bluuebunny/crossref_metadata_2025 huggingface dataset:
A Pilot Randomized Controlled Trial of Distress Tolerance Treatment for Weight Concern in Smoking Cessation Among Women
Authors: Bloom Erika Litvin , Ramsey Susan E , Abrantes Ana M , Hunt Laura , Wing Rena R , Kahler Christopher W , Molino Janine , Brown Richard A
Published: January 2020

Introduction

The majority of women who smoke cigarettes report that concern about weight gain is a barrier to quitting. We developed an intervention incorporating distress tolerance, appetite awareness, and mindful eating skills to target concerns about post-cessation weight gain and emotional eating (DT-W). In the current study, we conducted a pilot randomized controlled trial of DT-W versus a smoking health education (HE) intervention.

Methods

Participants (N = 69 adult female, weight-concerned smokers) were recruited in cohorts of 4–11. Cohorts were randomized to DT-W or HE. DT-W and HE were matched on format (single individual session followed by eight group sessions), inclusion of cognitive behavioral therapy for smoking cessation (CBT) content, and pharmacotherapy (nicotine patches). Follow-up assessments occurred at 1-, 3-, and 6-months post-treatment.

Results

The recruitment goal was met; 61 of the 69 participants attended at least one group session. There were no significant differences between DT-W and HE in the number of group sessions attended (DT-W adjusted M = 5.09, HE adjusted M = 5.03, p = .92), ratings of treatment effectiveness or usefulness of skills, or retention at 6-month follow-up (79% in DT-W vs. 78% in HE) (ps > .05), but comprehension ratings were lower in DT-W than in HE (p = .02).

Conclusions

Overall, these results suggest that the study procedures and interventions were feasible and acceptable, but changes to the DT-W intervention content to improve comprehension should be considered prior to conducting a fully powered trial.

Implications

A distress tolerance-based treatment targeting fear of weight gain after smoking cessation and post-cessation emotional eating was feasible and acceptable relative to a smoking HE comparison condition, but changes should be considered before conducting a larger trial. Continued innovation in treatment development for weight-concerned smokers is needed.
Teleassessment of Gait and Gait Aids: Validity and Interrater Reliability
Authors: Venkataraman Kavita , Amis Kristopher , Landerman Lawrence R , Caves Kevin , Koh Gerald C , Hoenig Helen
Published: January 2020

Background

Gait and mobility aid assessments are important components of rehabilitation. Given the increasing use of telehealth to meet rehabilitation needs, it is important to examine the feasibility of such assessments within the constraints of telerehabilitation.

Objective

The objective of this study was to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment gait scale (POMA-G) and cane height assessment under various video and transmission settings to demonstrate the feasibility of teleassessment.

Design

This repeated-measures study compared the test performances of in-person, slow motion (SM) review, and normal-speed (NS) video ratings at various fixed frame rates (8, 15, and 30 frames per second) and bandwidth (128, 384, and 768 kB/s) configurations.

Methods

Overall bias, validity, and interrater reliability were assessed for in-person, SM video, and NS video ratings, with SM video rating as the gold standard, as well as for different frame rate and bandwidth configurations within NS videos.

Results

There was moderate to good interrater reliability for the POMA-G (intraclass correlation coefficient [ICC] = 0.66–0.77 across all configurations) and moderate validity for in-person (β = 0.62; 95% confidence interval [CI] = 0.37–0.87) and NS video (β = 0.74; 95% CI = 0.67–0.80) ratings compared with the SM video rating. For cane height, interrater reliability was good (ICC = 0.66–0.77), although it was significantly lower at the lowest frame rate (8 frames per second) (ICC = 0.66; 95% CI = 0.54–0.76) and bandwidth (128 kB/s) (ICC = 0.69; 95% CI = 0.57–0.78) configurations. Validity for cane height was good for both in-person (β = 0.80; 95% CI = 0.62–0.98) and NS video (β = 0.86; 95% CI = 0.81–0.90) ratings compared with SM video rating.

Limitations

Some lower frame rate and bandwidth configurations may limit the reliability of remote cane height assessments.

Conclusions

Teleassessment for POMA-G and cane height using typically available internet and video quality is feasible, valid, and reliable.
Enthesitis in psoriatic arthritis (Part 1): pathophysiology
Authors: Araujo Elizabeth G , Schett Georg
Published: January 2020

Enthesitis is a key manifestation of PsA and current knowledge supports the concept that it may be among the primary events in the development of this disease, as well as other forms of SpA. Patients with PsA seem to have a different threshold to mechanical stress, which may be genetically determined. Hence patients with psoriatic disease respond pathologically with inflammation after being exposed to physiological mechanical stress. Activation of pro-inflammatory mediators such as IL-17 and TNF-α as well as the influx of innate immune cells are key events in the development of enthesitis in PsA. Chronic entheseal inflammation is accompanied by new bone formation, leading to bony spurs in peripheral (entheseophytes) and axial (syndesmophytes) structures. This article reviews the current knowledge on the mechanisms involved in the development of enthesitis in patients with PsA.
Subcortical Brain Volume Abnormalities in Individuals With an At-risk Mental State
Authors: Sasabayashi Daiki , Takayanagi Yoichiro , Takahashi Tsutomu , Katagiri Naoyuki , Sakuma Atsushi , Obara Chika , Katsura Masahiro , Okada Naohiro , Koike Shinsuke , Yamasue Hidenori , Nakamura Mihoko , Furuichi Atsushi , Kido Mikio , Nishikawa Yumiko , Noguchi Kyo , Matsumoto Kazunori , Mizuno Masafumi , Kasai Kiyoto , Suzuki Michio
Published: January 2020

Previous structural magnetic resonance imaging studies of psychotic disorders have demonstrated volumetric alterations in subcortical (ie, the basal ganglia, thalamus) and temporolimbic structures, which are involved in high-order cognition and emotional regulation. However, it remains unclear whether individuals at high risk for psychotic disorders with minimal confounding effects of medication exhibit volumetric changes in these regions. This multicenter magnetic resonance imaging study assessed regional volumes of the thalamus, caudate, putamen, nucleus accumbens, globus pallidus, hippocampus, and amygdala, as well as lateral ventricular volume using FreeSurfer software in 107 individuals with an at-risk mental state (ARMS) (of whom 21 [19.6%] later developed psychosis during clinical follow-up [mean = 4.9 years, SD = 2.6 years]) and 104 age- and gender-matched healthy controls recruited at 4 different sites. ARMS individuals as a whole demonstrated significantly larger volumes for the left caudate and bilateral lateral ventricles as well as a smaller volume for the right accumbens compared with controls. In male subjects only, the left globus pallidus was significantly larger in ARMS individuals. The ARMS group was also characterized by left-greater-than-right asymmetries of the lateral ventricle and caudate nucleus. There was no significant difference in the regional volumes between ARMS groups with and without later psychosis onset. The present study suggested that significant volume expansion of the lateral ventricle, caudate, and globus pallidus, as well as volume reduction of the accumbens, in ARMS subjects, which could not be explained only by medication effects, might be related to general vulnerability to psychopathology.
Improving Team Functioning and Performance in Age-Diverse Teams: Evaluation of a Leadership Training
Authors: Jungmann Franziska , Wegge Jürgen , Liebermann Susanne C , Ries Birgit C , Schmidt Klaus-Helmut
Published: January 2020

The ongoing demographic change in most European countries increases the proportion of older employees and the prevalence of age diversity in work groups. As the diversity literature supports theories predicting negative effects of age diversity in teams, practical interest is growing how to influence these groups to perform at their best. In this article, we present a model of productivity in age-diverse teams, which we used as the platform for conceptualizing a new training for leaders. The training aims at improving attitudes toward older employees, appreciation of team diversity, and performance in age-diverse teams. We evaluated this training in a public administration in Germany with a training–waiting control group design (47 leaders, 221 employees) including a follow-up measure after 1 year. Results revealed that the training increased appreciation of age diversity and reduced age stereotypes in leaders. Team members’ ratings of age stereotypes and conflicts were also positively influenced, in particular for younger team members who suffer most from working in age-diverse teams. Thus, the newly developed training is a recommendable intervention for leaders of age-diverse teams.
The Effects of High-Fidelity Simulation, Low-Fidelity Simulation, and Video Training on Nursing Student Anxiety in the Clinical Setting
Authors: Thompson C. Elise
Published: January 2020

Education in medication administration is essential to patient safety, but there is limited evidence to describe the best way to influence clinical practice by nursing students. In a medication administration pilot study, the state anxiety of 44 nursing students was evaluated presimulation and prior to giving medications in the clinical setting. Two-way analysis of variance for repeated measures indicated no significant differences between high-fidelity simulation, low-fidelity simulation, or video training groups. However, high- and low-fidelity simulation led to decreased anxiety in the clinical setting, whereas video training led to greater anxiety.
Caring for patients with venomous Crotalinae snakebites
Authors: Miller Ariel , Parsh Bridget
Published: January 2020

Venomous snakebites are surprisingly common in the US. This article provides an overview of what to do when a patient has been bitten by a North American pit viper, a venomous subset of indigenous snakes.
Quality of Care and Outcomes of Patients With Gynecologic Malignancies Treated at Safety-Net Hospitals
Authors: Gamble Charlotte R. , Huang Yongmei , Tergas Ana I. , Khoury-Collado Fady , Hou June Y. , St Clair Caryn M. , Ananth Cande V. , Neugut Alfred I. , Hershman Dawn L. , Wright Jason D.
Published: January 2020

(Abstracted from JNCI Cancer Spectr 2019;3(3):pkz039)

There are well-documented impacts of socioeconomic factors such as race and insurance status on outcomes for women with gynecologic malignancies; however, the role of hospital characteristics in modulating outcomes is less understood. Safety-net hospitals (SNHs), defined by the relative number of uninsured or Medicaid patients, play a critical role by serving the most vulnerable patients and improving access to care for many Americans.
Maternal and Neonatal Outcomes Associated With Trophectoderm Biopsy
Authors: Zhang Wendy Y. , von Versen-Höynck Frauke , Kapphahn Kristopher I. , Fleischmann Raquel R. , Zhao Qianying , Baker Valerie L.
Published: January 2020

(Abstracted from Fertil Steril 2019;112:283–290.e2)

The use of preimplantation genetic testing (PGT) is increasing rapidly, having gone from 4% of all cycles in 2005 to over 22% in 2015. Despite this increasing use, maternal and neonatal outcomes for pregnancies achieved via in vitro fertilization (IVF) with PGT have very little assessment.
Is Traditional Perinatal Autopsy Needed After Detailed Fetal Ultrasound and Postmortem MRI?
Authors: Shelmerdine Susan C. , Arthurs Owen J. , Gilpin Isobel , Norman Wendy , Jones Rod , Taylor Andrew M. , Sebire Neil J. , Chitty Lyn S.
Published: January 2020

(Abstracted from Prenat Diagn 2019;39:818–829)

Investigation after birth of fetal anomalies detected on prenatal ultrasound (US) is important, particularly after termination of pregnancy or fetal or perinatal loss, in terms of significant implications for genetic counseling, subsequent reproductive choices, and other family members. Confirmation of perinatal findings can traditionally be confirmed at a perinatal autopsy, but only 40% of parents consent to this procedure.
Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis
Authors: Korevaar Tim I. M. , Derakhshan Arash , Taylor Peter N. , Meima Marcel , Chen Liangmiao , Bliddal Sofie , Carty David M. , Meems Margreet , Vaidya Bijay , Shields Beverley , Ghafoor Farkhanda , Popova Polina V. , Mosso Lorena , Oken Emily , Suvanto Eila , Hisada Aya , Yoshinaga Jun , Brown Suzanne J. , Bassols Judith , Auvinen Juha , Bramer Wichor M. , López-Bermejo Abel , Dayan Colin , Boucai Laura , Vafeiadi Marina , Grineva Elena N. , Tkachuck Alexandra S. , Pop Victor J. M. , Vrijkotte Tanja G. , Guxens Mònica , Chatzi Leda , Sunyer Jordi , Jiménez-Zabala Ana , Riaño Isolina , Murcia Mario , Lu Xuemian , Mukhtar Shafqat , Delles Christian , Feldt-Rasmussen Ulla , Nelson Scott M. , Alexander Erik K. , Chaker Layal , Männistö Tuija , Walsh John P. , Pearce Elizabeth N. , Steegers Eric A. P. , Peeters Robin P.
Published: January 2020

(Abstracted from JAMA 2019;322(7):632–641)

Preterm birth complicates 5% to 15% of births worldwide, and although it is the most important direct cause of morbidity and mortality in children younger than 5 years, no known risk factors can be identified in the majority of cases. However, overt hypothyroidism and hyperthyroidism during pregnancy are well-known risk factors for preterm birth, and as such, the purpose of this study was to assess whether thyroid function test abnormalities and thyroid peroxidase (TPO) antibody positivity were associated with preterm birth.
Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?
Authors: Majeed Amara , Abuhamad Alfred , Romary Letty , Sinkovskaya Elena
Published: January 2020

(Abstracted from J Ultrasound Med 2019;38:2057–2063)

The worldwide obesity epidemic has led to more than 1.9 billion adults 18 years of age or older classified as “obese.” As obesity is associated with greater risk of maternal and feto-neonatal complications, this study aimed to assess the utility of early gestational ultrasounds (USs) in cardiac screening for obese patients. This entailed performing both late first-trimester/early second-trimester transvaginal and transabdominal US, in comparison with the current national guideline-based second-trimester abdominal US for initial fetal cardiac screening in obese patients.
What Is the Clinical Impact of the Endometrial Receptivity Array in PGT-A and Oocyte Donation Cycles?
Authors: Neves Ana Raquel , Devesa Marta , Martínez Francisca , Garcia-Martinez Sandra , Rodriguez Ignacio , Polyzos Nikolaos P. , Coroleu Buenaventura
Published: January 2020

(Abstracted from J Assist Reprod Genet 2019;36:1901–1908)

Endometrial receptivity is a critical factor to likelihood of implantation after embryonic transfer (ET), yet potential biomarkers for receptivity have thus far failed at reliably predicting clinical pregnancy. Recent evidence has suggested that the Endometrial Receptivity Analysis (ERA), a microarray-based test to evaluate endometrial gene expression, may be valuable in prediction of endometrial receptivity and recommendation of endometrial preparation before ET.
Summative Assessment of Interprofessional “Collaborative Practice” Skills in Graduating Medical Students: A Validity Argument
Authors: Fraser Kristin L. , Charania Irina , Hecker Kent G. , Donahue Marlene , Kaba Alyshah , Veale Pamela , Coderre Sylvain , McLaughlin Kevin
Published: January 2020

Purpose

To describe how the authors developed an objective structured clinical examination (OSCE) station to assess aspects of collaborative practice competency and how they then assessed validity using Kane’s framework.

Method

After piloting the collaborative practice OSCE station in 2015 and 2016, this was introduced at the Cumming School of Medicine in 2017. One hundred fifty-five students from the class of 2017 and 22 students from the class of 2018 participated. To create a validity argument, the authors used Kane’s framework that views the argument for validity as 4 sequential inferences on the validity of scoring, generalization, extrapolation, and implications,

Results

Scoring validity is supported by psychometric analysis of checklist items and the fact that the contribution of rater specificity to students’ ratings was similar to OSCE stations assessing clinical skills alone. The claim of validity of generalization is backed by structural equation modeling and confirmatory factor analysis that identified 5 latent variables, including 3 related to collaborative practice (“provides an effective handover,” “provides mutual support,” and “shares their mental model”). Validity of extrapolation is argued based upon the correlation between the rating for “shares their mental model” and the rating on in-training evaluations for “relationship with other members of the health care team,” in addition to the association between performance on the collaborative practice OSCE station and the subsequent rating of performance during residency. Finally, validity of implications is supported by the fact that pass/fail decisions on the collaborative practice station were similar to other stations and by the observation that ratings on different aspects of collaborative practice associate with pass/fail decisions.

Conclusions

Based upon the validity argument presented, the authors posit that this tool can be used to assess the collaborative practice competence of graduating medical students and the adequacy of training in collaborative practice.
The Relationship Between Clinical and Quantitative Measures of Pain Sensitization in Knee Osteoarthritis
Authors: Moore Rachel L. , Clifford Amanda M. , Moloney Niamh , Doody Catherine , Smart Keith M. , O’Leary Helen
Published: January 2020

Objectives:

Pain sensitization in knee osteoarthritis (OA) is associated with greater symptom severity and poorer clinical outcomes. Measures that identify pain sensitization and are accessible to use in clinical practice have been suggested to enable more targeted treatments. This merits further investigation. This study examines the relationship between quantitative sensory testing (QST) and clinical measures of pain sensitization in people with knee OA.

Methods:

A secondary analysis of data from 134 participants with knee OA was performed. Clinical measures included: manual tender point count (MTPC), the Central Sensitization Inventory (CSI) to capture centrally mediated comorbidities, number of painful sites on a body chart, and neuropathic pain-like symptoms assessed using the modified PainDetect Questionnaire. Relationships between clinical measures and QST measures of pressure pain thresholds (PPTs), temporal summation, and conditioned pain modulation were investigated using correlation and multivariable regression analyses.

Results:

Fair to moderate correlations, ranging from −0.331 to −0.577 (P<0.05), were identified between MTPC, the CSI, number of painful sites, and PPTs. Fair correlations, ranging from 0.28 to 0.30 (P<0.01), were identified between MTPC, the CSI, number of painful sites, and conditioned pain modulation. Correlations between the clinical and self-reported measures and temporal summation were weak and inconsistent (0.09 to 0.25). In adjusted regression models, MTPC was the only clinical measure consistently associated with QST and accounted for 11% to 12% of the variance in PPTs.

Discussion:

MTPC demonstrated the strongest associations with QST measures and may be the most promising proxy measure to detect pain sensitization clinically.
Clinical Scenarios for Which Cervical Mobilization and Manipulation Are Considered by an Expert Panel to Be Appropriate (and Inappropriate) for Patients With Chronic Neck Pain
Authors: Herman Patricia M. , Vernon Howard , Hurwitz Eric L. , Shekelle Paul G. , Whitley Margaret D. , Coulter Ian D.
Published: January 2020

Objectives:

Cervical mobilization and manipulation are 2 therapies commonly used for chronic neck pain (CNP). However, safety, especially of cervical manipulation, is controversial. This study identifies the clinical scenarios for which an expert panel rated cervical mobilization and manipulation as appropriate and inappropriate.

Methods:

An expert panel, following a well-validated modified-Delphi approach, used an evidence synthesis and clinical acumen to develop and then rate the appropriateness of cervical mobilization and manipulation for each of an exhaustive list of clinical scenarios for CNP. Key patient characteristics were identified using decision tree analysis (DTA).

Results:

Three hundred seventy-two clinical scenarios were defined and rated by an 11-member expert panel as to the appropriateness of cervical mobilization and manipulation. Across clinical scenarios more were rated inappropriate than appropriate for both therapies, and more scenarios were rated inappropriate for manipulation than mobilization. However, the number of patients presenting with each scenario is not yet known. Nevertheless, DTA indicates that all clinical scenarios that included red flags (eg, fever, cancer, inflammatory arthritides, or vasculitides), and some others involving major neurological findings, especially if previous manual therapy was unfavorable, were rated as inappropriate for both cervical mobilization and manipulation. DTA also identified the absence of cervical disk herniation, stenosis, or foraminal osteophytosis on additional testing as the most important patient characteristic in predicting ratings of appropriate.

Conclusions:

Clinical guidelines for CNP should include information on the clinical scenarios for which cervical mobilization and manipulation were found inappropriate, including those with red flags, and others involving major neurological findings if previous manual therapy was unfavorable.
Adherence to Consolidated Standards of Reporting Trials (CONSORT) Guidelines for Reporting Safety Outcomes in Trials of Medical Cannabis and Cannabis-based Medicines for Chronic Noncancer Pain
Authors: Mohiuddin Mohammed M. , Mizubuti Glenio B. , Haroutounian Simon , Smith Shannon M. , Rice Andrew S.C. , Campbell Fiona , Park Rex , Gilron Ian
Published: January 2020

Objective:

Current treatments for chronic pain have limited effectiveness and tolerability. With growing interest in the potential of cannabinoids, there is a need to inform risk-benefit considerations. Thus, this focused systematic review assesses the quality of safety assessment and reporting in chronic noncancer pain cannabinoid trials.

Methods:

The protocol for this review has been published, and, registered in PROSPERO. We searched MEDLINE, Embase, The Cochrane Library, Scopus, and PsychINFO for double-blind, placebo-controlled, randomized controlled trials of cannabinoids for chronic pain, with a primary outcome related to pain. The primary review outcome is adherence to the 2004 Consolidated Standards of Reporting Trials (CONSORT) Harms extension. Secondary outcomes included type, reporting method, frequency and severity of adverse events (AEs), trial participant withdrawals, and reasons for withdrawals.

Results:

In total, 43 studies (4436 participants) were included. Type of cannabinoid (number of studies) included nabiximols (12), dronabinol (8), nabilone (7), oral cannabis extract preparations (5), smoked tetrahydrocannabinol (5), vaporized tetrahydrocannabinol (3), novel synthetic cannabinoids (2), sublingual cannabis extract preparations (1). The median CONSORT score was 7. On average, 3 to 4 recommendations of the CONSORT guidelines were not being met in trials. Seventeen trials did not provide their method of AE assessment, 14 trials did not report on serious AEs and, 7 trials provided no quantitative data about AEs.

Discussion:

Better harms assessment and reporting are needed in chronic pain cannabinoid trials. Improvements may be achieved through: expanded education/knowledge translation increased research regulation by ethics boards, funding agencies and journals, and greater emphasis on safety assessment and reporting throughout research training.
Ultrasound to Detect Central Venous Catheter Placement Associated Complications
Authors: Smit Jasper M. , Haaksma Mark E. , Lim Endry H. T. , Steenvoorden Thei S. , Blans Michiel J. , Bosch Frank H. , Petjak Manfred , Vermin Ben , Touw Hugo R. W. , Girbes Armand R. J. , Heunks Leo M. A. , Tuinman Pieter R.
Published: January 2020

Background

Mechanical complications arising after central venous catheter placement are mostly malposition or pneumothorax. To date, to confirm correct position and detect pneumothorax, chest x-ray film has been the reference standard, while ultrasound might be an accurate alternative. The aim of this study was to evaluate diagnostic accuracy of ultrasound to detect central venous catheter malposition and pneumothorax.

Methods

This was a prospective, multicenter, diagnostic accuracy study conducted at the intensive care unit and postanesthesia care unit. Adult patients who underwent central venous catheterization of the internal jugular vein or subclavian vein were included. Index test consisted of venous, cardiac, and lung ultrasound. Standard reference test was chest x-ray film. Primary outcome was diagnostic accuracy of ultrasound to detect malposition and pneumothorax; for malposition, sensitivity, specificity, and other accuracy parameters were estimated. For pneumothorax, because chest x-ray film is an inaccurate reference standard to diagnose it, agreement and Cohen’s κ-coefficient were determined. Secondary outcomes were accuracy of ultrasound to detect clinically relevant complications and feasibility of ultrasound.

Results

In total, 758 central venous catheterizations were included. Malposition occurred in 23 (3.3%) out of 688 cases included in the analysis. Ultrasound sensitivity was 0.70 (95% CI, 0.49 to 0.86) and specificity 0.99 (95% CI, 0.98 to 1.00). Pneumothorax occurred in 5 (0.7%) to 11 (1.5%) out of 756 cases according to chest x-ray film and ultrasound, respectively. In 748 out of 756 cases (98.9%), there was agreement between ultrasound and chest x-ray film with a Cohen’s κ-coefficient of 0.50 (95% CI, 0.19 to 0.80).

Conclusions

This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Postoperative Intracochlear Electrocochleography in Pediatric Cochlear Implant Recipients: Association to Audiometric Thresholds and Auditory Performance
Authors: Attias Joseph , Ulanovski David , Hilly Ohad , Greenstein Tally , Sokolov Merav , HabibAllah Suhail , Mormer Hen , Raveh Eyal
Published: January 2020

Objectives:

The aim of this study was to compare intracochlear-recorded cochlear microphonics (CM) responses to behavioral audiometry thresholds in young children, with congenital hearing loss, 2 to 5 years after cochlear implantation early in life. In addition, differences in speech and auditory outcomes were assessed among children with and without residual hearing.

Design:

The study was conducted at a tertiary, university-affiliated, pediatric medical center. CM responses by intracochlear electrocochleography technique were recorded from 102 implanted ears of 60 children and those responses correlated to behavioral audiometry thresholds at 0.125 to 2 kHz frequencies. All children had received Advanced Bionics cochlear implant with High Focus J1 or MidScala electrodes, along with extensive auditory rehabilitation before and after implantation, including the use of conventional hearing aids. Speech Spatial and Hearing Qualities, Category of Auditory Performance scale, and educational settings information were obtained for each participant. Those cochlear implantation (CI) outcomes were compared between children with or without residual CM responses.

Results:

Two distinctive CM responses patterns were found among the implanted children. Of all ears diagnosed with cochlear hearing loss (n = 88), only in 29 ears, clear CM responses were obtained. In all other ears, no CM responses were obtained at the maximum output levels. The CM responses were highly correlated with coefficients ranging from 0.7 to 0.83 for the audiometric behavioral thresholds at 0.125 to 2 kHz frequency range. Of all ears diagnosed with auditory neuropathy syndrome disorder (n = 14), eight ears had residual hearing and recordable CM postimplantation. The other six ears showed no recordable CM responses at maximum output levels for all tested frequencies. Those showed supposedly better CM responses than the behavioral audiometry threshold, however with poor correlations with tested frequency thresholds. Children with residual hearing showed significantly better auditory outcomes with CI, compared with those without residual hearing.

Conclusions:

In children with congenital cochlear hearing loss, the objective CM intracochlear responses can reliably predict the residual audiometric threshold. However, in children with auditory neuropathy syndrome disorder, the CM thresholds did not match the behavioral audiometric responses. Postoperatively, children with recordable CM responses, showing preserved residual hearing, demonstrated better CI outcomes.
Autoimmunity and immunodeficiency
Authors: Hoyos-Bachiloglu Rodrigo , Chou Janet
Published: January 2020

Purpose of review

Advances in genomics and animal models of human disease have enabled the discovery of mechanisms important for host immunity and self-tolerance. Here, we summarize conceptual and clinical discoveries identified from 2018 to 2019 in the field of primary immunodeficiencies and autoimmunity.

Recent findings

Three new primary immunodeficiencies with autoimmunity were identified and the clinical phenotypes of NFKB1 haploinsufficiency and RASGRP1 deficiency were expanded. A diversity of novel mechanisms leading to autoimmunity associated with primary immunodeficiencies (PIDs) was reported, including pathways important for the metabolism and function of regulatory T cells and germinal B cells, the contribution of neutrophil extracellular traps to plasmacytoid dendritic cell activation and the influence of commensal bacteria on the generation of autoantibodies. With regard to therapeutic developments in the field, we highlight the use of janus kinase inhibitors for immune dysregulation associated with gain-of-function variants in STAT1 and STAT3, as well as the risks of persistent hypogammaglobulinemia associated with rituximab treatment.

Mechanistic studies of PIDs with autoimmunity elucidate key principles governing the balance between immune surveillance and self-tolerance.
Alleviation of Pain After Femur and Tibia Shaft Fractures Using Nothing Stronger Than Codeine and Tramadol
Authors: Reich Michael S. , Klahs Kyle J. , Fernandez Isaac , Nguyen Mai P.
Published: January 2020

Objective:

To determine whether using nothing stronger than codeine and tramadol provides adequate pain alleviation in people recovering from fixation of a fracture of the femur or tibia shaft.

Design:

Retrospective case series.

Setting:

Level 1 trauma center in the United States.

Patients:

All adult patients from October 2016 to October 2018 with femur (OTA/AO 32) and tibial (OTA/AO 42) shaft fractures who were treated surgically were included. A nurse counseled patients on safe and effective alleviation of pain. Charts were reviewed for pain medication prescribed, noting utilization of schedule II opioid medications.

Main Outcome Measures:

Frequency of schedule II pain medication prescription on discharge or during follow-up, emergency department presentation for pain, or readmission for pain.

Results:

One hundred fifty patients with 162 fractures were treated for femoral (N = 73 fractures) or tibial (N = 89 fractures) shaft fractures. Sixty patients (40%) were multiple injured patients. Thirteen (8.7%) patients were discharged with hydrocodone, oxycodone, or fentanyl. Of the remaining patients with adequate follow-up (N = 109), 6.4% requested hydrocodone, oxycodone, or fentanyl after discharge. There was 1 patient presentation to the emergency department for pain, and there were no pain-related readmissions.

Conclusions:

Alleviation of pain can be achieved in most patients with femoral and tibial shaft fractures, including multiply injured patients, with one-on-one patient support and by using nothing stronger than codeine and tramadol.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Biomechanical Study of Tuberosity-Based Locked Plate Fixation Compared with Standard Proximal Humeral Locking Plate Fixation for 3-Part Proximal Humeral Fractures
Authors: Walker Robert , Castaneda Paulo , Putnam Jill G. , Schemitsch Emil H. , McKee Michael D.
Published: January 2020

Background:

One of the main shortcomings of current proximal humeral plate designs is their inability to reliably secure the greater tuberosity (GT) or lesser tuberosity, leading to fixation failure, nonunion, and rotator cuff dysfunction. Traditional proximal humeral locking plates (PHLPs) rely on isolated screw fixation or suture repair to maintain reduction of the greater and/or lesser tuberosities. This study evaluates a tuberosity-based plate (TBP) specifically designed to improve tuberosity fixation, which may decrease tuberosity displacement and related clinical sequelae.

Methods:

Five cadaveric specimens (10 shoulders) were randomized to receive either standard PHLP or TBP fixation. The specimens were skeletonized except for the rotator cuff insertion on the GT. A reproducible 3-part osteotomy was performed for each cadaver, creating head, shaft, and GT segments. Anatomic reduction and plate fixation were performed according to the surgical technique guide for each plate system, with an equal number of screws placed in each plate both proximally and distally. GT fixation was enhanced with standardized suture augmentation through the rotator cuff in every specimen in both groups. In each trial, fracture displacement, load to failure, number of cycles endured, and mechanism of failure were noted.

Results:

The mean load to tuberosity fixation failure for the PHLP and TBP groups was 220 and 502 N (P = 0.005), respectively.

Conclusions:

The TBP had a significantly higher load to failure and significantly lower mean fracture displacement compared with the PHLP.
Prognostic value of the neutrophil/lymphocyte ratio in enteropancreatic neuroendocrine tumors
Authors: Grenader Tal , Pavel Marianne E. , Ruszniewski Philippe B. , Ćwikła Jarosław B. , Phan Alexandria T. , Raderer Markus , Sedláčková Eva , Cadiot Guillaume , Wolin Edward M. , Capdevila Jaume , Wall Lucy , Rindi Guido , Truong Thanh Xuan-Mai , Caplin Martyn E.
Published: January 2020

Accessible prognostic tools are needed to individualize treatment of neuroendocrine tumors (NETs). Data suggest neutrophil/lymphocyte ratios (NLRs) have prognostic value in some solid tumors, including NETs. In the randomized double-blind CLARINET study (NCT00353496; EudraCT 2005-004904-35), the somatostatin analog lanreotide autogel/depot increased progression-free survival (PFS) compared with placebo in patients with inoperable or metastatic intestinal and pancreatic NETs (grades 1–2, Ki-67 < 10%). The exploratory post-hoc analyses presented here evaluated the prognostic value of NLR in the CLARINET study cohort, in the context of and independently from treatment. Kaplan–Meier PFS plots were generated for patients with available NLR data, in subgroups based on NLR values, and 24-month survival rates were calculated. P values and hazard ratios for prognostic effects were generated using Cox models. 31216222 Baseline characteristics were balanced between lanreotide autogel/depot 120 mg (n = 100) and placebo (n = 101) arms. Irrespective of treatment, raw 24-month PFS rates were comparable across subgroups based on NLR tertiles [37.3% (low), 38.8% (middle), 38.8% (high); n = 67 per group] and NLR cutoff of 4 [38.1% (NLR ≤ 4; n = 176), 40.0% (NLR > 4; n = 25)]. Furthermore, NLRs were not prognostic in Cox models, irrespective of subgroups used. The therapeutic effect of lanreotide autogel/depot 120 mg was independent of NLRs (P > 0.1). These exploratory post-hoc analyses in patients with advanced intestinal and pancreatic NETs contrast with previous data suggesting NLR has prognostic potential in NETs. This may reflect the inclusion of patients with lower-grade tumors or use of higher NLR cutoff values in the current analysis.
Smoking history increases the risk of long-term mortality after thoracic endovascular aortic repair in patients with an uncomplicated type B dissection
Authors: Gao Hui-Qiang , Ren Chang-Wei , Yang Sheng , Huang Lian-Jun , Sun Li-Zhong , Xu Shang-Dong
Published: January 2020

Background:

The preferred treatment for uncomplicated type B dissection (thoracic endovascular aortic repair [TEVAR] or medical) is still under debate. Since 2001, our center has performed TEVAR for uncomplicated type B dissection. Based on our data, 5- and 10-year survival rates among patients with uncomplicated type B dissection after TEVAR were 96.5% and 83.0%, respectively. We, therefore, believe that TEVAR is preferable for uncomplicated type B dissections. This study analyzed the impact of a pre-operative smoking history on long-term survival after TEVAR in patients with uncomplicated type B dissections.

Methods:

From May 2001 to December 2013, data from 751 patients with type B dissections were collected and analyzed. Patients were divided into two groups (337 smoking patients and 414 non-smoking patients). The Kaplan-Meier method and log-rank test were used to compare survival curves of the two groups. Multivariable analyses using the Cox proportional hazards model were used to estimate the effects of smoking on survival rates.

Results:

The 5- and 10-year survival rates of non-smokers were 97.6% (95% confidence interval [CI], 96.0%–99.2%) and 87.0% (95% CI, 81.6%–92.7%), respectively, and 94.9% (95% CI, 92.2%–97.7%) and 73.8% (95% CI, 62.3%–87.5%) for smokers, respectively (Log-rank test, P = 0.006). Multivariable analyses showed that smoking increased the risk of death during follow-up, 2.1-fold when compared to non-smokers (P = 0.039).

Conclusion:

A pre-operative smoking history increases long-term mortality rates after TEVAR in patients with uncomplicated type B dissections.
Anxiety symptoms in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a cross-sectional study
Authors: Song Shuang , Chen Na , Duan Yan-Ping , Kang Jia , Deng Shan , Pan Hong-Xin , Zhu Lan
Published: January 2020

Background:

As a congenital malformation that results in infertility and an inability to have vaginal intercourse, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome places a considerable psychological burden on patients, which results in anxiety symptoms. However, only single case studies or a few small to medium-sized cross-sectional studies were identified to focus on anxiety symptoms in MRKH patients. Thus, the aim of this study was to explore the status of anxiety symptoms and the related factors in patients with MRKH syndrome.

Methods:

This cross-sectional study involving 141 patients with MRKH syndrome and 178 healthy women was conducted from January 2018 to December 2018. All participants were required to complete a demographic questionnaire and the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9, Eysenck Personality Questionnaire-Revised, Short Scale for Chinese, and Chinese Version of the Female Sexual Function Index. The main outcome was the anxiety symptoms measured by the GAD-7. Main outcome was compared between the MRKH syndrome group and the healthy control group. Then, we explored the related factors by comparing patients with and without anxiety symptoms.

Results:

Of the respondents, 24.1% experienced moderate to severe anxiety symptoms. Patients with MRKH syndrome manifested more severe anxiety symptoms than healthy women. Negative self-evaluation of femininity (odds ratio [OR] 2.706, 95% confidence interval [CI] 1.010–7.247), neurotic personality traits (OR 1.100, 95% CI 1.029–1.175), and coexisting depressive symptoms (OR 4.422, 95% CI 1.498–13.049) were more prevalent in anxious patients.

Conclusion:

The findings stress the importance of anxiety symptom screening in MRKH patients and identify patients at risk of anxiety symptoms, providing a possible basis for future intervention.
A Graphical Catalog of Threats to Validity
Authors: Matthay Ellicott C. , Glymour M. Maria
Published: January 2020

Directed acyclic graphs (DAGs), a prominent tool for expressing assumptions in epidemiologic research, are most useful when the hypothetical data generating structure is correctly encoded. Understanding a study’s data generating structure and translating that data structure into a DAG can be challenging, but these skills are often glossed over in training. Campbell and Stanley’s framework for causal inference has been extraordinarily influential in social science training programs but has received less attention in epidemiology. Their work, along with subsequent revisions and enhancements based on practical experience conducting empirical studies, presents a catalog of 37 threats to validity describing reasons empirical studies may fail to deliver causal effects. We interpret most of these threats to study validity as suggestions for common causal structures. Threats are organized into issues of statistical conclusion validity, internal validity, construct validity, or external validity. To assist epidemiologists in drawing the correct DAG for their application, we map the correspondence between threats to validity and epidemiologic concepts that can be represented with DAGs. Representing these threats as DAGs makes them amenable to formal analysis with d-separation rules and breaks down cross-disciplinary language barriers in communicating methodologic issues.
Intra-operative norepinephrine administration and cancer-related outcomes following radical cystectomy for bladder cancer
Authors: Löffel Lukas M. , Furrer Marc A. , Favre Aline , Engel Dominique , Gahl Brigitta , Burkhard Fiona C. , Wuethrich Patrick Y.
Published: January 2020

BACKGROUND

The impact of anaesthetic techniques on recurrence of cancers is controversial. Elevated plasma catecholamine levels have been implicated in angiogenesis and metastasis in various cancers.

OBJECTIVES

To assess the potential association between continuous intra-operative norepinephrine administration and tumour-related outcome in muscle-invasive bladder cancer patients undergoing radical cystectomy with urinary diversion.

DESIGN

Retrospective observational cohort study.

SETTING

Single tertiary centre, from 2000 to 2017.

PATIENTS

We included a consecutive series of 1120 urothelial carcinoma patients undergoing radical cystectomy and urinary diversion, including 411/1120 patients (37%) who received a continuous intra-operative administration of more than 2 μg kg BW−1 h−1 norepinephrine.

MAIN OUTCOME MEASURES

The primary outcome was time to tumour recurrence within 5 years after surgery, with death as competing outcome. We used inverse probability of treatment weighting to adjust for imbalances between treatment groups, one having received more than 2 μg kg BW−1 h−1 norepinephrine and the other having received less. We furthermore adjusted for intra-operative variables or years of surgery as sensitivity analyses.

RESULTS

The continuous administration of more than 2 μg kg BW−1 h−1 norepinephrine slightly increased tumour recurrence (hazard ratio: 1.47, 95% CI 0.98 to 2.21; P = 0.061). After adjustment for intra-operative variables, and year of surgery hazard ratios were 1.82 (95% CI 1.13 to 2.91, P = 0.013) and 1.85 (95% CI 1.12 to 3.07, P = 0.017), respectively. Overall mortality (with or without tumour recurrence) was not affected by norepinephrine (hazard ratio: 0.84, 95% CI 0.65 to 1.08, P = 0.170).

CONCLUSION

Continuous administration of more than 2 μg kg BW−1 h−1 norepinephrine was associated with a slightly increased hazard ratio for tumour recurrence if adjusted for intra-operative variables and year of surgery. This observation could reflect a low potential pro-oncogenic effect of norepinephrine during the intra-operative period.

TRIAL REGISTRATION

Not applicable.
The effect of intravenous magnesium on postoperative morphine consumption in noncardiac surgery
Authors: Ng Ka T. , Yap Jasmine L.L. , Izham Ilyanna N. , Teoh Wan Y. , Kwok Pei E. , Koh Wen J.
Published: January 2020

BACKGROUND

Several studies suggest that systemic magnesium reduces postoperative opioid consumption and the intensity of pain, but others report conflicting results. The efficacy and safety profile of intravenous magnesium in noncardiac surgery remain uncertain.

OBJECTIVES

The aim of this review was to investigate the effect of intravenous magnesium on the consumption of postoperative morphine in the first 24 h in adults undergoing noncardiac surgery.

DESIGN

Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES

MEDLINE, EMBASE, CENTRAL from their inception until January 2019.

ELIGIBILITY CRITERIA

All randomised clinical trials comparing intravenous magnesium versus placebo in noncardiac surgery were systematically searched in the databases. Observational studies, case reports, case series and nonsystematic reviews were excluded.

RESULTS

Fifty-one trials (n=3311) were included for quantitative meta-analysis. In comparison with placebo, postoperative morphine consumption at 24-h was significantly reduced in the magnesium group, with a mean difference [95% confidence interval (CI)] of −5.6 mg (−7.54 to −3.66, P < 0.001, I
2 = 92%, level of evidence low). The trial sequential analysis for the effect of magnesium on postoperative morphine consumption was conclusive. Patients who received magnesium had a longer time to the first analgesia request [143 (103 to 183) min, P < 0.001, I
2 = 99%, level of evidence low] and a lower incidence of shivering [0.26 (0.15 to 0.44), P < 0.001, I
2 = 35%, level of evidence very low]. However, no significance differences were demonstrated in postoperative pain scores in the first 24 h (mean difference, 95% CI) −0.30 (−0.69 to 0.09, P = 0.13, I
2 = 91%, level of evidence low), bradycardia (odds ratio, 95% CI) 1.13 (0.43 to 2.98, P = 0.80, I
2 = 35%, level of evidence very low) and postoperative nausea and vomiting (odds ratio, 95% CI) 0.90 (0.67 to 1.22, P = 0.49, I
2 = 25%, level of evidence moderate).

CONCLUSION

The current meta-analysis demonstrates that the use of intravenous magnesium as part of multimodal analgesia may reduce morphine consumption in the first 24 h after surgery and delay the time to the first request for analgesia in patients undergoing noncardiac surgery. However, the included studies were of low-quality with substantial heterogeneity.

TRIAL REGISTRATION

CRD42018086846.