bluuebunny/crossref_metadata_2025 huggingface dataset:
Musical Rehabilitation in Adult Cochlear Implant Recipients With a Self-administered Software
Authors: Smith Leah , Bartel Lee , Joglekar Samidha , Chen Joseph
Published: August 2017

Objective:

The goal of this study was to determine if a self-administered computer-based rehabilitation program could improve music appreciation and speech understanding in adults who have a cochlear implant (CI).

Study Design:

Prospective study.

Setting:

Tertiary adult CI program.

Patients:

Twenty-one postlingually deafened cochlear implant users between the ages of 27 and 79 years were recruited.

Interventions(s):

A self-administered music rehabilitative software was designed to help improve the perception of musical patterns of increasing complexity, as well as pitch and timbre perception, premised on focused and divided attention. All participants completed a diagnostic music test before and after rehabilitative training, including tests of pitch and timbre perception and pattern identification with increasing levels of difficulty. Speech data in quiet and noise was also collected both pre- and post-training. Participants trained for a minimum of 3.5 hours a week, for 4 weeks.

Main Outcome Measure(s):

Mean changes in music perception and enjoyment as well as speech perception (IEEE sentence test in quiet and noise).

Results:

Post-training diagnostic test scores, as compared with pretraining scores, indicated significant improvements in musical pattern perception. Tests of speech perception in quiet and in noise were significantly improved in a subset of this cohort. All of the training participants thought that the training helped to improve their recognition skills, and found the program to be beneficial.

Conclusion:

Despite the limitations of current CI technology, the results of this study suggest that auditory training can improve music perception skills, and possibly speech intelligibility, lending further support to rehabilitation being an integral part of the postimplantation paradigm.
What Does Music Sound Like for a Cochlear Implant User?
Authors: Jiam Nicole T. , Caldwell Meredith T. , Limb Charles J.
Published: August 2017

Objective:

Cochlear implant research and product development over the past 40 years have been heavily focused on speech comprehension with little emphasis on music listening and enjoyment. The relatively little understanding of how music sounds in a cochlear implant user stands in stark contrast to the overall degree of importance the public places on music and quality of life. The purpose of this article is to describe what music sounds like to cochlear implant users, using a combination of existing research studies and listener descriptions. We examined the published literature on music perception in cochlear implant users, particularly postlingual cochlear implant users, with an emphasis on the primary elements of music and recorded music. Additionally, we administered an informal survey to cochlear implant users to gather first-hand descriptions of music listening experience and satisfaction from the cochlear implant population.

Conclusion:

Limitations in cochlear implant technology lead to a music listening experience that is significantly distorted compared with that of normal hearing listeners. On the basis of many studies and sources, we describe how music is frequently perceived as out-of-tune, dissonant, indistinct, emotionless, and weak in bass frequencies, especially for postlingual cochlear implant users—which may in part explain why music enjoyment and participation levels are lower after implantation. Additionally, cochlear implant users report difficulty in specific musical contexts based on factors including but not limited to genre, presence of lyrics, timbres (woodwinds, brass, instrument families), and complexity of the perceived music. Future research and cochlear implant development should target these areas as parameters for improvement in cochlear implant-mediated music perception.
The Sound Quality of Cochlear Implants: Studies With Single-sided Deaf Patients
Authors: Dorman Michael F. , Natale Sarah Cook , Butts Austin M. , Zeitler Daniel M. , Carlson Matthew L.
Published: August 2017

Objective:

The goal of the present study was to assess the sound quality of a cochlear implant for single-sided deaf (SSD) patients fit with a cochlear implant (CI).

Background:

One of the fundamental, unanswered questions in CI research is “what does an implant sound like?” Conventional CI patients must use the memory of a clean signal, often decades old, to judge the sound quality of their CIs. In contrast, SSD-CI patients can rate the similarity of a clean signal presented to the CI ear and candidate, CI-like signals presented to the ear with normal hearing.

Methods:

For Experiment 1 four types of stimuli were created for presentation to the normal hearing ear: noise vocoded signals, sine vocoded signals, frequency shifted, sine vocoded signals and band-pass filtered, natural speech signals. Listeners rated the similarity of these signals to unmodified signals sent to the CI on a scale of 0 to 10 with 10 being a complete match to the CI signal. For Experiment 2 multitrack signal mixing was used to create natural speech signals that varied along multiple dimensions.

Results:

In Experiment 1 for eight adult SSD-CI listeners, the best median similarity rating to the sound of the CI for noise vocoded signals was 1.9; for sine vocoded signals 2.9; for frequency upshifted signals, 1.9; and for band pass filtered signals, 5.5. In Experiment 2 for three young listeners, combinations of band pass filtering and spectral smearing lead to ratings of 10.

Conclusion:

The sound quality of noise and sine vocoders does not generally correspond to the sound quality of cochlear implants fit to SSD patients. Our preliminary conclusion is that natural speech signals that have been muffled to one degree or another by band pass filtering and/or spectral smearing provide a close, but incomplete, match to CI sound quality for some patients.
Cognitive Evaluation of Cochlear Implanted Adults Using CODEX and MoCA Screening Tests
Authors: Ambert-Dahan Emmanuèle , Routier Shirley , Marot Lucie , Bouccara Didier , Sterkers Olivier , Ferrary Evelyne , Mosnier Isabelle
Published: August 2017

Objective:

The relationship between hearing loss and cognitive function has already been established. The objective of our study was to determine whether the two short cognitive tests, COgnitive Disorders EXamination (CODEX) and Montreal Cognitive Assessment (MoCA), could be used in daily clinical practice to detect cognitive impairment, and its changes after cochlear implantation.

Patients:

Eighteen patients with severe to profound postlingual progressive hearing loss (mean age ± SEM: 64 ± 3.5 yr; range, 23–83 yr) were tested before, and 12 months after cochlear implantation, with adapted visual presentation of CODEX and MoCA tests. Auditory performance was tested under best-aided conditions in quiet and noise.

Results:

Twelve months after cochlear implantation, hearing performance had clearly improved (paired t tests, p < 0.05). In addition, among the eight patients who had an abnormal cognitive score before implantation, four improved their cognitive performance, and were thus considered to be normal. No major alteration of cognitive performance was observed in the 10 patients who had normal cognitive performance before implantation.

Conclusion:

CODEX and MoCA are rapid tests that could be considered to be relevant cognitive performance screening tests. They could be used in daily clinical practice to improve the multidisciplinary sensory-cognitive monitoring of the elderly population.
Recurrent Vestibular Migraine Vertigo Attacks Associated With the Development of Profound Bilateral Vestibulopathy: A Case Series
Authors: Wester Jacob L. , Ishiyama Akira , Ishiyama Gail
Published: August 2017

Background:

Bilateral vestibulopathy (BVP) is a debilitating condition characterized by gait ataxia, oscillopsia, and imbalance.

Objective:

Case series of patients with migraine-linked vertigo spells and profound BVP.

Patient 1:

A 69-year-old man presented with a history of recurrent severe vertigo spells lasting up to 3 days in duration associated with prostrating migraine headaches starting at age 60. His symptoms were misdiagnosed as an anxiety syndrome. At age 68, electronystagmography (ENG) revealed bilaterally absent caloric responses and complete BVP. His hearing was normal.

Patient 2:

A 51-year-old man presented with a history of “earthquake-like” vertigo, sharp head pain, and phonophobia. These episodes occurred a handful of times over a 7-year period. Previous ENG testing at age 43 was normal. However, his ENG at age 48 revealed complete BVP. He was started on acetazolamide and noted improved balance, although subsequent ENG was unchanged.

Patient 3:

A 49-year-old woman presented with a history of recurrent migraines with visual aura associated with vertigo lasting 1 hour. ENG at age 50 revealed complete BVP. Subjectively, she noted improved balance with acetazolamide and subsequent ENG demonstrated mild improvement.

Patient 4:

A 43-year-old man presented with a 5-year history of optical migraines and recurrent vertigo spells, lasting 30 seconds, which was misdiagnosed as positional vertigo. He additionally had a 10-year history of oscillopsia. ENG at age 61 revealed complete BVP.

Conclusion:

In these cases, vestibular migraine was linked to recurrent vertigo spells that eventually led to complete bilateral vestibulopathy.
Mice with cancer-induced bone pain show a marked decline in day/night activity
Authors: Majuta Lisa A. , Guedon Jean-Marc G. , Mitchell Stefanie A.T. , Kuskowski Michael A. , Mantyh Patrick W.
Published: August 2017

Introduction:

Cancer-induced bone pain (CIBP) is the most common type of pain with cancer. In humans, this pain can be difficult to control and highly disabling. A major problem with CIBP in humans is that it increases on weight-bearing and/or movement of a tumor-bearing bone limiting the activity and functional status of the patient. Currently, there is less data concerning whether similar negative changes in activity occur in rodent models of CIBP.

Objectives:

To determine whether there are marked changes in activity in a rodent model of CIBP and compare this to changes in skin hypersensitivity.

Methods:

Osteosarcoma cells were injected and confined to 1 femur of the adult male mouse. Every 7 days, spontaneous horizontal and vertical activities were assessed over a 20-hour day and night period using automated activity boxes. Mechanical hypersensitivity of the hind paw skin was assessed using von Frey testing.

Results:

As the tumor cells grew within the femur, there was a significant decline in horizontal and vertical activity during the times of the day/night when the mice are normally most active. Mice also developed significant hypersensitivity in the skin of the hind paw in the tumor-bearing limb.

Conclusion:

Even when the tumor is confined to a single load-bearing bone, CIBP drives a significant loss of activity, which increases with disease progression. Understanding the mechanisms that drive this reduction in activity may allow the development of therapies that allow CIBP patients to better maintain their activity and functional status.
Pharmacoeconomics of genotyping-based treatment decisions in patients with chronic pain
Authors: Morlock Robert , Braunstein Glenn D.
Published: August 2017

Introduction:

Genotyping-based treatment decisions may optimize treatment response and minimize adverse drug events (ADEs) in patients with chronic pain.

Objectives:

To estimate the financial impact of genotyping-based treatment decisions in patients with moderate to severe chronic pain in a managed care setting.

Methods:

A budget impact model was built with a 1-year time horizon to estimate costs of genotyping-based treatment decisions in a 1000-patient cohort. The model includes drug costs, type and cost of ADEs, distribution of treatments used, and genotyping costs. Event rates and health care costs were derived from primary literature. Three patient cohorts were assessed with and without genotyping-based treatment decisions: no genetic testing; 50% genetic testing; and 100% genetic testing. Sensitivity analysis was performed varying costs, adherence, and the percentage of patients treated according to genotyping results.

Results:

Medical and ADE costs varied by patient severity and genotyping rates. Without genotyping, drug and ADE costs ranged from $1,544,377 to $24,313,844. With genotyping-based treatment, total costs ranged from $1,780,922 to $18,868,032. Sensitivity analysis, varying costs, adherence, and genotyping rates suggested genotyping improves outcomes and is cost saving in patients with chronic pain.

Conclusion:

Genotyping-based treatment costs are offset by reduced medication utilization and adverse event costs. Genotyping should be considered for patients with chronic pain in clinical practice and within clinical trials.
Quantitative Evaluation of Diffusion and Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Differentiation Between Primary Central Nervous System Lymphoma and Glioblastoma
Authors: Lu Shanshan , Wang Siqi , Gao Qianqian , Zhou Minlin , Li Yang , Cao Peng , Hong Xunning , Shi Haibin
Published: August 2017

Objective

This study aimed to evaluate the utility of diffusion and permeability parameters derived from diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for differentiating primary central nervous system lymphoma (PCNSL) and glioblastoma multiforme (GBM) and to assess the correlation among these parameters.

Materials and Methods

Forty-two patients with GBM and 18 patients with PCNSL underwent conventional 3.0-T MRI, diffusion-weighted imaging, and DCE-MRI before surgery. Normalized apparent diffusion coefficient ratio (rADC) and DCE-MRI–derived parameters (the volume transfer constant [Ktrans], the flux rate constant, the volume fraction of extravascular extracellular space [Ve], and the fractional plasma volume) were measured within the entire enhancing tumor and compared between the 2 groups. The diagnostic ability of each parameter and their optimal combination for differentiating between PCNSL and GBM, and the correlation among these parameters, were statistically analyzed.

Results

The PCNSLs demonstrated significantly lower rADC (P = 0.000), higher Ktrans (P = 0.000), and higher Ve (P = 0.001) than GBMs. With the combination of rADC and Ktrans, the diagnostic ability for discriminating between PCNSL and GBM was significantly improved (area under the receiver operating characteristic curve [AUC] = 0.930) as compared with rADC (AUC = 0.858) and Ktrans (AUC = 0.852) alone (P < 0.001 for both). The rADC did not correlate with Ktrans or Ve derived from DCE-MRI.

Conclusions

Apparent diffusion coefficient ratio, Ktrans, and Ve are useful parameters for differentiating between PCNSL and GBM. The combination of rADC and Ktrans helps to improve the diagnostic accuracy. The rADC may not show correlation with Ktrans or Ve.
Liver Imaging Reporting and Data System: Discordance Between Computed Tomography and Gadoxetate-Enhanced Magnetic Resonance Imaging for Detection of Hepatocellular Carcinoma Major Features
Authors: Chernyak Victoria , Flusberg Milana , Law Amy , Kobi Mariya , Paroder Viktoriya , Rozenblit Alla M.
Published: August 2017

Purpose

The goal of this study was to compare agreement between computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of the major Liver Imaging Reporting and Data System (LI-RADS) features used in assessment of hepatocellular carcinoma: arterial phase hyperenhancement (APHE), portal venous phase washout (WO), capsule appearance (capsule), and largest diameter (diameter).

Methods

Patients with liver protocol CT and gadoxetate-enhanced MRI within 1 month of each other and at least 1 discrete untreated liver lesion were included. Two readers independently reviewed hepatic arterial phase and portal venous phase of each lesion on both CT and MRI, presented at random. The APHE, WO, capsule, and diameter were assessed for each lesion on CT and MRI. The LI-RADS category was assigned based on the recorded major features. Interobserver agreements between the readers for both imaging modalities and for each of the major features were assessed using κ statistics. Agreement between CT and MRI for each reader and for each feature was assessed using κ statistics. Agreement was interpreted based on κ as follows: 0.20 or less, slight agreement; 0.21 to 0.40, fair agreement; 0.41 to 0.60, moderate agreement; 0.61 to 0.80, substantial agreement; and 0.81 to 1.00, almost perfect agreement. Intraclass correlation coefficient was used to assess concordance of diameter measurements.

Results

There were 42 patients (mean age, 62.2 ± 7.0 years; 33 men [78.6%]) with 50 lesions. On CT, the interobserver agreement between the readers was almost perfect for APHE (κ = 0.85), WO (κ = 0.83), and capsule (κ = 0.86). On MRI, the interobserver agreement between the readers was almost perfect for APHE (κ = 0.86) and WO (κ = 0.83) and moderate for capsule (κ = 0.59). Intraclass correlation coefficient for diameter measurement was 0.99 for CT and 0.98 for MRI. For reader 1, the agreement between CT and MRI was fair for APHE (κ = 0.39) and capsule (κ = 0.26) and moderate for WO (κ = 0.49). For reader 2, the agreement between CT and MRI was moderate for APHE (κ = 0.43) and capsule (κ = 0.43) and fair (κ = 0.38) for WO. Agreement between readers for final LI-RADS category was substantial for CT (κ = 0.79) and moderate for MRI (κ = 0.60). Agreement for final LI-RADS categories between MRI and CT was fair for both reader 1 (κ = 0.33) and reader 2 (κ = 0.39).

Conclusions

Interobserver agreement for the major LI-RADS features varies from moderate to almost perfect, for both CT and MRI. However, the agreement between CT and MRI for each of the major LI-RADS features is poor, ranging from fair to moderate. This poor agreement contributes to substantial differences between final LI-RADS category assigned on CT versus MRI.
The Value of Quality-Assured Magnetic Resonance Imaging of the Breast for the Early Detection of Breast Cancer in Asymptomatic Women
Authors: Fischer Uwe , Luftner-Nagel Susanne , Baum Friedemann , Marten-Engelke Katharina , Wienbeck Susanne
Published: August 2017

Purpose

The aim of this study was to evaluate the exclusive performance of quality-assured high-resolution breast magnetic resonance imaging (MRI) for early detection of breast cancer in a population of asymptomatic women.

Materials and Methods

A total of 1189 MRI examinations performed in 789 asymptomatic women (mean age, 51.1 years) were evaluated. All examinations were performed using open bilateral surface coil, dedicated compression device, and high spatial resolution (matrix, 512 × 512). Digital mammography was available for all participants. Assessment included density types, artifact level, and Breast Imaging Reporting and Data System classification. Evaluation was performed by 2 readers. In addition, a computer-assisted diagnosis (CAD) system was used for image assessment.

Results

Breast MRI showed density types I and II in 87.6% and artifacts categories III and IV in 3.1%. Study included 32 carcinomas (8 ductal carcinoma in situ, 24 invasive tumors). Both readers detected 29 of 32 correctly (sensitivity 90.6%). The variation between the readers was low (reader 1: specificity, 94.4% and positive predictive value (PPV), 25.7%; reader 2: specificity, 97.6% and PPV, 34.1%). Sensitivity of CAD was 62.5% (specificity, 84.4%; PPV, 5.2%). Digital mammography detected 13 of 32 carcinomas (sensitivity, 56.3%; specificity, 98.4%; PPV, 32.1%).

Conclusions

The exclusive use of quality-assured breast MRI allows the early detection of breast cancer with a high sensitivity and specificity. The CAD analysis of MRI does not give additional information but shows results comparable with digital mammography.
Transient Segmental Enhancement of Pyogenic Liver Abscess: A Comparison Between Contrast-Enhanced Ultrasound and Computed Tomography
Authors: Sun Kun , Zhu Wei , Luo Yan , Li Yongzhong , Zhou Xiang
Published: August 2017

Objective

This study aimed to investigate the correlation between the transient segmental enhancement (TSE) of liver abscesses on contrast-enhanced ultrasound (CEUS) imaging and contrast-enhanced computed tomography (CT) scans.

Methods

In total, 42 abscesses in 38 patients were evaluated with real-time CEUS and contrast-enhanced CT imaging. The CT imaging and CEUS examinations were performed within one to 2 days of each other in all cases. The initial reports of the observations of TSE on CEUS scans were correlated later with the findings of TSE on contrast-enhanced CT images. Contrast-enhanced CT was used as the reference standard to evaluate the presence of TSE. Relationships between the 2 groups were analyzed using the χ2 test. P < 0.05 was considered to be statistically significant.

Results

In 16 patients, 16 typical TSE signs were shown by CEUS. Meanwhile, enhanced CT imaging showed 18 typical signs of TSE in 17 patients. We identified 38 patients with hepatic abscesses proven by needle aspiration (10 patients) or image-guided biopsy (28 patients). Ten patients had hepatobiliary cholelithiasis, 5 had diabetes mellitus type 2, and 2 had gastric cancer, whereas no evidence of underlying hepatobiliary or gastrointestinal diseases was found in the other 21 patients. Considering that enhanced CT is the reference standard for the diagnosis of hepatic abscesses, the sensitivity of CEUS in showing TSE was 89%, and the specificity was 100%. The χ2 test indicated that CEUS and enhanced CT were significantly correlated for detection of hepatic perfusion disorders (P < 0.05).

Conclusions

The appearance of TSE in liver abscess was reliably detected by CEUS, which correlated well with the enhanced CT images (P < 0.05).
Computed Tomography Image Quality Evaluation of a New Iterative Reconstruction Algorithm in the Abdomen (Adaptive Statistical Iterative Reconstruction–V) a Comparison With Model-Based Iterative Reconstruction, Adaptive Statistical Iterative Reconstruction, and Filtered Back Projection Reconstructions
Authors: Goodenberger Martin H. , Wagner-Bartak Nicolaus A. , Gupta Shiva , Liu Xinming , Yap Ramon Q. , Sun Jia , Tamm Eric P. , Jensen Corey T.
Published: August 2017

Objective

The purpose of this study was to compare abdominopelvic computed tomography images reconstructed with adaptive statistical iterative reconstruction–V (ASIR-V) with model-based iterative reconstruction (Veo 3.0), ASIR, and filtered back projection (FBP).

Methods and Materials

Abdominopelvic computed tomography scans for 36 patients (26 males and 10 females) were reconstructed using FBP, ASIR (80%), Veo 3.0, and ASIR-V (30%, 60%, 90%). Mean ± SD patient age was 32 ± 10 years with mean ± SD body mass index of 26.9 ± 4.4 kg/m2. Images were reviewed by 2 independent readers in a blinded, randomized fashion. Hounsfield unit, noise, and contrast-to-noise ratio (CNR) values were calculated for each reconstruction algorithm for further comparison. Phantom evaluation of low-contrast detectability (LCD) and high-contrast resolution was performed.

Results

Adaptive statistical iterative reconstruction–V 30%, ASIR-V 60%, and ASIR 80% were generally superior qualitatively compared with ASIR-V 90%, Veo 3.0, and FBP (P < 0.05). Adaptive statistical iterative reconstruction–V 90% showed superior LCD and had the highest CNR in the liver, aorta, and, pancreas, measuring 7.32 ± 3.22, 11.60 ± 4.25, and 4.60 ± 2.31, respectively, compared with the next best series of ASIR-V 60% with respective CNR values of 5.54 ± 2.39, 8.78 ± 3.15, and 3.49 ± 1.77 (P <0.0001). Veo 3.0 and ASIR 80% had the best and worst spatial resolution, respectively.

Conclusions

Adaptive statistical iterative reconstruction–V 30% and ASIR-V 60% provided the best combination of qualitative and quantitative performance. Adaptive statistical iterative reconstruction 80% was equivalent qualitatively, but demonstrated inferior spatial resolution and LCD.
Quality and Safety in Health Care, Part XXX
Authors: Harolds Jay A.
Published: August 2017

Initially, the transcatheter aortic valve replacement procedure was approved only for patients with aortic stenosis that was both severe and symptomatic who either also had too high a risk of aortic valve replacement surgery to have the surgery or who had a high risk for the surgery. Between the years 2012 and 2015, the death rate at 30 days declined from an initial rate of 7.5% to 4.6%. There has also been more use of the transfemoral approach over the years. In 2016, the transcatheter aortic valve replacement was approved for patients with aortic stenosis at intermediate risk of surgery.
Quality and Safety in Health Care, Part XXXI
Authors: Harolds Jay A.
Published: August 2017

The Transcatheter Valve Therapy Registry has been very helpful in providing data to better understand patient risk factors for transcatheter aortic valve replacement (TAVR). The outcome of TAVR depends on many patient indicators, some of which are given in this article, including the age, dependence on oxygen, classification of pulmonary disease, gender, and the speed of walking. Patient characteristics also help determine which approach will be used to place the device. There are models for the outcome of the TAVR procedure now and more being developed.
18F-FDG PET/CT of Brown Adipose Tissue Hyperactivation Associated With Pregnancy and Paraganglioma
Authors: Maffione Anna Margherita , Rampin Lucia , Chondrogiannis Sotirios , Marzola Maria Cristina , Colletti Patrick M. , Rubello Domenico
Published: August 2017

This 32-year-old woman presented with pregnancy-related arterial hypertension unresponsive to antihypertensive therapy. During cesarean delivery, a lobulated retroperitoneal mass was discovered. 18F-FDG PET/CT performed 18 days postpartum demonstrated the hyperactive retroperitoneal mass and extensive hyperactivated brown adipose tissue. The mass was surgically removed, revealing a para-aortic multicentric paraganglioma. After surgery, blood pressure normalized, and serum chromogranin A and urinary metanephrines normalized. Brown adipose tissue hypermetabolism disappeared on follow-up FDG PET. Her initial FDG PET demonstrated brown adipose tissue hyperactivation, which may have been caused by the combination of hormonal changes in pregnancy and the paraganglioma.
Improving Benchmarks for Global Surgery: Nationwide Enumeration of Operations Performed in Ghana
Authors: Gyedu Adam , Stewart Barclay , Gaskill Cameron , Boakye Godfred , Appiah-Denkyira Ebenezer , Donkor Peter , Maier Ronald , Quansah Robert , Mock Charles
Published: August 2017

Objective:

To evaluate the operation rate in Ghana and characterize it by types of procedures and hospital level.

Background:

The Lancet Commission on Global Surgery recommended an annual rate of 5000 operations/100,000 people as a benchmark at which low- and middle-income countries could achieve most of the population-wide benefits of surgery, but did not define procedure-type benchmarks.

Methods:

Data on operations performed from June 2014 to May 2015 were obtained from representative samples of 48 of 124 district-level (first-level) hospitals, 9 of 11 regional (referral) hospitals, and 3 of 5 tertiary hospitals, and scaled-up to nationwide estimates. Operations were categorized into those deemed as essential procedures (most cost-effective, highest population impact) by the World Bank's Disease Control Priorities Project versus other.

Results:

An estimated 232,776 [95% uncertainty interval (95% UI) 178,004 to 287,549] operations were performed nationally. The annual rate of operations was 869 of 100,000 (95% UI 664 to 1073). The rate fell well short of the benchmark. 77% of the estimated annual national surgical output was in the essential procedure category. Most operations (62%) were performed at district-level hospitals. Most district-level hospitals (54%) did not have fully trained surgeons, but nonetheless performed 36% of district-level hospital operations.

Conclusion:

The operation rate was short of the Lancet Commission benchmark, indicating large unmet need, although most operations were in the essential procedure category. Future global surgery benchmarking should consider both total numbers and priority levels. Most surgical care was delivered at district-level hospitals, many without fully trained surgeons. Benchmarking to improve surgical care needs to address both access deficiencies and hospital and provider level.
Surgery for Primary Hyperparathyroidism
Authors: Kuo Eric J. , Al-Alusi Mostafa A. , Du Lin , Shieh Albert , Livhits Masha J. , Leung Angela M. , Yeh Michael W.
Published: August 2017

Objective:

To determine the extent to which consensus guidelines for surgery in patients with primary hyperparathyroidism (PHPT) are followed within an academic health system.

Background:

Previous studies have shown that adherence to consensus guidelines in community practice is low.

Methods:

Adults with biochemically confirmed PHPT who received primary care within an academic health system were identified from 2005 to 2015. Multivariable logistic regression was used to analyze predictors of parathyroidectomy (PTx).

Results:

In 617 patients, the overall PTx rate was 30.8%. When individual consensus criteria were examined, age <50 (P<0.01), serum calcium >11.3 mg/dL (P < 0.01), and hypercalciuria (P = 0.02) were associated with PTx; while nephrolithiasis (P = 0.07) and osteoporosis (P = 0.34) did not affect the PTx rate. The PTx rate increased with the number of consensus criteria satisfied (1 criterion, 33%; 2 criteria, 45%; 3 or more criteria, 82%, P < 0.01). Independent predictors of PTx included male sex [odds ratio (OR) 1.7, 95% confidence interval (CI) 1.1–2.8], increasing serum parathyroid hormone (OR 1.1 per 10 pg/mL 95% CI 1.05–1.13), and endocrinologist evaluation (OR 1.6, 95% CI 1.1–2.4); while Black race (OR 0.4, 95% CI 0.2–0.8), lack of 24-hour urine calcium measurement (OR 0.5, 95% CI 0.3–0.8), Charlson Comorbidity Index ≥ 2 (OR 0.6, 95% CI 0.4–0.9), and age ≥80 years (OR 0.2, 95% CI 0.1–0.4) predicted against PTx.

Conclusion:

Within an academic health system, consensus guidelines do appear to influence the decision for surgery in patients with PHPT. However, the level of compliance is generally low, and similar to that observed in community practice.
Peritoneal cavity lavage reduces the presence of mitochondrial damage associated molecular patterns in open abdomen patients
Authors: Martinez-Quinones Patricia A. , McCarthy Cameron G. , Mentzer Caleb J. , Wenceslau Camilla F. , Holsten Steven B. , Webb R Clinton , O’Malley Keith
Published: August 2017

BACKGROUND

Mitochondrial damage-associated molecular patterns (mtDAMPs), such as mitochondrial DNA and N-formylated peptides, are endogenous molecules released from tissue after traumatic injury. mtDAMPs are potent activators of the innate immune system. They have similarities with bacteria, which allow mtDAMPs to interact with the same pattern recognition receptors and mediate the development of systemic inflammatory response syndrome (SIRS). Current recommendations for management of an open abdomen include returning to the operating room every 48 hours for peritoneal cavity lavage until definitive procedure. These patients are often critically ill and develop SIRS. We hypothesized that mitochondrial DAMPs are present in the peritoneal cavity fluid in this setting, and that they accumulate in the interval between washouts.

METHODS

We conducted a prospective pilot study of critically ill adult patients undergoing open abdomen management in the surgical and trauma intensive care units. Peritoneal fluid was collected daily from 10 open abdomen patients. Specimens were analyzed via quantitative polymerase chain reaction (qPCR) for mitochondrial DNA (mtDNA), via enzyme immunoassay for DNAse activity and via Western blot analysis for the ND6 subunit of the NADH: ubiquinone oxidoreductase, an N-formylated peptide.

RESULTS

We observed a reduction in the expression of ND6 the day after lavage of the peritoneal cavity, that was statistically different from the days with no lavage (% change in ND6 expression, postoperative from washout: −50 ± 11 vs. no washout day, 42 ± 9; p < 0.05). Contrary to expectation, the mtDNA levels remained relatively constant from sample to sample. We then hypothesized that DNAse present in the effluent may be degrading mtDNA.

CONCLUSION

These results indicate that the peritoneal cavity irrigation reduces the presence of mitochondrial DAMPs in the open abdomen. It is possible that increased frequency of peritoneal cavity lavage may lead to decreased systemic absorption of mtDAMPs, thereby reducing the risk of SIRS.

LEVEL OF EVIDENCE

Prospective study, Case Series, Level V.
Is extracorporeal cardiopulmonary resuscitation practical in severe chest trauma? A systematic review in single center of developing country
Authors: Huh Up , Song Seunghwan , Chung Sung Woon , Kim Sang-pil , Lee Chung Won , Ahn Hyo Young , Bae Miju , Kim Seon Hee
Published: August 2017

BACKGROUND

We report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma.

METHODS

From April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels after focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a Level I trauma center presenting with cardiac tamponade and tension hemothorax due to severe chest trauma. Patients were divided as follow: group A (n = 3), patients without cardiac arrest before entering the operating theatre; group B (n = 5), patients with cardiac arrest for whom ECPR was applied, and group C (n = 2), patients with cardiac arrest for whom ECPR was not applied.

RESULTS

All patients underwent exploratory thoracotomy or sternotomy. Injuries included cardiac chamber ruptures (n = 8), lesions in the internal mammary arteries (n = 1), and lesions of the bronchial arteries (n = 1). In group B, extracorporeal membrane oxygenation (ECMO) was initiated and circulation was restored promptly with adequate extracorporeal blood flow in all five cases. These patients were weaned off ECMO uneventfully after controlling the bleeding in the operating theatre. Mean ECMO time was 142 ± 48.2 minutes. Conversely, both patients in group C died, one due to low cardiac output on postoperative day 1, and the other due to multiple-organ failure on postoperative day 7.

CONCLUSION

ECPR may be an option to rescue and stabilize patients with cardiac arrest due to severe chest trauma.

LEVELS OF EVIDENCE

Therapeutic/Care Management, Level V.
Developing a 3- to 6-state EEG-based brain-computer interface for a robotic manipulator control
Authors: Mishchenko Yuriy , Kaya Murat , Ozbay Erkan , Yanar Hilmi
Published: August 2017

Recent developments in BCI techniques have demonstrated high-performance control of robotic prosthetic systems primarily via invasive methods. In this work we develop an electroencephalography (EEG) based noninvasive BCI system that can be used for a similar, albeit lower-speed robotic control, and a signal processing system for detecting user’s mental intent from EEG data based on up to 6-state motor-imagery BCI communication paradigm. We examine the performance of that system on experimental data collected from 12 healthy participants and analyzed offline. We show that our EEG BCI system can correctly identify different motor imageries in EEG data with high accuracy: 3 out of 12 participants achieved accuracy of 6-state communication in 80-90% range, while 2 participants could not achieve a satisfactory accuracy. We further implement an online BCI system for control of a virtual 3 degree-of-freedom prosthetic manipulator and test it with our 3 best participants. The participants’ ability to control the BCI is quantified by using the percentage of successfully completed BCI tasks, the time required to complete a task, and the error rate. 2 participants were able to successfully complete 100% of the test tasks, demonstrating on average the error rate of 80% and requiring 5-10 seconds to execute a manipulator move. 1 participant failed to demonstrate a satisfactory performance in online trials. Our results lay a foundation for further development of EEG BCI-based robotic assistive systems and demonstrate that EEG-based BCI may be feasible for robotic control by paralyzed and immobilized individuals.
qDSB-Seq: quantitative DNA double-strand break sequencing
Authors: Zhu Yingjie , Biernacka Anna , Pardo Benjamin , Dojer Norbert , Forey Romain , Skrzypczak Magdalena , Fongang Bernard , Nde Jules , Yousefi Raziyeh , Pasero Philippe , Ginalski Krzysztof , Rowicka Maga
Published: August 2017

Sequencing-based methods for mapping DNA double-strand breaks (DSBs) allow measurement only of relative frequencies of DSBs between loci, which limits our understanding of the physiological relevance of detected DSBs. We propose quantitative DSB sequencing (qDSB-Seq), a method providing both DSB frequencies per cell and their precise genomic coordinates. We induced spike-in DSBs by a site-specific endonuclease and used them to quantify labeled DSBs (e.g. using i-BLESS). Utilizing qDSB-Seq, we determined numbers of DSBs induced by a radiomimetic drug and various forms of replication stress, and revealed several orders of magnitude differences in DSB frequencies. We also measured for the first time Top1-dependent absolute DSB frequencies at replication fork barriers. qDSB-Seq is compatible with various DSB labeling methods in different organisms and allows accurate comparisons of absolute DSB frequencies across samples.
X10 Expansion Microscopy Enables 25 nm Resolution on Conventional Microscopes
Authors: Truckenbrodt Sven , Maidorn Manuel , Crzan Dagmar , Wildhagen Hanna , Kabatas Selda , Rizzoli Silvio O.
Published: August 2017

Expansion microscopy is a recently introduced imaging technique that achieves super-resolution through physically expanding the specimen by ~4x, after embedding into a swellable gel. The resolution attained is, correspondingly, approximately 4-fold better than the diffraction limit, or ~70 nm. This is a major improvement over conventional microscopy, but still lags behind modern STED or STORM setups, whose resolution can reach 20-30 nm. We addressed this issue here by introducing an improved gel recipe that enables an expansion factor of ~10x in each dimension, which corresponds to an expansion of the sample volume by more than 1000-fold. Our protocol, which we termed X10 microscopy, achieves a resolution of 25-30 nm on conventional epifluorescence microscopes. X10 provides multi-color images similar or even superior to those produced with more challenging methods, such as STED, STORM and iterative expansion microscopy (iExM), in both cell cultures and tissues.
Identifying factors that may improve mechanistic forecasting models for influenza
Authors: Riley Pete , Ben-Nun Michal , Turtle James A. , Linker Jon , Bacon David P. , Riley Steven
Published: August 2017

Influenza causes substantial morbidity and mortality and places strain on healthcare systems, some of which could be mitigated by accurate forecasting. Specific humidity and school vacations have both been shown independently to affect the transmission dynamics of influenza at large spatial scales. Here, we compare the ability of five compartmental transmission models, which include these two processes, to explain influenza-like-illness (ILI) incidence data for five United States counties for which school vacations and specific humidity data were available over a span of four seasons. We used the models in two different ways. First we fitted all available data at the same time and assessed model performance using standard measures of parsimony and goodness-of-fit. Then we conducted a retrospective forecasting study in which we attempted to predict incidence beyond a given week by fitting to data available up to that week. In general, when fitting the data using the whole season, we found that either specific humidity, school closures, or a combined model incorporating both effects captured the variability in incidence better than a fully constrained SIR-like model. Moreover, where these factors play a role, the timing of the variations suggests a causal relationship. When school vacations and specific humidity were important, the model-estimated parameters were broadly consistent. Retrospective forecasting simulations were consistent with the explanatory use of the models, with both specific humidity and school vacations giving more accurate forecasts than a simple SIR-like model in some populations and for some seasons. Our results suggest that influenza forecast models should test for the importance of different factors such as school vacations and specific humidity on a population-by-population and year-by-year basis.
Chemosensory proteins in the CSP4 clade evolved as plant immunity suppressors before two suborders of plant-feeding hemipteran insects diverged
Authors: Drurey Claire , Mathers Thomas C. , Prince David C. , Wilson Christine , Caceres-Moreno Carlos , Mugford Sam T. , Hogenhout Saskia A.
Published: August 2017

Chemosensory proteins (CSPs) are small globular proteins with hydrophobic binding pockets that have a role in detection of chemicals, regulation of development and growth and host seeking behaviour and feeding of arthropods. Here, we show that a CSP has evolved to modulate plant immune responses. Firstly, we found that the green peach aphidMyzus persicaeCSP Mp10, which is delivered into the cytoplasm of plant cells, suppresses the reactive oxygen species (ROS) bursts to both aphid and bacterial elicitors inArabidopsis thalianaandNicotiana benthamiana. Aphid RNA interference studies demonstrated that Mp10 modulates the first layer of the plant defence response, specifically the BAK1 pathway. We identified Mp10 homologs in diverse plant-sucking insect species, including aphids, whiteflies, psyllids and leafhoppers, but not in other insect species, including blood-feeding hemipteran insects. We found that Mp10 homologs from other splant-sucking insect species are also capable of suppressing plant ROS. Together, these data and phylogenetic analyses provides evidence that an ancestral Mp10-like sequence acquired plant ROS suppression activity before the divergence of plant-sucking insect species over 250 million years ago.

Significance

Aphids, whiteflies, psyllids, leafhoppers and planthoppers are plant-sucking insects of the order Hemiptera that cause dramatic crop losses via direct feeding damage and vectoring of plant pathogens. Chemosensory proteins (CSPs) regulate behavioural and developmental processes in arthropods. Here we show that the CSP Mp10 of the green peach aphidMyzus persicaeis an effector that suppresses plant reactive oxygen species (ROS) bursts and the first layer of plant defence responses. Surprisingly, Mp10 homologs are present in diverse plant-feeding hemipteran species, but not blood-feeding ones. An ancestral Mp10-like sequence most likely acquired ROS suppression activity before the divergence of plant-sucking insect species 250 million years ago.
On the relative role of different age groups during epidemics associated with the respiratory syncytial virus
Authors: Goldstein E. , Nguyen H. H. , Liu P. , Viboud C. , Steiner C.A. , Worby C. J. , Lipsitch M.
Published: August 2017

Background

While RSV circulation results in high burden of hospitalization, particularly among infants, young children and the elderly, little is known about the role of different age groups in propagating annual RSV epidemics in the community.

Methods

During a communicable disease outbreak, some subpopulations may play a disproportionate role during the outbreak's ascent due to increased susceptibility and/or contact rates. Such subpopulations can be identified by considering the proportion that cases in a subpopulation represent among all cases in the population occurring before (Bp) and after the epidemic peak (Ap) to calculate the subpopulation's relative risk, RR=Bp/Ap. We estimated RR for several age groups using data on RSV hospitalizations in the US between 2001-2012 from the Healthcare Cost and Utilization Project (HCUP).

Results

Children aged 3-4y and 5-6y each had the highest RR estimate for 5/11 seasons in the data, with RSV hospitalization rates in infants being generally higher during seasons when children aged 5-6y had the highest RR estimates. Children aged 2y had the highest RR estimate during one season. RR estimates in infants and individuals aged 11y and older were mostly lower than in children aged 1-10y.

Conclusions

The RR estimates suggest that preschool and young school-age children have the leading relative roles during RSV epidemics. We hope that those results will aid in the design of RSV vaccination policies.
Predictors of intestinal inflammation in asymptomatic first-degree relatives of patients with Crohn’s disease
Authors: Taylor Kirstin M. , Hanscombe Ken B. , Iniesta Raquel , Traylor Matthew , Taylor Nicola S. , Powell Nicholas , Irving Peter M. , Anderson Simon H. , Prescott Natalie J. , Mathew Christopher G. , Lewis Cathryn M. , Sanderson Jeremy D.
Published: August 2017

Objective

Relatives of individuals with Crohn’s disease (CD) carry an increased number of CD-associated genetic variants and are at increased risk of developing the disease. Multiple environmental and genetic factors contribute to this increased risk. We aimed to estimate the utility of genotype, smoking, family history, and a panel of biomarkers to predict risk in asymptomatic first-degree relatives (FDRs) of CD patients.

Design

We calculated a combined genotype (72 CD-associated genetic markers) and smoking relative risk score in 454 FDRs, and performed capsule endoscopy and collected 22 biomarkers in individuals from the highest and lowest risk quartiles. We then predicted small intestinal inflammation using genetic risk score, smoking status, number of relatives with CD, capsule transit time, and the panel of biomarkers in 124 individuals with complete data. Our principal analysis was to calculate the predictive utility from two machine learning classifiers: an elastic net and a random forest.

Results

Both classifiers successfully predicted FDRs with intestinal inflammation: elastic net (AUC=0.80, 95% CI: 0.62-0.98), random forest (AUC=0.87, 95% CI: 0.75-1.00). The elastic net selected a 3-predictor solution: CD family history (OR=1.31), genetic risk score (OR=1.14), and faecal calprotectin (OR=1.04). The same 3 variables were among the top 5 most important predictors as ranked by the random forest.

Conclusion

A readily collectable panel of genetic risk variants, added to family history and faecal calprotectin, predicts those at greatest risk for developing CD with a good degree of accuracy.
A simple genetic basis of adaptation to a novel thermal environment results in complex metabolic rewiring in Drosophila
Authors: Mallard François , Nolte Viola , Tobler Ray , Kapun Martin , Schlötterer Christian
Published: August 2017

Population genetic theory predicts that rapid adaptation is largely driven by complex traits encoded by many loci of small effect. Because large effect loci are quickly fixed in natural populations, they should not contribute much to rapid adaptation. To investigate the genetic architecture of thermal adaptation - a highly complex trait - we performed experimental evolution on a naturalDrosophila simulanspopulation. Transcriptome and respiration measurements revealed extensive metabolic rewiring after only ∼60 generations in a hot environment. Analysis of genome-wide polymorphisms identified two interacting selection targets,SestrinandSNF4Aγ, pointing to AMPK, a central metabolic switch, as a key factor for thermal adaptation. Our results demonstrate that large-effect loci segregating at intermediate allele frequencies can allow natural populations to rapidly respond to selection. BecauseSNF4Aγalso exhibits clinal variation in variousDrosophilaspecies, we suggest that this large effect polymorphism is maintained by temporal and spatial temperature variation in natural environments.