bluuebunny/crossref_metadata_2025 huggingface dataset:
Mycotic abdominal aortic aneurysm in a patient with systemic lupus erythematosus: A case of critical antinomy
Authors: Kobayashi Kensuke , Inoue Nobuyuki , Fukunishi Takuma
Published: October 2021

Mycotic abdominal aortic aneurysms (MAAAs) are rare but life-threatening, and no standard therapy has yet been established. Effective surgery with intensive antimicrobial therapy is crucial; however, this can be fatal in immunocompromised patients. Only a few reports of MAAA with concomitant autoimmune disease exist; therefore, we were concerned about our lack of experience and knowledge about appropriate treatment. We report a 69-year-old male with an MAAA secondary to septic shock after spinal fusion surgery. He had also been on long-term oral immunosuppressants for systemic lupus erythematosus (SLE). After preoperative cephazolin, we performed debridement of infected tissue, graft replacement with a rifampicin-bonded prosthesis, and omentopexy. On the 52nd post-operative day, he was transferred back to the previous attending hospital under oral antibiotics and prednisolone. MAAA in patients with SLE should be treated with in situ replacement using an antimicrobial prosthetic or biological graft with thorough debridement and omentopexy, followed by antimicrobials and immunosuppressants, as needed.
Rice bodies in the wrist
Authors: Gillijns Maurice , Vandesande Wim
Published: October 2021

Rice bodies are a rare finding in medicine and offer a therapeutic challenge. As their occurrence varies over multiple rheumatic as well as infectious diseases, multiple hypotheses have been made about their origin. While rice bodies are most frequently reported in the shoulder and knee joints, flexor tendon synovitis with accompanying rice bodies is rarer. We report a case of extensive flexor tenosynovitis with rice bodies in the wrist in a 90-year-old patient with seronegative rheumatoid arthritis. The patient reported a 5-month history of painful swelling of the right wrist. Ultrasound showed pronounced swelling of the synovial tissue of the flexor tendons. Laboratory test were negative for rheumatology tests with normal C-reactive protein and sedimentation rates. T2-weighted magnetic resonance imaging demonstrated an extensive synovitis reaching from the distal forearm into the hand with inclusions, better known as rice bodies. Synovectomy including carpal tunnel release was performed with dissection of the mass revealing an extensive synovitis with a multitude of rice bodies. Histopathology showed lymphohistiocytic infiltrates consistent with rheumatoid nodules. After surgery, the patient regained full function of the wrist within 2 weeks without any pain or remaining mass in the affected limb.
PhylomeDB V5: an expanding repository for genome-wide catalogues of annotated gene phylogenies
Authors: Fuentes Diego , Molina Manuel , Chorostecki Uciel , Capella-Gutiérrez Salvador , Marcet-Houben Marina , Gabaldón Toni
Published: October 2021

PhylomeDB is a unique knowledge base providing public access to minable and browsable catalogues of pre-computed genome-wide collections of annotated sequences, alignments and phylogenies (i.e. phylomes) of homologous genes, as well as to their corresponding phylogeny-based orthology and paralogy relationships. In addition, PhylomeDB trees and alignments can be downloaded for further processing to detect and date gene duplication events, infer past events of inter-species hybridization and horizontal gene transfer, as well as to uncover footprints of selection, introgression, gene conversion, or other relevant evolutionary processes in the genes and organisms of interest. Here, we describe the latest evolution of PhylomeDB (version 5). This new version includes a newly implemented web interface and several new functionalities such as optimized searching procedures, the possibility to create user-defined phylome collections, and a fully redesigned data structure. This release also represents a significant core data expansion, with the database providing access to 534 phylomes, comprising over 8 million trees, and homology relationships for genes in over 6000 species. This makes PhylomeDB the largest and most comprehensive public repository of gene phylogenies. PhylomeDB is available at http://www.phylomedb.org.
CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014–2018
Authors: Ostrom Quinn T , Cioffi Gino , Waite Kristin , Kruchko Carol , Barnholtz-Sloan Jill S
Published: October 2021

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI), is the largest population-based cancer registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy and is the first CBTRUS Report to provide the distribution of molecular markers for selected brain and CNS tumor histologies. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 24.25 (Malignant AAAIR=7.06, Non-malignant AAAIR=17.18). This overall rate was higher in females compared to males (26.95 versus 21.35) and non-Hispanics compared to Hispanics (24.68 versus 22.12). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.3% of all tumors and 49.1% of malignant tumors), and the most common non-malignant tumor was meningioma (39.0% of all tumors and 54.5% of non-malignant tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0–19 years), the incidence rate of all primary brain and other CNS tumors was 6.21. An estimated 88,190 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US population in 2021 (25,690 malignant and 62,500 non-malignant). There were 83,029 deaths attributed to malignant brain and other CNS tumors between 2014 and 2018. This represents an average annual mortality rate of 4.43 per 100,000 and an average of 16,606 deaths per year. The five-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 35.6%, for a non-malignant brain and other CNS tumors the five-year relative survival rate was 91.8%.
Cell biology of primary cell wall synthesis in plants
Authors: Gu Ying , Rasmussen Carolyn G
Published: October 2021

Building a complex structure such as the cell wall, with many individual parts that need to be assembled correctly from distinct sources within the cell, is a well-orchestrated process. Additional complexity is required to mediate dynamic responses to environmental and developmental cues. Enzymes, sugars, and other cell wall components are constantly and actively transported to and from the plasma membrane during diffuse growth. Cell wall components are transported in vesicles on cytoskeletal tracks composed of microtubules and actin filaments. Many of these components, and additional proteins, vesicles, and lipids are trafficked to and from the cell plate during cytokinesis. In this review, we first discuss how the cytoskeleton is initially organized to add new cell wall material or to build a new cell wall, focusing on similarities during these processes. Next, we discuss how polysaccharides and enzymes that build the cell wall are trafficked to the correct location by motor proteins and through other interactions with the cytoskeleton. Finally, we discuss some of the special features of newly formed cell walls generated during cytokinesis.
Perceived work engagement and performance amongst police officers during the COVID-19 pandemic in Hong Kong
Authors: Li Jessica C M , Cheung Chau-Kiu , Sun Ivan Y , Cheung Yuen-Kiu
Published: October 2021

Although work-related stress among police officers during the Coronavirus disease 2019 pandemic has been examined in recent studies, empirical studies of the impacts of multiple stressors on police officers’ work engagement and performance during this difficult time have been scarce. Using data collected from a sample of 335 police officers in Hong Kong, this study investigated the effects of supervisor support and different occupational stressors on police officers’ work engagement and performance during the pandemic. The regression results indicated that the impact of supervisor support was significantly and positively associated with both work outcomes. Operational stressors had a significant negative impact on the two work outcomes, and supervisor support had no moderating effect on the relationships between the various stressors and the two work outcomes. Practical suggestions on how to increase supervisor support for police officers and mitigate operational stressors are discussed.
Operational stress of police officers: A cross-sectional study in three countries with centralized, hierarchical organization
Authors: Kukić Filip , Streetman Aspen , Koropanovski Nenad , Ćopić Nemanja , Fayyad Fadi , Gurevich Konstantin , Zaborova Victoria , Krikheli Natella , Dopsaj Milivoj , Heinrich Katie M
Published: October 2021

Law enforcement is a stressful occupation with both work-related and social-related stressors. Too much stress can negatively affect behaviours, mental states, and job performance. Centralized police organizations limit officers’ individual autonomy, likely increasing stress. This study examined differences in occupational stress in two different European countries and one Middle East country. Participants were 351 male police officers from Serbia (n = 130, age 36 ± 8 years), Russia (n = 121, age 22 ± 4 years), and Lebanon (n = 100, age 36 ± 6 years) who completed the 20-item Operational Police Stress Questionnaire in their own language. Items were averaged and interpreted as low (≤2.0), stress (2.1–3.4), and high stress (≥3.5). Analysis of covariance (ANCOVA) analyses using age as the covariate with Bonferroni post hoc analyses were used. A principal component analysis (PCA) was used to determine stress structure per country. Significant differences were found with lower occupational stress in Russian (P < 0.001) and Lebanon (P = 0.003) than Serbian officers. PCA factor patterns differed by country, with six found for Russian and Lebanese and three for Serbian officers. More work-related stressors were rated higher for the younger Russian officers, while more social-related stressors were rated higher for the older Serbian officers. Results suggest that it is vital to consider officers’ stress sources and overall stress levels.
Mycorrhizal fungi regulate daily rhythm of circadian clock in trifoliate orange under drought stress
Authors: Ding Yu-E , Zou Ying-Ning , Wu Qiang-Sheng , Kuča Kamil
Published: October 2021

The circadian rhythm of plants is associated with stress responses; however, it is not clear whether increased host plant drought tolerance by arbuscular mycorrhizal fungi (AMF) is associated with changes in the circadian clock. The present study aimed to analyze the effect of Funneliformis mosseae (Nicol. & Gerd.) Schüßler & Walker on the circadian clock gene expression patterns in trifoliate orange (Poncirus trifoliata L. Raf.) along with gas exchange, abscisic acid (ABA) levels and antioxidant enzyme gene expression under well-watered (WW) and drought stress (DS) conditions. Plant growth, net photosynthetic rate, stomatal conductance and ABA levels were significantly higher in AMF- than in non-AMF-inoculated plants regardless of soil water regimes. Six circadian clock genes, including PtPRR7, PtLHY, PtCCA1, PtGI, PtPIF3 and PtSRR1, were identified and showed rhythmic expression patterns over the course of the day. The AMF inoculation reduced the expression of most circadian clock genes in different time periods. However, AMF treatment significantly increased PtPRR7 and PtGI expression at 5:00 p.m. under WW and DS conditions, PtLHY expression at 1:00 a.m. and PtSRR1 expression at 9:00 p.m. At 1:00 a.m., AMF inoculation up-regulated the expression of the circadian clock genes PtPRR7, PtCCA1, PtLHY and PtPIF3 and the antioxidant enzyme genes PtFe-SOD, PtMn-SOD, PtCu/Zn-SOD, PtPOD and PtCAT1. Correlation analysis revealed that these changes in circadian clock gene expression were associated with antioxidant enzyme gene expression, root ABA and gas exchange. We concluded that mycorrhizal fungi have the ability to regulate the daily rhythm of the circadian clock in trifoliate orange plants in response to drought.
A practical approach to selecting a colorectal cancer screening test
Authors: Carter Kimberly
Published: October 2021

Colorectal cancer is the second leading cause of cancer-related deaths in the United States, but timely, effective, and adherent screening can reduce the number of cases. Screening tests continue to evolve, creating opportunities and challenges. Medical societies offer varying guidelines about optimal screening tests and when to begin screening. This article reviews available and emerging colorectal cancer screening tests and discusses how to educate patients, advise them in selecting an appropriate test, and promote increased participation in colorectal cancer screening.
Vasopressor Initiation Within 1 Hour of Fluid Loading Is Associated With Increased Mortality in Septic Shock Patients: Analysis of National Registry Data*
Authors: Yeo Hye Ju , Lee Young Seok , Kim Tae Hwa , Jang Jin Ho , Lee Heung Bum , Oh Dong Kyu , Park Mi Hyeon , Lim Chae-Man , Cho Woo Hyun ,   on behalf of the Korean Sepsis Alliance (KSA) Investigators
Published: October 2021

OBJECTIVES:

To investigate whether administration of a vasopressor within 1 hour of first fluid loading affected mortality and organ dysfunction in septic shock patients.

DESIGN:

Prospective, multicenter, observational study.

SETTING:

Sixteen tertiary or university hospitals in the Republic of Korea.

PATIENTS:

Patients with septic shock (n = 415) were classified into early and late groups according to whether the vasopressor was initiated within 1 hour of the first resuscitative fluid load. Early (n = 149) patients were 1:1 propensity matched to late (n = 149) patients.

INTERVENTIONS:

None.

Measurement and Main Results:

The median time from the initial fluid bolus to vasopressor was shorter in the early group (0.3 vs 2.3 hr). There was no significant difference in the fluid bolus volume within 6 hours (33.2 vs 35.9 mL/kg) between the groups. The Sequential Organ Failure Assessment score and lactate level on day 3 in the ICU were significantly higher in the early group than that in the late group (Sequential Organ Failure Assessment, 9.2 vs 7.7; lactate level, 2.8 vs 1.7 mmol/L). In multivariate Cox regression analyses, early vasopressor use was associated with a significant increase in the risk of 28-day mortality (hazard ratio, 1.83; 95% CI, 1.26–2.65).

CONCLUSIONS:

Vasopressor initiation within 1 hour of fluid loading was associated with higher 28-day mortality in patients with septic shock.
Rethinking Our Annual Congress—Meeting the Needs of Specialist Physicians by Partnering With Provincial Simulation Centers
Authors: Daniel Sam J. , Bouchard Marie-Josée , Tremblay Martin
Published: October 2021

Canada's maintenance of certification programs for physicians has evolved to emphasize assessment activities. Our organization recognized the importance of offering more practice assessment opportunities to our members to enhance their practice and help them comply with a regulation from our provincial professional body related to ongoing continuing education. This led us to rethink our annual congress and enrich the program with a curriculum of interdisciplinary simulation sessions tailored to meet the needs of a broad audience of specialists. Our challenges are similar to those of many national specialty societies having limited access to simulation facilities, instructors, and simulation teams that can cover the breadth and scope of perceived and unperceived simulation needs for their specialty. Our innovative solution was to partner with local experts to develop 22 simulation sessions over the past three years. The response was very positive, drawing 867 participants. Over 95% of participants either agreed or strongly agreed that their simulation session (1) met their learning objectives, (2) was relevant for their practice, and (3) encouraged them to modify their practice. Narrative comments from a survey sent to the 2018 participants four months after their activity indicated several self-reported changes in their practice or patient outcomes. We were able to centralize offers from organizations that had previously worked in silo to develop simulation sessions meeting the needs of our members. Proposing simulation sessions allowed our organization to establish long-term partnerships and to expend our “educational toolbox” to address skill gaps not usually addressed during annual meetings.
Patient Partners in Continuing Professional Development: Experience Developing an End-of-Life Care Program for Family Physicians
Authors: Tajani Sarah , Towle Angela , Beamish Laura , Bluman Bob
Published: October 2021

Involvement of patients in continuing professional development (CPD) is less developed than in health professional education at undergraduate or postgraduate levels. Although patients are sometimes involved in delivering CPD, they are less likely to be involved in education planning. At our institution, patients have sometimes acted as consultants in the design of CPD. The problem we address is how to engage patients as partners throughout the design process. We applied principles of authentic patient engagement and lessons learned from patient involvement in undergraduate health professional education to the design of CPD for family physicians. We created a partnership between the CPD Office and Patient and Community Partnership for Education, a unit with a history of patient involvement in the education of health professional students. Practices for meaningful involvement were identified through literature review, environmental scan, and interviewing key informants, including patients involved in health professional education at the university. These principles and practices were applied to the development of a CPD module on end-of-life care. Patient partners contributed new perspectives and some CPD providers reassessed components of their own practice as a result. Lessons learned include the need for stakeholder buy-in; mechanisms to identify those patients best able to contribute expertise; ways to facilitate involvement that work for both patients and CPD providers; the importance of feedback mechanisms to patient partners; and recognition for patient contributions. CPD offices should view integration of patient partners in program planning as an opportunity to engage in ongoing quality improvement.
Aligning Family–Clinician Expectations During Pediatric Surgical Informed Consent: Development and Implementation of an Innovative Communication Skills Workshop
Authors: Cohen-Bearak Adena , Meyer Elaine C. , Mednick Lauren , Varrin Pamela , Burgess Lisa , Kuhlmann Pia H. , Bell Sigall , Lillehei Craig
Published: October 2021

Introduction:

Aligning expectations during the informed consent process before a child's surgery is an important element of good communication that benefits both surgical staff and families. We developed and evaluated a 2-hour pilot interprofessional workshop to improve the communication and relational skills of pediatric surgeons and nurse practitioners.

Methods:

Focus groups with families identified key challenges in the process of informed consent. An interprofessional team, including parents whose children had experienced complex surgeries, developed the workshop collaboratively. A realistic simulation with professional actors portraying parents allowed surgical staff to practice communication skills and receive feedback about the parent perspective. Participants completed a postworkshop evaluation to determine whether the workshop met its objectives and whether they would change practice.

Results:

Five key themes identified for the workshop included customize communication; align expectations; share clinical uncertainty; recognize/attend to emotions; and identify team members. Thirty-five clinicians participated in a workshop, and 89% completed evaluations. Three-quarters reported the learning to be valuable, and 64% were likely to change practice. Eighty-seven percent would recommend the workshop to other colleagues, and 58 to 74% felt more prepared to achieve each of eight specific skills.

Discussion:

An innovative workshop for pediatric surgical practitioners to align family–clinician expectations can help improve clinician communication skills and comfort with informed consent. Keys to workshop development included involving parents to identify themes and participate as workshop co-faculty; enlisting leadership and recruiting surgical champions; and using pre-existing meetings to ease scheduling challenges of busy practitioners. Booster sessions may facilitate the desired cultural changes.
Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms
Authors: Xu Shan-Shan , Chai Ning-Li , Tang Xiao-Wei , Linghu En-Qiang , Wang Sha-Sha , Li Bao
Published: October 2021

Background:

With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.

Methods:

A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.

Results:

A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0–9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).

Conclusions:

The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.
ACUTE MACULAR NEURORETINOPATHY AFTER SARS-COV-2 VACCINATION
Authors: Patel Samir N. , Yonekawa Yoshihiro
Published: October 2021

Purpose:

To present the rare case of a patient who developed acute macular neuroretinopathy (AMN) after administration of a single-dose adenovector coronavirus vaccine.

Methods:

Retrospective chart review.

Results:

A 26-year-old woman presented with paracentral scotomas in both eyes that acutely developed 2 days after administration of a single-dose adenovector SARS-CoV-2 vaccine (Johnson & Johnson, New Brunswick, NJ). She had previously received the seasonal influenza immunization without any symptoms and denied having any recent history of viral illnesses. On examination, optical coherence tomography showed parafoveal hyperreflective bands in the outer retina of both eyes without retinal thickening and near-infrared reflectance showed wedge-shaped parafoveal lesions pointing to the fovea, both classic findings in acute macular neuroretinopathy.

Discussion:

This report highlights the development of acute macular neuroretinopathy after a SARS-CoV-2 vaccination in an otherwise healthy female patient. A single case cannot establish cause and effect, and millions of COVID-19 vaccines have been administered safely at the time of writing. However, this may be a rare association, and clinicians can consider inquiring about recent vaccination history in patients presenting with acute macular neuroretinopathy.
Surveillance Chest X-Ray and Pulmonary Function Testing in Patients Undergoing Intralesional Bleomycin in the Treatment of Vascular Malformations
Authors: DeHart Austin N. , Mack Joana M. , Garner Annsley , Nicholas Richard , Smith Amber , Lewis P. Spencer , Crary Shelley E.
Published: October 2021

Purpose:

Bleomycin is an effective sclerosant in the treatment of vascular malformations; however, the risk of pulmonary toxicity remains a concern. This study analyzes the utility of routine chest x-ray (CXR) and pulmonary function testing (PFT) in a pediatric patient population receiving intralesional bleomycin sclerotherapy.

Methods:

Retrospective chart review of CXR and PFT results in patients who underwent bleomycin intralesional injection for the treatment of vascular malformations.

Results:

A total of 64 patients were identified with vascular malformations treated with intralesional bleomycin. The median cumulative bleomycin dose per patient was 10.9 U/m2 (range 1.8–106.8 U/m2 per patient). No difference was found in mean cumulative bleomycin dose between patients with a normal compared with abnormal CXR (32.4 versus 31.8 U/m2, P = 0.96). No patients had CXR findings which precluded the administration of bleomycin. Of 41 successfully completed PFTs, 39 (95.1%) were normal and 2 (4.9%) were abnormal with an obstructive pattern. There was no decrease in the mean DLCO (Hg) % predicted between baseline PFT and follow-up PFT groups (94.1 versus 101.8, P = 0.17). Linear regression was performed and no decrease in DLCO (Hg) % predicted with increasing cumulative bleomycin dose was identified (slope coefficient 0.37; 95% CI, –2.2 to 2.9; R2 = 0.01).

Conclusion:

Routine CXR for the surveillance of bleomycin-induced pulmonary toxicity seems to be of limited clinical utility. No diffusion abnormalities on PFT were seen in this patient cohort to date; however, as cumulative bleomycin doses increase, follow-up PFT monitoring will remain important.
Long-Term Hearing Outcomes From Gamma Knife Treatment for Vestibulocochlear Nerve Schwannomas in a Large, Tertiary Care, Academic Hospital
Authors: Maksimoski Matthew , Bajaj Amishi , Giri Sneha , Sharpe Laurin M. , Kalapurakal John , Micco Alan G.
Published: October 2021

Objective:

Describe long-term hearing outcomes with audiologic data with modern stereotactic radiosurgery techniques for vestibular schwannoma tumors.

Background:

Since the mid-20th century, stereotactic radiosurgery has been an option for central nervous system tumors. Due to the non-invasive manner of treatment, this was extended to treatment for benign vestibular schwannomas without intracranial surgery. Modern advances have localized radiation and reduced dosage, but data are still lacking in the long-term hearing outcomes of this method of treatment. As one of the national leaders in this procedure, we present our full database of these outcomes over the full time period of our institutions utility of this modality.

Methods:

A retrospective review was performed of all patients undergoing stereotactic radiotherapy for vestibular schwannomas within the study period of 1998 to 2019 and their audiograms analyzed along with patient data. Laterality Gardner–Robertson hearing score changes were the primary outcome analyzed for each patient; and controls were placed to accommodate for patient demographic data.

Results:

Long-term, multi-year audiometric evaluation showed statistically significant loss of serviceable hearing and reduction in hearing ability with the use of stereotactic radiosurgery for treatment of vestibular schwannomas.

Conclusions:

Little long-term data exists on the audiometric outcomes related to stereotactic radiosurgery treatment for vestibular schwannomas. Our institution has performed more than 300 stereotactic radiosurgery treatments showing a continued reduction over time in serviceable hearing. Practitioners should advise patients undergoing treatment for vestibular schwannomas with this treatment of long-term results.
Auditory Outcomes Following Transmastoid and Middle Cranial Fossa Approaches for Superior Semicircular Canal Dehiscence Repair
Authors: Ellsperman Susan E. , Telian Steven A. , Kileny Paul R. , Welch Christopher M.
Published: October 2021

Objective:

To describe postoperative hearing outcomes following transmastoid (TM) and middle cranial fossa (MCF) approaches for semicircular canal dehiscence (SSCD) repair.

Study Design:

Retrospective review.

Setting:

Academic, tertiary referral center.

Patients:

Adults with SSCD who underwent repair between 2005 and 2019.

Interventions:

Pure tone audiometry pre- and postoperatively after SSCD repair.

Main Outcome Measures:

Change in air-bone gap (ABG) at 250 and 500 Hz, pure tone average (PTA), bone conduction (BC), and air conduction (AC) thresholds at 500, 1000, 2000, and 4000 Hz for patients undergoing TM and MCF approaches for SSCD repair.

Results:

The average change in BC PTA for patients undergoing TM (n = 26) and MCF (n = 24) SSCD repair was not significantly different between the two groups. The first and final postoperative PTAs were recorded an average of 1.7 (range 0.30–3.0) and 29.1 (range 3.5–154) months postoperatively. For patients who underwent MCF repair, the average BC PTAs increased (+) by 2.2 dB HL (p 0.43) and 0.57 dB HL (p 0.88) at the first and final audiograms respectively compared to +1.27 dB HL (p 0.53) and a decrease (−) of 0.57 dB HL (p 0.63) for the TM group. The average changes in low frequency ABG for patients undergoing MCF repair were −4.7 dB (p 0.08) and −6.9 dB (p 0.15) at first and final audiograms respectively compared to −4.9 dB (p 0.06) and −4.1 dB (p 0.36) for patients who underwent TM repair. There was a high frequency hearing loss noted at 8000 Hz for the MCF (30.0 dB ± 18.7 preop; 41.7 dB ± 21.7 postop; p 0.01) and TM (32.1 dB ± 23.2 preop; 44.3 dB ± 29.6 postop; p 0.001) groups which persisted on long term follow up.

Conclusions:

Both TM and MCF approaches to SSCD repair can be performed with long-term preservation of hearing. ABGs were reduced in each treatment group but did not reach significance. A high frequency hearing loss (8000 Hz) may be expected with either approach.
Patient Self-Management of Benign Paroxysmal Positional Vertigo: Instructional Video Development and Preliminary Evaluation of Behavioral Outcomes
Authors: Kerber Kevin A. , Carender Wendy , Telian Steven A. , Fagerlin Angela , Tsodikov Alex , Meurer William J.
Published: October 2021

Importance:

Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) is a common disorder that is diagnosed using the Dix-Hallpike test (DHT) and treated with the canalith repositioning maneuver (CRM). Patients often seek out information about BPPV self-management, but studies to develop and evaluate patient-centered instructional resources are limited.

Objective:

To develop and preliminarily evaluate a patient-oriented PC-BPPV self-management instructional video.

Methods:

We assembled a multidisciplinary team and used an iterative process to develop a theory-based instructional video for self-performing the DHT and CRM. We recruited individuals searching online for information about dizziness to complete a survey and review the video. Patients rated the video by scoring seven questions that measure behavioral intent to perform the DHT or CRM (attitudes/acceptability, perceived self-efficacy, and social norms) using a 10-point scale (higher scores = more favorable ratings). A multilevel linear regression model was used to determine the association of age, sex, race, and education with video ratings.

Results:

Of the 771 participants who completed the survey, 124 (16%) also reviewed and evaluated the PC-BPPV instructional video. The video review participants were typically more than or equal to 55 years old (70%; 93/124), women (70%; 87/124), and White (70%; 88/124). These participants also generally reported acute-subacute and moderate-to-severe dizziness, and 60% (75/124) reported typical BPPV triggers. The median scores for the seven questions about attitudes/acceptability, self-efficacy, and social norms on the PC-BPPV instructional video were all more than or equal to 9 out of 10 with interquartile ratios that ranged from 7 to 9 at the 25th percentile to 10 at the 75th percentile. Female sex was the only demographic variable associated with higher video ratings (coefficient, 1.21, 95% CI 0.60–1.83).

Conclusion:

This study found that participants rated the PC-BPPV self-management video favorably on measures that contribute to behavioral intent to perform the DHT or CRM. The findings provide support that the video is appropriate to use in future studies that evaluate patient self-performance accuracy and outcomes.
The Value of Ultrashort Echo Time MR in Depiction of the Eustachian Tube at 3 Tesla
Authors: Wu Chao , Xu Qiang
Published: October 2021

Objectives:

To investigate the feasibility of ultrashort echo time (UTE) imaging in the visualization of Eustachian tubes (ETs).

Methods:

The local institutional review board approved the study protocol. Twenty volunteers were involved in this study. The scanning scheme consisted of T2-sampling perfection with application-optimized contrasts by using different flip angle evolutions (T2-SPACE) MR imaging with water excitation, a UTE scan with a prototype sequence and a CT scan. The UTE images were compared with both the T2-SPACE and CT images. The quality of the images was rated by two radiologists blindly. Interobserver agreement was assessed using the kappa statistic. Statistical analysis was performed using SPSS software (version 17, SPSS Inc.). A value of p < 0.05 was considered statistically significant.

Results:

For all subjects, the T2-SPACE images successfully displayed the cartilaginous part of the ET (Fig. 1). The CT images fully showed the bony part of the ET for all the subjects (Fig. 2). The UTE images successfully displayed both the cartilaginous and bony parts of the ET (Fig. 3). However, the UTE images showed the cartilaginous and bony portions of the ET as a whole.

Conclusions:

By analyzing the depiction of the ET from UTE images and comparing it with that from MR and CT images, we found that UTE images could display not only the cartilaginous structure of the ET that cannot be seen by conventional MR sequences, but also the bony structure that previously could only be seen on CT images. This imaging modality could help provide a convenient and new method to display the overall shape of the ET.
Spontaneous Regression of a Middle Ear Melanoma
Authors: Krebbers Iris , Kunst Henricus P. M. , Baijens Laura W. J. , van den Hout Mari F. C. M. , Waterval Jerome J.
Published: October 2021

Objective:

To describe a case of complete spontaneous regression of a middle ear melanoma.

Patient:

We present a case of a 68-year-old man with complaints of unilateral hearing loss and an ipsilateral facial nerve paresis. Radiological and histopathological examination revealed a cT4bN0M0 mucosal melanoma of the middle ear.

Interventions:

The patient underwent a subtotal petrosectomy and postoperative radiotherapy.

Main Outcome Measure:

Computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography/computed tomography with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG-PET-CT), and histopathological examination.

Results:

After subtotal petrosectomy, histopathological examination of the resection specimen showed only fibrosis and a histiocytic and clonal T-cell infiltration, but no residual melanoma at the primary tumor site, consistent with spontaneous tumor regression. Follow-up MRI scanning 6 and 12 months after radiotherapy showed no signs of tumor recurrence.

Conclusions:

This case describes the concept of spontaneous regression of a mucosal melanoma of the middle ear. Spontaneous tumor regression at this location has not been described before.
The Interplay of Biopsychosocial Factors and Quality of Life in Inflammatory Bowel Diseases
Authors: Thomann Anne K. , Knödler Laura-Louise , Karthikeyan Sandeep , Atanasova Konstantina , Bernstein Charles N. , Ebert Matthias P. , Lis Stefanie , Reindl Wolfgang
Published: October 2021

Goal:

The aim of this study was to investigate the network of biopsychosocial factors and quality of life (QoL) in persons with inflammatory bowel diseases (IBDs) and explore the influence of psychological factors on the course of the disease.

Background:

QoL of persons with IBD depends on disease activity but also on numerous interacting psychosocial factors. The influence of psychosocial factors on the disease course in controversially discussed.

Materials and Methods:

In 2 independent IBD samples (sample 1: n=209, anonymous internet survey; sample 2: n=84, outpatients with active disease), we measured QoL, anxiety, depression, illness identity, self-esteem, loneliness, childhood trauma, and visceral sensitivity with questionnaires. In addition, fatigue, hemoglobin levels, and response to therapy were assessed in sample 2. We estimated multiple regularized partial correlation networks and conducted accuracy and stability tests of the networks.

Results:

In both samples, QoL had the strongest relationships with visceral sensitivity and the illness identity engulfment. Depression was the most central factor in the networks. Baseline depression scores, visceral sensitivity, and engulfment were associated with response to therapy in sample 2.

Conclusions:

This first network study to assess the interplay between biopsychosocial factors and QoL in IBD reveals a comparable network structure in 2 samples. Results partly replicate findings from previous studies with regard to the importance of depression and yield information on the central role of the newly introduced concepts of illness identity and visceral sensitivity. Preliminary findings point to an influence of these parameters on the disease course, which indicates their role as a possible target in individualized therapy.
Healthy lifestyle interventions across diverse workplaces: a summary of the current evidence
Authors: Sidossis Amalia , Gaviola Gabriel C. , Sotos-Prieto Mercedes , Kales Stefanos
Published: October 2021

Purpose of review

Workplaces provide a unique opportunity to deliver health promotion interventions to their workers. This review summarizes evidence from the most recent studies (September 2019 to April 2021) of workplace healthy lifestyle interventions and identifies gaps in the literature and key aspects for successful future workplace lifestyle interventions.

Recent findings

Recent intervention studies have focused on four health domains: (1) multicomponent wellness programs, (2) healthy diet interventions, (3) physical activity interventions, and (4) mental health/sleep interventions. Within each group of studies, there was significant heterogeneity in study length, intervention components, and worker populations. Nonetheless, most studies across all categories showed positive associations between healthy lifestyle interventions and improved worker health.

Although recent literature has shown an overall positive trend between healthy lifestyle interventions implemented at the workplace and improvements in markers of health and wellbeing, further research should include longer follow-up periods, more objective measures of wellbeing, evaluation of worker performance, and analogous interventions between studies to identify the most effective interventions to improve worker health and wellness.
Racial disparities in pediatric otolaryngology: current state and future hope
Authors: Pritchett Cedric V. , Johnson Romaine F.
Published: October 2021

Purpose of review

The current article reviews the current literature and selected sentinel papers on health disparities particularly relevant to the field of pediatric otolaryngology. The discussion will explore racial disparities in otologic and airway intervention areas, as well as general adenotonsillar disease management. Access to and quality of care will be examined, and disparate outcomes discussed.

Recent findings

Growing published data demonstrate children from nonwhite backgrounds receive disparate specialty care in representative fields of pediatric otolaryngology.

Racial disparities exist in specialty care pediatric otolaryngology. Such disparities should be viewed in the light of generational inequalities in the United States and the foundational inequities that perpetuate them. Parity in the delivery of such specialty care depends on recognizing our current state and intentional efforts to modulate the impact of such effectual factors.
Lynch syndrome in urological practice: diagnosis, therapeutic strategies, and screening for upper tract urothelial carcinoma
Authors: Lonati Chiara , Moschini Marco , Simeone Claudio , Spiess Philippe E. , Necchi Andrea
Published: October 2021

Purpose of review

To provide a comprehensive overview of diagnosis, treatment, and screening for upper tract urothelial carcinoma (UTUC) among Lynch syndrome patients.

Recent findings

Lynch syndrome is an autosomal dominant disorder resulting from the germline mutation in the mismatch repair (MMR) system. The Lynch syndrome predisposes to early onset of a broad spectrum of tumours, among which UTUC represents the third most frequent malignancy. Since up to 10% of UTUC can be attributed to Lynch syndrome, a correct recognition of this disease provides the opportunity for patients and their relatives to be properly treated for UTUC and to be followed up for other Lynch syndrome-related malignancies.

UTUC patients less than 65 years, or UTUC patients with personal history of Lynch syndrome-related cancer, or with one first-degree relative (FDR) less than 50 years with Lynch syndrome-related cancer, or two FDRs with Lynch syndrome-related cancer regardless of age should be referred to molecular testing and subsequent DNA sequencing to confirm Lynch syndrome diagnosis. Considering the increased risk of metachronous recurrence, treatments other than radical nephroureterectomy, such as ureteroscopic laser ablation may represent valuable therapeutic strategies. As Lynch syndrome patients exhibit an approximate 14-fold increased risk of developing UTUC compared with general population, expert recommendations are urgently required in order to point out appropriate screening protocols.
Current trends in colistin susceptibility testing methods in enteric Gram-negative bacilli and other non-fermentative pathogens
Authors: Najafi Khadijeh , Yousefi Leila , Zeinalzadeh Elham , Kafil Hossein Samadi
Published: October 2021

Polymyxins, an age-old sort of cationic polypeptide antibiotic, are regarded as final-resort drugs in handling infections caused by multidrug-resistant Gram-negative bacteria. An exact assessment of colistin susceptibility is crucial due to increasing colistin resistance and absence of other antibiotics in curing multidrug resistance pathogens. Both Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing have investigated colistin broth microdilution and offer particular recommendations, but this method has a challenging perform in routine daily practice. It is time consuming and requires ≥48 h. In this issue, several alternative rapid tests are developed such as ResaPolymyxin Acinetobacter/Pseudomonas NP. The sensitivity and specificity of 100% for the Rapid ResaPolymyxin Acinetobacter/Pseudomonas NP test to Enterobacterales have been reported. Colistin broth disk elution test and colistin agar test are another novel potential methods that were validated by the Clinical laboratory standard institutes subcommittee for colistin screening in the Enterobacterales and Pseudomonas aeruginosa. In addition, recently, Rapid flow cytometry (FASTinov) method was introduced which requires only 2 h compared with conventional methods. This review will take a look at current trends on methods for colistin resistance measurements.
Evaluation of a Nurse-Led Patient Navigation Intervention
Authors: van der Lans Mariska C.M. , Oldenmenger Wendy H. , van der Stege Heleen A. , van Staa AnneLoes , Molendijk Annemieke , Broers Annoek E.C.
Published: October 2021

Background

Complex survivorship cancer care requires nurse-led interventions. Therefore, a nurse-led patient navigation intervention was developed in which trained cancer nurses gave advice and referred to other professionals during the process of recovery and rehabilitation of hematopoietic stem cell transplantation (HSCT) patients.

Objective

The aim of this study was to understand the nature and effect of this nurse-led information and referral intervention.

Methods

Of the 199 included patients in the intervention group, 75 completed the quality of life, quality of care, self-efficacy, and self-management behavior questionnaires at baseline and at 6 and 12 months after HSCT. A historical control group of 62 patients completed the same questionnaires 12 months after HSCT. In addition, patients’ experiences with the intervention were evaluated in 2 focus groups.

Results

Patients emphasized the holistic approach of the cancer nurses and the opportunity to discuss psychosocial domains of life. Within the intervention group, a statistically significant effect on quality of life was demonstrated over time. The differences in quality of life, self-efficacy, and self-management were not significant between the intervention group and control group.

Conclusion

The holistic focus of this nurse-led intervention proved to be acceptable to the HSCT patients and promising in supporting the (complex) challenges that these patients face during their process of recovery and rehabilitation.

Implications for Practice

Nurse-led patient navigation interventions with a holistic approach when included in the daily practice of complex survivorship cancer care can support HSCT patients’ information and referral needs during their rehabilitation.