bluuebunny/crossref_metadata_2025 huggingface dataset:
CD73 Is Enriched in Cutaneous Carcinomas That Invade the Orbit
Authors: Wladis Edward J. , Weller Brandon , Adam Alejandro P.
Published: November 2019

Purpose:

To compare the expression of CD73 in indolent nodular basal cell carcinomas and cutaneous lesions that invade the orbit.

Methods:

Immunohistochemical staining for CD73 was performed on nodular basal cell carcinomas and invasive basal cell carcinomas. The numbers of positively staining cells were counted across 5 consecutive ×40 microscopic fields, and a statistical comparison was performed via a dedicated computerized software package.

Results:

Ten control specimens and 11 invasive tumors were analyzed. In nodular basal cell carcinomas, the mean number of positively staining cells was 0.72/×40 field (standard deviation = 0.80 cells/×40 field), whereas invasive tumors demonstrated a mean of 6.53 positive staining cells/×40 field (standard deviation = 3.33 cells/×40 field). This difference was statistically significant (p = 0.0002).

Conclusions:

CD73 is enriched in orbital invasion of cutaneous carcinomas. This checkpoint may represent an important target for therapeutic management of these lesions. Immunotherapeutic agents that have been designed to treat other neoplasms may decrease the requirement for orbital exenteration in this clinical scenario.
Diffuse Nonresolving Violaceous Plaques
Authors: Mitri Andia , Vaudreuil Adam , Lake Eden
Published: November 2019

This is a case of a patient presenting with nonresolving violaceous plaques for over 12 years of duration. In addition to the skin findings, the patient notes progressive arthropathy and nail changes. A multiple-choice question is presented, and readers will be challenged to diagnose this patient based on the case presentation, symptoms, and patient history. An answer is given followed by a discussion of the diagnosis, clinical features, and therapeutic management.
Candida Infections in Clinical Trials of Ixekizumab (Taltz), an Interleukin-17A Monoclonal Antibody, in Patients With Psoriasis or Psoriatic Arthritis
Authors: Bobonich Margaret , Young Melodie S. , Parker Patti A. , Xu Wen , Ridenour Terri L.
Published: November 2019

Interleukin-17 mediates immunity against pathogens such as Candida. Ixekizumab, an anti-interleukin-17A antibody, showed efficacy treating psoriasis (PsO) and psoriatic arthritis (PsA). Detailed here are Candida infections from 11 PsO and three PsA ixekizumab studies.

Overall, patients received 80-mg ixekizumab every 2 or 4 weeks for 12 weeks (PsO) or 24 weeks (PsA) and then every 4 weeks. Candida (high-level term), six Candida subcategories (oral, vulvovaginal, skin, esophageal, nail, and unspecific), and four fungal infections (esophagitis, oral, oropharyngitis, and vulvovaginal mycotic) were included. Patients were counted once per category for multiple events.

Analysis included 5,689 patients with PsO (12,061.5 patient-years of exposure, median exposure = 883 days) and 1,118 patients with PsA (1,373.4 patient-years of exposure, median exposure = 309 days). Overall, Candida infections were low and occurred in 4.4% (PsO incidence rate = 2.1) and 3.1% (PsA incidence rate = 2.5); most were mild or moderate in severity. The average duration of moderate and mild Candida ranged from 33 to 105 days. Most Candida infections were single events, 74% and 91%, with median onset of 328 and 146 days for PsO and PsA, respectively. Five patients (four with PsO and one with PsA) were reported to have a severe infection. Oral, skin, and vulvovaginal Candida were the most frequently reported Candida infections.
White Plaques of the Posterior Buccal Mucosa
Authors: Rundle Chandler W. , Meadows LaVonne
Published: November 2019

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of oral lichen planus.
Use of 5-Fluorouracil “Chemowraps” as a Method of Field Therapy for Actinic Keratosis and Adjunctive Therapy for Squamous Cell Carcinoma
Authors: Heath Christopher , Zito Patrick M.
Published: November 2019

Drugs are medications or substances that are used to modify physiologic responses and alleviate associated symptoms. In dermatology, medications and substances are utilized on a daily basis and include topical treatments to anesthetics in micrographic surgery to biologic-acting immunologic agents. The purposes of this section are to focus on drug, specifically how it works and how it is utilized, and to discuss routine alternatives (if available). In this column, we will focus on the uses, mechanism of action, adverse effects, and alternatives of 5-fluorouracil used in chemowraps for actinic keratoses and squamous cell carcinoma.
Military Environmental Exposure Concerns, Posttraumatic Stress Disorder, and Somatic Symptoms: Their Interrelation Among Treatment-Seeking Veterans
Authors: LaRocca Michael A. , Ashford John W. , Katz Ronit B. , Furst Ansgar J.
Published: November 2019

Objective:

Research suggests military environmental exposure concerns are associated with negative health outcomes. This study investigated the relationship among exposure concerns, Posttraumatic Stress Disorder (PTSD), and somatic symptoms to enhance post-deployment health care programs for veterans.

Methods:

We analyzed intake health data from a heterogeneous sample of predominantly Operation Desert Storm/Shield and Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans (N = 247).

Results:

Individual exposure concerns and somatic symptoms were associated with higher PTSD symptom severity. Regression modeling demonstrated total exposure concerns and PTSD symptom severity linked with total somatic symptom severity. Mediation modeling revealed PTSD symptom severity to partially explain the relation between exposure concerns and somatic symptoms.

Conclusions:

These findings illustrate the need for integrative treatment approaches incorporating physiological and exposure-related concerns associated with PTSD among veterans.
Descriptive Epidemiology of Gradual Return to Work for Workers With a Work-Acquired Musculoskeletal Disorder in British Columbia, Canada
Authors: Maas Esther T. , Koehoorn Mieke , McLeod Christopher B.
Published: November 2019

Objective:

This study investigates the injury, socio-demographic, workplace, and temporal characteristics related with gradual return to work (RTW) among workers with a work-acquired musculoskeletal disorder in British Columbia, Canada.

Methods:

Accepted workers’ compensation lost-time claims were extracted between 2010 and 2015 (n = 141,490). A multivariable logistic regression model was used to analyze the determinants of Gradual RTW.

Results:

Within 1 year after injury, 41.0% of workers had at least 1 day of Gradual RTW. Serious injury severity, female sex, increasing age, wage, and firm size, longer sickness absence, and recent previous claims increased the proportion of workers being provided with Gradual RTW.

Conclusion:

Consideration of injury, socio-demographic, workplace, and temporal variability in the provision of Gradual RTW can identify inequalities in the provision and increase effective use of Gradual RTW for workers with musculoskeletal disorders.
Experiences of Healthcare in Australia's Workers’ Compensation Schemes
Authors: Gray Shannon E. , Collie Alex
Published: November 2019

Objective:

To determine personal, injury, and scheme factors are associated with experiencing stressful healthcare provider (HCP) interactions, and to determine impact of stressful HCP interactions on return to work (RTW).

Methods:

Using the 2018 National RTW Survey of 4574 injured workers that submitted a workers’ compensation claim, multivariable logistic regression determined factors associated with stressful HCP interactions (recorded as “a bit stressful” to “extremely stressful”) and RTW (self-reported yes/no at interview).

Results:

Workers claiming for mental illness, who found healthcare difficult to access, who consulted with multiple HCPs, and who experienced psychological or financial stress, were significantly more likely to experience stressful HCP interactions. Stressful HCP interactions were associated with lower odds of RTW.

Conclusions:

Findings provide impetus to investigate why HCP interactions are stressful to enable efforts to reduce stress, possibly improving RTW outcomes.
Can Workplace Rest Breaks Prevent Work-Related Injuries Related to Long Working Hours?
Authors: Park Sungjin , Lee Wanhyung , Lee June-Hee
Published: November 2019

Objective:

This study examined the relationship between long working hours, rest breaks, and work-related injuries.

Methods:

A total of 25,439 employees were examined from the 4th Korean Working Conditions Survey. Rest breaks were divided into two groups and working hours were divided into four groups. Multiple logistic regression was conducted to estimate the relationship between long working hours, rest breaks, and work-related injuries.

Results:

Work-related injuries were significantly associated with long working hours. Stratified by rest breaks, the risk of work-related injuries increased with increasing working hours in a dose–response pattern among those with insufficient rest breaks, while the risk was not significant among those with sufficient rest breaks.

Conclusion:

It is important to provide sufficient rest breaks to prevent work-related injuries among workers with long working hours.
Does a Delay in Anterior Cruciate Ligament Reconstruction Increase the Incidence of Secondary Pathology in the Knee? A Systematic Review and Meta-Analysis
Authors: Matthewson Graeme , Kooner Sahil , Rabbani Rasheda , Gottschalk Tania , Old Jason , Abou-Setta Ahmed M. , Zarychanski Ryan , Leiter Jeff , MacDonald Peter
Published: November 2019

Objective:

Previous systematic reviews looking at timing of anterior cruciate ligament reconstruction (ACLR) examined the functional outcomes and range of motion; however, few have quantified the effect of timing of surgery on secondary pathology. The goal of this study was to analyze the effects of early ACLRs versus delayed ACLR on the incidence of meniscal and chondral lesions.

Data Sources:

We searched MEDLINE, EMBASE, and CINAHL on March 20, 2018, for randomized control trials (RCTs) that compared early and delayed ACLR in a skeletally mature population. Two reviewers independently identified trials, extracted trial-level data, performed risk-of-bias assessments using the Cochrane Risk of Bias tool, and evaluated the study methodology using the Detsky scale. A meta-analysis was performed using a random-effects model with the primary outcome being the total number of meniscal and chondral lesions per group.

Results:

Of 1887 citations identified from electronic and hand searches, we included 4 unique RCTs (303 patients). We considered early reconstruction as <3 weeks and delayed reconstruction as >4 weeks after injury. There was no evidence of a difference between early and late ACLR regarding the incidence of meniscal [relative risk (RR), 0.98; 95% confidence interval (CI), 0.74-1.29] or chondral lesions (RR, 0.88; 95% CI, 0.59-1.29), postoperative infection, graft rupture, functional outcomes, or range of motion.

Conclusions:

We found no evidence of benefit of early ACLR. Further studies may consider delaying surgery even further (eg, >3 months) to determine whether there are any real benefits to earlier reconstruction.
Comparison of the Stanford ECG Left Atrial Criteria With the International ECG Criteria for Sports Screening
Authors: Hock Julia , Wheeler Matthew , Singh Tamanna , Ha Le Dung , Hadley David , Froelicher Victor
Published: November 2019

Objective:

Because the International left atrial enlargement electrocardiographic (ECG) screening criteria (ECG-LAE) for athletes are rarely fulfilled in young athletes, we compared it with evidence-based criteria from a recent clinical outcome study of ECG left atrial abnormality (ECG-LAA).

Design:

Retrospective analyses.

Setting:

Routine preparticipation ECG screening in California.

Participants:

Four thousand four hundred thirty-eight young individuals (18.5 ± 5.4 years, 40% women).

Assessment of Risk Factors:

The International criteria for ECG-LAE were applied: prolonged P wave duration of ≥120 ms in leads I or II AND negative portion of ≥1 mm in depth in lead V1. This was compared with Stanford criteria for ECG-LAA: prolonged P wave duration of ≥140 ms odds ratio (OR) negative portion in V1 and V2 greater than 1 mm.

Main Outcome Measures:

Differences in the classification of abnormal ECGs between the 2 criteria applied to the same population of young athletes.

Results:

Only 33 (0.7%) of our subjects fulfilled the International criteria for ECG-LAE while 110 (2.5%) fulfilled the ECG-LAA criteria. Adding our new ECG-LAA criterion and considering it a major criterion raised the abnormal ECG prevalence and athletes referred for further evaluation from 2.9% to 4.4%.

Conclusions:

The Stanford evidence-based criterion for ECG-LAA incorporating V2 and replacing “or” for “and” regarding P wave duration increased the yield of abnormal classification for P waves. Future follow-up studies are needed to confirm that this new criterion should be included in future ECG screening consensus documents.
Multiple Treatment Comparisons for Large and Massive Rotator Cuff Tears: A Network Meta-analysis
Authors: Maillot Cédric , Martellotto Alice , Demezon Hugues , Harly Edouard , Le Huec Jean-Charles
Published: November 2019

Background:

There is no consensus about the best choice between all the options available for large and massive rotator cuff tear (mRCTs) management.

Objective:

To determine the comparative effectiveness of current treatment options for management of large and mRCTs.

Design:

Network meta-analysis.

Setting:

We searched the Cochrane systematic reviews, MEDLINE and EMBASE databases for all trials of adults with large and mRCTs that report preoperative and postoperative functional scores after an intervention option.

Patients:

The network meta-analysis included 20 trials with 1233 patients with 37.24 months follow-up.

Interventions:

Eight treatment options for management of large and mRCTs were compared.

Main Outcome Measures:

The primary effectiveness outcome was the functional score.

Results:

This meta-analysis did not show statistically significant differences between conservative, partial repair, patch or platelet rich plasma (PRP) augmentation, reverse total shoulder arthroplasty, and complete repair. Latissimus dorsi (LD) transfer was ranked first for effectiveness [standardized mean difference (SMD): 2.17, 0.28-4.07] and debridement ranked last (SMD: −2.15, −3.13 to −1.17).

Conclusions:

Latissimus dorsi transfer seems to be most effective for management of large and mRCTs, although some heterogeneity was observed in this network meta-analysis of full text reports. The choice of the operating technique depends on the patient's general health status and his expectations. When a decision has been reached to perform surgery, a repair, even if partial, should be attempted. Procedures involving biologic augmentation (eg, PRP) seem to convey no additional benefit while introducing more risk. Debridement alone should be avoided.
What Do Patients With Musculoskeletal Injuries Learn From Psychologically Informed Physical Therapy?
Authors: Weiser Sherri , Lis Angela , Brennan Tara , Hiebert Rudi , Ziemke Gregg , Campello Marco
Published: November 2019

Introduction.

To develop successful psychologically informed physical therapy (PiPT) education programs, it is important to understand what makes them effective. We contend that successful transmission of PiPT concepts from the physical therapist (PT) to the patient is critical for good outcomes. This paper aims to determine whether PiPT trained PTs successfully transfer core concepts of this approach to patients with musculoskeletal injuries (MSIs). We hypothesize that patients who receive PiPT learn more PiPT concepts than patients who receive usual care. We demonstrated successful adoption of the PiPT model by US Navy PTs in a previous paper. In this paper, we ask whether these concepts are successfully transferred to the patient. Musculoskeletal injuries are a burden to the US Navy in terms of sick calls and attrition. Therefore, active duty service members (ADSM) are an excellent population in which to study this question.

Methods.

All ADSM deployed aboard 2 US Navy aircraft carriers (1 with PiPT trained PTs and 1 without) who presented to the physical therapy clinic with MSIs were included. Subjects were asked to list the most important thing(s) they learned in physical therapy at 4 weeks after treatment. Three blinded raters reviewed each response for PiPT concepts. The responses of subjects in both groups were compared to determine whether there were differences in the types of messages they received from treatment.

Results.

Eighty-five intervention and 90 control subjects participated. The number of subjects expressing important concepts learned from their physical therapy reflecting PiPT concepts was 29 (34%) in the intervention group and 0 (0%) in the control group.

Discussion.

Subjects who received PiPT were more likely to report learning PiPT concepts than those who did not. This indicates that the transfer of PiPT knowledge from the PT to the patient was successful. This paper is limited; in that, subjects included only ADSM, and the generalizability of the findings is unknown.
Factors Associated With Facial Nerve Paresis Following Gamma Knife for Vestibular Schwannoma
Authors: Lerner David K. , Lee Daniel , Naples James G. , Brant Jason A. , Bigelow Douglas , Alonso-Basanta Michelle , Ruckenstein Michael J.
Published: November 2019

Objective:

Evaluate the incidence of and potential contributory factors to facial nerve paresis and other cranial neuropathies (CN) following stereotactic radiosurgery with Gamma Knife (GK) for primary treatment of vestibular schwannoma (VS).

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Charts were reviewed for all adult patients receiving primary GK treatment for unilateral VS between 2005 and 2013. Patients with NF2 or previous surgery were excluded from analysis.

Intervention:

GK radiosurgery.

Main Outcome Measures:

The incidence of new-onset facial nerve paresis after primary GK treatment of VS was evaluated. Secondary endpoints included other cranial neuropathies.

Results:

One hundred thirty-three patients with VS received primary GK therapy. Posttreatment CN developed in 33 patients (24.8%). Twelve patients (9.0%) experienced trigeminal paresthesia, 11 (8.3%) developed sudden sensorineural hearing loss (SSNHL) requiring steroids, and seven (5.3%) demonstrated facial paresis. The mean maximum cochlear dose was 15.49 Gy in patients with facial paresis compared with 12.42 Gy in subjects without facial paresis (p = 0.032). Subjects with facial paresis were more likely to have a lateral tumor without fundal fluid on magnetic resonance imaging (MRI) (71%) compared with subjects without facial paresis (43%).

Conclusions:

In the treatment of VS with primary GK, maximum cochlear dose was significantly associated with facial paresis. Laterally extending tumors without fundal fluid on MRI experienced higher rates of facial paresis. These factors should be considered during GK treatment planning for VS.
Intratympanic Diltiazem-Chitosan Hydrogel as an Otoprotectant Against Cisplatin-Induced Ototoxicity in a Mouse Model
Authors: Naples James G. , Ruckenstein Michael J. , Singh Jarnail , Cox Brandon C. , Li Daqing
Published: November 2019

Hypothesis:

Local administration of the calcium-channel blocker (CCB), diltiazem, via intratympanic (IT) chitosan-glycerophosphate (CGP) hydrogel will protect against cisplatin-induced ototoxicity.

Background:

Cisplatin induces calcium-mediated apoptosis of cochlear outer hair cells (OHCs). Previous work demonstrated otoprotection and reduced auditory brainstem response (ABR) threshold shifts in a cisplatin-induced ototoxicity mouse model treated with multiple doses of IT diltiazem given in solution. Here, we evaluated the role of a single dose of IT CGP-diltiazem as a novel otoprotectant against cisplatin-induced ototoxicity.

Methods:

Baseline pure-tone and click-evoked ABRs were performed in control (IT CGP-saline, n = 13) and treatment (IT CGP-diltiazem 2 mg/kg, n = 9) groups of female CBA/J mice. A single dose of IT CGP hydrogel was administered just before intraperitoneal injection of cisplatin (14 mg/kg). On Day 7 posttreatment, ABRs were performed and cochleae were harvested. Hair cells were quantified using anti-myosin VIIa immunostaining and inner hair cell ribbon synapses were quantified using Ctbp2 immunostaining.

Results:

There was a statistically significant effect of treatment on click- and tone-evoked ABRs between groups. The mean threshold shifts were significantly reduced in both click- and tone-evoked ABRs on Day 7 in IT CGP-diltiazem treated mice compared with CGP-saline control mice. There were no significant differences in OHC counting between groups, but there appears to be an otoprotection against loss of synapses in the apical turn from IT CGP-diltiazem treated mice (p < 0.05).

Conclusions:

This preliminary work suggests that IT CGP-diltiazem reduces ABR threshold shifts with possible mechanisms of protecting ribbon synapses in the setting of cisplatin-induced ototoxicity. More work is necessary to determine the mechanism underlying this otoprotection.
Hearing Preservation Outcomes Using a Precurved Electrode Array Inserted With an External Sheath
Authors: Nassiri Ashley M. , Yawn Robert J. , Holder Jourdan T. , Dwyer Robert T. , O’Malley Matthew R. , Bennett Marc L. , Labadie Robert F. , Rivas Alejandro
Published: November 2019

Objectives:

Describe audiologic outcomes in hearing preservation cochlear implantation (CI) using a precurved electrode array inserted using an external sheath and evaluate association of electrode positioning and preservation of residual hearing.

Study Design:

Retrospective review.

Setting:

Tertiary otologic center.

Patients:

Twenty-four adult patients who underwent hearing preservation CI with precurved electrode array.

Interventions:

CI, intraoperative computed tomography (CT)

Outcome Measures:

Audiologic measures (consonant-nucleus-consonant [CNC] words, AzBio sentences, low-frequency pure tone averages [LFPTA]) and electrode location (scalar location, electrode-to-modiolus distance (

JOURNAL/otneu/04.03/00129492-202001000-00008/inline-graphic1/v/2023-08-21T201642Z/r/image-tiff

), angular insertion depth).

Results:

Twenty-four adults with less than 80 dB LFPTA with a precurved electrode array inserted using an external sheath; 16 underwent intraoperative CT. LFPTA was 58.5 dB HL preoperatively, with a 17.3 dB threshold shift at CI activation (p = 0.005). CNC word scores improved from 6% preoperatively to 64% at 6 months postoperatively (p < 0.0001). There was one scalar translocation and no tip fold-overs. The average angular insertion depth was 388.2 degrees, and the average

JOURNAL/otneu/04.03/00129492-202001000-00008/inline-graphic2/v/2023-08-21T201642Z/r/image-tiff

across all electrodes was 0.36 mm. Multivariate regression revealed a significant correlation between CNC scores at 6 months and angular insertion depth (p = 0.0122; r
2 = 0.45, adjusted r
2 = 0.35). Change in LFPTA was not significantly associated with angular insertion depth or

JOURNAL/otneu/04.03/00129492-202001000-00008/inline-graphic3/v/2023-08-21T201642Z/r/image-tiff

.

Conclusions:

A low rate of translocation allows a precurved electrode array inserted using an external sheath to maintain hearing preservation rates comparable to straight electrode arrays. With scala tympani insertion, angular insertion depth is a positive marker of improved speech performance postoperatively but may be a confounder variable based on individual cochlear size.
Comparison of Spontaneous Temporal Bone Cerebrospinal Fluid Leaks From the Middle and Posterior Fossa
Authors: Cooper Timothy , Choy Matthew H. , Gardner Paul A. , Hirsch Barry E. , McCall Andrew A.
Published: November 2019

Objectives:

To compare patients surgically managed for spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone arising from the middle cranial fossa (MCF) and posterior cranial fossa (PCF) and to describe the surgical management of posterior fossa CSF leaks.

Study Design:

Retrospective case review.

Setting:

Academic tertiary center.

Patients:

Adult patients presenting with spontaneous temporal bone CSF leaks undergoing operative repair between January 2010 and August 2018. Patients with a history of trauma, previous mastoid surgery, and iatrogenic CSF leaks were excluded.

Intervention:

Transmastoid or MCF CSF leak repair.

Main Outcome Measures:

Patient demographics, body mass index (BMI), comorbidities, presenting features, and lumbar puncture opening pressures were compared between groups and the management of the PCF CSF leaks described.

Results:

Forty-six patients (26 women, 20 men) were included. The mean age at the time of repair was 58.0 ± 12.9 years (±SD). The origin of the CSF leak was from the PCF in three patients and MCF in 43 patients. All three patients with PCF leaks presented with an acute history of meningitis compared with only seven (16%) in the MCF group. This difference was statistically significant (p = 0.01, Fisher's exact test). There were no statistically significant differences in age, sex, BMI, or lumbar puncture opening pressures. The PCF leaks were repaired using a transmastoid approach with multilayer closure of the bony defect and fat graft obliteration of the mastoid.

Conclusions:

Spontaneous CSF leaks arising from the PCF are rare and may present more commonly with meningitis. Identification requires careful review of imaging.
Risks of Intracochlear Pressures From Laser Stapedotomy
Authors: Misch Emily S. , Banakis Hartl Renee M. , Gubbels Samuel P. , Greene Nathaniel T.
Published: November 2019

Hypothesis:

Surgical manipulations during laser stapedotomy can produce intracochlear pressure changes comparable to pressures created by high-intensity acoustic stimuli.

Background:

New-onset sensorineural hearing loss is a known risk of stapes surgery and may result from pressure changes from laser use or other surgical manipulations. Here, we test the hypothesis that high sound pressure levels are generated in the cochlea during laser stapedotomy.

Methods:

Human cadaveric heads underwent mastoidectomy. Fiber-optic sensors were placed in scala tympani and vestibuli to measure intracochlear pressures during key steps in stapedotomy surgery, including cutting stapedius tendon, lasering of stapedial crurae, crural downfracture, and lasering of the footplate.

Results:

Key steps in laser stapedotomy produced high-intensity pressures in the cochlea. Pressure transients were comparable to intracochlear pressures measured in response to high intensity impulsive acoustic stimuli.

Conclusion:

Our results demonstrate that surgical manipulations during laser stapedotomy can create significant pressure changes within the cochlea, suggesting laser application should be minimized and alternatives to mechanical downfracture should be investigated. Results from this investigation suggest that intracochlear pressure transients from stapedotomy may be of sufficient magnitude to cause damage to the sensory epithelium and affirm the importance of limiting surgical traumatic exposures.
A Possible Role of Video-Head Impulse Test in Detecting Canal Involvement in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus
Authors: Castellucci Andrea , Malara Pasquale , Delmonte Silvia , Ghidini Angelo
Published: November 2019

Objective:

To describe the possible diagnostic role of video-head impulse test (vHIT) in patients presenting with positional downbeat nystagmus (PDN) due to benign paroxysmal positional vertigo (BPPV) involving the anterior canal (AC) or the non-ampullary arm of the posterior canal (PC).

Patients:

Three patients presenting with positional vertigo, PDN, symmetrical cervical and ocular vestibular-evoked myogenic potentials, and selective deficit of the vestibulo-ocular reflex (VOR) gain for a single vertical canal on vHIT.

Interventions:

Diagnostic evaluation and rehabilitative treatment for BPPV involving the deficient canals.

Main Outcome Measures:

Video-oculographic and vHIT findings before and after canalith repositioning procedures (CRP) for AC-BPPV and apogeotropic PC-BPPV.

Results:

Each patient was treated with CRP for BPPV involving the hypoactive canal. In one case, symptoms receded with physical therapy, whereas two patients developed a paroxysmal positional upbeat nystagmus consistent with BPPV involving the ampullary arm of the ipsilateral PC and were treated with Epley CRP. Posttreatment evaluation showed resolution of symptoms and signs and restitution of canal function in all cases.

Conclusions:

PDN can be due to both peripheral and central vestibular pathologies. In case of BPPV, involvement of the non-ampullary arm of the PC is hardly distinguishable from contralateral AC canalolithiasis. In these situations, vHIT may play a key role in the differential diagnosis. Considering these findings, we propose to include vHIT in the test battery of patient with PDN, as it may provide clues to the differential diagnosis with central pathologies enabling the identification of the canal involved by BPPV.
On the Relationship Between Menière's Disease and Endolymphatic Hydrops
Authors: Gluth Michael B.
Published: November 2019

The relationship between Menière's disease and endolymphatic hydrops is ambiguous. On the one hand, the existence of cases of endolymphatic hydrops lacking the classic symptoms of Menière's disease has prompted the assertion that endolymphatic hydrops alone is insufficient to cause symptoms and drives the hypothesis that endolymphatic hydrops is a mere epiphenomenon. Yet, on the other hand, there is considerable evidence suggesting a relationship between the mechanical pressure effects of endolymphatic hydrops and resultant disordered auditory physiology and symptomatology. A critical appraisal of this topic is undertaken, including a review of key histopathologic data chiefly responsible for the epiphenomenon hypothesis. Overall, a case is made that A) the preponderance of available evidence suggests endolymphatic hydrops is likely responsible for some of the auditory symptoms of Menière's disease, particularly those that can be modulated by mechanical manipulation of the basilar membrane and cochlear microphonic; B) Menière's disease can be reasonably considered part of a larger spectrum of hydropic inner ear disease that also includes some cases that lack vertigo. C) The relationship with endolymphatic hydrops sufficiently robust to consider its presence a hallmark defining feature of Menière's disease and a sensible target for diagnostic detection.
Cochlear Implantation in Craniometaphyseal Dysplasia
Authors: Huang Alice E. , Adkins Weston J. , Patel Neil S.
Published: November 2019

Objective:

Describe the first case of cochlear implantation (CI) for auditory rehabilitation of a patient with craniometaphyseal dysplasia (CMD) and progressive mixed hearing loss.

Patients:

A 65-year-old woman with known autosomal dominant CMD presented with progressive mixed hearing loss and declining benefit from conventional hearing aids. Computed tomography and magnetic resonance imaging revealed hyperostosis of the entire craniofacial skeleton. Hearing evaluation demonstrated pure-tone thresholds in the profound range bilaterally by air conduction, and bone conduction thresholds that matched aided thresholds for her left ear, though testing was somewhat limited by inability to mask at high air-conduction thresholds. CI candidacy testing confirmed poor word and sentence scores in the right ear.

Intervention:

Due to the inability to access the cochlea via a conventional mastoidectomy and facial recess approach, cochlear implantation via a postauricular subtotal petrosectomy approach with ear canal overclosure was performed.

Main Outcome Measures:

Post-implantation word and sentence testing.

Results:

Despite extensive internal auditory canal stenosis, the patient demonstrated excellent early speech understanding results 5 weeks after device activation. Postimplantation audiologic evaluation showed thresholds between 20 and 30 dB HL from 250 to 6000 Hz. Word and sentence testing scores were 76% Consonant-nucleus-consonant in quiet (up from 2% preoperatively) and 77% AzBio sentences in quiet (up from 10% preoperatively).

Conclusion:

This report describes the first description of CI for CMD. Despite the extensive radiologic abnormalities, the patient has demonstrated excellent benefit from implantation. Further study of rare temporal bone dysplasias, such as CMD, is critical to better characterize the progression of otologic disease and determine optimal treatment.
Balloon Eustachian Tuboplasty Combined With Tympanocentesis Is not Superior to Balloon Eustachian Tuboplasty in Chronic Otitis Media With Effusion—A Randomized Clinical Trial
Authors: Formánková Debora , Formánek Martin , Školoudík Lukáš , Zeleník Karol , Tomášková Hana , Chrobok Viktor , Komínek Pavel
Published: November 2019

Objective:

Balloon Eustachian tuboplasty (BET) appears to be a promising therapeutic option for Eustachian tube dysfunction. However, data are lacking on its effect in adults with chronic otitis media with effusion (COME) and whether it should be combined with tympanocentesis. The aim of our study was to determine if there is a beneficial effect of BET combined with tympanocentesis compared with BET only and provide data on the effect of BET in adults with COME.

Study Design:

Randomized clinical trial.

Setting:

Tertiary referral hospital.

Participants:

Adults with COME lasting more than 6 months after tympanostomy tube exclusion. Among 40 eligible ears, 30 were randomized to treatment.

Intervention:

BET (group 1) versus BET with concurrent tympanocentesis (group 2).

Main Outcome Measures:

Tympanometry, Valsalva or Toynbee maneuver with tympanometry verification, Eustachian Tube Dysfunction Questionnaire, and pure-tone audiometry.

Results:

A total of 25 patients (14 ears in group 1 and 15 ears in group 2) were included in the analysis. No significant difference in the effect of treatment was found between the groups. When patients were evaluated as one group, after 2, 6, and 12 months, improvement was found in tympanometry in 55, 48, and 48%; in the ability to perform maneuvers in 55, 41, and 41%; in audiometry in 69, 62, and 59%; and in questionnaire scores in 76, 72, and 69%, respectively.

Conclusions:

There was no beneficial outcome of tympanocentesis performed concurrently with BET and therefore it should not be routinely recommended. The success of therapy appears to be reduced compared with other pathologies caused by Eustachian tube dysfunction.
The utility of thromboelastography and tranexamic acid in plasminogen activator inhibitor deficiency during pregnancy: a rare case report
Authors: Prabhakaran Nitya , Laziuk Katsiaryna , Hammer Richard D.
Published: November 2019

Complete plasminogen activator inhibitor-1 (PAI-1) deficiency is a very rare genetic disorder that is associated with an increased risk of bleeding diathesis. Patients with PAI-1 deficiency are also known to be at increased risk for massive postpartum hemorrhage. We discuss one such rare case of PAI-1 deficiency in a young pregnant patient at 22 weeks of gestation with history of prolonged bleeding. Tranexamic acid was administered for menorrhagia and resumed later for labor and continued into the postpartum period since antifibrinolytics have been the mainstay in the management of PAI-1 deficiency. The patient delivered a healthy infant at 39 weeks. As PAI-1 deficiency causes increased fibrinolysis, the patient's coagulation panel was monitored by performing serial thromboelastograms to monitor for any increase in fibrinolysis. We believe that thromboelastograms might be a useful tool in the monitoring and management of fibrinolytic conditions such as PAI-1 deficiency.
Diagnostic performance of extrinsic apoptosis pathway in hepatitis C virus patients: apoptosis fibrosis crosstalk
Authors: Toson El-Shahat A. , Shiha Gamal E. , El-sharkawy Aml M. , El-mezayen Hatem A.
Published: November 2019

Background/aim:

Liver fibrosis assessment and evaluation of disease severity in hepatitis C virus (HCV) patients provides useful information for therapeutic decisions. Chronic HCV infection is associated with increased levels of peripheral T cell apoptosis. The aim was to study whether peripheral blood T lymphocyte apoptosis markers may contribute to clinical progression, and develop a simple index based on combination of apoptosis and routine biomarkers for accurate evaluation of fibrosis stages in HCV patients.

Patients and methods:

Peripheral blood T lymphocytes were isolated from 72 patients with hepatitis C virus and 25 healthy control individuals. Serum samples were collected at time of liver biopsy. Liver fibrosis was tested in biopsies using the Metavair score system. Stepwise linear discriminate analysis and area under receiver-operating characteristic curves were utilized to produce a predictive score comprising significant apoptosis biomarkers.

Results:

A novel score named apoptosis fibrosis index (AFI) was created on the basis of a combination of CD8/Annexin, albumin and platelets. The multivariate discriminate analysis selected a score based on absolute values of the three biochemical markers; score = 5.8 + 0.008×CD8/Annexin-V (%) - 1.4×Albumin (g/dl) - 0.001×Platelet count (109/L), where 5.8 considered numerical constant. AFI produce an area under the curve of one for significant fibrosis, 0.80 for advanced fibrosis, and 0.889 for cirrhosis.

Conclusion:

Apoptosis biomarkers in HCV patients were associated with liver fibrosis. AFI score, a novel noninvasive test, can be used easily for the prediction of liver fibrosis stage and may decrease the need for liver biopsy in hepatitis C virus Egyptian patients.
A Rapid Cytologic Double Staining of Epstein-Barr Virus–encoded Small RNA and Cell Surface Markers for Diagnosis of Epstein-Barr Virus–associated Hemophagocytic Lymphohistiocytosis
Authors: Takahashi Natsuki , Kudo Ko , Tanaka Miyuki , Kumagai Naoya , Sato Tomohiko , Kamio Takuya , Sasaki Shinya , Terui Kiminori , Kurose Akira , Yanagisawa Ryu , Nakazawa Yozo , Ito Etsuro
Published: November 2019

A 3-year-old boy was clinically diagnosed with Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis. We identified EBV-infected CD8-positive T-lymphocytes by cytologic double staining of the peripheral blood for EBV-encoded small RNA and cell surface markers. The patient was subsequently administered immunosuppressive therapy with a reduced dose of etoposide because of previous organ damage. EBV clearance was confirmed by serial quantification of cell-fractionated EBV-DNA, whereas EBV-DNA persisted in the plasma for 18 weeks. Immunochemotherapy with low-dose etoposide combined with serial viral load monitoring is a potential therapeutic option for severe EBV-hemophagocytic lymphohistiocytosis cases with organ damage.
Paternal Smoking Before Conception and During Pregnancy Is Associated With an Increased Risk of Childhood Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of 17 Case-Control Studies
Authors: Cao Yue , Lu Jing , Lu Jing
Published: November 2019

Objective:

Current evidence regarding the association between paternal smoking before conception or during pregnancy and the risk of childhood acute lymphoblastic leukemia (ALL) are inconsistent. We aimed to systematically summarize the current evidence regarding this potential association.

Methods:

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE), we systematically retrieved PubMed, Embase, Web of Science, and Scopus, screened relevant literature, and assessed the methodologic quality of the included studies. We calculated the pooled estimates using random-effects models. We assessed statistical heterogeneity by I
2 values and χ2 tests for the Cochrane Q statistic. We further investigate the dose-response relation using 2-stage nonlinear models.

Results:

A total of 17 case-control studies were identified, and the synthesized risk ratios (RRs) for smoking before conception (RR=1.15, 95% confidence interval: 1.04-1.27) and during pregnancy (RR=1.20, 95% confidence interval: 1.12-1.28) were both statistically significant. Moreover, the dose-response analysis showed a positive association as well.

Conclusion:

Current evidence from observational studies suggests the association between paternal smoking before conception or during pregnancy and the increased risk of childhood ALL, which needs to be confirmed in prospective studies.
Retrospective Diagnosis of Ataxia-Telangiectasia in an Adolescent Patient With a Remote History of T-Cell Leukemia
Authors: Sze Sei-Gyung K. , Lederman Howard M. , Crawford Thomas O. , Wangler Michael F. , Lewis Andrea M. , Kastan Michael B. , Dibra Harpreet K. , Taylor Alexander M.R. , Wechsler Daniel S.
Published: November 2019

Ataxia-telangiectasia (A-T) is a rare autosomal recessive disorder characterized by progressive cerebellar degeneration that is typically diagnosed in early childhood. A-T is associated with a predisposition to malignancies, particularly lymphoid tumors in childhood and early adulthood. An adolescent girl with minimal neurologic symptoms was diagnosed with A-T 8 years after completing therapy for T-cell acute lymphoblastic leukemia, following a diagnosis of ATM-mutated breast cancer in her mother. We highlight the importance of recognizing ATM mutations in T-cell acute lymphoblastic leukemia, appreciating the phenotypic heterogeneity of A-T, and defining optimal cancer screening in A-T patients.
Successful Haploidentical Stem Cell Transplant With Posttransplant Cyclophosphamide for Isolated Central Nervous System Blast Crisis in a Child With Chronic Myeloid Leukemia
Authors: Chatterjee Goutomi , Rastogi Neha , Thakkar Dhwanee , Kapoor Rohit , Sharma Anil , Yadav Satya P.
Published: November 2019

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder. The extramedullary blast crisis (BC) is a known complication of CML, but it usually accompanies a systemic disease. However, an isolated central nervous system (CNS) BC at relapse is very rare and has a very poor prognosis. Salvage is even more difficult for patients who relapse with a CNS BC after an allogeneic stem cell transplant (SCT). Here, we report successful treatment of an isolated CNS BC of CML in a 14-year-old boy who relapsed with isolated a CNS BC after matched sibling donor SCT by haploidentical SCT with posttransplant cyclophosphamide.
Self-efficacy, Hope as Mediators Between Positive Coping and Resilience Among Patients With Gastric Cancer Before the First Chemotherapy
Authors: Wu Xiaoting , Xu Haibo , Zhang Xiaomin , Han Shiyu , Ge Liuna , Li Xiaohui , Zhang Xinqiong
Published: November 2019

Background

Patients with gastric cancer experience severe psychological distress as a result of their cancer diagnosis and chemotherapy. Resilience is a defense mechanism that enables one to thrive amid distress. However, little research has been done to explore the formation and development mechanism of resilience among patients with gastric cancer before their first chemotherapy treatment.

Objective

The mediating roles of self-efficacy and hope on the relationship between positive coping and resilience among patients with gastric cancer before their first chemotherapy treatment were examined to inform the future resilience intervention.

Methods

A total of 253 patients with gastric cancer before their first chemotherapy treatment were investigated using the Simplified Coping Style Questionnaire, the General Self-efficacy Scale, the Herth Hope Index, and the 14-Item Resilience Scale. Structural equation modeling was conducted using Mplus version 7.03 to test the hypothesized mediational model.

Results

Structural equation modeling analysis showed self-efficacy and hope completely mediated the relationship between positive coping and resilience; the indirect effects were 0.242 (P < .01) and 0.258 (P < .01), respectively; indirect effects accounted for 81% of the total effect.

Conclusions

Positive coping is not the independent predictor that may contribute to resilience among patients with gastric cancer before their first chemotherapy treatment, but it can indirectly affect resilience through self-efficacy and hope.

Implications

Self-efficacy and hope may increase the positive influence of positive coping on resilience among patients with gastric cancer before their first chemotherapy treatment. Resilience intervention might be enhanced by addressing the impact of positive coping on self-efficacy and hope.
Innovating Fall Safety
Authors: Radecki Bethany , Keen Alyson , Miller Joan , McClure Janelle K. , Kara Areeba
Published: November 2019

Background:

Injury falls are common, with nearly a million hospitalized patients falling annually. Fall risk identification and prevention are largely clinician-centric, lacking patient input.

Local Problem:

Our fall rates were below the national mean; however, patients who fell and sustained injury were at or above the mean. We lacked processes that engaged patients as safety collaborators.

Methods:

This was a quality improvement study examining the effect of a collaborative fall intervention on (1) patient knowledge in action and (2) incidence of falls.

Intervention:

The patient fall assessment tool was implemented to facilitate collaborative safety conversations.

Results:

We achieved a statistically significant improvement (P = .0007) in the patient's participation in the development of the safety plan, with a 25% reduction in total falls and a 67% reduction in injury falls.

Conclusions:

The patient fall assessment tool may be a successful strategy to engage patients in the development of their safety plan and positively affect safety partnerships.
Intravenous Access in Gastrointestinal Hemorrhage
Authors: Koop Andree H. , Cowdell Jed , Patel Neej , Kesler Alex , Mwakyanjala Edson , Heckman Alexander , Padmanabhan Menon Divya , Patel Neil , Narciso Patricia , Reid Ashley , Decicco Nicholl , Speicher Leigh
Published: November 2019

Background:

The management of acute gastrointestinal hemorrhage (GIH) is focused on early resuscitation through 2 large-bore intravenous (2LBIV) catheters, although adherence to this recommendation is low.

Local Problem:

Of 100 patients hospitalized with GIH in 2017, only 14 received 2LBIV access. The goal of this study was to improve this measure.

Methods:

A multidisciplinary team used the DMAIC (define, measure, analyze, improve, and control) framework to perform a quality improvement initiative.

Interventions:

The team used quality tools including a stakeholder survey, swimlane diagram, and fishbone diagram. The first intervention involved education of the hospitalists directing admissions, and the second intervention involved education of emergency department (ED) physicians and nurses regarding the importance of 2LBIV placement.

Results:

Following the second intervention, there was a substantial increase in 2LBIV placement to 37 of 86 (43%).

Conclusions:

Carefully directed education of ED physicians and nurses with monthly feedback was effective in improving appropriate intravenous placement in patients with GIH.