bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for persistent pain after breast and thoracic surgeries: a systematic literature review and meta-analysis
Authors: Lim Joshua , Chen Dili , McNicol Ewan , Sharma Lokesh , Varaday Grihith , Sharma Anshuman , Wilson Elizabeth , Wright-Yatsko Tiffany , Yaeger Lauren , Gilron Ian , Finnerup Nanna B. , Haroutounian Simon
Published: April 2021

Persistent postsurgical pain (PPSP) is common after breast and thoracic surgeries. Understanding which risk factors consistently contribute to PPSP will allow clinicians to apply preventive strategies, as they emerge, to high-risk patients. The objective of this work was to systematically review and meta-analyze the literature on risk factors of PPSP after breast and thoracic surgeries. A systematic literature search using Ovid Medline, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus databases was conducted. Study screening with inclusion and exclusion criteria, data extraction, and risk of bias assessment was performed independently by 2 authors. The data for each surgical group were analyzed separately and meta-analyzed where possible. The literature search yielded 5584 articles, and data from 126 breast surgery and 143 thoracic surgery articles were considered for meta-analysis. In breast surgery, younger age, higher body mass index, anxiety, depression, diabetes, smoking, preoperative pain, moderate to severe acute postoperative pain, reoperation, radiotherapy, and axillary lymph node dissection were the main factors associated with higher risk of PPSP. In thoracic surgery, younger age, female sex, hypertension, preoperative pain, moderate to severe acute postoperative pain, surgical approach, major procedure, and wound complications were associated with PPSP. This systematic review demonstrated certain consistent risk factors of PPSP after breast and thoracic surgeries, as well as identified research gaps. Understanding the factors that increase susceptibility to PPSP can help selectively allocate resources to optimize perioperative care in high-risk patients and help develop targeted, risk-stratified interventions for PPSP prevention.
Relationship between gait complexity and pain attention in chronic low back pain
Authors: Homs Alexis F. , Dupeyron Arnaud , Torre Kjerstin
Published: April 2021

Clinical models of chronic low back pain (cLBP) highlight the role of excessive attention to pain and kinesiophobia on the origin of disability. At the motor control level, various mechanisms are involved in the impairments observed in patients with cLBP. We aimed to assess the role of maladaptative attentional behaviors by using a complex systems approach and a visual display as a distraction during walking. Sixteen patients with cLBP with no previous surgery or significant leg pain and 16 healthy matched controls were included. Patients walked on a treadmill at preferred walking speed with and without distraction. Stride time (ST) fractal complexity was assessed using detrended fluctuation analysis. A two-way analysis of variance with repeated measures on distraction was performed on fractal exponents. We found a significant group × distraction interaction effect on fractal complexity of ST series (F(1,30) = 9.972, P = 0.004). Post hoc analysis showed that, without distraction, patients with cLBP had significantly lower ST complexity than controls, but when distracted, they regained gait complexity, recovering the level of controls. Our results suggest that excessive attention to pain causes loss of complexity and adaptability in cLBP and explain alterations of motor control with pain. Fractal analysis seems to be a promising method to explore movement variability and individual adaptability in musculoskeletal disorders.
Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: a systematic review and meta-analysis
Authors: Siddall Benjamin , Ram Adrian , Jones Matthew D. , Booth John , Perriman Diana , Summers Simon J.
Published: April 2021

Exercise and pain neuroscience education (PNE) have both been used as standalone treatments for chronic musculoskeletal pain. The evidence supporting PNE as an adjunct to exercise therapy is growing but remains unclear. The aim of this systematic review and meta-analysis was to evaluate the effect of combining PNE and exercise for patients with chronic musculoskeletal pain, when compared with exercise alone. A systematic search of electronic databases was conducted from inception to November 6, 2020. A quality effects model was used to meta-analyze outcomes where possible. Five high-quality randomized controlled studies (n = 460) were included in this review. The PEDro scale was used to assess the quality of individual studies, and Grading of Recommendations, Assessment, Development, and Evaluation analysis was conducted to determine the quality of evidence for each outcome. Meta-analyses were performed for pain intensity, disability, kinesiophobia, and pain catastrophizing using data reported between 0 and 12 weeks postintervention. Long-term outcomes (>12 weeks) were only available for 2 studies and therefore were not suitable for meta-analysis. Meta-analysis revealed a significant difference in pain (weighted mean differences, −2.09/10; 95% confidence interval [CI], −3.38 to −0.80; low certainty), disability (standardized mean difference, −0.68; 95% CI, −1.17 to −0.20; low certainty), kinesiophobia (standardized mean difference, −1.20; CI, −1.84 to −0.57; moderate certainty), and pain catastrophizing (weighted mean differences, −7.72; 95% CI, −12.26 to −3.18; very low certainty) that favoured the combination of PNE and exercise. These findings suggest that combining PNE and exercise in the management of chronic musculoskeletal pain results in greater short-term improvements in pain, disability, kinesiophobia, and pain catastrophizing relative to exercise alone.
Olorinab (APD371), a peripherally acting, highly selective, full agonist of the cannabinoid receptor 2, reduces colitis-induced acute and chronic visceral hypersensitivity in rodents
Authors: Castro Joel , Garcia-Caraballo Sonia , Maddern Jessica , Schober Gudrun , Lumsden Amanda , Harrington Andrea , Schmiel Shirdi , Lindstrom Beatriz , Adams John , Brierley Stuart M.
Published: April 2021

Abdominal pain is a key symptom of inflammatory bowel disease and irritable bowel syndrome, for which there are inadequate therapeutic options. We tested whether olorinab—a highly selective, full agonist of the cannabinoid receptor 2 (CB2)—reduced visceral hypersensitivity in models of colitis and chronic visceral hypersensitivity (CVH). In rodents, colitis was induced by intrarectal administration of nitrobenzene sulfonic acid derivatives. Control or colitis animals were administered vehicle or olorinab (3 or 30 mg/kg) twice daily by oral gavage for 5 days, starting 1 day before colitis induction. Chronic visceral hypersensitivity mice were administered olorinab (1, 3, 10, or 30 mg/kg) twice daily by oral gavage for 5 days, starting 24 days after colitis induction. Visceral mechanosensitivity was assessed in vivo by quantifying visceromotor responses (VMRs) to colorectal distension. Ex vivo afferent recordings determined colonic nociceptor firing evoked by mechanical stimuli. Colitis and CVH animals displayed significantly elevated VMRs to colorectal distension and colonic nociceptor hypersensitivity. Olorinab treatment significantly reduced VMRs to control levels in colitis and CVH animals. In addition, olorinab reduced nociceptor hypersensitivity in colitis and CVH states in a concentration- and CB2-dependent manner. By contrast, olorinab did not alter VMRs nor nociceptor responsiveness in control animals. Cannabinoid receptor 2 mRNA was detected in colonic tissue, particularly within epithelial cells, and dorsal root ganglia, with no significant differences between healthy, colitis, and CVH states. These results demonstrate that olorinab reduces visceral hypersensitivity through CB2 agonism in animal models, suggesting that olorinab may provide a novel therapy for inflammatory bowel disease– and irritable bowel syndrome–associated abdominal pain.
Sexual Activity After Acute Coronary Syndrome
Authors: Boothby Célina A. , Santana Maria J. , Norris Colleen M. , Campbell Tavis S. , Rabi Doreen M.
Published: April 2021

Background

Little is known about how best to support both patients and their partners in the reengagement of sexual activity (SA) after acute coronary syndrome (ACS), with sparse direct data from the partner on their needs and concerns in the area of SA support.

Objectives

We undertook a qualitative study to address this gap in the literature through 3 objectives from a patient and partner perspective: (1) to characterize the experience of reengaging in SA post ACS, (2) to identify needs and priorities in the area of SA support post ACS, and (3) to determine whether cardiac rehabilitation (CR) could be an acceptable point of intervention for SA support.

Methods

Semistructured qualitative interviews were conducted with 6 male patients who were post ACS and their partners (age range, 47–81 years). Patients were criterion sampled from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease database. Inductive thematic data analysis was conducted.

Results

Four themes were identified: “importance,” “support received,” “on their own,” and “wanting support.” Couples reaffirmed the importance of SA pre and post ACS, reported SA support as currently insufficient but articulated ways it could be improved, and reported CR as a current source of SA support but thought there could be room for improvement on the content and delivery of such information.

Conclusions

This study illustrates the potential value of promoting SA support for both patients who are post ACS and their partners and reports that SA support provided at CR would be viewed as important, needed, and acceptable.
Mononitrate Isosorbide as an Adjunctive Therapy in Schizophrenia
Authors: Guimarães Tiago M. , Guimarães Mara R. C. , Oliveira Ícaro A. F. , Leoni Renata F. , Santos Antonio C. , Dursun Serdar M. , Crippa Jose A.S. , Bressan Rodrigo A. , Machado-de-Sousa João Paulo , Lacerda Acioly L. T. , Hallak Jaime E. Cecílio
Published: April 2021

Background

Schizophrenia is a complex disabling mental disorder, and many patients present poor response to available treatments. Accumulating evidence about the role of the glutamate/nitric oxide pathway in mediating the positive and negative symptoms of schizophrenia suggests potential benefits of drugs that modulate this system. The aim of this study was to test the efficacy of isosorbide mononitrate (ISMN) as an adjunctive therapy for symptomatic outpatients with schizophrenia.

Methods

This was a 2-month randomized, double-blind, placebo-controlled trial with 24 schizophrenia patients. Participants were treated with ISMN 50 mg for 1 month and placebo for another month in a crossover design. The Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale, Global Assessment of Functioning, and MATRICS Cognitive Consensual Battery were used for symptom assessment and arterial spin labeling was used to assess brain activation patterns.

Results

We found significant differences in the total, general, and positive subscales of the PANSS, Global Assessment of Functioning scores, and Clinical Global Impression scores during treatment with ISMN relative to placebo. No treatment effects were found comparing scores in the MATRICS Cognitive Consensual Battery and the negative subscale of the PANSS between the active and placebo conditions. A post hoc analysis of neuroimaging data showed reduced activity in the thalamus in subgroup of patients with severe psychopathology.

Conclusions

Schizophrenia patients with persistent symptoms showed significant improvement after 4 weeks of treatment with ISMN 50 mg/d compared with placebo. Isosorbide mononitrate added beneficial effects to antipsychotic treatment in terms of positive symptoms and functioning.
A Review of the State of HIV Nursing Science With Sexual Orientation, Gender Identity/Expression Peoples
Authors: Phillips J. Craig , Hidayat Jufri , Clark Kristen D. , Melisek Julia , Balthazar Monique S. , Beck Albert G. D. , Moore Scott E. , Dawson-Rose Carol
Published: April 2021

Throughout the HIV pandemic, nurses have contributed to or led approaches to understanding the effects of HIV disease at individual and societal levels. Nurses have advocated for socially just care for more than a century, and our efforts have created a foundation on which to further build the state of HIV nursing science with sexual orientation and gender identity/expression (SOGI) Peoples. Nurses have also participated in the development of approaches to manage HIV disease for and in collaboration with populations directly affected by the disease. Our inclusive approach was guided by an international human rights legal framework to review the state of nursing science in HIV with SOGI Peoples. We identified articles that provide practice guidance (n = 44) and interventions (n = 26) to address the health concerns of SOGI Peoples and our communities. Practice guidance articles were categorized by SOGI group: SOGI People collectively, bisexual, transgender, cisgender lesbian, women who have sex with women, cisgender gay men, and men who have sex with men. Interventions were categorized by societal level (i.e., individual, family, and structural). Our review revealed opportunities for future HIV nursing science and practices that are inclusive of SOGI Peoples. Through integrated collaborative efforts, nurses can help SOGI communities achieve optimal health outcomes that are based on dignity and respect for human rights.
The Effect of High-Fidelity Simulation–Based Learning in Acute Cardiorespiratory Physical Therapy—A Mixed-Methods Systematic Review
Authors: Brown Laura , Ilhan Emre , Pacey Verity , Hau Wendy , Van Der Kooi Veronica , Dale Marita
Published: April 2021

Background and Purpose.

Simulation-based learning is commonly used in physical therapy education. However, given the financial cost and resources required to provide high-fidelity simulation (HFS)-based learning, it is necessary to determine its effectiveness. Therefore, the purpose of this study was to investigate the effect of HFS-based learning using computerized mannequins on clinical performance and preparedness of physical therapy students and physical therapists in acute cardiorespiratory physical therapy.

Methods.

We undertook a mixed-methods systematic review and meta-analysis. Search strategies were used to find articles in electronic databases. Reference lists of studies were also searched. Included studies investigated the effect of HFS-based learning on physical therapy students' and physical therapists' clinical performance and preparedness in acute cardiorespiratory physical therapy and included the use of computerized mannequins. Both quantitative and qualitative studies were considered.

Results.

A total of 12 trials from 11 articles were included. Quantitative findings of pooled studies indicated a small, but not statistically significant, effect of simulation training on clinical performance of physical therapy students' when compared with traditional learning methods (Hedges' g = 0.18; 95% confidence interval, −0.18 to 0.64; P = .07; I
2 = 57%). Qualitative data were synthesized into 4 themes in which HFS positively impacted students' preparedness: familiarization with the clinical setting, real-world learning in a controlled environment, learning about patient safety, and self-efficacy and confidence. Only the theme of self-efficacy and confidence were able to be integrated with quantitative data, demonstrating a positive effect of HFS on students' and physical therapists' self-efficacy and confidence.

Discussion and Conclusion.

High-fidelity simulation involving the use of computerized mannequins improves students' preparedness for clinical practice but does not improve students' clinical performance, although limited evidence exists for physical therapists' preparedness and clinical performance, indicating that further research of physical therapy clinicians is required.
Organizational empowerment and practice outcomes of acute care nurse practitioners in Taiwan: A national survey
Authors: Luo Pei-Ying , Tung Heng-Hsin , Huang Sheng-Shiung , Kau Kevin , Chang Shu-Chen , Shiu Shu-Ying , Tsay Shiow-Luan
Published: April 2021

Background:

Nurse practitioners (NPs) play an important role in addressing growing health care needs. Among NPs, organizational empowerment is positively associated with overall practice outcomes. Therefore, efforts to promote organizational empowerment in practice are necessary to increase job satisfaction among NPs as well as decrease the stress and intention to leave.

Purpose:

This study investigated the relationships of organizational empowerment and practice outcomes of job satisfaction, work stress, and intention to leave in acute care practices.

Methodological orientation:

This study was conducted as a cross-sectional design with a national survey of 946 acute care NPs. Questionnaires contained demographic and practice characteristics, Misener Nurse Practitioner Job Satisfaction Scale, Condition for Work Effectiveness Questionnaire II, and the work stress VAS scale. Hierarchical Linear Model (HLM) was used to investigate individual NP-level or organization-level effects on job satisfaction. The factors associated with job satisfaction were examined by stepwise multiple regression.

Results:

The organizational empowerment was low, work stress was moderately high, and job satisfaction was between slightly unsatisfied and slightly satisfied. The HLM results indicated that organization-level effects did not affect the job satisfaction of NPs. Nurse practitioners with greater formal power, resources, and informal power had higher job satisfaction. Conversely, NPs with an intention to leave and a higher level of stress showed lower job satisfaction.

Conclusions:

Organizational empowerment, intention to leave, and stress affect job satisfaction of acute care NPs in Taiwan.

Implications for practic:

To enhance the job satisfaction of NPs, health care administrators should empower NPs by providing access to opportunity, support, information, and resources in the health care delivery system.
Drivers for seeking the doctor of nursing practice degree and competencies acquired as reported by nurses in practice
Authors: Kesten Karen S. , Moran Katherine , Beebe Sarah L. , Conrad Dianne , Burson Rosanne , Corrigan Catherine , Manderscheid Amy , Pohl Elizabeth
Published: April 2021

Background:

The American Association of Colleges of Nursing introduced the Doctor of Nursing Practice (DNP) degree in 2004. To date, few publications examine the competencies and impact of nurses with practice doctorates.

Purpose:

The purpose of this study was to examine reasons for seeking a DNP degree, assess knowledge and competencies acquired from DNP programs, and to inform stakeholders about the skills acquired by nurses with practice doctorates.

Methods:

A cross-sectional design was used to administer a self-report survey to a convenience sample of DNP-prepared nurses in practice, recruited from a national membership organization. The electronic survey was designed using constructs developed from the literature, national organization position statements, and standards of doctoral nursing education.

Results:

A total of 306 participants responded to the survey, 270 were used after data review. The majority of respondents did not seek a DNP degree because it was required for a job, to gain additional supervised practice, or to receive additional training with a specialty population. The majority strongly agreed that they gained competency in translating and synthesizing research evidence into practice, designing and implementing quality improvement, and identifying, measuring, and evaluating outcomes.

Conclusions:

Primary reasons for seeking a DNP degree were seeking knowledge, skills, competencies, confidence, and job opportunities.

Implications for practice:

Doctor of Nursing Practice–prepared nurses hold unique, advanced knowledge, competencies and skills to affect health care across multiple settings. Study results suggest that highly skilled DNP-prepared nurses are equipped to lead quality improvement, engage in practice scholarship, and improve clinical outcomes.
Diabetes management among underserved older adults through telemedicine and community health workers
Authors: Marsh Zyrene , Nguyen Yen , Teegala Yamini , Cotter Valerie T.
Published: April 2021

Background:

Diabetes mellitus (DM) disproportionately affects older adults from marginalized communities. In the United States, the prevalence of DM in ages ≥65 years is twofold higher than the national average for adult populations. Telemedicine and community health workers (CHWs) are emerging diabetes care models but their impact on older adults with limited resources are relatively neglected within the medical literature.

Objectives:

The purpose of this systematic review was to explore the impact of telemedicine and CHW interventions for improving A1C levels and self-management behaviors among underserved older adults with DM.

Data sources:

A systematic literature search was performed in PubMed, CINAHL, Embase, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a reporting guideline.

Conclusions:

Diabetes self-management education (DSME) administered through telemedicine and CHW interventions were effective for improving A1C levels, self-care adherence, and patient and provider satisfaction among adults aged ≥50 years. Common barriers to diabetes care include inadequate resources, lack of transportation, inconsistent means of communications, social isolation, and low motivation. Community health workers and telemedicine were effective in improving disease management and optimizing care coordination within the vulnerable adult populations.

Implications for practice:

Well-coordinated, evidence-based, and population-centered interventions can overcome the unique disparities experienced by underserved older adults with diabetes. Incorporating DSME-guided telemedicine and CHW interventions into primary care can mitigate diabetes-related complications in older populations. The lack of evidence specific to adults aged ≥65 years calls for a universally accepted age range when referring to older adults in future research.
Counterpunching to improve the health of people with Parkinson's disease
Authors: Hermanns Melinda , Mastel-Smith Beth , Donnell Rachel , Quarles Allison , Rodriguez Melissa , Wang Tianjing
Published: April 2021

Background:

Boxing programs designed specifically for people with Parkinson's disease (PD) can be beneficial in improving the physical, mental, and functional health of persons with PD.

Purpose:

This study examined the effect of a boxing program, Rock Steady Boxing (RSB), on the health of people with PD from both the boxers' and their caregivers' perspectives as well as evaluated balance, quality of life (QoL), and depressive symptoms after 12 weeks of RSB.

Methods:

A mixed methods, one-group experimental design with focus groups were embedded within an intervention study. Six boxers completed baseline and 12-week postassessments.

Results:

The majority of boxers maintained or improved scores for balance, QoL, and reduced depressive symptoms. Findings indicate physical and mental benefits of RSB among persons with PD and this was further validated by qualitative data from boxers and caregivers, along with quantitative data of boxers. Caregivers and boxers reported that boxers' ability to perform activities of daily living (ADLs) improved and is supported by quantitative improvements in the Parkinson's disease Questionnaire-39 ADL subscale. All boxers reported reduced stigma, and caregivers and boxers valued the opportunity to work out in an environment free of stigma, a finding not previously reported.

Conclusions:

It is important for nurse practitioners to recognize exercise benefits for people with PD and recommend the program to patients and include caregivers in their overall assessment of health and wellness.

Implications for practice:

Nurse practitioners and other health practitioners may consider recommending a boxing program, such as RSB, for their PD patients as a sole or supplemental exercise program.
Erosive Lichen Sclerosus—A Clinicopathologic Subtype
Authors: Day Tania , Otton Geoffrey , Dennerstein Graeme , Tran Hong , Scurry James
Published: April 2021

Objective

The aim of the study was to identify whether erosive lichen sclerosus (LS) is a distinct clinicopathologic subtype.

Materials and Methods

The pathology database was searched for “erosion,” “erosive,” “ulcer,” and “lichen sclerosus.” Inclusion criteria were histopathologic diagnosis of LS and erosion or ulcer overlying a band of hyalinization and/or fibrosis. Exclusions were concurrent neoplasia and insufficient tissue. Histopathologic review documented site, epithelial thickness, adjacent epidermal characteristics, infiltrate, and dermal collagen abnormality. Clinical data included demographics, comorbidities, examination findings, microbiologic results, treatment, and response.

Results

Ten examples of erosive LS and 15 of ulcerated LS occurred in 24 women with a mean age of 67 years. Ulcerated LS was associated with diabetes and nontreatment at time of biopsy. Clinicians identified red patches in all but 1 case of erosive LS. Ulcerated LS was documented as fissure, ulcer, or white plaque, with 8 (53%) described as lichenified LS with epidermal breaches. Erosive LS favored hairless skin with normal adjacent stratum corneum sloping gently into erosion, whereas most ulcers in LS had an abrupt slope from hair-bearing skin. All cases were treated with topical steroids; 2 patients with erosive LS and 10 with ulcerated LS also had oral antifungals, topical estrogen, antibiotics, and/or lesional excision. Treatment yielded complete resolution in 50%.

Conclusions

Erosive LS is an unusual clinicopathologic subtype characterized by red patches on hairless skin seen microscopically as eroded epithelium overlying a band of hyalinized or fibrotic collagen. In contrast, ulcerated LS is usually a traumatic secondary effect in an uncontrolled dermatosis.
Aeration of the Human Prussak's Space: A 3D Synchrotron Imaging Study
Authors: Li Hao , Giese Dina , Rohani Seyed Alireza , Zhu Ning , Ladak Hanif M. , Agrawal Sumit , Rask-Andersen Helge
Published: April 2021

Objectives:

Prussak's space (PS) is an intricate middle ear region which may play an essential role in the development of middle ear disease. The three-dimensional (3D) anatomy of the human PS and its drainage routes remain relatively unknown. Earlier studies have histologically analyzed PS, by micro-dissection and endoscopy. Here, we used synchrotron-radiation phase-contrast imaging (SR-PCI), 3D reconstructions, and modeling to study the framework of the human PS, including aeration pathways. It may lead to increased understanding of development of middle ear pathology.

Design:

Nine human temporal bone specimens underwent in-line SR-PCI at the Canadian Light Source in Saskatoon, Saskatchewan, Canada. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping and segmentations to visualize its walls in fixed, undecalcified human temporal bones.

Results:

The PS was found to be an irregular, variably shaped chamber with different aeration systems. Three different drainage pathways were found: 1) via the posterior malleolar pouch of von Tröltsch in seven of nine ears; 2) directly posterior-inferior into the mesotympanum medial to the posterior malleolar pouch in one ear; and 3) anteriorly in another. The posterior-inferior communications depended on the anatomy of the posterior malleolar fold. In one bilateral case, the aeration differed between the ears. Earlier descriptions of upper ventilation routes between the PS and the epitympanic spaces could not be substantiated.

Conclusions:

The 3D anatomy of the membrane folds organizing the PS in humans was demonstrated for the first time using in-line SR-PCI. The PS was always aerated into the mesotympanum, suggesting its relative independence of attic ventilation. The impact of its various drainage routes on middle ear ventilation and disease were discussed.
Pharmacokinetics of Single Dose Lidocaine and Epinephrine Following Iontophoresis of the Tympanic Membrane in a Double-Blinded Randomized Trial
Authors: England Laura J. , Syms Charles A. , York Christopher
Published: April 2021

Objective:

To evaluate local and systemic safety of bilateral iontophoretic administration of lidocaine with epinephrine or lidocaine alone to the tympanic membrane (TM).

Study Design:

A randomized, double-blind, two-arm study was conducted at a single center. Healthy adults were randomized to bilateral iontophoretic treatment with 2% lidocaine, 1:100,000 epinephrine, or 2% lidocaine (control). Otoscopy, cranial nerve examination, tympanometry, and audiometry safety evaluations were conducted before and 3-days post-procedure. Systemic safety was evaluated via analysis of vital signs taken before and up to 120 minutes post-iontophoresis, and blood samples collected before and up to 230 minutes post-iontophoresis.

Results:

Twenty-five subjects were treated with bilateral iontophoresis of either lidocaine and epinephrine (n = 15 subjects) or lidocaine alone (n = 10). Mean plasma epinephrine concentrations for both groups remained within the normal range for endogenous epinephrine. Mean plasma concentrations of lidocaine were not statistically different between groups, ranging from 0.245 to 2.28 ng/ml after administration of lidocaine with epinephrine (immediate post-iontophoresis to 230 min post-iontophoresis), compared with 1.35 to 2.14 ng/ml after administration of lidocaine alone. The presence of epinephrine slowed the systemic absorption of lidocaine. Lidocaine levels (Cmax 2.24 ng/ml) were approximately 2000-fold lower than the threshold for minor lidocaine toxicity. No device-, procedure- or drug-related adverse events were reported.

Conclusion:

The local and systemic safety of bilateral iontophoretic delivery of 2% lidocaine, 1:100,000 epinephrine to the TM was demonstrated by low plasma levels of drug and absence of both serious and non-serious device-, procedure-, or drug-related adverse events.
Magnetic Steering of Robotically Inserted Lateral-wall Cochlear-implant Electrode Arrays Reduces Forces on the Basilar Membrane In Vitro
Authors: Hendricks Cameron M. , Cavilla Matt S. , Usevitch David E. , Bruns Trevor L. , Riojas Katherine E. , Leon Lisandro , Webster Robert J. , Warren Frank M. , Abbott Jake J.
Published: April 2021

Hypothesis:

Undesirable forces applied to the basilar membrane during surgical insertion of lateral-wall cochlear-implant electrode arrays (EAs) can be reduced via robotic insertion with magnetic steering of the EA tip.

Background:

Robotic insertion of magnetically steered lateral-wall EAs has been shown to reduce insertion forces in vitro and in cadavers. No previous study of robot-assisted insertion has considered force on the basilar membrane.

Methods:

Insertions were executed in an open-channel scala-tympani phantom. A force plate, representing the basilar membrane, covered the channel to measure forces in the direction of the basilar membrane. An electromagnetic source generated a magnetic field to steer investigational EAs with permanent magnets at their tips, while a robot performed the insertion.

Results:

When magnetic steering was sufficient to pull the tip of the EA off of the lateral wall of the channel, it resulted in at least a 62% reduction of force on the phantom basilar membrane at insertion depths beyond 14.4 mm (p < 0.05), and these beneficial effects were maintained beyond approximately the same depth, even with 10 degrees of error in the estimation of the modiolar axis of the cochlea. When magnetic steering was not sufficient to pull the EA tip off of the lateral wall, a significant difference from the no-magnetic-steering case was not found.

Conclusions:

This in vitro study suggests that magnetic steering of robotically inserted lateral-wall cochlear-implant EAs, given sufficient steering magnitude, can reduce forces on the basilar membrane in the first basilar turn compared with robotic insertion without magnetic steering.
Combined Electric and Acoustic Stimulation (EAS) in Children: Investigating Benefit Afforded by Bilateral Versus Unilateral Acoustic Hearing
Authors: Roberts Jillian B. , Stecker G. Christopher , Holder Jourdan T. , Gifford René H.
Published: April 2021

Purpose:

Electric and acoustic stimulation (EAS) with preserved hearing in the implanted ear provides benefit for speech understanding, spatial hearing, and quality of life in adults. However, there is limited research on EAS outcomes in children. The aims of this study were to estimate the magnitude of EAS-related benefit on speech understanding in children with preserved acoustic hearing and to determine what role acoustic interaural time difference (ITD) sensitivity may have on said EAS benefit.

Methods:

Six children with acoustic hearing preservation and 20 children with normal hearing (NH) were recruited to participate. Speech recognition was assessed via an eight-loudspeaker array with speech presented from one loudspeaker at 0 degree and restaurant noise from all other loudspeakers (45–315 degrees). ITD thresholds were measured for a 250-Hz signal presented acoustically via insert earphones.

Results:

Only one EAS listener demonstrated significant benefit from bilateral acoustic hearing as compared with acoustic hearing from a single ear. ITD thresholds were poor in the range of 302 to 1000+ ms and were considerably poorer than ITD thresholds for the NH group.

Conclusion:

These data suggest that children with acoustic hearing preservation may not exhibit initial EAS benefit for speech recognition in semi-diffuse noise; however, because none exhibited a decrement in performance with bilateral acoustic stimulation, EAS fittings are recommended to provide binaural acoustic access allowing for EAS adaptation to binaural cues over time. Future research should address the emergence of EAS benefit, binaural cue sensitivity, and the role of EAS experience in children and adults.
Identification of a Novel Copy Number Variation of EYA4 Causing Autosomal Dominant Non-syndromic Hearing Loss
Authors: Ishino Takashi , Ogawa Yui , Sonoyama Toru , Taruya Takayuki , Kono Takashi , Hamamoto Takao , Ueda Tsutomu , Takeno Sachio , Moteki Hideaki , Nishio Shin-ya , Usami Shin-ichi , Nagano Yuka , Yoshimura Akiko , Yoshikawa Kohei , Kato Mikako , Ichimoto Masaya , Watanabe Rina
Published: April 2021

Objective:

Eyes absent 4 (EYA4) is the causative gene of autosomal dominant non-syndromic hereditary hearing loss, DFNA10. We aimed to identify a copy number variation of EYA4 in a non-syndromic sensory neural hearing loss pedigree.

Family and Clinical Evaluation:

A Japanese family showing late-onset and progressive hearing loss was evaluated. A pattern of autosomal dominant inheritance of hearing loss was recognized in the pedigree. No cardiac disease was observed in any of the individuals.

Methods:

Targeted exon sequencing was performed using massively parallel DNA sequencing (MPS) analysis. Scanning of the array comparative genomic hybridization (aCGH) was completed and the copy number variation (CNV) data from the aCGH analysis was confirmed by matching all CNV calls with MPS analysis. Breakpoint detection was performed by whole-genome sequencing and direct sequencing. Sequencing results were examined, and co-segregation analysis of hearing loss was completed.

Results:

We identified a novel hemizygous indel that showed CNV in the EYA4 gene from the position 133,457,057 to 133,469,892 on chromosome 6 (build GRCh38/hg38) predicted as p.(Val124_Pro323del), and that was segregated with post-lingual and progressive autosomal dominant sensorineural hearing loss by aCGH analysis.

Conclusion:

Based on the theory of genotype–phenotype correlation with EYA4 mutations in terms of hearing loss and comorbid dilated cardiomyopathy, the region of amino acids 124 to 343 is hypothesized not to be the pathogenic region causing dilated cardiomyopathy. Additionally, the theory of genotype–phenotype correlation about the prevalence of dilated cardiomyopathy is thought to be rejected because of no correlation of deleted amino acid region with the prevalence of dilated cardiomyopathy. These results will help expand the research on both the coordination of cochlear transcriptional regulation and normal cardiac gene regulation via EYA4 transcripts and provide information on the genotype–phenotype correlations of DFNA10 hearing loss.
Real Time Monitoring During Cochlear Implantation: Increasing the Accuracy of Predicting Residual Hearing Outcomes
Authors: Weder Stefan , Bester Christofer , Collins Aaron , Shaul Chanan , Briggs Robert J. , O’Leary Stephen
Published: April 2021

Objectives:

Real-time electrocochleography (rt-ECochG) is a method to detect intracochlear potential changes during cochlear implantation (CI). Steep amplitude drops of the cochlear microphonic (CM) signal (so called “ECochG events”) have been correlated with worse residual hearing outcomes. However, the sensitivity and specificity of monitoring CM amplitude on its own are too low to use it as a biomarker. The aim of this article was to establish if additional signal components would help to better predict postoperative hearing outcomes.

Design and Setting:

Single-center, prospective cohort study at a tertiary referral hospital.

Participants and Interventions:

Between 2017 and 2020, we included 73 adult patients receiving a lateral wall cochlear implant electrode. During electrode insertion, rt-ECochG measurements were performed.

Main Outcomes:

We calculated a multiple regression analysis for patients with one ECochG event. The dependant variable was the relative acoustic hearing result 4 weeks after surgery. Independent variables were CM latency, a ratio of the auditory nerve neurophonic to the CM (the ANN/CM index) as well as CM signal recovery.

Results:

The change of the ANN/CM index linearly correlated with acoustic hearing outcomes 4 weeks after surgery. Adding this factor led to a statistically significant increase in the variance accounted for by the regression model.

Conclusions:

When monitoring the implantation process with rt-ECochG, prediction of postoperative hearing thresholds is improved by addition of the ANN/CM index to a model that includes CM amplitude fluctuation.
Endoscopic Repair of a Temporal Bone Pneumatocele
Authors: Mooney Craig P. , Patel Nirmal
Published: April 2021

Objective:

Pneumatoceles of the temporal bone are rare entities. A symptomatic external auditory canal pneumatocele repaired endoscopically is demonstrated.

Methods:

A 79-year-old man presented with fluctuating hearing loss and difficulty wearing in-ear hearing aids. The patient had two previous tube insertions which both failed within days. Examination of the left ear revealed a cyst filling the superior aspect of the lateral canal and obscuring the view of the majority of the tympanic membrane. Pre-op audiogram demonstrated a symmetric bilateral mild to moderate sensorineural hearing loss. The patient underwent a transcanal endoscopic composite cartilage myringoplasty. On incising the pneumatocele, a pars flaccida defect was identified in continuity with the pneumatocele. After excising the pneumatocele, a posterosuperior based tympanomeatal flap was raised and the defect repaired with a composite tragal cartilage perichondrial graft.

Results:

The patient had an uneventful recovery. On first postoperative review, the tympanomeatal flap had healed and the cartilage graft was intact with partial integration and epithelialization. There was no evidence of pneumatocele recurrence and his existing hearing aids were able to be worn with satisfactory amplification. The formation of the pneumatocele was presumed secondary to a ball-valve effect of skin through the pars flaccida defect and progressive raising of the epithelial layer in continuity with the canal skin.

Conclusion:

Surgical repair of temporal bone pneumatoceles is warranted in symptomatic patients. Identifying and addressing the underlying cause of their development is essential to surgical management.

SDC video link: http://links.lww.com/MAO/B267
Initial Hearing Preservation Is Correlated With Cochlear Duct Length in Fully-inserted Long Flexible Lateral Wall Arrays
Authors: Hollis Emily S. , Canfarotta Michael W. , Dillon Margaret T. , Rooth Meredith A. , Bucker Andrea L. , Dillon Sarah A. , Young Allison , Quinones Kristen , Pillsbury Harold C. , Dedmon Matthew M. , O’Connell Brendan P. , Brown Kevin D.
Published: April 2021

Objectives:

To characterize the relationship between cochlear duct length (CDL) and initial hearing preservation among cochlear implant recipients of a fully inserted 31.5 mm flexible lateral wall electrode array.

Study Design:

Retrospective review.

Setting:

Tertiary academic referral center.

Patients:

Adult cochlear implant recipients who presented preoperatively with unaided hearing detection thresholds of ≤ 65 dB HL at 125 Hz and underwent cochlear implantation with a 31.5 mm flexible lateral wall array.

Intervention:

Cochlear implantation with a hearing preservation surgical approach.

Main Outcome Measures:

Computed tomography was reviewed to determine CDL. Hearing preservation was characterized by the shift in low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz), and shift in individual unaided hearing detection thresholds at 125, 250, and 500 Hz.

Results:

Nineteen patients met the criteria for inclusion. The mean CDL was 34.2 mm (range: 30.8–36.5 mm). Recipients experienced a mean LFPTA shift of 27.6 dB HL (range: 10–50 dB HL). Significant, negative correlations were observed between CDL and smaller threshold shifts at individual frequencies and LFPTA (p ≤ 0.048).

Conclusion:

A longer CDL is associated with greater likelihood of preserving low-frequency hearing with long arrays. Low-frequency hearing preservation is feasible with fully inserted long flexible arrays within the initial months after cochlear implantation. Preoperative measurement of CDL may facilitate a more individualized approach in array selection to permit optimal cochlear coverage while enhancing hearing preservation outcomes.
Sensorineural Hearing Loss Caused by Labyrinthine Erosion Due to a Cerebrospinal Fluid Diverticulum
Authors: Dielmann Alexandra , Moncada Paola , Monfared Ashkan
Published: April 2021

Objective:

To present a case of progressive sensorineural hearing loss (SNHL) caused by labyrinthine erosion secondary to expanding geniculate ganglion cerebrospinal fluid (CSF) diverticulum extending along the path of the facial nerve.

Patient:

Thirteen-year-old man with no past medical history or risk factors presented with unilateral progressive SNHL and no other otologic or neurologic symptoms.

Interventions:

Audiological data as well as imaging studies including a magnetic resonance imaging (MRI) of the brain and internal auditory canal and a temporal bone computed tomography (CT) are presented. Partial labyrinthectomy, CSF leak closure, and cochlear implantation were performed. A lumbar puncture was obtained 2 months postoperatively.

Main Outcome Measure:

Closure of the CSF leak.

Results:

Mastoidectomy revealed a wide area of CSF leak through the geniculate ganglion and fallopian canal with partial destruction of the superior and lateral semicircular canals by an expanding diverticulum.

Conclusions:

This is an unusual presentation of progressive SNHL due to partial labyrinthine erosion due to a meningocele of the geniculate ganglion along the fallopian canal. It is likely that the patient had a congenital open pathway through the labyrinthine segment of the facial nerve and CSF pulsations created the meningocele over a few years. This case argues for early closure of such CSF diverticula to prevent possible SNHL due to labyrinthine erosion.
Spinal epidural hematoma in a child with hemophilia A with high titer inhibitors and follow-up with prophylactic emicizumab: case report and literature review
Authors: Villarreal-Martínez Laura , Sepúlveda-Orozco María d.C. , García-Viera Daniel A. , Robles-Sáenz David A. , Bautista-Gómez Andrea J. , Ortiz-Castillo Miguel , González-Martínez Gerardo , Mares-Gil José E.
Published: April 2021

Hemorrhage in the central nervous system is the most severe and debilitating manifestation affecting patients with hemophilia A. The spinal epidural space is the most unusual and clinically challenging site of central nervous system hemorrhage in hemophilia A. These patients often show insidious neurological signs and symptoms that delay diagnosis and treatment. We share our experience treating a 4-year-old male patient with severe hemophilia A and high titer inhibitors with a spontaneous spinal epidural hematoma. The patient presented initially with intense headache and neck pain. After blood tests and imaging studies, bypassing agent therapy with recombinant-activated factor VII was used until discharge; this was later replaced with emicizumab. After 18 months, the patient is without neurological sequelae and has not experienced subsequent bleeding episodes. We review the available literature and discuss the relevance of emicizumab compared with standard therapies in the context of spontaneous spinal epidural hematoma.
Blood lactate levels in sepsis: in 8 questions
Authors: Vincent Jean-Louis , Bakker Jan
Published: April 2021

Purpose of review

Blood lactate concentrations are frequently measured in critically ill patients and have important prognostic value. Here, we review some key questions related to their clinical use in sepsis.

Recent findings

Despite the metabolic hurdles, measuring lactate concentrations remains very informative in clinical practice. Although blood lactate levels change too slowly to represent the only guide to resuscitation, serial lactate levels can help to define the patient's trajectory and encourage a review of the therapeutic strategy if they remain stable or increase over time.

Lactate concentrations respond too slowly to be used to guide acute changes in therapy, but can help evaluate overall response. Hyperlactatemia should not be considered as a problem in itself, but as a warning of altered cell function.
Clinical use of peripheral perfusion parameters in septic shock
Authors: Bakker Jan
Published: April 2021

Purpose of review

Current goals of resuscitation in septic shock are mainly a fixed volume of fluids and vasopressors to correct hypotension and improve tissue perfusion indicated by decreasing lactate levels

Recent findings

Abnormal peripheral perfusion by objective and subjective parameters are associated with increased mortality in various phases of the treatment of critically ill patients including patients with septic shock. Ongoing resuscitation in septic shock patients with normal peripheral perfusion is not associated with improved outcome, rather with increased mortality. Mitigation of fluid resuscitation by using parameters of peripheral perfusion in septic shock seems to be safe.

Septic shock patients with normal peripheral perfusion represent a different clinical phenotype of patients that might benefit from limited resuscitation efforts. Parameters of peripheral perfusion could be used to guide the individualization of patients with septic shock