening colonoscopy nonattendance at a safety net hospital can be identified. These findings can be used to tailor community-based interventions to improve colorectal cancer screening rates.
Development and validation of a nomogram to predict the overall survival of patients with neuroblastoma
Authors: Liu Qinglin , Feng Lei , Xue Hao , Su Wandong , Li Gang
Published: March 2020

Neuroblastoma is the most prevalent malignancy in infants characterized by heterogeneous prognosis. It is critical to stratify the risks for patients with neuroblastoma. To stratify the risks for neuroblastoma, clinical characteristics of neuroblastoma patients were retrieved from the Therapeutically Applicable Research to Generate Effective Treatment program. All patients were randomly sampled into the development and validation sets. Cox regression was used to construct a prediction nomogram. The discrimination and calibration capacity of the nomogram was assessed. Prognostic index (PI) was calculated and tested to evaluate the performance of the nomogram. This nomogram demonstrated reasonable discrimination and calibration capacity. The nomogram derived PI exhibited acceptable accuracy in predicting the prognosis for neuroblastoma patients. The overall survival rate was significantly different between the PI discriminated high and low-risk patient subgroups. In conclusion, besides traditional staging systems, some newly defined risk factors could be involved in risk stratification for patients with neuroblastoma. Our nomogram may aid the risk stratification for neuroblastoma patients.
Comparison of the efficacy and safety of shockwave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy, and minimally invasive percutaneous nephrolithotomy for lower-pole renal stones
Authors: Tsai Sheng-Han , Chung Hsiao-Jen , Tseng Ping-Tao , Wu Yi-Cheng , Tu Yu-Kang , Hsu Chih-Wei , Lei Wei-Te
Published: March 2020

Background:

Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and minimally invasive PCNL are currently therapeutic options for lower-pole renal stones (LPS). However, the optimal treatment for LPS remains unclear. A comprehensive evaluation of the efficacy and safety of each intervention is needed to inform clinical decision-making. This study aimed at assessing the efficacy and safety of different interventions for LPS.

Methods:

PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov were searched from inception to December 6th 2018. Only randomized controlled trials (RCTs) including the patients treated for LPS were included. The frequentist models of network meta-analysis were used to compare the effect sizes. The primary outcome was stone free rate, and the secondary outcomes were overall complication rate, major complication rate, retreatment rate, and auxiliary procedure rate.

Results:

This study included 13 RCTs comprising 1832 participants undergoing 6 different interventions, including RIRS, PCNL, Mini-PCNL, Micro-PCNL, SWL, and conservative observation. PCNL had the best stone free rate (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.30–9.12), followed by Mini-PCNL (OR = 2.90, 95% CI = 1.13–7.46). Meta-regression did not find any association of the treatment effect with age, sex, and stone size. Although PCNL tended to exhibit a higher complication rate, the difference of complication rate among various interventions did not achieve a statistical significance. SWL was the less effective and associated with higher retreatment rate compared with PCNL, Mini-PNCL, and RIRS.

Conclusions:

PCNL was associated with the best stone free rate for LPS regardless of age, sex, and stone size. Each treatment achieved a similar complication rate compared with the others. Future large-scale RCTs are warranted to identify the most beneficial management for renal stones at a more complicated location.
The Influence of Screening, Misclassification, and Reporting Biases on Reported Chlamydia Case Rates Among Young Women in the United States, 2000 Through 2017
Authors: Learner Emily R. , Powers Kimberly A. , Torrone Elizabeth A. , Pence Brian W. , Fine Jason P. , Miller William C.
Published: March 2020

Background

National chlamydia case rate trends are difficult to interpret because of biases from partial screening coverage, imperfect diagnostic tests, and underreporting. We examined the extent to which these time-varying biases could influence reported annual chlamydia case rates.

Methods

Annual reported case rates among women aged 15 through 24 years from 2000 through 2017 were obtained from the Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention AtlasPlus tool. Estimates of reporting completeness, diagnostic test sensitivity and specificity, and screening coverage were derived from literature review and expert opinion. We adjusted annual reported case rates for incomplete reporting, imperfect diagnostic tests, and partial screening coverage through a series of corrections, and calculated annual adjusted case rates of correctly diagnosed chlamydia.

Results

Adjusted chlamydia case rates among young women were higher than reported case rates throughout the study period. Reported case rates increased over the study period, but adjusted rates declined from 12,900 to 7900 cases per 100,000 person-years between 2000 and 2007. After 2007, adjusted case rates declined to 7500 cases per 100,000 person-years in 2017. Bias from partial screening coverage had a larger impact on case rate magnitude and trend shape than bias from imperfect diagnostic tests or underreporting.

Conclusions

Reported chlamydia case rates may be substantially lower than true chlamydia case rates because of incomplete reporting, imperfect diagnostic tests, and partial screening coverage. Because the magnitude of these biases has declined over time, the differences between reported and adjusted case rates have narrowed, revealing a sharp decline in adjusted case rates even as reported case rates have risen. The decline in adjusted case rates suggests that the rise in reported case rates should not be interpreted strictly as increasing chlamydia incidence, as the observed rise can be explained by improvements in screening coverage, diagnostic tests, and reporting.
Ingenol Mebutate Gel 0.05% in the Treatment of Anogenital Warts: A Prospective Controlled Trial Comparing It With Topical Podophyllin Solution 25%
Authors: Shahidi Dadras Mohammad , Bizaval Zeinab , Hoormand Mahmood , Mozafari Nikoo
Published: March 2020

Background

Anogenital warts (AGWs) are a common therapeutic challenge. All therapies are associated with burning, pain, and frustrating high rate of recurrence. The search for a new alternative continues. Recently, a diterpene ester extracted from the Euphorbia peplus plant (ingenol mebutate [IM]) has been shown to possess activity against AGWs.

Objective

This study aimed to compare and evaluate the therapeutic efficacy and safety of topical 0.05% ingenol gel with another herbal extract medication (topical 25% podophyllin solution) in treatment of AGWs.

Methods

This was a comparative single blinded nonrandomized, 2-arm trial of ingenol 0.05% gel versus podophyllin solution 25% administered up to 6 times to patients with AGWs. To evaluate the therapeutic efficacy, the complete clearance rate and recurrence rate were assessed 1 and 12 weeks after last treatment, respectively. Safety was assessed by occurrence and severity of pain and local skin reaction (LSR).

Results

Of 31 and 36 patients in the IM group and podophyllin group who completed the study, initial complete resolution was observed in 20 (64.5%) and 14 (38.9%) patients, respectively (P = 0.03). The initial clearance was faster in the IM group (2.00 ± 0.91 weeks) compared with the podophyllin group (4.21 ± 1.05 weeks, P = 0.00). After 3 months, recurrence was seen in 13 (65.0%) of 20 patients in the IM group and 6 (42.8%) of 14 in the podophyllin group (P = 0.20). The number of patients with complete resolution after 3 months was not different between the 2 groups (7/31 in the IM group and 8/36 in the podophyllin group, P = 0.97). The mean ± SD severity scores for LSR and pain in the IM group were 6.65 ± 1.76 and 6.13 ± 2.57, respectively, which was significantly higher than their scores (3.39 ± 1.57 and 2.58 ± 1.38) in the podophyllin group (P = 0.00).

Conclusion

Ingenol mebutate 0.05% gel is effective as podophyllin 25% solution in treating AGWs, with further benefit of being much more rapid. However, high recurrence rate, sever pain, and LSR limit its use.
Extracorporeal Membrane Oxygenation Support for Pediatric Burn Patients: Is It Worth the Risk?*
Authors: Thompson Kelly B. , Dawoud Fakhry , Castle Shannon , Pietsch John B. , Danko Melissa E. , Bridges Brian C.
Published: March 2020

Objectives:

Examine the outcomes of pediatric burn patients requiring extracorporeal membrane oxygenation to determine whether extracorporeal membrane oxygenation should be considered in this special population.

Design:

Retrospective cohort study.

Setting:

All extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization.

Subjects:

Pediatric patients (birth to younger than 18 yr) who were supported with extracorporeal membrane oxygenation with a burn diagnosis between 1990 and 2016.

Interventions:

None.

Measurements and Main Results:

A total of 113 patients were identified from the registry by inclusion criteria. Patients cannulated for respiratory failure had the highest survival (55.7%, n = 97) compared to those supported for cardiac failure (33.3%, n = 6) or extracorporeal cardiopulmonary resuscitation (30%, n = 10). Patients supported on venovenous extracorporeal membrane oxygenation for respiratory failure had the best overall survival at 62.2% (n = 37). Important for the burn population, rates of surgical site bleeding were similar to other surgical patients placed on extracorporeal membrane oxygenation at 22.1%. Cardiac arrest prior to cannulation was associated with increased hospital mortality (odds ratio, 3.41; 95% CI, 0.16–1.01; p = 0.048). Following cannulation, complications including the need for inotropes (odds ratio, 2.64; 95% CI, 1.24–5.65; p = 0.011), presence of gastrointestinal hemorrhage (p = 0.049), and hyperglycemia (glucose > 240 mg/dL) (odds ratio, 3.42; 95% CI, 1.13–10.38; p = 0.024) were associated with increased mortality. Of patients with documented burn percentage of total body surface area (n = 19), survival was 70% when less than 60% total body surface area was involved.

Conclusions:

Extracorporeal membrane oxygenation could be considered as an additional level of support for the pediatric burn population, especially in the setting of respiratory failure. Additional studies are necessary to determine the optimal timing of cannulation and other patient characteristics that may impact outcomes.
Role of Salivary Biomarkers in Predicting Significant Traumatic Brain Injury
Authors: Yeung Claudia , Bhatia Rahul , Bhattarai Bikash , Sinha Madhumita
Published: March 2020

Objectives

The highest rates of traumatic brain injury (TBI)–related morbidity and mortality occur in young children and adolescents. The objective of this study was to describe the levels of 3 biomarkers (S100B, glial fibrillary acidic protein, neuron-specific enolase) in saliva of children with TBI requiring inpatient admission at a pediatric trauma center and compare these levels in children without TBI.

Methods

A convenience sample of 24 children aged 0 to 18 years, presenting with acute isolated TBI, was enrolled prospectively. The non-TBI comparison groups consisted of patients with medical complaints and musculoskeletal injuries only. Salivary specimens were collected, and biomarkers were measured using quantitative enzyme-linked immunosorbent assay method. Demographic, clinical data, and brain imaging findings were obtained.

Results

Seventy-four children were enrolled. Twenty-four had TBI (mean age, 5.07 years; SD, 4.8 years); 14 subjects (58.3%) with TBI were found to have significant traumatic brain injury (SBI) on computed tomography scan. S100B levels were significantly higher in TBI group compared with those with musculoskeletal injury only (median, 113.2 pg/mL vs 18 pg/mL; P = 0.021). Area under the receiver operating characteristic curve for S100B in predicting SBI was 0.675; the optimum threshold for S100B to achieve the optimum sensitivity and specificity of SBI was at 86.9 pg/mL for SBI versus no injury group.

Conclusions

S100B levels in saliva were higher in children with TBI and may be predictive of SBI identified by presence of computed tomography abnormalities. Larger studies are needed to replicate our findings in using a noninvasive diagnostic measure for children with TBI and SBI.
Quantification of Avoidable Radiation Exposure in Interventional Fluoroscopy With Eye Tracking Technology
Authors: Zimmermann Jan Michael , Vicentini Luca , Van Story David , Pozzoli Alberto , Taramasso Maurizio , Lohmeyer Quentin , Maisano Francesco , Meboldt Mirko
Published: March 2020

Objectives

Reducing avoidable radiation exposure during medical procedures is a top priority. The purpose of this study was to quantify, for the first time, the percentage of avoidable radiation during fluoroscopically guided cardiovascular interventions using eye tracking technologies.

Materials and Methods

Mobile eye tracking glasses were used to measure precisely when the operators looked at a fluoroscopy screen during the interventions. A novel machine learning algorithm and image processing techniques were used to automatically analyze the data and compute the percentage of avoidable radiation. Based on this percentage, the amount of potentially avoidable radiation dose was computed.

Results

This study included 30 cardiovascular interventions performed by 5 different operators. A significant percentage of the administered radiation (mean [SD], 43.5% [12.6%]) was avoidable (t
29 = 18.86, P < 0.00001); that is, the operators were not looking at the fluoroscopy screen while the x-ray was on. On average, this corresponded to avoidable amounts of air kerma (mean [SD], 229 [66] mGy) and dose area product (mean [SD], 32,781 [9420] mGycm2), or more than 11 minutes of avoidable x-ray usage, per procedure.

Conclusions

A significant amount of the administered radiation during cardiovascular interventions is in fact avoidable.
18F-FDG PET/CT Findings in a Patient With Neutrophilic Leukemoid Reaction Associated With Multiple Myeloma
Authors: An Caixia , Zhai Luoping , Geng Huixia , Wang Pingzhi , Zhang Wanchun
Published: March 2020

18F-FDG PET/CT was performed on a 48-year-old woman with leukocytosis (white blood cell count 57.10 × 109/L, 84.0% neutrophils) and monoclonal gammopathy to investigate the possibility of reactive neutrophilia secondary to plasmacytoma. On the background of skeletal “superscan,” the maximum intensity projection image of PET demonstrated the highest metabolic region in the left sacrum, which was confirmed as an osteolytic lesion by CT. Biopsy of the sacral lesion revealed a plasma cell myeloma, indicating the diagnosis of neutrophilic leukemoid reaction associated with multiple myeloma. The white blood cell counts dramatically dropped to the normal level after 1 cycle of chemotherapy for multiple myeloma.
New Technique for Correcting Bony Deformity in Racquet Thumb
Authors: Du Zijing , Cui Yan , Hao Jiang , Cao Yi , Han Jialuan , Du Chao , Han Dong
Published: March 2020

This article aims to present a new method for correcting bony deformity in racquet thumb.

Methods

We operated on 37 thumbs of 32 patients (age, 17–52 years) with racquet thumb using a procedure that included narrowing the nail bed, recreating the lateral nail fold, making a bone defect in the widened proximal base, and exposing more proximal nail bed. The ratio of the length to the width of the nail was calculated.

Results

The ratio of the length to the width of the nail increased from 0.55 before surgery to 0.78 at the final follow-up visit. Most patients were satisfied with the cosmetic and functional results.

Conclusions

This technique is simple, safe, and both cost- and time-effective and is a good option for the repair of racquet thumb.