bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence Trends, Risk Factors, Mortality and Healthcare Utilization in Congenital Syphilis-related Hospitalizations in the United States
Authors: Umapathi Krishna Kishore , Thavamani Aravind , Chotikanatis Kobkul
Published: August 2019

Background:

Congenital syphilis (CS) is a devastating yet preventable disease affecting the fetus. Recent increase in cases of CS in the United States has been reported by Centers for Disease Control and Prevention. There is a lack of data on hospitalization trends and healthcare utilization related to CS. We sought to describe CS hospitalization trends, morbidity and mortality during 2009 through 2016 and related healthcare expenditure.

Methods:

National inpatient level data collected from Kid’s Inpatient Database and National Inpatient Sample databases from 2009 to 2016 were analyzed. CS hospitalizations were identified using International Classification of Diseases codes in age less than 1 year. Related demographics, risk factors and outcomes were calculated. Infant mortality related to CS were calculated per number of hospitalizations.

Results:

From 2009 to 2016, there were a total of 5912 CS-related hospitalizations. The overall trends in hospitalizations related to CS was up trending since 2009. African American ethnicity, public insurance/uninsured, low socioeconomic status, geographic location (South and West hospital regions), prematurity and low birth weight were significantly associated with CS and remained as independent risk factors. The mean length of stay (12.38 ± 0.10 d vs. 3.42 ± 0.1 d) and mean hospitalization charges were significantly higher in CS (P < 0.001) as compared with other hospitalized infants without CS. The total inflation-adjusted hospitalization charges have more than doubled over the years ($120,665,203 in 2016 vs. $54,290,310 in 2009). The rate of in-hospital deaths in CS hospitalization was 0.54% (32 deaths among 5912 hospitalizations).

Conclusions:

The incidence of CS hospitalization has been increasing since 2009. CS contributes to a significant healthcare utilization burden; its prevention can save a large amount of healthcare-related expenditure.
Pharmacogenomics of Cytochrome P450 of Nimodipine Metabolism After Aneurysmal Subarachnoid Hemorrhage
Authors: Peacock Sarah H. , James Courtney , Turnbull Marion T. , Cowart Jennifer B. , Reid Joel M. , Freeman W. David
Published: August 2019

INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that is life threatening with high rates of mortality, and many survivors are left with permanent neurologic deficits. Nimodipine is the treatment of choice for aSAH with the goal of reduction of delayed cerebral ischemia. It is the only evidence-based medication that has been shown to have improved outcomes for delayed cerebral ischemia; therefore, it is important for neuroscience nurses to be knowledgeable of the pharmacology and pharmacogenomics properties of this medication, including cytochrome P450 (CYP450) enzymes. METHODS AND RESULTS: This article reviews the CYP450 enzyme system including a review of the pharmacotherapy and pharmacogenomics of nimodipine for patients with aSAH illustrated with case study of a patient with abnormal drug metabolism. CONCLUSION: CYP450 enzymes can be inhibited or induced by multiple medications resulting in clinically significant differences in drug metabolism. Food and Drug Administration–approved medication nimodipine is the only medication shown to improve outcomes in patients with aSAH. Hence, it is important to have awareness of potential drug-to-drug interactions and pharmacogenomics of nimodipine when caring for critically ill patients with aSAH.
Validity and Reliability of the Turkish Version of the Amyotrophic Lateral Sclerosis Assessment Questionnaire
Authors: Alankaya Naile , Tülek Zeliha , Özakgül Aylin , Kaya Alper , Dik Aynur
Published: August 2019

OBJECTIVE

The aim of this study was to adapt the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ), developed for the evaluation of quality of life in amyotrophic lateral sclerosis (ALS) patients, into the Turkish society.

METHODS

This methodological study was conducted in 92 ALS patients registered in 2 chapters (Istanbul and Izmir) of Turkish ALS-Motor Neuron Diseases Association. The expert opinion and forward-backward translation methods were applied for the linguistic validity of the ALSAQ (long and short versions: ALSAQ-40 and ALSAQ-5, respectively).

RESULTS

In the analysis of internal consistency, the Cronbach’s α reliability coefficient was .96 for the total scale, whereas it was between .88 and .98 for the 5 dimensions. The dimensions of the long form were correlated with the items of the short form.

CONCLUSION

The Turkish versions of the ALSAQ short and long forms are valid and reliable tools to be used in the assessment of the quality of life in ALS patients.
Delayed Tumor Growth in Vestibular Schwannoma: An Argument for Lifelong Surveillance
Authors: Macielak Robert J. , Patel Neil S. , Lees Katherine A. , Lohse Christine M. , Marinelli John P. , Link Michael J. , Carlson Matthew L.
Published: August 2019

Objective:

Previous research has shown that tumor growth during observation of small-to-medium sized sporadic vestibular schwannomas (VSs) occurs almost exclusively within 3 to 5 years following diagnosis. This has led some to consider ending surveillance after this interval. This study seeks to characterize a cohort of patients with tumors that exhibited late growth.

Study Design:

Retrospective cohort study.

Setting:

Tertiary referral center.

Patients:

Adults with sporadic VSs who initially elected observation with serial magnetic resonance imaging (MRI) surveillance.

Intervention(s):

None.

Main Outcome Measure(s):

Linear tumor growth was measured in accordance with AAO-HNS reporting guidelines. Delayed growth was defined as growth ≥2 mm in linear diameter that was first detected 5 years or more from the initial MRI.

Results:

From a total of 361 patients, 172 experienced tumor growth during the interval of observation. Fourteen of these 172 patients (8.1%) experienced late growth occurring at 5 years or beyond. Among patients with delayed growth, the fastest growth rate after extended quiescence was 1.33 mm/yr, and the longest delay before tumor growth detection was 11.1 years. Additional treatment was recommended for six (42.9%) of the patients with delayed growth. Of 68 tumors that remained in the IAC, 11 (16.2%) demonstrated delayed growth. Of 66 tumors that presented in the CPA, 2 (3.0%) demonstrated delayed growth. Initial size was larger for tumors demonstrating early growth compared with those with delayed growth. For tumors within the IAC, those with early growth had a significantly higher median growth rate than those with delayed growth (1.40 vs. 0.45 mm/yr, p < 0.001).

Conclusions:

Delayed growth encompassed 8.1% of growing VSs and 3.9% of all observed tumors. Patients with delayed growth exhibited slower growth rates compared with those who were diagnosed with growth early in their observation course. These findings support the need for lifelong surveillance of untreated VSs given the possibility of clinically significant delayed growth. Increasing the time interval between MRI studies after 5 years is a reasonable concession to balance practicalities of cost and convenience with risk of delayed of tumor growth.
Intraoperative Electrocochleography in Patients With Menière's Disease Undergoing Endolymphatic Sac Decompression and Shunt Surgery
Authors: Mattingly Jameson K. , Zhan Kevin Y. , Hiss Meghan M. , Harris Michael S. , Dodson Edward E. , Moberly Aaron C. , Adunka Oliver F. , Riggs William J.
Published: August 2019

Hypothesis:

Objective physiologic changes measured using electrocochleography at the round window (ECOGRW) are observable during endolymphatic sac decompression and shunt surgery (ELS).

Background:

Limited effective treatment options are available to patients with Menière's disease (MD) who have failed conservative management, experience persistent vertigo symptoms, and have substantial residual hearing. ELS is a feasible therapeutic option for these patients. However, the efficacy of this procedure has been questioned, and objective measures assessing inner ear physiologic alterations are lacking.

Methods:

ECOGRW was measured in patients with MD undergoing ELS. Stimuli consisted of tone bursts (250, 500, 1000, 2000, 4000 Hz) and 100 μs broadband clicks at various intensities (60–90 dB nHL). Cochlear microphonic (CM), summation potential (SP), compound action potential (AP), SP:AP ratio, and CM harmonic distortions were measured.

Results:

ECOGRW was completed in 18 patients. The mean SP magnitude at 500 Hz changed significantly from −7.1 μV before to −5.1 μV after ELS (p < 0.05). However, the mean SP:AP ratio in those tested (n = 13) did not significantly change after ELS. CM harmonic magnitudes remained unchanged from pre- to post-ELS (n = 12) across all frequencies.

Conclusion:

ECOGRW allows detection of acute electrophysiological changes in the cochlea. However, our results indicate only small objective changes in the low-frequency SP magnitude (500 Hz) immediately after ELS, but not in other frequencies or measures tested (CM, SP:AP, CM harmonic distortions). These results suggest minimal electrophysiological changes occur in the cochlea as a result of ELS.
Transvenous Stent-assisted Coil Embolization for Management of Dehiscent High Jugular Bulb With Tinnitus and Contralateral Hypoplastic Venous Sinuses
Authors: Oh Se-Joon , Kim Deoksoo , Lee Jae Il , Ko Jun Kyeung , Choi Sung-Won , Kong Soo-Keun , Goh Eui-Kyung , Lee Tae Hong
Published: August 2019

Objectives:

This study aimed to evaluate the safety and efficacy of transvenous stent-assisted coil embolization for dehiscent high jugular bulb (HJB) with tinnitus and contralateral hypoplastic venous sinus.

Study Design:

Case series with chart review.

Setting:

Tertiary academic medical center.

Methods:

From September 2008 to October 2018, a series of patients with dehiscent HJB presenting with intractable pulsatile tinnitus abated only by ipsilateral jugular vein compression were included. Patients underwent transvenous stent-assisted coil embolization for selective obstruction to the dome of the HJB due to hypoplastic contralateral transverse or sigmoid venous sinus. Technical safety and clinical efficacy were retrospectively analyzed. Clinical outcome measurements included pure-tone audiogram, tinnitus character, and tinnitus handicap inventory and evaluated based on the change during the first 6 months after the procedure.

Results:

Subjects included five patients with dehiscent HJB and troublesome pulsatile tinnitus who refused surgery (n = 4), or who experienced recurrence after surgical covering and reinforcement using autologous cartilage (n = 1). The mean age of the five patients (only female) was 45 years. Transvenous stent-assisted coil embolization was technically successful in all patients with symptomatic dehiscent HJB, with no procedure-related complications. Temporary postprocedural headache was observed in two patients, but resolved within 3 days. Symptoms were completely resolved in all cases. There was no recurrence or aggravation of tinnitus during follow-up period.

Conclusions:

Transvenous stent-assisted coil embolization for dehiscent HJB with tinnitus and contralateral hypoplastic transverse or sigmoid venous sinus could be a technically safe and clinically effective treatment strategy while preserving cranial venous drainage.
Clinical and Radiological Characteristics of Malignant Tumors Located to the Cerebellopontine Angle and/or Internal Acoustic Meatus
Authors: Eliezer Michael , Tran Hugo , Inagaki Akira , Vérillaud Benjamin , Takahashi Mariko , Marie Jean-Paul , Hautefort Charlotte , Herman Philippe , Murakami Shingo , Kania Romain
Published: August 2019

Objective:

Metastatic lesions to the internal auditory meatus (IAM) and/or the cerebellopontine angle (CPA) are rare and may appear like a vestibular schwannoma (VS). We herein raise the issue of the diagnosis and treatment of nine malignant cases of the CPA and IAM among three referral centers in France and Japan. The aim of this study was 1) to report malignant lesions of the CPA, their diagnosis and treatment, 2) to review the literature, 3) to propose criteria of suspicion for malignant tumors of the CPA.

Methods:

Nine patients who had malignant lesions of the CPA and/or IAM for whom the final diagnosis was made by surgery, lumbar puncture, or PET scan were included. The main outcomes measured were: rapid onset of symptoms, association of cochlea-vestibular symptoms with facial palsy, and MRI analysis.

Results:

Among the nine patients with malignant tumor of the CPA, 8 of them (89%) had a facial palsy associated with cochlea-vestibular symptoms. Rapid growth of the tumor was observed in 77% (7/9) of the cases in a mean time interval of 4.6 months. The initial diagnosis evoked was VS in 44% of the cases (4/9). Atypical MRI aspect was seen in 67% of the cases (6/9) with bilateral tumors in 55% of cases (5/9).

Conclusion:

Although rare, malignant tumors of the CPA and/or IAM should be evoked in case of association of cochleovestibular symptoms and facial palsy, rapid onset and atypical MRI aspect.
Simulator-based assessment of ankle arterial systolic blood pressure measurement skills
Authors: Congnard Florian , Henni Samir , Le Duff Alain , Abraham Pierre , Pommeau Thierry , Noury-Desvaux Bénédicte
Published: August 2019

Objective

Learning basic vascular examination is a complex process. Very few studies have focused on the ability to measure the arterial systolic blood pressure at the ankle (ASBPa). The aim of this study was to objectively assess the effects of a 1-h practical educational intervention on the ability to measure ASBPa among medical students.

Methods

A total of 27 medical students were prospectively recruited. Two evaluation sessions of ASBPa measurement skills were conducted, before (T1) and after a 1-h practical lesson (T2). To assess the learning effect associated to the simulator-based evaluation, a control group composed by nonmedical students, not involved in the practical lesson, was also tested. Objective assessments of ASBPa measurements were performed by an instrumented leg prototype.

Results

There was a nonsignificant decreasing trend measurement time after practical lesson. The average pressure determination error (ΔP) was significantly reduced: ΔPT1: 10.5 ± 13.8 mmHg vs. ΔPT2: 5.7 ± 6.0 mmHg (P = 0.002). The mean deflation rate (DR) of the cuff was significantly decreased: DRT1: 12.9 ± 9.2 mmHg/s vs. DRT2: 8.7 ± 4.6 mmHg/s (P = 0.001). The control group did not show significant changes.

Conclusion

A 1-h practical learning could improve some parameters of the ASBPa measurement among medical students, but was not sufficient to allow the measured technical factors to reach established guidelines.
A novel missense variant in the BBS7 gene underlying Bardet-Biedl syndrome in a consanguineous Pakistani family
Authors: Hayat Amir , Khan Atif Ahmad , Rauf Abdur , Khan Saad Ullah , Hussain Shabir , Ullah Asmat , Ahmad Wasim , Shams Sulaiman , Khan Bushra
Published: August 2019

Bardet-Biedl syndrome (BBS) is characterized by six major features: postaxial polydactyly, obesity, learning disabilities, renal anomalies, retinitis pigmentosa and hypogonadism and is inherited in an autosomal recessive manner. BBS is caused by disease causing sequence variants in the 22 BBS genes identified to date. In the present study, a single consanguineous Pakistani Family with BBS was clinically and genetically characterized. After establishing linkage to a BBS gene on chromosome 4q27, Sanger sequencing was performed in all available affected and unaffected members. Sequence analysis of the BBS7 gene revealed novel substitution mutation (c.719G>T; p. Gly240Val). Our findings further extend the body of evidence implicating BBS7 in causing BBS and expand the mutation spectrum.
Association of radiomic features with epidermal growth factor receptor mutation status in non-small cell lung cancer and survival treated with tyrosine kinase inhibitors
Authors: Wang Changbin , Dong Xinzhe , Sun Xiaorong , Zhang Ran , Xing Ligang
Published: August 2019

Since the discovery of the fact that tyrosine kinase inhibitors could improve progression-free survival for patients with advanced non-small cell lung cancer compared with traditional chemotherapy, it has been extremely important to identify epidermal growth factor receptor mutation status in treatment stratification. Although lack of sufficient biopsy samples limit the precise detection of epidermal growth factor receptor mutation status in clinical practice, and it is difficult to identify the sensitive patients who confer favorable response to tyrosine kinase inhibitors. An increasing number of scholars tried to deal with these problems using methods based on the non-invasive imaging including computed tomography and PET to find the association with epidermal growth factor receptor mutation status and survival treated with tyrosine kinase inhibitor in non-small cell lung cancer. Although the conclusions have not reached a consensus, quantitative and high-throughput radiomics have brought us a new direction and might successfully help identify patients undergoing tyrosine kinase inhibitors who could get significant benefits.
The ability of pre-treatment F-18 FDG PET/CT metabolic parameters for predicting axillary lymph node and distant metastasis and overall survival
Authors: Yilmaz Burcak , Dağ Sedef , Ergul Nurhan , Çermik Tevfik Fikret
Published: August 2019

Introduction

The current study aimed to investigate the diagnostic performance of metabolic parameters of pre-treatment F-18 fluorodeoxyglucose PET/computed tomography for predicting axillary lymph node metastases, distant metastases, and overall survival rates in breast cancer patients.

Materials and methods

One hundred thirteen breast cancer patients who underwent pre-treatment F18 [FDG] PET-computed tomography with biopsy-proven axillary lymph node status were included in the current study. In pre-treatment F18 [FDG] PET-computed tomography for primary tumour area maximum standard uptake value, metabolic tumour volume, tumour lesion glycolysis, tumour diameter and for axillary lymph nodes maximum standard uptake value-LN were recorded. Also if distant metastatic sites were observed they were verified.

Results

The median follow-up period was 43.8 months. Five-year overall survival was 98% vs. 56% in patients with tumour diameter < vs. ≥22 mm, 93% vs. 50% in patients with maximum standard uptake value-T < vs. ≥6.7, 71% vs. 70% in patients with metabolic tumour volume < vs. ≥8.31cm3, 94% vs. 49% in patients with maximum standard uptake value-LN < vs. ≥1.6, 98% vs. 48% in patients with tumour lesion glycolysis < vs. ≥19 084 g/ml × cm3, 90% vs. 30% in patients with negative or positive distant metastases in initial PET/computed tomography, respectively. Maximum standard uptake value-LN with a cut-off level of <1.6 and <5.7 had high sensitivity and specificity for predicting axillary lymph node and systemic metastasis, respectively. Additionally, tumour lesion glycolysis was the strongest independent prognostic factor for overall survival.

Conclusion

Our data shows that the combination of pre-treatment tumour lesion glycolysis and maximum standard uptake value-LN could improve risk stratification among breast cancer patients.
Dizziness in a Child With Irlen Syndrome: Differentiating Visual and Vestibular Complaints
Authors: Hoppes Carrie W. , Morrell Rebecca L. , Woelfel Laura Ward , Whitney Susan L.
Published: August 2019

Purpose:

A case study of a 12-year-old boy with Irlen syndrome illustrates the overlapping symptoms of Irlen syndrome and vestibular-related dizziness.

Summary of Key Points:

Individuals with Irlen syndrome have eyestrain and headache, and often report visual perceptual distortions of blurring, doubling, and movement of print on the page. These symptoms can be relieved with the use of individually prescribed tinted lenses or overlays. Visually induced dizziness, also known as visual vertigo, is characterized by dizziness and/or unsteadiness that is triggered by complex, distorted, large field/moving visual stimuli. Visually induced dizziness can be effectively treated with progressive, controlled exposure to optokinetic visual stimuli. The child with Irlen syndrome had impaired balance, impaired gaze stability, and symptoms of visual vertigo. His complaint of visually induced dizziness resolved following vestibular rehabilitation.

Conclusions and Recommendations for Clinical Practice:

When an individual with Irlen syndrome complains of dizziness, ruling out a concomitant diagnosis of a central and/or peripheral vestibular disorder is warranted.

What This Adds to the Evidence:

The visual symptoms associated with Irlen syndrome can overlap with those of visually induced dizziness. This case report is the first to describe overlapping visual and vestibular complaints of dizziness in an individual with Irlen syndrome.
Neuroticism as a Predictor of Frailty in Old Age: A Genetically Informative Approach
Authors: Daníelsdóttir Hilda Björk , Jylhävä Juulia , Hägg Sara , Lu Yi , Colodro-Conde Lucía , Martin Nicholas G. , Pedersen Nancy L. , Mosing Miriam A. , Lehto Kelli
Published: August 2019

Objective

Neuroticism is associated with poor health outcomes, but its contribution to the accumulation of health deficits in old age, that is, the frailty index, is largely unknown. We aimed to explore associations between neuroticism and frailty cross-sectionally and longitudinally, and to investigate the contribution of shared genetic influences.

Methods

Data were derived from the UK Biobank (UKB; n = 274,951), the Australian Over 50’s Study (AO50; n = 2849), and the Swedish Twin Registry (Screening Across the Lifespan of Twins Study [SALT], n = 18,960; The Swedish Adoption/Twin Study of Aging [SATSA], n = 1365). Associations between neuroticism and the frailty index were investigated using regression analysis cross-sectionally in UKB, AO50, and SATSA and longitudinally in SALT (25–29 years of follow-up) and SATSA (6 and 23 years of follow-up). The co-twin control method was applied to explore the contribution of underlying shared familial factors (SALT, SATSA, AO50). Genome-wide polygenic risk scores for neuroticism were used in all samples to further assess whether common genetic variants associated with neuroticism predict frailty.

Results

High neuroticism was consistently associated with greater frailty cross-sectionally (adjusted β [95% confidence intervals] in UKB = 0.32 [0.32–0.33]; AO50 = 0.35 [0.31–0.39]; SATSA = 0.33 [0.27–0.39]) and longitudinally up to 29 years (SALT = 0.24 [0.22–0.25]; SATSA 6 years = 0.31 [0.24–0.38]; SATSA 23 years = 0.16 [0.07–0.25]). When adjusting for underlying shared genetic and environmental factors, the neuroticism-frailty association remained significant, although decreased. Polygenic risk scores for neuroticism significantly predicted frailty in the two larger samples (meta-analyzed total β = 0.059 [0.055–0.062]).

Conclusions

Neuroticism in midlife predicts frailty in late life. Neuroticism may have a causal influence on frailty, whereas both environmental and genetic influences, including neuroticism-associated common genetic variants, contribute to this relationship.
Dexmedetomidine as an Alternative Anesthetic Agent for Flap Surgery: An Intravital Evaluation in the Cremaster Muscle Flap
Authors: Gencay Isin , Boybeyi Ozlem , Unlu Gulhan , Yazici Ilker , Aydin Gulcin , Buyukkocak Unase
Published: August 2019

Introduction:

Flap surgery is one of the most commonly used techniques of reconstructive surgery for effective repair of damaged tissue. Optimal anesthetic technique and anesthetic agent plays an important role in flap perfusion. This study aimed to evaluate the effects of dexmedetomidine infusion on the microcirculation in the cremaster muscle flap by direct in vivo monitoring.

Materials and Methods:

We randomly divided 9 Wistar albino rats into 3 groups. The rats in the control group underwent the surgical procedure (isolation of the cremaster muscle) alone; the rats in the experimental groups 1 and 2 received an infusion of dexmedetomidine (10 and 30 min) after the surgical procedure.

Results:

The means of vessel diameters, number of functional capillaries, and movements of leukocytes in all groups were evaluated using intravital microscopic examination. The diameters of the arterioles and venules of the cremaster muscle significantly increased in the dexmedetomidine groups. The number of functional capillaries was higher in the dexmedetomidine groups than in the control group. No difference was observed in the movements of leukocytes between the control and experimental groups. Dexmedetomidine significantly increased the diameters of the arterioles and venules of the cremaster flap and the number of functional capillaries.

Conclusion:

On the basis of the effects of dexmedetomidine on microcirculation, we suggest that dexmedetomidine continue to be used as an anesthetic agent, and may be considered also for reconstructive procedures, particularly flap surgery.
Classification of Angulation Deformities of Lower Lateral Cartilages and Their Restoration
Authors: Çerçi Özkan Aret , Mete Fethi Sarper
Published: August 2019

Background:

Shape of the tip is supplied by lower lateral cartilages (LLC) which are divided into 3 crura each composed of 2 segments divided by junction lines (JL). Tip restoration becomes more complicated with the presence of angulation deformities (AD) over LLC. It is aimed to classify AD based on their relationship to JL, to clarify their causes of the formation and to discuss restoration techniques for each of them.

Material and Methods:

Between 2016 and 2018, 375 primary rhinoplasties have been performed. All types of the AD have been retrospectively determined, renamed. Six different types of AD have been encountered in this series. Four of AD (types A, B, C, and D) have been located over JL and 2 of AD (types S and T) have not been located over JL.

Results:

Type-A AD diverging the footplates were observed in 9 patients, type-B AD resulting in a boxy-nose were observed in 18 cases, type-C AD resulting in acute angulation of the dome at the medial genu were observed in 4 patients, type-D AD resulting in a pinched tip and concave alar wings were observed in 6 patients, type-S AD resulting in a weak, and short columella were observed in 5 patients, type-T AD that creates a bulge over ala was observed just in 1 patient in our series. The total number of patients with AD was 39 (10.4% of all cases).

Conclusion:

Classification of AD over LLC based on their relationship to certain JL provides ease for recognition of these deformities and immediate per-operative planning for their restoration.
Sphenopalatine Foramen Computed Tomography Landmarks
Authors: El-Anwar Mohammad Waheed , Khazbak Alaa Omar , Hussein Atef , Saber Sameh , Bessar Ahmed Awad , Eldib Diaa Bakry
Published: August 2019

Objective:

The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF).

Methods:

Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed.

Results:

In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 ± 2.4, 8.5 ± 1.38, 36.4 ± 2.6, 34.6 ± 4.26, 8.1 ± 1.27, and 13.7 ± 1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P = 0.0011), choanal arch (P = 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P = 0.5579), anterior head of middle turbinate (P = 0.8581), and basal lamella (P = 0.0638).

Conclusion:

Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.
The Value of Managing Severe Traumatic Brain Injury During the Perioperative Period Using Intracranial Pressure Monitoring
Authors: He Jianqing , Chen Junhui , Wu Ting , Zhang Chunlei , Yang Likun , Shi Zhong-Hua , Wang Yu-Hai
Published: August 2019

This study aimed to investigate the clinical efficacy of intracranial pressure (ICP) monitoring regarding the perioperative management of patients with severe traumatic brain injury (sTBI). This was a cohort study performed between Jan 2013 and Jan 2016 and included all patients with sTBI. All patients were split into ICP monitoring and non-ICP monitoring groups. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores 6 months after injury, whereas the secondary outcomes include rate of successful nonsurgical treatment, rate of decompression craniotomy (DC), the length of stay in the ICU, and the hospital and medical expenses. This retrospective analysis included 246 ICP monitoring sTBI patients and 695 without ICP monitoring sTBI patients. No significant difference between groups regarding patient demographics. All patients underwent a GOS assessment 6 months after surgery. Compared to the non-ICP monitoring group, a lower in-hospital mortality (20.3% vs 30.2%, P < 0.01) and better GOS scores after 6 months (3.3 ± 1.6 vs 2.9 ± 1.6, P < 0.05) with ICP monitoring. In addition, patients in the ICP monitoring group had a lower craniotomy rate (41.1% vs 50.9%, P < 0.01) and a lower DC rate (41.6% vs 55.9%, P < 0.05) than those in the non-ICP monitoring group. ICU length of stay (12.4 ± 4.0 days vs 10.2 ± 4.8 days, P < 0.01) was shorter in the non-ICP monitoring group, but it had no difference between 2 groups on total length of hospital stay (22.9 ± 13.6 days vs 24.6 ± 13.6 days, P = 0.108); Furthermore, the medical expenses were significantly higher in the non-ICP monitoring group than the ICP monitoring group (11.5 ± 7.2 vs 13.3 ± 9.1, P < 0.01). Intracranial pressure monitoring has beneficial effects for sTBI during the perioperative period. It can reduce the in-hospital mortality and DC rate and also can improve the 6-month outcomes. However, this was a single institution and observational study, well-designed, multicenter, randomized control trials are needed to evaluate the effects of ICP monitoring for perioperative sTBI patients.
A Study of the Effect of Platelet-Rich Plasma on Outcomes After Aspirated Human Fat Grafting With Experimental Design
Authors: Lei Hua , Xiao Ran
Published: August 2019

Introduction:

Over the past decade, some studies have focused on whether platelet-rich plasma (PRP) can promote the survival of fat grafts after transplantation. However, the results of these studies have been controversial because of the variations in research methods and assessment methodologies.

Methods:

In this study, the authors aspirated fat particles from the abdomen of a healthy woman, mixed them with PRP, and injected them into the backs of nude mice subcutaneously, which simulates the clinical model. The control group was designed to mix aspired fat with normal saline. The fat grafts were removed 10 weeks after transplantation, stained with hematoxylin and eosin, and sliced into pathological sections, which were subsequently scanned and analyzed using the Digital Slide Scanning System (PRECICE, Beijing, China).

Results:

The total area of the graft section and the necrotic adipose tissue area in the control group were significantly larger than that in the PRP group. The fibrosis tissue area in the PRP group was significantly larger than that in the control group. There were no statistically significant differences in the viable adipocyte area, the cyst area, and the mature blood vessel number between the PRP and control groups.

Conclusion:

In this study, PRP did not cause an increase in the number of viable adipocytes; however, it did increase the amount of inflammation, which promoted necrotic tissue absorption and the proliferation of granulation tissue. Further research, including research on normalization of fat preparation and grafting, unification of the PRP preparation and application scheme, and optimization of histological measurement and analysis methods, is needed to assess the effect of PRP on fat grafting.
Medicare's Hospital Acquired Condition Reduction Program Disproportionately Affects Minority-serving Hospitals
Authors: Zogg Cheryl K. , Thumma Jyothi R. , Ryan Andrew M. , Dimick Justin B.
Published: August 2019

Objective:

To assess whether a hospital's percentage of Black patients associates with variations in FY2017 overall/domain-specific Hospital Acquired-Condition Reduction Program (HACRP) scores and penalty receipt. Differences in socioeconomic status and receipt of disproportionate share hospital payments (a marker of safety-net status) were also assessed.

Summary of Background Data:

In FY2015, Medicare began reducing payments to hospitals with high adverse event rates. Concern has been expressed that HACRP penalties could adversely affect minority-serving hospitals, leading to reductions in resources and exasperation of disparities among hospitals with the greatest need.

Methods:

100% Medicare FFS claims from 2013 to 2014 identified older adult inpatients, aged ≥65 years, presenting for 8 common surgical conditions. Multilevel mixed-effects regression determined differences in FY2017 HACRP scores/penalties among hospitals managing the highest decile of minority patients.

Results:

A total of 695,775 patients from 2923 hospitals were included. As a hospital's percentage of Black patients increased, climbing from 0.6% to 32.5% (lowest vs highest decile), average HACRP scores also increased, rising from 5.33 to 6.36 (higher values indicate worse scores). Increases in HACRP penalties did not follow the same stepwise increase, instead exhibiting a marked jump within the highest decile of racial minority-serving extent (45.7% vs 36.7%; OR [95% CI]: 1.45[1.42–1.47]). Similar patterns were observed for high disproportionate share hospital (OR [95% CI]: 1.44 [1.42–1.47]; absolute difference: +7.4 percentage-points) and low socioeconomic status-serving (1.38[1.35–1.40]; +7.3% percentage-points) hospitals. Restricted analyses accounting for the influence of teaching status and severity of patient case-mix both accentuated disparities in HACRP penalties when limiting hospitals to those at the highest known penalty-risk (more residents-to-beds, more severe), absolute differences +13.9, +20.5 percentage-points. Restriction to high operative volume, in contrast, reduced the penalty difference, +6.6 percentage-points.

Conclusions:

Minority-serving hospitals are being disproportionately penalized by the HACRP. As the program continues to develop, efforts are needed to identify and protect patients in vulnerable institutions to ensure that disparities do not increase.
Classifying dementia progression using microbial profiling of saliva
Authors: Bathini P. , Foucras S. , Perna A. , Berreux J.L. , Doucey M.A. , Annoni J.M. , Auber L. Alberi
Published: August 2019

Introduction

There is increasing evidence linking periodontal infections to Alzheimer’s disease. Saliva sampling can reveal information about the host and pathogen interactions that can inform about physiological and pathological brain states.

Methods

A cross-sectional cohort of age-matched subjects (78) was segmented according to their chemosensory (University of Pennsylvania smell identification test; UPSIT) and cognitive scores (mini-mental score evaluation; MMSE and clinical dementia rating; CDR). Mid-morning saliva was sampled from each subject and processed for microbiome composition and cytokine analysis. Linear discriminant analysis (LDA) was used to unravel specific changes in microbial and immunological signatures and logistic regression analysis (LRA) was employed to identify taxa that varied in abundance among patients’ groups.

Results

Using olfaction we distinguish in the cognitively normal population a segment with high chemosensory scores (CNh, 27) and another segment with chemosensory scores (CNr, 16) as low as MCI (21) but higher than the AD group (17). We could identify stage-specific microbial signatures changes but no clear distinct cytokine profiles. Periodontal pathogen species as F. villosus decline with increasing severity of AD while opportunistic oral bacteria as L. Wadei shows a significant enrichment MCI. Conclusions: The salivary microbiome indicates stage-dependent changes in oral bacteria favoring opportunistic bacteria at the expenses of periodontal bacteria, while the inflammatory profiles remain mainly unchanged in the sampled population.
Clinical benefits and adverse effects of genetically-elevated free testosterone levels: a Mendelian randomization analysis
Authors: Mohammadi-Shemirani Pedrum , Chong Michael , Pigeyre Marie , Morton Robert W. , Gerstein Hertzel C. , Paré Guillaume
Published: August 2019

BACKGROUND

Testosterone products are increasingly being prescribed to males for a variety of possible health benefits but the causal relationship between testosterone and health-related outcomes is unclear. Evidence from well-powered randomized controlled trials are difficult to obtain, particularly regarding effects on long-term or adverse outcomes. We sought to determine the effects of genetically-predicted calculated free testosterone (CFT) on 23 health outcomes.

METHODS

Genetic variants associated with CFT were determined from 136,531 white British males in the UK Biobank. One-sample and two-sample Mendelian randomization (MR) analyses were performed to infer the effects of genetically-predicted CFT on 23 health outcomes selected based on relevance with known or suspected effects of testosterone therapy.

FINDINGS

In males from the UK Biobank, 81 independent genetic variants were associated with CFT levels at genome-wide significance (p<5×10−8). Each 0.1 nmol/L increase in genetically-predicted CFT was associated with clinical benefits on increased heel bone mineral density (0.053 SD; 95% CI = 0.038 to 0.068; p=8.77×10−12) and decreased body fat percentage (−1.86%; 95% CI = −2.35 to −1.37; p=1.56×10−13), and adverse effects on increased risk of prostate cancer (OR=1.28; 95% CI=1.11 to 1.49; p=1.0×10−3), risk of androgenic alopecia (OR=1.82; 95% CI = 1.55 to 2.14; p=3.52×10−13), risk of benign prostate hyperplasia (BPH) (OR=1.81; 95% CI = 1.34 to 2.44; p=1.05×10−4) and hematocrit percentage (1.49%; 95% CI = 1.24 to 1.74; p=3.49×10−32).

CONCLUSIONS

Long-term elevated free testosterone levels cause prostate cancer, BPH, and hair loss while reducing body fat percentage and increasing bone density. It also has a neutral effect on type 2 diabetes, cardiovascular and cognitive outcomes. Well powered randomized trials are needed to address the effects of shorter term use of exogenous testosterone on these outcomes.
The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study
Authors: Gibb Kate , Seeley Anna , Quinn Terry , Siddiqi Najma , Shenkin Susan , Rockwood Kenneth , Davis Daniel
Published: August 2019

Introduction

Delirium is associated with a wide range of adverse patient safety outcomes. We sought to identify if trends in healthcare complexity were associated with changes in reported delirium in adult medical patients in the general hospital over the last four decades.

Methods

We used identical criteria to a previous systematic review, including studies using DSM and ICD-10 criteria for delirium diagnosis. Random effects meta-analysis pooled estimates across studies, meta-regression estimated temporal changes, funnel plots assessed publication bias.

Results

Overall delirium occurrence was 23% (95% CI 19%-26%) (33 studies). There was no change between 1980-2019, nor was case-mix (average age of sample, proportion with dementia) different. There was evidence of increasing publication bias over time.

Discussion

The incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may mask true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.
Characteristics of Cardiac Memory in Patients with Implanted Cardioverter Defibrillator: the CAMI study
Authors: Haq Kazi T. , Cao Jian , Tereshchenko Larisa G.
Published: August 2019

Objective

The goal of this study was to determine factors associated with cardiac memory (CM) in patients with implantable cardioverter-defibrillators (ICD).

Methods

Patients with structural heart disease (n=20; mean age 72.6±11.6 y; 80% male; mean left ventricular ejection fraction (LVEF) 31.7±7.6%; history of myocardial infarction (MI) in 75%, ventricular tachycardia (VT) in 85%) and preserved atrioventricular (AV) conduction received primary (80%) or secondary (20%) prevention dual-chamber ICD. Standard 12-lead ECG was recorded in AAI and DDD mode, before and after 7 days of right ventricular (RV) pacing in DDD mode with short AV delay. Direction (azimuth and elevation) and magnitude of spatial QRS, T, and ventricular gradient (SVG) vectors were measured before and after 7 days of RV pacing. CM was quantified as the degree of alignment between QRSDDD-7and TAAI-7vectors (QRSDDD-7-TAAI-7angle). Circular statistics and mixed models with a random slope and intercept were adjusted for days 1-7 change in cardiac activation, LVEF, known risk factors, and use of medications known to affect CM.

Results

QRSDDD-7-TAAI-7angle strongly correlated (circular r = - 0.972; P<0.0001) with TAAI-7-TDDD-7angle. In the mixed models, history of MI (−180°(95%CI −320° to −40°); P=0.011) and female sex (−162°(95%CI −268° to −55°); P=0.003) counteracted CM-T azimuth changes (+132°(95%CI 80°-184°); P<0.0001). History of VT (+27(95%CI 4-46) mV*ms; P=0.007) amplified CM-T area increase (+15(95%CI 6–24) mV*ms; P<0.0001).

Conclusions

Existing cardiac remodeling affects CM in response to RV pacing. Women develop less CM than men. Activation memory is another manifestation of CM.
Modelling erythropoiesis in congenital dyserythropoietic anaemia type I (CDA-I)
Authors: Scott Caroline , Downes Damien J. , Brown Jill M. , Babbs Christian , Olijnik Aude-Anais , Gosden Matthew , Beagrie Robert , Schwessinger Ron , Fisher Christopher A. , Rose Anna , Ferguson David J.P , Johnson Errin , Hill Quentin. A , Okoli Steven , Renella Raffaele , Ryan Kate , Brand Marjorie , Hughes Jim , Roy Noemi , Higgs Douglas R. , Buckle Veronica J.
Published: August 2019

We employ and extensively characterise anex vivoculture system to study terminal erythroid maturation of CD34+progenitors from the peripheral blood of normal individuals and patients with Congenital Dyserythropoietic Anaemia type 1 (CDA-I). Using morphological analysis, FACS analysis and the proteomic approach CyTOF, we analysed patient-derived erythroblasts stage-matched with those from healthy donors during the expansion phase and into early differentiation. In patient cells, aspects of disordered erythropoiesis manifest midway through differentiation, including increased proliferation and changes in the DNA accessibility profile. We also show that cultured erythroblasts from CDA-I patients recapitulate the pathognomic feature of this erythroid disorder with up to 40% of the cells having abnormal ‘spongy’ chromatin morphology by electron microscopy, as well as upregulation of GDF15, a marker of ineffective erythropoiesis. In the tertiary phase of culture, patient cells show significantly less enucleation and there is persistence of earlier erythroid precursors. Furthermore, the enucleation defect appears to be more severe in patients with mutations inC15orf41, as compared to the other known causative geneCDAN1, indicating a genotype/phenotype correlation in CDA-I. Such erythroblasts are a valuable resource for investigating the pathogenesis of this disease and provide the opportunity for streamlining diagnosis for CDA-I patients and ultimately other forms of unexplained anaemia.
Ca2+signaling in astrocytes is sleep-wake state specific and modulates sleep
Authors: Bojarskaite Laura , Bjørnstad Daniel M. , Pettersen Klas H. , Cunen Céline , Hermansen Gudmund Horn , Åbjørsbråten Knut Sindre , Sprengel Rolf , Vervaeke Koen , Tang Wannan , Enger Rune , Nagelhus Erlend A.
Published: August 2019

Astrocytic Ca2+signaling has been intensively studied in health and disease but remains uncharacterized in sleep. Here, we employed a novel activity-based algorithm to assess astrocytic Ca2+signals in the barrel cortex of awake and naturally sleeping mice while monitoring neuronal Ca2+activity, brain rhythms and behavior. We discovered that Ca2+signaling in astrocytes exhibits distinct features across the sleep-wake cycle and is reduced in sleep compared to wakefulness. Moreover, an increase in astrocytic Ca2+signaling precedes transitions from slow-wave sleep to wakefulness, with a peak upon awakening exceeding the levels during whisking and locomotion. Genetic ablation of a key astrocytic Ca2+signaling pathway resulted in fragmentation of slow-wave sleep, yet increased the frequency of sleep spindles. Our findings suggest a role for astrocytic Ca2+signaling in modulating sleep.