bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and Safety of a New Resilient Hyaluronic Acid Filler in the Correction of Moderate-to-Severe Dynamic Perioral Rhytides: A 52-Week Prospective, Multicenter, Controlled, Randomized, Evaluator-Blinded Study
Authors: Sundaram Hema , Shamban Ava , Schlessinger Joel , Kaufman-Janette Joely , Joseph John H. , Lupin Mark , Draelos Zoe , Carey Wayne , Smith Stacy , Eaton Laura
Published: October 2021

BACKGROUND

The perioral region is highly mobile and subject to multifactorial changes during aging. Resilient Hyaluronic Acid Redensity (RHAR), an RHA filler, was developed with the aim of optimizing outcomes in dynamic facial areas.

OBJECTIVE

This randomized, blinded, multicenter clinical study aimed to demonstrate superiority of RHAR over no-treatment control for correction of moderate-to-severe dynamic perioral rhytides.

MATERIALS AND METHODS

Blinded live evaluator assessments of efficacy included improvement in perioral rhytides severity using a proprietary scale (Perioral Rhytids Severity Rating Scale [PR-SRS]) and the Global Aesthetic Improvement Scale. Subjects self-assessed their results with FACE-Q, a validated patient-reported outcome measure, and satisfaction scales. Safety was monitored throughout the study based on common treatment responses (CTRs) and adverse events (AEs).

RESULTS

The primary efficacy end point was achieved, with the treatment group showing statistically significant superiority over the control group at Week 8 (80.7% vs 7.8% responder rate by PR-SRS, p < .0001). Most patients (66%) were still responders at Week 52 (study completion). Most AEs were CTRs after perioral injection of a dermal filler, and none was a clinically significant treatment-related AE.

CONCLUSION

Resilient Hyaluronic Acid Redensity is effective and safe for the correction of dynamic perioral rhytides in all Fitzpatrick phototypes, with marked durability.
Tightening and Reduction of Unwanted Submental Fat Using Triple-Layer High-Intensity Focused Ultrasound: Clinical and 3-Dimensional Imaging Analysis
Authors: Kwon Hyuck Hoon , Yang Steven Hoseong , Choi Mira , Jung Jae Yoon , Park Gyeong-Hun
Published: October 2021

BACKGROUND

Unwanted submental fat (SMF) is aesthetically unappealing, but methods of reduction are either invasive or lack evidence of their use.

OBJECTIVE

The authors sought to evaluate the safety and efficacy of a novel triple-layer high-intensity focused ultrasound (HIFU) regimen for SMF reduction.

METHODS

Forty Korean subjects with moderate/severe SMF were evaluated after receiving a session of triple-layer HIFU treatments (using 3.0-, 4.5-, and 6.0-mm focusing transducers). The objective evaluation based on the 5-point Clinician-Reported Submental Fat Rating Scale (CR-SMFRS) and patients' satisfaction based on the 7-point Subject Self-Rating Scale (SSRS) were determined 8 weeks after treatment. Three-dimensional image analysis was also performed.

RESULTS

At the follow-up visit, the proportion of treatment responders defined as subjects with ≥1-point improvement in CR-SMFRS was 62.5%, and the proportion of patients satisfied with appearance of their face and chin (score ≥4 on the SSRS) was 67.5% of the total patients. The results of 3-dimensional analysis were consistent with clinical observations. Only mild and transient side effects were observed for some patients with no serious adverse effects.

CONCLUSION

The triple-layer HIFU regimen including the novel 6.0-mm transducer has benefits for tightening and rejuvenation of the area with unwanted SMF, showing reasonable safety profiles.
Skin Cancer in the Incarcerated Population—A Single-Center Study
Authors: Swigert Anna , Majidian Mandy , Chen Lauren , Vick Garrett , Murina Andrea
Published: October 2021

BACKGROUND

The incarcerated population may have variable access to specialty care that may affect the detection and diagnosis of skin cancer.

OBJECTIVE

The purpose of the study was to characterize skin cancers in the incarcerated population and determine time to treatment initiation (TTI) after biopsy.

METHODS

A retrospective cohort study was performed using data from a single-center referral hospital of incarcerated patients with biopsy-proven basal cell carcinoma (BCC), squamous cell carcinoma (SCC), or melanoma between January 2009 and December 2019. The main outcome measured was TTI after biopsy.

RESULTS

One hundred thirteen patients, majority men (96.5%) and of Caucasian race (89.4%), were diagnosed and/or treated for 191 skin cancers. Of these 191 skin cancers, 118 were BCC (61.8%), 58 were SCC (30.4%), and 15 were melanomas (7.9%). The average TTI after biopsy for melanoma was 57 days (range: 21–136, median: 51, 95% confidence interval: 39.89–74.10) with an average Breslow depth of 1.57 mm.

CONCLUSION

The average TTI of melanoma in the incarcerated population in this study was greater than 30 days, which may have increased mortality risk.
Morbidity and Mortality of Melanoma on the Trunk and Extremities Treated With Mohs Surgery Versus Wide Excision: A Systematic Review
Authors: Bednar E. Dimitra , Zon Michael , Abu-Hilal Mohannad
Published: October 2021

BACKGROUND

Recommendations for the approved use of Mohs surgery for cutaneous melanoma on the trunk and extremities remain uncertain.

OBJECTIVE

To compare survival and recurrence between patients treated with Mohs surgery versus wide excision for melanoma on the trunk and extremities.

METHODS

The databases Medline, Embase, Web of Science, CENTRAL, and EMCare were searched from inception on January 11, 2021. Contemporary comparisons were included exclusively. Meta-analysis was conducted using generic inverse variance and a fixed effects model.

RESULTS

Four studies were eligible for inclusion. The study population (n = 279,556) was 52.1% men and 97.2% White. There were no observed differences in 5-year overall survival (hazard ratio 0.98, 95% confidence interval 0.90–1.07, I2 = 0%), disease-free survival (HR 0.89, 95% CI 0.12–6.47, I2 = 0), or local recurrence among patients treated with Mohs surgery relative to wide excision. Quality of the evidence was very low.

CONCLUSION

This systematic review found survival and local recurrence were comparable among patients treated with Mohs surgery or wide excision for melanoma on the trunk and extremities. Future prospective contemporary studies with more diverse representation that report surgical complications and costs may facilitate more definitive recommendations.
Every child with congenital heart disease should be exercising
Authors: Hansen Katherine , Tierney Seda
Published: October 2021

Purpose of review

Historically, children with congenital heart disease have been restricted from exercise, contributing to a sedentary lifestyle as well as increased cardiovascular risk factors. Given the large benefits and small risks of exercise in this population, guidelines have recently shifted towards exercise promotion. However, these recommendations have yet not gained traction and children with congenital heart disease continue to live sedentary lives. The purpose of this review is to summarize the current literature on exercise and exercise promotion in this population.

Recent findings

New literature reinforces the importance of recommending exercise and improving exercise capacity both in congenital heart disease in general and for specific lesions. Exercise recommendations should be individualized based on functional parameters using a structured methodology to approach the evaluation, risk classification, and prescriptions of exercise and physical activity.

Regular exercise is essential for children with congenital heart disease and providers must take an active role in providing exercise recommendations for their patients. Exercise promotion remains a challenge, necessitating novel approaches to promote exercise. Further studies are needed to improve the risk stratification of patients with congenital heart disease, assess the long-term outcomes of specific exercise interventions, and inform individualized recommendations to encourage children with congenital heart disease to safely engage in exercise and establish healthy lifelong habits that will decrease their cardiovascular risk.
CORRELATION BETWEEN FOCAL CHOROIDAL EXCAVATION AND UNDERLYING RETINOCHOROIDAL DISEASE
Authors: Gan Yuhong , Ji Yuying , Zuo Chengguo , Su Yongyue , Liao Nanying , Zhang Xiongze , Zeng Yunkao , Wen Feng
Published: October 2021

Purpose:

To evaluate focal choroidal excavation (FCE) in eyes with various diseases using multimodal imaging modalities and to investigate the correlation of FCE and underlying chorioretinal diseases.

Methods:

This retrospective observational study included 62 eyes from 56 patients who were identified by optical coherence tomography as having FCE. All included patients underwent comprehensive clinical examinations and multimodal imaging to identify and detect the characteristics of FCE and its correlation with underlying chorioretinal diseases.

Results:

All included patients were of Chinese descent, and the median age at diagnosis was 43 years (range: 15–66). Seventy-three FCEs appeared in these included eyes. Most FCEs were formed at sites with anatomical changes caused by various chorioretinal diseases. Choroidal osteoma, punctate inner choroidopathy, and central serous chorioretinopathy were the most common etiologies of FCE. During follow-up, 14 eyes (22.58%) exhibited a pattern change and three eyes (4.84%) developed new-onset choroid neovascularization.

Conclusion:

Focal choroidal excavation is a common sign found in a variety of chorioretinal diseases. Processes that involve impairment or tissue loss of the outer retina and inner choroid and disrupt the balance of intraocular pressure and choroidal pressure because of mechanical disturbance may play a role in FCE formation.
EVALUATION OF MACULAR FLOW VOIDS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AS POTENTIAL BIOMARKERS FOR SILENT CEREBRAL INFARCTION IN SICKLE CELL DISEASE
Authors: Thangamathesvaran Loka , Ong Sally S. , Wang Jiangxia , Lance Eboni , Tekes Aylin , Scott Adrienne W.
Published: October 2021

Purpose:

To determine the relationship between macular microvascular abnormalities on optical coherence tomography angiography and silent cerebral infarctions (SCIs) on cerebral magnetic resonance imaging in sickle cell disease.

Methods:

Patients (age <18 years old) from our previous pediatric sickle cell disease study cohort who had prior optical coherence tomography angiography and brain magnetic resonance imaging were identified. Brain magnetic resonance imaging images were compared with macular optical coherence tomography angiography scans to identify macular vascular density differences between patients with SCI and without SCI.

Results:

Sixty-eight eyes from 34 patients who underwent optical coherence tomography angiography were evaluated, of whom 28 eyes from 14 patients met the inclusion criteria for this study. Eight patients (57%) with SCI and 6 patients (43%) without SCI were identified. The mean age (17 years in SCI and 16.3 years in non-SCI) was comparable between groups. There was no statistically significant difference in systemic complications. Deep capillary plexus vessel density was lower in the temporal quadrant in patients with SCI (49.3% vs. 53.7%, P = 0.014).

Conclusion:

Patients with SCI were found to have lower vessel density in the deep capillary plexus compared with those without SCI. This finding suggests that deep capillary plexus vessel density may have utility as an imaging biomarker to predict the presence of SCI.
Corneal Structural Changes in Congenital Glaucoma
Authors: Drechsler Jennifer , Lee Adrianna , Maripudi Snehaa , Kueny Laura , Levin Moran R. , Saeedi Osamah J. , Bazemore Marlet , Karwoski Bethany , Birdsong Richard , Martinez Camilo , Jaafar Mohamad S. , Yousaf Sairah , Ahmed Zubair M. , Madigan William P. , Alexander Janet Leath
Published: October 2021

Objective:

To identify corneal structure differences on quantitative high-frequency ultrasound biomicroscopy (UBM) among subjects with congenital glaucoma compared with controls.

Methods:

This prospective case–control study evaluated 180 UBM images from 44 eyes of 30 subjects (18 control and 12 glaucoma, mean age 5.2±8.0 years, range 0.2–25.8 years) enrolled in the Pediatric Anterior Segment Imaging and Innovation Study (PASIIS). ImageJ was used to quantify a comprehensive set of corneal structures according to 21 quantitative parameters. Statistical analysis compared corneal measurements in glaucoma subtypes and age-matched controls with significance testing and mixed effects models.

Results:

Significant differences between congenital glaucoma cases and controls were identified in 16 of 21 measured parameters including angle-to-angle, central and peripheral corneal thicknesses, scleral integrated pixel density, anterior corneal radius of curvature, and posterior corneal radius of curvature. Eight parameters differed significantly between primary congenital glaucoma and glaucoma following congenital cataract surgery.

Conclusion:

Multiple measurable corneal structural differences exist between congenital glaucoma and control eyes, and between primary and secondary congenital glaucoma, including but not limited to corneal width and thickness. The structural differences can be quantified from UBM image analysis. Further studies are needed to determine whether corneal features associated with glaucoma can be used to diagnose or monitor progression of congenital glaucoma.
The Role of Physical Therapy Following CAR T-Cell Therapy: A Case Report
Authors: Firestein Helaine
Published: October 2021

Background:

Diffuse large B-cell lymphoma (DLBCL) affects 7 out of 100 000 people in the United States every year. Chimeric antigen receptor (CAR) T-cell therapy is approved by the Food and Drug Administration to treat patients with relapsed/refractory DLBCL who have not responded to 2 prior lines of therapy. CAR T-cell therapy can lead to debilitating side effects necessitating rehabilitation intervention.

Case Description:

This case report details a 38-year-old woman with refractory DLBCL who received CAR T-cell therapy. The patient experienced grade 2 cytokine release syndrome and grade 4 immune effector cell-associated neurotoxicity syndrome, which resulted in, among other symptoms, lower extremity paraplegia. Upon medical stabilization, the patient was referred to physical therapy.

Outcomes:

The patient participated in acute care rehabilitation for 8 weeks and progressed significantly toward her prior level of function before being discharged to an inpatient rehabilitation facility. Upon discharge, the patient was able to ambulate with a rolling walker, a knee orthosis, and supervision for safety and had initiated stair training.

Discussion/Conclusion:

Physical therapists need to understand and recognize the range of side effects that can occur following CAR T-cell therapy. As more patients receive CAR T-cell therapy to treat malignancies, acute care oncology units will undoubtedly be challenged with patients exhibiting severe side effects. Physical therapists are well trained to address physical impairments resulting from CAR T-cell therapy's side effects and will play a vital role in these patients' interdisciplinary care.
Value of neutrophil/lymphocyte ratio, N-terminal pro-B-type natriuretic peptide, urea, and creatinine for the prediction of acute kidney injury in acute heart failure: a retrospective observational study
Authors: Huang Lisi , He Jian , Lin Xianghua , Luo Ling , Zhong Rihui , Xie Xiaoying , Peng Xiaodan , Duan Chaohui
Published: October 2021

Objective:

Early identification of acute kidney injury (AKI) is essential to improve the prognosis of patients with acute heart failure (AHF). We aimed to determine the utility of neutrophil/lymphocyte ratio (NLR), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), urea, and creatinine (Cr), as well as combinations of these, for the prediction of AKI in patients with AHF.

Methods:

A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study. Their NLR, NT-proBNP, urea, and Cr concentrations were measured on admission. AKI was defined using the Acute Kidney Injury Network criteria. Receiver operating characteristic (ROC) curves, the areas under the curves (AUCs), sensitivity, and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI. This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (approval No. SYSEC-KY-KS-2021-126) on June 22, 2021.

Results:

Forty-six (30.1%) participants developed AKI during hospitalization. The NLR and NT-proBNP of the participants with AKI were higher than those without (NLR: median 7.886 vs 4.717,
P
< 0.0001; NT-proBNP, median 6774 vs 2786pg/mL,
P
< 0.0001). ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI (NLR: cut-off 5.681, AUC 0.716, sensitivity 58.9%, specificity 80.4%; NT-proBNP: cut-off 5320pg/mL, AUC 0.700, sensitivity 72.9%, specificity 65.2%). Moreover, a combination of NLR, NT-proBNP, urea, and Cr yielded an AUC of 0.815, sensitivity 80.4%, and specificity of 74.8%. In addition, the AUCs for the prediction of AKI in the participants with New York Heart Association (NYHA) classes II, III, and IV were 0.936, 0.860, and 0.772, respectively, using this combination.

Conclusion:

A combination of NLR, NT-proBNP, urea, and Cr, measured at admission, may represent a promising tool for the prediction of AKI in patients with AHF. This method performs best for AKI risk assessment in patients with NYHA II, followed by those with NYHA III or IV.
Increased Quality of Life Among Newly Diagnosed Patients With Heart Failure With Reduced Ejection Fraction in the Months After Initiation of Guideline-Directed Medical Therapy and Wearable Cardioverter Defibrillator Prescription
Authors: Burch Ashley E. , Colley Byron J. , Döring Michael , Gummadi Siva , Perings Christian , Robertson Michael , Sanchez Robert , Shroff Girish , Veltmann Christian , Sears Samuel F.
Published: October 2021

Background

The patient experience of heart failure involves a multi-impact symptom response with functional limitations, psychological changes, and significant treatment burden.

Objective

The aim of this study was to examine the change in patient-reported outcomes in newly diagnosed patients with heart failure and reduced ejection fraction (HFrEF) prescribed a wearable cardioverter defibrillator.

Methods

Adults hospitalized for new-onset heart failure, due to ischemic or nonischemic cardiomyopathy, and prescribed a wearable cardioverter defibrillator within 10 days post discharge were approached for inclusion. Participants completed the Kansas City Cardiomyopathy Questionnaire at 3 time points: baseline, day 90, and day 180.

Results

A total of 210 patients (26% female) were included. All Kansas City Cardiomyopathy Questionnaire subscales (physical limitation, symptom frequency, quality of life, and social limitation) showed improvement from baseline to day 90 (all Ps < .001). Only quality of life continued to improve from day 90 to day 180 (P < .001). By day 90, nearly 70% of patients showed an improvement in quality of life (67.9%, n = 91), and by day 180, more than 80% (82.8%, n = 111) reported a net improvement. Five patients (3.7%) reported a net decrease, and 18 patients (13.4%) had no net change in quality of life during the 180-day period.

Conclusion

Patient-reported quality of life improved significantly among patients newly diagnosed with HFrEF and prescribed a wearable cardioverter defibrillator. These results suggest that pursuing guideline-directed medical therapy for HFrEF, while being protected by the wearable cardioverter defibrillator, is likely to provide symptom relief and improve quality of life.
The Association Between Dimethylacetamide Exposure and Liver Toxicity
Authors: Antoniou Evangelia E. , Gelbke Heinz-Peter , Ballach Jochen , Zeegers Maurice P. , Schrage Arnhild
Published: October 2021

Objective:

This study examines the association between 8-h time weighted N, N-dimethylacetamide (DMAc) air exposure and potential hepatocellular injury in a retrospective study among fibre-production workers in four European factories.

Methods and Results:

Twenty-nine (1.5%) of 1844 alanine aminotransferase (ALT) observations had liver values two times above normal; 0.2% three times above normal and 0.05% five times above normal. Two (0.1%) observations were indicative of hepatocellular injury. Logistic regression analyses showed an odds ratio for elevated ALT of 0.88 per 1 ppm (P trend = 0.39). Linear random effects regression analyses showed a decrease of one international unit (IU/L) ALT per 1 ppm increase of DMAc exposure (P = 0.002).

Conclusions:

This study found no association between DMAc exposure and hepatoxicity amongst European workers. The prevalence of elevated liver values was lower compared to the general population without occupational exposure.
Burden and Protection
Authors: de Carvalho Thalyta Gleyane Silva , Araújo Larissa Fortunato , Lima Eduardo de Paula , de Andrade Alan Lúcio Alencar , Bastos Maria Luiza Almeida , Lacerda Eliana Mattos , Ferreira Marcelo José Monteiro
Published: October 2021

Objective:

To investigate the association between occupational stressors and Burnout dimensions among Brazilian firefighters.

Method:

A cross-sectional study about firefighters (n = 237) was developed in Fortaleza, Northeast of Brazil. Logistic regression analysis was applied to investigate the association between high strain (high demand and low job control), low social support, high operational exposure, and Burnout dimensions (emotional exhaustion, depersonalization, and low personal accomplishment).

Results:

High strain was associated to emotional exhaustion (odds ratio [OR] = 11.65; 95% confidence interval [CI]: 3.92 to 34.60) and depersonalization (OR = 5.43; 95% CI: 2.03 to 14.58). Low social support was associated to emotional exhaustion (OR = 2.86; 95% CI: 1.24 to 6.60) and low personal accomplishment (OR = 2.59; 95% CI: 1.36 to 4.93). High operational exposure did not increase the odds of emotional exhaustion and depersonalization and decreased the odds of low personal accomplishment (OR = 0.31; 95% CI: 0.10 to 0.94).

Conclusion:

The study highlights the heterogeneous effects that operational and organisational stressors have on each dimension of Burnout.
Usual Interstitial Pneumonia Associated With Crystalline Silica Exposure in Pneumoconiosis
Authors: Kang WonYang , Kim Daeho , Kim Mi-Yeon , Kim Boowook , Shin Jungah , Kim Eun Young , Choi Sungwon , Cha Wonseok , Choi Byung-Soon
Published: October 2021

Objective:

We aimed to identify a relation between the level of silica exposure and the associated increase in the risk of radiologic usual interstitial pneumonia (UIP) pattern.

Methods:

We selected data of 796 individuals with pneumoconiosis who had undergone a chest computed tomography (CT). We estimated the silica exposure by comparing their occupational history with the data silica dust exposure.

Results:

Individuals employed as stonemasons demonstrated a 2.30-fold increase in the risk of developing UIP than coal mine workers (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.04 to 5.07). The high silica exposure group was associated with a 2.23-fold increase in the risk of developing UIP than the low silica exposure group (OR, 2.23; 95% CI, 1.07 to 4.69).

Conclusions:

This study suggests that silica exposure is associated with an increased risk of developing UIP pattern, highlighting a dose–response relationship.
Surgical Factors Influencing Wound Complication After Cochlear Implantation: A Systematic Review and Meta-Analysis
Authors: Laureano Jack , Ekman Brady , Balasuriya Beverly , Mahairas Anthony , Bush Matthew L.
Published: October 2021

Objective:

To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI).

Data Sources:

PubMed, Web of Science, and Cochrane databases.

Study Selection:

Eligible studies included peer-reviewed research in English evaluating wound complications (wound infection, skin flap breakdown/dehiscence, seroma/hematoma) following CI. Studies with paired samples were included in the meta-analysis.

Data Extraction:

Surgical factors (techniques and perioperative management) in CI and reported wound complications were examined. Level of evidence was assessed using the Oxford Centre for Evidence-based Medicine guidelines and bias was assessed using the NIH Quality Assessment Tool.

Data Synthesis:

Twenty-six studies representing 10,214 cochlear implantations were included. The overall wound complications rate was 3.1% (range 0.03–13.9%). Eleven studies contained paired data and were used for meta-analysis regarding three different surgical factors: incision length, implant placement method, and antibiotic usage. Longer incision lengths (≥7 cm) demonstrated a higher risk of wound complications (risk ratio 2.27, p = 0.02, CI 1.16–4.43). Different implant placement techniques (suture fixation versus periosteal pocket) (p = 0.08, CI 0.92–3.69) and postoperative antibiotic regimens (postoperative use versus none) (p = 0.68, CI = 0.28–7.18) were not associated with differences in wound complication rates following CI.

Conclusions:

Overall rate of wound complications following CI is low. Shorter incision length is associated with lower risk of wound complications. Differences in perioperative techniques and practices regarding implant placement and antibiotic use were not associated with differences in wound complication rates. Considering the low number and quality of studies, there is a need for research in CI outcomes using paired sample prospective designs and standardized reporting.
Histopathologic Analysis of Temporal Bones With Otosclerosis Following Cochlear Implantation
Authors: Hodge Sarah E. , Ishiyama Gail , Lopez Ivan A. , Ishiyama Akira
Published: October 2021

Objective:

Analyze changes in osteoneogenesis and fibrosis following cochlear implant (CI) surgery in patients with otosclerosis and compare differences based on insertion technique.

Background:

When advanced otosclerotic disease extends to the otic capsule, severe and profound sensorineural hearing loss necessitates consideration of a cochlear implant. Histopathological analysis of the human temporal bone after implantation in the patient with otosclerosis may reveal important variables that predict CI success.

Methods:

Histopathological evaluation of archival human temporal bones from subjects with a history of CI for cochlear otosclerosis. A total of 17 human temporal bones (HTB) were analyzed, 13 implanted, and 4 contralateral non-implanted controls.

Results:

Histopathological studies revealed extensive osteoneogenesis and fibrosis which was more prominent at the cochleostomy insertion site in the basal turn of the cochlea often obliterating the scala tympani in the basal turn, and in some cases extending to the scala media and scala vestibuli. Cochlear hydrops was nearly universal in these cases. This contrasted with the round window insertion, which exhibited minimal osteoneogenesis within the cochlear duct. In addition, in the contralateral, unimplanted control ears, there was otosclerosis at the stapes footplate, fissula ante fenestrum but no osteoneogenesis within the cochlear duct.

Conclusion:

Cochleostomy approach to CI insertion in otosclerosis patients is associated with significant fibrosis, osteoneogenesis, and cochlear hydrops. A round window insertion technique can be utilized to help minimize these histopathologic findings whenever feasible.
Opioid Prescribing Patterns After Skull Base Surgery for Vestibular Schwannoma
Authors: Ren Yin , Mehranpour Pasha , Moshtaghi Omid , Schwartz Marc S. , Friedman Rick A.
Published: October 2021

Objective:

Excessive opioid prescription is a source of prescription diversion and could contribute to chronic opioid abuse. This study describes the opioid prescribing patterns and risk factors for additional opioid prescription after surgical resection of vestibular schwannoma (VS).

Study Design:

Retrospective chart review.

Setting:

Single tertiary referral center.

Patients:

Adult VS patients undergoing surgical resection between May 2019 and March 2020.

Interventions:

Opioid use postoperatively and up to 60 days following surgery were characterized from medical records and by querying the state-wide Controlled Substance Utilization Review and Evaluation System.

Main Outcome Measures:

The presence of additional opioid prescriptions within 60 days of surgery.

Results:

A total of 109 patients (mean age 50 yrs, 65.5% female) were prescribed an average of 138.2 ± 117.8 mg of morphine equivalents (MME). Twenty-two (20.9%) required additional prescriptions of 163.2 ± 103.2 MME. Age, gender, tumor size, or surgical approach (translabyrinthine, retrosigmoid, versus middle fossa) were not associated with additional prescriptions. Patients with additional prescriptions had higher body mass index (BMI 28.8 vs. 25.8 kg/m2, p = 0.015) and required more opioid medications during hospitalization (51.8 vs. 29.1 MME, p = 0.002). On multivariate logistic regression, higher BMI (odds ratio [OR] 1.32; p = 0.001), history of headaches (OR 11.9, p = 0.011), and history of opioid use (OR 29.3, p = 0.008) were associated with additional prescription.

Conclusions:

Additional opioid prescriptions may be necessary in a portion of VS patients undergoing surgery. The choice of surgical approach is not associated with excess opioid requirements. Patients with higher BMI, history of headaches, or preoperative opioid use may require additional prescriptions.
Outcomes in Patients Meeting Cochlear Implant Criteria in Noise but Not in Quiet
Authors: Thai Anthony , Tran Emma , Swanson Austin , Fitzgerald Matthew B. , Blevins Nikolas H. , Ma Yifei , Smith Michael L. , Larky Jannine B. , Alyono Jennifer C.
Published: October 2021

Objective:

Evaluate outcomes in cochlear implant (CI) recipients qualifying in AzBio noise but not quiet, and identify factors associated with postimplantation improvement.

Study Design:

Retrospective cohort study.

Setting:

Tertiary otology/neurotology clinic.

Patients:

This study included 212 implanted ears. The noise group comprised 23 ears with preoperative AzBio more than or equal to 40% in quiet and less than or equal to 40% in +10 signal-to-noise ratio (SNR). The quiet group included 189 ears with preoperative AzBio less than 40% in quiet. The two groups displayed similar demographics and device characteristics.

Interventions:

Cochlear implantation.

Main Outcome Measures:

AzBio in quiet and noise.

Results:

Mean AzBio quiet scores improved in both the quiet group (pre-implant: 12.7%, postimplant: 67.2%, p < 0.001) and noise group (pre-implant: 61.6%, postimplant: 73.8%, p = 0.04). Mean AzBio +10 SNR also improved in the quiet group (pre-implant: 15.8%, postimplant: 59.3%, p = 0.001) and noise group (pre-implant: 30.5%, postimplant: 49.1%, p = 0.01). However, compared with the quiet group, fewer ears in the noise group achieved within-subject improvement in AzBio quiet (≥15% improvement; quiet group: 90.3%, noise group: 43.8%, p < 0.001) and AzBio +10 SNR (quiet group: 100.0%, noise group: 45.5%, p < 0.001). Baseline AzBio quiet (p < 0.001) and Consonant-Nucleus-Consonant (CNC) scores (p = 0.004) were associated with within-subject improvement in AzBio quiet and displayed a higher area under the curve than either aided or unaided pure-tone average (PTA) (both p = 0.01).

Conclusions:

CI patients qualifying in noise display significant mean benefit in speech recognition scores but are less likely to benefit compared with those qualifying in quiet. Patients with lower baseline AzBio quiet scores are more likely to display postimplant improvement.
Auricular Cartilage Resection for Treatment-Refractory Idiopathic Chronic Chondritis: A Case Series
Authors: Gordon Steven A. , Nassiri Ashley M. , Driscoll Colin L. , Carlson Matthew L. , Patel Neil S.
Published: October 2021

Objective:

Describe a series of cases of idiopathic chronic auricular chondritis refractory to antibiotics and steroids treated successfully with surgery.

Study Design:

Case series.

Setting:

Two tertiary academic medical centers.

Patients:

We analyzed four patients diagnosed with chronic auricular deformity, pain, and drainage for a period of 1 to 5 years who had failed prolonged treatment consisting of antibiotics, corticosteroids, and incision and drainage. All four patients were smokers, three were diabetic, and two had a history of bariatric surgery.

Interventions:

Operative subcutaneous partial auriculectomy (removal of diseased cartilage and excess skin) was performed.

Main Outcome Measures:

Resolution of pain and drainage, need for additional procedures, and reduction in narcotics required for pain control were analyzed.

Results:

Two of the four patients were given an immediate postoperative course of doxycycline and ciprofloxacin. With a minimum of 6 weeks’ follow-up, all four patients had complete resolution of pain and recurrent drainage postoperatively. One patient requiring daily narcotic medication for pain and benzodiazepine for sleep preoperatively no longer required prescription medication. All specimens revealed chronic dermal and cartilage inflammation. Three of four cases had polymicrobial infection. One case had only skin contaminant growth on culture following multiple oral and parental antibiotic regimens.

Conclusions:

Surgical excision of diseased cartilage as a result of idiopathic chronic chondritis is an effective treatment in those cases refractory to antibiotics and incision and drainage, and should be considered in the treatment algorithm for similar patients, potentially offering definitive cure.
Reduced cleavage of von willebrand factor by ADAMTS13 is associated with microangiopathic acute kidney injury following trauma
Authors: Plautz William E. , Haldeman Shannon H. , Dyer Mitchell R. , Sperry Jason L. , Guyette Francis X. , Loughran Patricia A. , Alvikas Jurgis , Hassoune Adnan , Hoteit Lara , Alsaadi Nijmeh , Zuckerbraun Brian S. , Rollins-Raval Marian A. , Raval Jay S. , Mota Roberto I. , Neal Matthew D.
Published: October 2021

Acute kidney injury (AKI) is common after trauma, but contributory factors are incompletely understood. Increases in plasma von Willebrand Factor (vWF) with concurrent decreases in ADAMTS13 are associated with renal microvascular thrombosis in other disease states, but similar findings have not been shown in trauma. We hypothesized that molecular changes in circulating vWF and ADAMTS13 promote AKI following traumatic injury. VWF antigen, vWF multimer composition and ADAMTS13 levels were compared in plasma samples from 16 trauma patients with and without trauma-induced AKI, obtained from the Prehospital Air Medical Plasma (PAMPer) biorepository. Renal histopathology and function, vWF and ADAMTS13 levels were assessed in parallel in a murine model of polytrauma and haemorrhage. VWF antigen was higher in trauma patients when compared with healthy controls [314% (253–349) vs. 100% (87–117)] [median (IQR)], while ADAMTS13 activity was lower [36.0% (30.1–44.7) vs. 100.0% (83.1–121.0)]. Patients who developed AKI showed significantly higher levels of high molecular weight multimeric vWF at 72-h when compared with non-AKI counterparts [32.9% (30.4–35.3) vs. 27.8% (24.6–30.8)]. Murine plasma cystatin C and vWF were elevated postpolytrauma model in mice, with associated decreases in ADAMTS13, and immunohistologic analysis demonstrated renal injury with small vessel plugs positive for fibrinogen and vWF. Following traumatic injury, the vWF-ADAMTS13 axis shifted towards a prothrombotic state in both trauma patients and a murine model. We further demonstrated that vWF-containing, microangiopathic deposits were concurrently produced as the prothrombotic changes were sustained during the days following trauma, potentially contributing to AKI development.
Proton Pump Inhibitor Prescribing and Monitoring Patterns Among Gastroenterology Practitioners
Authors: Leiman David A. , Ravi Karthik , Freedberg Daniel E. , Gyawali C. Prakash
Published: October 2021

Goals:

The aim was to quantify proton pump inhibitor (PPI) practice habits among gastroenterology (GI) practitioners.

Background:

Reports of side effects have prompted patients and practitioners alike to discontinue PPI use. Emerging evidence-based literature on PPI risks and safety seek to guide practitioners, but the impact of this literature on PPI prescribing patterns has not been evaluated.

Study:

We performed an anonymous online survey of US GI practitioners across 6 academic and community affiliated medical centers. Demographic data including practice type and number of weekly gastroesophageal reflux disease patients seen were obtained. Survey questions evaluated practitioners’ monitoring for PPI side effects, dose adjustments, and sources of information about PPI risks.

Results:

The survey response rate was 60% (256/429). The majority of respondents were male (169, 66%) attending physicians (178, 70%) practicing general GI (63, 25%). There were 92 (36%) respondents who reported testing for PPI side effects at least once a year. Most respondents (143, 56%) reported discontinuing PPIs at least 50% of the time because of patients’ concerns about PPI side effects. The majority of respondents reported getting their information regarding PPI safety from published journals (239, 98%) as well as colleagues (222, 91%).

Conclusions:

Despite best available evidence suggesting safety of long-term PPI use without routine monitoring, stopping PPIs and monitoring for potential side effects occurs frequently, even within a cohort of mostly academic GI practitioners. Alternative strategies are needed to improve adherence to best practices, especially since gastroenterologists often serve as PPI experts.
Taking Advantage of the Teachable Moment at Initial Diagnosis of Prostate Cancer—Results of a Pilot Randomized Controlled Trial of Supervised Exercise Training
Authors: Schulz Gerald B. , Locke Jennifer A. , Campbell Kristin L. , Bland Kelcey A. , Van Patten Cheri L. , Black Peter C. , Goldenberg S. Larry , Flannigan Ryan
Published: October 2021

Background

Increased physical activity (PA) levels are associated with improved prostate cancer (PCa) outcomes. Sustainable PA has been linked to improved health-related quality of life (QoL) in cancer patients. The time of diagnosis of PCa may offer a critical time point when patients might be more likely to consider lifestyle changes. This, in turn, may contribute to sustainable PA and its likely benefits.

Objective

The aims of this study were to determine if a structured PA intervention introduced at the time of diagnosis can (1) lead to sustainable PA and (2) help improve psychosocial and QoL outcomes as compared with usual PA.

Interventions/Methods

This was a pilot randomized controlled trial enrolling patients with intermediate-risk PCa into either arm A (supervised 8- to 12-week physical exercise program; n = 10) or control arm B (usual PA; n = 10). Primary outcome was PA at 6 months. Secondary outcomes were QoL, psychological well-being, physical fitness, and functional outcomes postintervention. Change over time was compared using a nonparametric Wilcoxon test.

Results

Demographic variables were the same between arms. Comparing parameters at the start and 6 months post–radical prostatectomy, PA significantly improved in arm A (self-reported Godin score 24.7 vs 42.8 units, P < .01, objective number of chair stands [14–19, P < .01]), but not in arm B. There were no significant differences between arms in QoL and psychosocial outcomes.

Conclusions

A preoperative supervised exercise training program increases long-term PA.

Implications for Practice

Future trials should evaluate PA sustainability beyond 6 months and if this leads to improved psychosocial and QoL outcomes.
Adherence to Oral Nutritional Supplements in Patients With Gastrointestinal Cancer
Authors: Qin Liyuan , Xu Doudou , Tian Qiuju , Wu Beiwen
Published: October 2021

Background

Oral nutritional supplements (ONS) is a cost-effective nutritional therapy in patients with gastrointestinal cancer. However, information is lacking about adherence to ONS in general clinical settings. Figuring out adherence to ONS and related factors will provide evidence for the improvement of ONS usage practice.

Objective

The aim of this study was to survey adherence to ONS in gastrointestinal cancer patients with an ONS prescription and the factors associated with it.

Methods

A mixed-method prospective study was conducted. Multivariate analysis and semistructured interviews were performed to identify factors that affected patient adherence to ONS.

Results

Of 111 gastrointestinal cancer patients provided with an ONS prescription, the median of adherence to ONS was 50.00% (interquartile range, 28.57%–91.67%). Multivariate analysis indicated that participants with low weight showed higher adherence to ONS than those with normal weight (β = −2.61, P = .011) or overweight (β = −3.25, P = .002). Semistructured interviews on 14 participants suggested that factors related to adherence to ONS were needs perception and benefits, clarity of the target daily ONS intake, tolerance to ONS, the impact of disease or treatment, personal preference, and professional support.

Conclusion

This study reveals poor adherence to ONS in patients with gastrointestinal cancer and factors related to it in current clinical settings.

Implications for Practice

Our findings could provide evidence for the development of strategies to improve ONS usage practice. It suggests that the practice in ONS should be improved from aspects of nutritional assessment, education, tolerance, and symptom management, as well as follow-up and monitoring of patients.
Family Cohesiveness: A Dying Concern for the Coparent in Families With Parents With Advanced Cancer With Dependent Children
Authors: Caparso Cinzia , Benkert Ramona A.
Published: October 2021

Background

Dying concerns are thoughts expressed by a person diagnosed with a terminal illness or by an individual coping with the impending death of a loved one. Little is known about the dying concerns of parents with advanced cancer (PWACs) with dependent children, and even less is known about the dying concerns of the coparent. Understanding the PWACs’ dying concerns for the coparent can contribute to the overall health of the family when faced with the death of a loved one.

Objective

The aim of this pilot descriptive study was to explore the PWACs’ perspective of their dying concerns for their coparent.

Methods

Four PWACs were recruited from 2 oncology inpatient units from an urban community hospital within the same hospital system. Semistructured interviews were conducted, audio-recorded, and transcribed with 4 participants. Data analysis used directed content analysis.

Results

Parents with advanced cancer expressed concern about the repercussions of advanced cancer on family cohesiveness. Three subthemes within this general structure were “My Weakest Link,” “If I’m Not There, Where Do They Go?” and “Putting Up a Front.”

Conclusions

Parents with advanced cancer have concerns beyond their role as a parent could make a difference in the overall health of the PWACs, but also the family unit. The PWACs’ concerns are present but may be covered over by use of protective mechanisms to maintain family cohesiveness.

Implications for Practice

Understanding dying concerns may enhance nurse-initiated communications between family members and healthcare providers to improve psychological distress and enhance family functioning.
Identifying Barriers to Effective Patient-Provider Communication About Food Insecurity Screenings in Outpatient Clinical Settings in Central Florida: A Mixed-Methods Study
Authors: Bernhardt Christina , Hou Su-I , King Christian , Miller Ann
Published: October 2021

Objective:

Screening for food insecurity in health care settings is inconsistently performed among health care providers. This study examined how patient-provider interactions influenced patient comfort discussing food insecurity, an important social determinant of health.

Design:

We conducted a convergent mixed-methods study and surveyed patients on their experiences with patient-centered care when communicating and interacting with their providers, and their comfort level being screened for food insecurity. Telephone interviews were also conducted to better understand the concepts in the survey.

Setting:

Various clinical organizations in Central Florida, as well as food pantries affiliated with Second Harvest Food Bank.

Participants:

Forty-six patients in Central Florida completed the survey, 12 of whom completed qualitative portions of the study (7 completing the qualitative survey questions and 5 completing a telephone interview).

Main Outcome Measure:

Patient comfort discussing food insecurity with their health care providers.

Results:

Quantitative findings show that patient involvement in care planning and cultural sensitivity of health care providers were 2 important factors associated with patient comfort being screened for food insecurity. Qualitative findings suggest that providers' effective communication and empathy are other factors that can influence patient comfort.

Conclusion:

To effectively address food insecurity of vulnerable patients and communities, it is important that providers conduct screenings within their practice. This study points to specific actions that providers may employ to increase patient comfort discussing this topic. Efficiently identifying food-insecure patients and connecting them to appropriate community resources would improve patient health and aid in efforts to eliminate health disparities.
Physiological and Perceptual Responses in Spinal Cord Injury Handcyclists During an Endurance Interval Training
Authors: Antunes Diego , Borszcz Fernando K. , Nascimento Eduardo M. F. , Cavalheiro Giulia Pereira , Fischer Gabriela , Brickley Gary , de Lucas Ricardo D.
Published: October 2021

Objective

This study sought to determine the physiological (oxygen uptake, heart rate, and blood lactate concentration) and perceptual (rating of perceived exertion) responses during an endurance interval training at the critical speed in elite handcyclists with spinal cord injury.

Design

Eight handcyclists performed an incremental test, three tests to exhaustion at a constant speed to determine critical speed, and the endurance interval training. The endurance interval training consisted of 6 × 5 mins at the individualized critical speed, with passive recovery of 50 secs. All testing was performed using their own handcycles on an oversized motorized treadmill. Physiological and perceptual responses were assessed during the incremental and endurance interval training tests.

Results

There was no significant difference in average oxygen uptake from the first to the sixth repetition. The mean ∆[La−]10_last between the 10th to the 30th minute of the exercise was −0.36 mmol·l−1, and no difference was detected from the first to the sixth repetition. The heart rate also remained stable during endurance interval training, whereas rating of perceived exertion increased significantly throughout the session.

Conclusions

Repetitions of 5 mins at the critical speed in elite handcyclists are associated with cardiorespiratory and lactate steady state, whereas the perceived exertion increased systematically.