bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Neuroanesthesia Practice During the Early Stages of the COVID-19 Pandemic: Experiences From a Single Center in China
Authors: Jian Minyu , Liang Fa , Liu Haiyang , Zeng Hengyu , Peng Yuming , Han Ruquan
Published: September 2020

Background:

Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, is highly contagious. Global medical systems have been heavily impacted by the COVID-19 pandemic. Although the majority of patients with intracranial disease require time-sensitive surgery, how to conduct neurosurgery and prevent and control nosocomial infection during a pandemic is challenging.

Materials and Methods:

We retrospectively reviewed the clinical data of patients undergoing neurosurgical and neurointerventional procedures at Beijing Tiantan Hospital, China during the early stages of the COVID-19 pandemic between January 21 and July 31, 2020. A 3-level system of COVID-19 risk was established based on medical conditions, epidemiologic, and symptom inquiry and the results of triage. A transitional unit was established for patients in whom COVID-19 had not been ruled out on admission to hospital.

Results:

A total of 4025 patients underwent neurosurgery during the study period, including 768 emergent and 3257 nonemergent procedures. Of these patients, 3722 were low-risk for COVID-19, 303 were moderate-risk, and none were high-risk. In addition, 1419 patients underwent neurointerventional procedures, including 114 emergent and 1305 nonemergent interventions, of which 1339 were low-risk patients, 80 were moderate-risk and none were high-risk. A total of 895 patients (neurosurgical and neurointerventional) were admitted to the transitional unit. Forty-five patients were diagnosed with COVID-19 and transferred to the COVID-19 designated hospital. There were no cases of COVID-19 nosocomial infections among surgical patients or health care workers.

Conclusion:

On the basis of our single-center experience, developing a full screening protocol for COVID-19, establishing a risk level, and using a transitional unit for those with unknown COVID-19 status are effective measures to provide a safe environment for patients and health care workers.
Arthroscopic Superior Capsular Reconstruction With Achilles Tendon Allograft: A Good Option for Irreparable Supraspinatus Tendon Tears
Authors: Xará-Leite Francisco , Barros Luís H. , Claro Rui
Published: September 2020

Introduction:

Irreparable rotator cuff tears in the elderly population are still a challenge for the orthopedic surgeon, with no consensus regarding ideal treatment strategies and their respective indications. Superior capsule reconstruction has shown good results in the treatment of this condition, however ideal graft origin is yet to be established.

Methods and Results:

The authors describe our team’s technique for superior capsule reconstruction, which uses an Achilles tendon allograft, and has shown good short-term functional and radiologic results.

Discussion:

Achilles tendon allograft is a valuable alternative to other sources, providing an easy-to-prepare graft with a low-risk profile and avoiding donor-site morbidity.
Postless Hip Arthroscopy Using Standard Maquet Fracture Table With a Pink Hip Kit Positioning Device
Authors: Suarez-Ahedo Carlos , Olivos-Meza Anell , Lodhia Parth
Published: September 2020

The last decade has seen a tremendous increase in hip arthroscopy. As the number of procedures increase, surgeons have come to appreciate the various risks and complications associated with hip arthroscopy. As such, traction-related complications have become more noticeable in this patient population. To combat this issue, in recent years, surgeons have developed effective methods of postless traction to reduce these complications. However, many of these methods rely on extra equipment and its economic costs to the health care delivery. We present a novel technique of postless traction for hip arthroscopy using a fracture table (Maquet), thereby highlighting a practical and economical alternative to the various other techniques of postless traction that have been described in the literature.
Using Anterior Segment Optical Coherence Tomography (ASOCT) Parameters to Determine Pupillary Block Versus Plateau Iris Configuration
Authors: Crowell Eric L. , Chuang Alice Z. , Bell Nicholas P. , Blieden Lauren S. , Feldman Robert M.
Published: September 2020

Précis:

The potential parameters for differentiating pupillary block (PB) from plateau iris configuration (PIC) on anterior segment optical coherence tomography (ASOCT) are lens/pupil size parameters and angles. Further study is needed to determine a landmark peripheral to the centroid of the iris.

Purpose:

Investigate anterior segment parameters to distinguish between 2 mechanisms of angle closure, PB and PIC, using swept-source Fourier domain ASOCT.

Patients and Methods:

Retrospective ASOCT images from narrow angle eyes were reviewed. PIC was defined either by ultrasound biomicroscopy and/or clinically when an iridoplasty was performed. Images were read by a masked reader using Anterior Chamber Analysis and Interpretation software to identify scleral spur landmarks and calculate anterior chamber, peripheral angle, iris size, iris shape, and lens/pupil size parameters. ASOCT parameters were summarized and compared using the 2-sample t test. Thresholds and area under receiver operating characteristic curve were calculated using logistic regression analysis.

Results:

One hundred eyes (66 PB and 34 PIC) of 100 participants were reviewed. Of all ASOCT parameters, iris length in each quadrant, pupil arc, lens/pupil parameters (pupil arc, lens vault, and pupil diameter), all pupillary margin-center point-scleral spur landmark (PM-C-SSL) parameters, and all except superior central iris vault parameters were significantly different between PB and PIC. On threshold evaluation, lens/pupil parameters had the greatest area under receiver operating characteristic curve values (0.77 to 0.80), followed by PM-C-SSL angles (0.71 to 0.75).

Conclusions:

We propose that the pupil size parameters and PM-C-SSL angle are the most reliable novel ASOCT parameters to distinguish between PB and PIC eyes. These parameters do not rely on the visibility of the posterior iris surface, which is difficult to identify with ASOCT, but may be ambient lighting dependent.
Periphlebitis of the Superior Ophthalmic Vein
Authors: Lee Jiyoung J. , Cohen Liza M. , Lo Christopher C. , Rootman Daniel B.
Published: September 2020

Isolated orbital periphlebitis in the context of nonspecific orbital inflammation is rare. This case series describes 3 patients with periphlebitis of the superior ophthalmic vein, 2 of which were confirmed with pathology. All 3 cases had a history of Graves hyperthyroidism. Superior ophthalmic vein periphlebitis is a rare form of orbital inflammation presenting with proptosis and motility restriction yet few inflammatory signs. It may be associated with autoimmune hyperthyroidism and represent a rare feature of thyroid eye disease, or perhaps could be an overlap syndrome between thyroid eye disease and nonspecific orbital inflammation. Treatment response is variable and may require a prolonged course of steroids or other immunosuppressive medications.
Rapidly Enlarging Hidradenoma of the Eyelid
Authors: Hartford Juliet B. , Sweeney Adam R. , Allen Richard C. , Yen Michael T.
Published: September 2020

Hidradenoma is a rare benign neoplasm, with few cases reported to involve the eyelid. When affecting the eyelid, hidradenomas may mimic other benign or malignant lesions. Rarely, a benign hidradenoma may transform into a malignant hidradenoma and metastasize. The authors present a case of a benign hidradenoma arising from the eyelid, presenting with rapid growth, ulceration, and bleeding, suggestive of a malignant lesion.
Teprotumumab for Dysthyroid Optic Neuropathy: Early Response to Therapy
Authors: Sears Connie M. , Azad Amee D. , Dosiou Chrysoula , Kossler Andrea L.
Published: September 2020

A 45-year-old male presented with active progressive thyroid eye disease refractory to intravenous steroids and right orbital radiation. Visual acuity, left relative afferent pupillary defect, and Humphrey visual field defects were consistent with worsening left dysthyroid optic neuropathy. Orbital MRI demonstrated extraocular muscle enlargement and effacement of the left optic nerve sheath. After 2 infusions of teprotumumab, the patient’s visual acuity, relative afferent pupillary defect, Humphrey visual fields, proptosis, and extraocular muscle size improved. This is the first report of dysthyroid optic neuropathy responsive to teprotumumab, and it supports the need for further studies to better understand the role of teprotumumab in treating sight-threatening thyroid eye disease.
Reduction of High School Ice Hockey Injuries With Implementation of New Checking/Boarding Rules
Authors: Nadkarni Lauren , Haskins Amy , Holt Christina , Dexter William
Published: September 2020

Objective:

Evaluate whether rule changes by the National Federation of State High School Associations (NFHS) were associated with reduced injury rates in US high school ice hockey players.

Design:

We compared injury rates for the 3 seasons before the rule changes (2011-2012, 2012-2013, and 2013-2014) with the 2 subsequent seasons (2014-2015 and 2015-2016) using data from the High School Reporting Information Online (RIO) database.

Setting:

Convenience sample of US high schools.

Participants:

High school ice hockey athletes.

Interventions:

The sports injury surveillance system that supplied the data for this study was funded in part by the Centers for Disease Control and Prevention (grant Nos. R49/CE000674-01, R49/CE001172-01, and R49/CE002106-01) as well as research funding contributions of the NFHS, National Operating Committee on Standards for Athletic Equipment (NOCSAE), DonJoy Orthotics, and EyeBlack. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or any other funding agency. In the 2014 to 2015 ice hockey season, the NFHS increased the penalty for boarding (illegally causing opponent to be thrown violently into the boards) and for checking from behind.

Main Outcome Measures:

Injury rates and mechanism of injury.

Results:

There was a statistically significant 40% reduction in rates of injury attributed to being checked in the 2 seasons after the rule changes (5.0 injuries per 10 000 athlete exposures) compared with the 3 previous seasons (8.3) (rate ratio = 0.60, P = 0.002). There were no significant differences in overall injury rates (P = 0.12) or injury rates due to checking (P = 0.27), contact with the boards (P = 0.31), or contact with another player (P = 0.55).

Conclusions:

Among US high school ice hockey athletes, implementation of stricter penalties for boarding and checking from behind was associated with a significant decrease in injury rate due to being checked. Rates of injury due to other mechanisms were not significantly altered, suggesting the rule changes achieved their targeted effect.
Incidence of Total Knee Replacement in Patients With Previous Anterior Cruciate Ligament Reconstruction
Authors: McCammon James , Zhang Yiyang , Prior Heather J. , Leiter Jeff , MacDonald Peter B.
Published: September 2020

Objective:

To determine the rate of total knee replacement (TKR) after anterior cruciate ligament reconstruction (ACL-R) compared to the general population.

Design:

Retrospective review.

Setting:

All hospitals that performed TKR and ACL-R in Manitoba between 1980 and 2015.

Participant:

All patients that underwent TKR and ACL-R in Manitoba between 1980 and 2015.

Intervention:

Patient factors gathered at time of surgery included: age, sex, urban or rural residence, neighborhood income quintile, and resource utilization band (RUB). Each person was matched with up to 5 people from the general population who had never had ACL-R and had not had a TKR at the time of the case ACL-R.

Main Outcome Measures:

The rate of TKR after ACL-R.

Results:

Overall from 1980 to 2015, 8500 ACL-R were identified within the 16 to 60 years age group with a resultant 42 497 population matches. Sex was predominantly male. The mean age of the ACL-R group at the time of TKR was 53.7 years, whereas the mean age for the matched cohort was 58.2 years, P < 0.001. Those with ACL-R were 4.85 times more likely to go on to have TKR. Apart from age, no other risk factors examined (location, year of surgery, place of residence, income quintile, and RUB) seemed to increase risk of TKR after ACL-R.

Conclusion:

Patients who underwent ACL-R were 5 times more likely to undergo TKR.
The shared decision-making model: Providers' and patients' knowledge and understanding in clinical practice
Authors: Baca-Dietz Debbie , Wojnar Danuta M. , Espina Christine R.
Published: September 2020

Background:

Shared decision making (SDM) is a collaborative approach to patient care that facilitates patient engagement in self-care by upholding the patient's values and perspectives. The Affordable Care Act (2010) offers provisions for using SDM in clinical practice to improve care outcomes; however, inconsistent evidence exists about the provider–patient satisfaction and effectiveness of using SDM in Federally Qualified Health Centers (FQHCs), which offer care predominantly to the underserved.

Purpose:

This study assessed providers' and patients' knowledge and understanding of SDM in two FQHC in the Pacific Northwest.

Methodological orientation:

Descriptive phenomenological approach guided the investigation. Data were gathered through in-person interviews. Interviews were analyzed using the method discussed by Colaizzi (1978).

Sample:

A purposive sample of 13 providers and 6 patients.

Conclusions:

Although providers and patients had divergent understandings of SDM, they highly valued this approach to care. An overarching theme “We use SDM as a Cornerstone of Patient Centered Care” and two subthemes: “We are partners in care” and “Being in the driver seat may not be comfortable but necessary” captured the providers' experiences. “They tell you what's up and we do it together” was a key theme that emerged from the patients' narratives. Several processes further described provider and patient experiences with SDM in the FQHC.

Implications for practice:

Findings suggest that the use of SDM in FQHC contributes to provider and patient satisfaction and improved patient engagement in self-care. Providers should therefore strongly consider using SDM model when working with the underserved.
A multidisciplinary care model to increase access to neurologic ambulatory care
Authors: Hill Chloe E. , Thomas Bethany , Amendt Alisha , Lawler Meredith , Kalfin Michael
Published: September 2020

Background:

Expert patient care has been associated with improved outcomes for neurology patients, yet timely access to specialists is challenging. The employment of nurse practitioners (NPs) holds great potential to increase access to neurologic ambulatory care, however little practical guidance exists to date for how this may be achieved.

Local problem:

To improve timely care provision for patients with neurologic disease, we employed a multidisciplinary care utilization framework that used NPs to expand clinic appointment availability.

Methods and intervention:

After evaluating our baseline performance, we applied a standardized approach to the deployment of NPs in neurology clinic with regard to scheduling clinic sessions and patient appointments. The primary outcome measure was appointment availability measured over 6 months preintervention (June to November 2016) and 6 months postintervention (June to November 2017). Secondary measures included NP effort allocation.

Results:

The postintervention period demonstrated an increase in available appointments (3,731 preintervention vs. 4,318 postintervention) and scheduled appointments (2,014 vs. 2,685). Nurse practitioners spent more time practicing at the fullest extent of their licensure. All improvements were accomplished without the hiring of additional staff.

Conclusions:

A multidisciplinary care utilization framework for NP employment across neurology subspecialties resulted in an increase in appointment availability. Furthermore, this model is likely to be sustainable due to provider satisfaction and financial viability.
Impact of nurse practitioner care on patients with chronic conditions
Authors: Dusseldorp Loes van , Groot Marieke , Adriaansen Marian , Vught Anneke van , Vissers Kris , Peters Jeroen
Published: September 2020

Background:

A previous study found that care provided by a nurse practitioner (NP) during oncological or palliative care was highly regarded. These patients, however, were considered a special population due to suffering from life-threatening illnesses. It remains unclear whether the results are transferable to patients with chronic conditions. Patient's perceptions of the quality of NP care have reflected that it equals or exceeds that of physicians, but the root causes of these remarks remain unclear.

Purpose:

To describe the difference in perception of NP care by patients suffering from chronic heart failure (CHF) or inflammatory bowel disease (IBD) in contrast with NP oncological or palliative care.

Methodological orientation:

A qualitative study from a phenomenological perspective was conducted. Data were analyzed using Colaizzi's seven-step method and the Metaphor Identification Procedure.

Sample:

In 2018 and 2019, 16 outpatients receiving CHF or IBD care were interviewed.

Conclusions:

Although chronic and life-threatening diseases may differentiate patients' perspectives, it can be generally stated that patients value NPs to be reliable, helpful, and empathic. Patients feel empowered, at peace and in control thanks to integrated care by dedicated experts.

Implications for practice:

Outpatients highly appreciate the “communicator role” and “skilled companionship” performed by NPs, to fulfill their needs for attention to the “complete picture.” Therefore, further consideration of these competencies is recommended.
Visual analysis of global comparative mapping of the practice domains of the nurse practitioner/advanced practice nursing role in respondent countries
Authors: Sastre-Fullana Pedro , Gray Deborah C. , Cashin Andrew , Bryant-Lukosius Denise , Schumann Lorna , Geese Franziska , Rae Bernadette , Duff Elsie , Bird Beverley
Published: September 2020

Background:

Internationally, there is increasing demand for nurse practitioner (NP) and advanced practice nursing (APN) roles; however, high variability exists in how NP/APN roles are defined and understood.

Purpose:

The aim of this research was to improve our understanding of how the NP/APN is defined globally by: 1) examining role definitions, competencies, and standards of practice for advanced practice nurses internationally; 2) describing from a global perspective the core concepts and common features of NP/APN associated with practice domains; and 3) exploring the utility of text mining and visual analytics in identifying the clustered core concepts common to NP/APN roles organized around the five advanced practice domains of the Strong Advanced Practice Model.

Methods:

This article describes the findings of a secondary analysis of an international NP/APN competency mapping project, using innovative text mining and visual analysis techniques to reexamine and summarize the NP/APN role in 19 countries from Africa, Australia, Asia, Europe, and North America.

Results:

Although weak aggrupation/associations suggest that further work is needed to define the domains of advanced practice with associated model development, visual analysis points to the identification of common concepts and linkages between concepts for each practice domain of advanced practice outlined in the Strong Model.

Implications for practice:

The secondary text mining and visual analysis presented in this article allows for comparison of core elements between advanced practice role descriptions, standards, and competencies globally to ultimately provide a global perspective on the common features of NP/APN roles and areas where further delineation is required.
Electronic health record usage among nurse practitioners, physician assistants, and junior residents
Authors: Watson Michael D. , Elhage Sharbel A. , Scully Casey , Peterson Sabrina , Gulledge Marialice , Cunningham Kyle , Sachdev Gaurav
Published: September 2020

Background:

Studies demonstrate significant electronic health record (EHR) use by junior residents; however, few studies have investigated this for nurse practitioners and physician assistants (NPs/PAs).

Purpose:

The aim of this study was to quantify the time spent on the EHR by NPs/PAs and junior residents.

Methods:

Electronic health record usage data were collected from April 2015 through April 2016. Monthly EHR usage was compared between NPs/PAs and postgraduate second and third year residents. Further subgroup analysis of NPs/PAs and residents from surgical or nonsurgical fields was conducted.

Results:

Data for 22 NPs/PAs (16 surgical and six nonsurgical) and 125 residents (31 surgical and 94 nonsurgical) were analyzed. Nurse practitioners/physician assistants opened fewer charts per day (4.9 ± 1.5 vs. 5.4 ± 3.1), placed more orders per month, and spent more daily time on the EHR (176.5 ± 51.7 minutes vs. 152.3 ± 71.9 minutes; p < .0001). Compared with residents, NPs/PAs spent more time per patient in all categories (chart review, documentation, order entry) and in total time per patient chart (all p < .05). Comparing surgical NPs/PAs to surgical residents, findings were similar with fewer charts per day, more total daily EHR time, and more EHR time per patient in every tracked category (all p < .05).

Implications for practice:

This is the first study to quantify time on the EHR for NPs/PAs. Nurse practitioners/physician assistants spent more time on the EHR than residents, and this is accentuated with surgical NPs/PAs. Electronic health record utilization appears more burdensome for NPs/PAs; however, the reason for this is unclear and highlights the need for targeted interventions.
Parkinson's disease: Addressing health care practitioners' automatic responses to hypomimia
Authors: Lilly Mary LuAnne , Hermanns Melinda , Dallam Deborah L. , Soomro Amal
Published: September 2020

Hypomimia/reduced facial mobility in individuals living with Parkinson's disease can lead to negative impressions and judgments by nurse practitioners and other health care practitioners. Negative impressions and judgments can affect the quality of an episode of care. To attenuate automatic judgments, nurse practitioners must self-monitor and correct, recognizing that hypomimia is due to an underlying neurological condition and does not provide information on the personality or character of the person living with Parkinson's. Nurse practitioners can integrate inquiries that go beyond a problem focused approach to include questions about pleasurable, positive events in the life of a person living with Parkinson's disease.
Reducing sexually associated transmission of COVID-19 in men who have sex with men
Authors: Blackwell Christopher W.
Published: September 2020

Believed to be zoonotic in origin, COVID-19 is a novel coronavirus subtype, which spreads from person to person through droplet transmission. As of late April, 2020, 895,766 cases of COVID-19 infections were recorded in the United States. This infection was responsible for 50,439 deaths. Because of close, person-to-person proximity, coupled with possible contact with body fluids, transmission of COVID-19 during sexual activity is possible. However, some activities carry higher risks of transmission than others. This article explores the risks of COVID-19 transmission associated with kissing, oral sex (fellatio and annilingus), and anal receptive and anal insertive intercourse among men who have sex with men (MSM). Recommendations for counseling MSM on safer sexual decision-making, many of which are applicable in the general prevention of sexually transmitted infections, are also provided. Nurse practitioners can serve as advocates in preventing sexually associated COVID-19 communication in MSM and contribute to the advancement of this continuously evolving area of public health science.
Pharmacologic heart failure treatment: A case-based review of current guidelines
Authors: Albert Nancy M. , Lindstrom Rachel C.
Published: September 2020

Heart failure (HF) is a growing health problem associated with high morbidity and mortality. Use of evidence-based therapies improves clinical outcomes in patients with HF with reduced ejection fraction (HFrEF). However, in real-world research studies, adults with HFrEF were often medically undermanaged, including failure to use the right medications and failure to up titrate core HF therapies to doses similar to those used in randomized controlled trials. Although guidelines provide best-practice statements about care management, nurse practitioners and physician assistants (NPs and PAs) and clinical nurses often have questions about how to implement guideline-directed therapies in patient care management. With emerging new medications for managing HFrEF, and the possibility of new medications for patients with HF with preserved ejection fraction, complexity of care management will continue to increase. The aims of this review are to provide a summary of the 2017 updates to the national chronic HF management guidelines and use a case-based approach to discuss treatment change considerations associated with optimal guideline-based clinical care.
Comparison of Speech Recognition and Localization Ability in Single-sided Deaf Patients Implanted With Different Cochlear Implant Electrode Array Designs
Authors: Speck Iva , Ketterer Manuel Christoph , Arndt Susan , Aschendorff Antje , Jakob Till F. , Hassepass Frederike
Published: September 2020

Objective:

Choice of electrode array (EA) design and differences in outcome are major concerns both to patients with single-sided deafness (SSD) and to surgeons before cochlear implant (CI) surgery. The present work investigates the effects of EA design on 1) insertion depths, and 2) audiological outcomes of SSD CI recipients.

Study Design:

Retrospective study.

Setting:

Tertiary academic center.

Patients:

Forty patients with acquired SSD matched according to duration of deafness

Main Outcome Measures:

Fourteen CI recipients were implanted with a perimodiolar electrode (cochlear perimodiolar [CPM]), 12 with a shorter lateral wall electrode (cochlear lateral wall [CLW]), and 14 with a longer lateral wall electrode array (medEl lateral wall [MLW]). Postoperative rotational tomography was evaluated to determine cochlear size and EA angle of insertion depth (AID). Binaural speech comprehension in noise (in three configuration presentations) and localization ability were assessed 12 months postoperatively with CI.

Results:

AID was significantly deeper in MLW (mean 527.94 degrees) compared with the CPM (mean 366.35 degrees) and CLW groups (mean 367.01 degrees). No significant difference in AID was seen between the CPM and CLW groups (difference 0.66 degrees). Cochlear sizes revealed no significant differences between any groups. All three groups showed significant improvement in head shadow effect (difference on average CPM: 6.3 dB SPL, CLW 5 dB SPL, and MLW 4.05 dB SPL) and localization ability at 12 months postoperatively (difference on average CPM: 19.72 degrees, CLW: 24 degrees, and MLW: 12.9 degrees). No significant difference in the extent of audiological benefit was observed between any groups.

Conclusion:

No effect on binaural benefit was apparent from the selection of the three EA designs in SSD CI recipients. Further studies focusing on subjective results, sound quality, and music perception depending on EA design in SSD CI recipients are needed.
Cochlear Dysfunction Is a Frequent Feature of Facioscapulohumeral Muscular Dystrophy Type 1 (FSHD1)
Authors: Frezza Erica , Fuccillo Emanuela , Petrucci Antonio , Greco Giulia , Nucera Gabriele , Bruno Ernesto , Giardina Emiliano , Tupler Rossella , Di Mauro Roberta , Di Girolamo Stefano , Massa Roberto
Published: September 2020

Introduction:

Facioscapulohumeral muscular dystrophy type 1 (FSHD) represents one of the most common forms of muscular hereditary diseases and it is characterized by a great clinical variability with the typical muscular symptoms and other clinical features, including hearing impairment. However, etiopathogenetic mechanisms of auditory dysfunction are still not completely understood and it has been suggested that it could be assigned to a cochlear alteration that is present even in those subjects with a normal pure tonal audiometry (PTA) examination.

Methods:

We found out the cochlear function in 26 patients with molecular diagnosis of FSHD1 and in healthy controls. All patients underwent complete neurological and audiological examinations, including FSHD clinical score, pure-tone audiometry (PTA), and otoacoustic emissions (OAEs), in particular transient evoked otoacoustic emissions (TEOAEs) and distortion product evoked otoacoustic emissions (DPOAEs).

Results:

All FSHD1 patients showed significantly reduced DPOAEs and TEOAEs, bilaterally and at all frequencies, even when considering only subjects with a normal PTA or a mild muscular involvement (FSHD score ≤ 2). No correlation between OAEs and FSHD clinical score was found.

Discussion:

Cochlear echoes represent a sensitive tool in detecting subclinical cochlear dysfunction in FSHD1 even in subjects with normal hearing and/or subtle muscle involvement. Our study is focused on the importance of evaluating the cochlear alteration through OAEs and, in particular, by performing TEOAEs and DPOAEs sequentially, to evaluate more frequent specificities of cochlear dysfunction with a wider spectrum of analysis.
Preimplant Hearing Threshold: An Important Predictor of Hearing Preservation in Cochlear Implantation With Lateral Wall Electrodes
Authors: Lee Geonho , Lee Seulgi , Chung Jee-Hye , Choi Jin Woong
Published: September 2020

Objective:

To evaluate the outcomes and association factors of long-term hearing preservation (HP) in cochlear implantation with lateral wall (LW) electrode arrays.

Study Design:

Retrospective case review.

Setting:

Tertiary academic center.

Patients:

Thirty-four consecutive ears from 32 patients with a ≤ 80 dB HL preoperative low-frequency pure-tone average of 250 to 500 Hz were included.

Intervention:

Cochlear implantation with LW electrode arrays and the intention of achieving HP.

Main Outcome Measures:

HP classifications according to the HEARRING group and functional HP methods (≤ 85 dB HL of pure-tone threshold at 250 Hz) at 1 year postoperatively.

Results:

Based on the HEARRING classification, complete, partial, and minimal HP was achieved in 7 ears (21%), 12 ears (35%), and 4 ears (12%), respectively. Under functional classification, 14 ears (41%) exhibited functional hearing after surgery. The average threshold shift was 17.1 dB HL (SD = 16.9 dB HL). Among various clinical features, a ≤ 60 dB HL preimplant pure-tone threshold of 250 Hz was associated with HP outcome in both classifications (OR = 12.95, 95% CI = 1.29–130.01, p = 0.029 in HEARRING classification; OR = 14.36, 95% CI = 1.07–191.40, p = 0.044 in functional classification). The following parameters were not associated with HP (p > 0.05): patient demographics, surgical aspects (insertion route and depth), electrode array size, scalar electrode position, and presence of comorbidity.

Conclusion:

With LW electrode arrays, HP was achieved in 68% of HEARRRING group patients and 41% of functional classification patients. A ≤ 60 dB HL preimplant pure-tone threshold of 250 Hz was significantly associated with an increased rate of long-term HP.
Posterior Tympanotomy Versus Subtotal Petrosectomy: A Comparison of Complications in Cochlear Implantation
Authors: Lee Seulgi , Lee Jong Bin , Chung Jee-Hye , Choi Jin Woong
Published: September 2020

Objective:

To compare the postoperative complications between posterior tympanotomy cochlear implantation (PTCI) and subtotal petrosectomy cochlear implantation (SPCI).

Study Design:

A retrospective cohort study.

Setting:

Two tertiary referral centers.

Patients:

Two hundred ninety-eight patients who underwent PTCI and 33 who underwent SPCI.

Interventions:

Cochlear implantation using either posterior tympanotomy or subtotal petrosectomy.

Main Outcome Measures:

Postoperative complications between the two groups were compared after categorization into minor complications (requiring conservative management) and major complications (requiring surgical revision or hospitalization treatment).

Results:

Dizziness was the most common complication in both groups. The major complication rate in the SPCI group was significantly higher than in the PTCI group (12.1% [4 of 33] versus 1.3% [4 of 298], p = 0.004), while the minor complication rate was similar between the two groups. Among the major complications, device migration was significantly more common when SPCI was performed (9.1% [3 of 33] versus 0.3% [1 of 298], p = 0.003).

Conclusions:

Major complication rate of SPCI was higher than that of PTCI; particularly, device migration was more commonly observed after SPCI than PTCI. Therefore, special attention should be paid to device placement and fixation during SPCI.
Comparison of coronary angioscopic findings 8 months after stent implantation between two kinds of biodegradable polymer-coated and one durable polymer-coated drug-eluting stent
Authors: Yasumura Keisuke , Shutta Ryu , Matsunaga-Lee Yasuharu , Nakamura Daisuke , Yano Masamichi , Yamato Masaki , Egami Yasuyuki , Sakata Yasushi , Nishino Masami , Tanouchi Jun
Published: September 2020

Background

The difference of chronic neointimal conditions of biodegradable polymer-coated and durable polymer-coated drug-eluting stent have not been well investigated.

Objective

We aimed to compare the angioscopic findings among SYNERGY biodegradable polymer-coated everolimus-eluting stent (BP-EES), ULTIMASTER biodegradable polymer-coated sirolimus-eluting stent (BP-SES), and XIENCE Alpine durable polymer-coated everolimus-eluting stent (DP-EES) 8 months after stent implantation.

Methods

Patients who underwent implantation of BP-EES (n = 30), BP-SES (n = 26), or DP-EES (n = 21) in Osaka Rosai Hospital from December 2015 to April 2017 were retrospectively enrolled. Coronary angioscopic evaluation including dominant grade of neointimal coverage (NIC) over the stent, maximum yellow plaque grade, and existence of red thrombi were performed 8 months after stent implantation. The incidence of major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, and target vessel revascularization were assessed 1 year after coronary angioscopic evaluation among the three groups.

Results

The patient and lesion characteristics were similar among the three groups. Dominant grade of NIC and maximum yellow plaque grade were not significantly different among BP-EES, BP-SES, and DP-EES groups [mean ± SD, 1.50 ± 0.73, 1.58 ± 0.64, and 1.33 ± 0.48 (P = 0.38) and 0.83 ± 0.59, 0.81 ± 0.75, and 0.95 ± 0.38 (P = 0.68), respectively]. The existence of red thrombi was similar among the three groups [20, 12, and 19% (P = 0.67)]. There was no significant difference in the MACE 1 year after coronary angioscopic evaluation among the three groups [0, 8, and 0% (P = 0.13)].

Conclusions

Coronary angioscopic findings revealed that BP-EES, BP-SES, and DP-EES produced similar favorable NIC 8 months after stent implantation.
Hepatic Injury in Patients With COVID-19
Authors: Kullar Ravina , Patel Ankur P. , Saab Sammy
Published: September 2020

Background:

Coronavirus disease 2019 (COVID-19) has infected over 2 million people worldwide over the course of just several months. Various studies have highlighted that patients infected with COVID-19 may develop various degrees of liver injury. Here, we discuss the impact of underlying liver disease and manifestations of hepatic injury with COVID-19. We also review mechanisms of hepatic injury.

Methods:

We searched the database PubMed for all studies focused on hepatic injury in COVID-19.

Results:

We identified 13 studies that assessed the impact of underlying liver disease in patients infected with COVID-19 (N=3046). Underlying liver disease was one of the most common known comorbid categories in patients infected with COVID-19. Overall, 25% of the patients identified from the 13 studies had hepatic injury. Twenty-one percent and 24% had elevated alanine transaminase and aspartate transaminase values, respectively. Nine percent of the patients had elevated total bilirubin values. Ten of the 13 studies assessed COVID-19 acuity with severity of hepatic injury. In 9 of the 10 studies, clinical outcomes were worse with hepatic injury.

Conclusions:

Liver injury is highly prevalent in patients that present with COVID-19. Since the liver is one of the most affected organs outside of the respiratory system in COVID-19, more intensive surveillance is warranted for severe cases, particularly among those with pre-existing advanced liver disease.
Patient’s perspective on the implementation of measures to contain the SARS-CoV-2 pandemic in a Portuguese Gastroenterology Department
Authors: Gomes Catarina , Pinho Rolando , Ponte Ana , Silva João Carlos , Afecto Edgar , Correia João , Carvalho João
Published: September 2020

Background and aims

As the COVID-19 pandemic emerged, departments had to adapt their activities, jeopardizing patient’s best interests. Our aim is to evaluate the patient’s perspective to the implementation of SARS-CoV-2 measures in a gastroenterology department in a Portuguese Hospital.

Methods

A survey with 13 questions was created and available to patients with at least one gastroenterology appointment at our center in the year 2019.

Results

Nine hundred seventy-three patients completed the survey, 51.6% (n = 502) females, and 82.6% (n = 804) with less than 65 years of age. 50.7% of 962 patients were not working. 49.5% had an appointment for monitoring a suspected or established inflammatory bowel disease (IBD). 76.8% and 69.6% subjects agreed in postponing endoscopic and non-endoscopic procedures, respectively. 93.6%, 94.3% and 95.7% patients declared to be worried about the postponing of endoscopic procedures, non-endoscopic procedures and medical visits, respectively. 88.8% supported remote consultations and 77.3% were satisfied with this type of appointment, independently of the age group (P = 0.66). 80.9% of IBD patients treated with immunosuppression or biologics were concerned about a severe infection by COVID-19.

Conclusion

A great part of our respondents belong to IBD appointments. The majority of our patients agreed in postponing procedures, although they feel concerned. Almost all patients supported remote consultations and most patients found them positive.
Network Interconnectivity and Community Detection in HIV/Syphilis Contact Networks Among Men Who Have Sex With Men
Authors: Billock Rachael M. , Mucha Peter J. , Samoff Erika , Dennis Ann M. , Pence Brian W. , Lund Jennifer L. , Powers Kimberly A.
Published: September 2020

Background

Despite persistent HIV and syphilis epidemics among men who have sex with men (MSM), the relationship between HIV and syphilis contact networks has not been well characterized. We aimed to measure interconnectivity between HIV and syphilis contact networks among MSM and identify network communities with heightened interconnectivity of the syphilis network with the HIV network.

Methods

Using contact-tracing data, we generated independent and combined HIV and syphilis networks for all MSM diagnosed with HIV or early syphilis, respectively, in North Carolina between 2015 and 2017. We treated the independent networks as layers and identified network communities, or groups of densely connected nodes, in the 2-layer network. We assessed interconnectivity by comparing the mean node degree among syphilis network members in the syphilis network alone versus the combined HIV/syphilis network, both overall and by network community.

Results

The syphilis network was interconnected with the HIV network, especially in network communities with younger median age, higher proportions of persons self-identifying as Black, non-Hispanic, and higher proportions of syphilis cases diagnosed at sexually transmitted disease clinics.

Conclusions

Interconnected contact networks underlie HIV and syphilis epidemics among MSM, particularly among young, Black MSM. Intensified transmission prevention interventions within highly interconnected network communities may be particularly beneficial.
High Prevalence of Sexually Transmitted Infections in Pregnant Women Living in Southern Brazil
Authors: Yeganeh Nava , Kreitchmann Regis , Leng Mei , Nielsen-Saines Karin , Gorbach Pamina M. , Klausner Jeffrey
Published: September 2020

Background

Porto Alegre, Brazil, has the highest rates of congenital syphilis and HIV in the country. Other treatable sexually transmitted infections (STIs) are associated with poor pregnancy and neonatal outcomes, but are only diagnosed by syndromic algorithms.

Methods

Between September 2018 and November 2019, we offered all pregnant women clinic-based STI testing for HIV antibody and treponemal antibody (via lateral flow assay rapid tests provided by the Brazilian Government) and for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis (via polymerase chain reaction–based testing provided by Gene Xpert, Sunnyvale, CA) in 10 public prenatal health clinics in Porto Alegre. Participating women answered a brief survey via audio computer-assisted survey instrument regarding demographics, partnerships, and sexual behaviors. All infected individuals received appropriate treatment and referrals.

Results

Of 400 pregnant women recruited, 94 (24%) were diagnosed with an STI, including 2% with HIV, 11% with syphilis, 9% with chlamydia, 1% with gonorrhea, 5% with trichomoniasis, and 3% with more than 1 STI. In our multivariate analysis, younger age (adjusted odds ratio [AOR], 1.1; 95% confidence interval [CI], 1–1.2), being non-White (AOR, 1.8; 95% CI, 1.1–3.1), having less education (AOR, 2; 95% CI, 1.2–3.4), and having a relationship <1 year (AOR, 2; 95% CI, 1.1–3.6) were all independent predictors of women having an STI. Endorsing symptoms of an STI (e.g., vaginal ulcers/lesions and vaginal discharge) was not predictive of having a laboratory-diagnosed STI (OR, 1.1; 95% CI, 0.7–1.7).

Conclusions

Etiologic-based screening for STIs was uniformly accepted by women attending both hospital-based and primary health clinics in the south of Brazil and can result in appropriate treatment of pregnant women.
High Prevalence of Chlamydia and Gonorrhea and the Need for Sexually Transmitted Infection Testing Among Men Who Have Sex With Men and Transgender Women in Papua New Guinea
Authors: Hakim Avi J. , Iwamoto Chelsea , Badman Steven G. , Willie Barne , Pekon Simon , Aeno Herick , Neo-Boli Ruthy , Ase Sophie , Weikum Damian , Vallely Andrew J. , Kelly-Hanku Angela ,   on behalf of the Kauntim mi tu Study Team
Published: September 2020

Background

Papua New Guinea has among the highest prevalence of sexually transmitted infections in the world but no estimates of Chlamydia trachomatis, Neisseria gonorrhoeae, or hepatitis B virus (HBV) are available among men who have sex with men (MSM) or transgender women (TGW).

Methods

We conducted respondent-driven sampling surveys among MSM and TGW in Port Moresby, Lae, and Mt Hagen (2016–2017) to characterize the prevalence of these infections. Eligibility criteria were as follows: aged ≥12 years, born male, could speak English or Tok Pisin, and had oral or anal sex with another person born male in the past 6 months. Participants were surveyed face-to-face and offered testing for anorectal and genital chlamydia and gonorrhea, syphilis, HIV, and HBV. All results are respondent-driven sampling weighted.

Results

We enrolled 400 participants in Port Moresby, 352 in Lae, and 111 in Mt Hagen. Chlamydia prevalence rates in the 3 cities regardless of anatomical site were 19.9%, 19.2%, and 24.3%, respectively. Gonorrhea prevalence rates regardless of anatomical site were 10.3%, 9.4%, and 9.6%, respectively. Hepatitis B virus prevalence rates were 11.7%, 13.8%, and 13.6%, respectively. In multivariable analysis, syphilis was associated with having either chlamydia or gonorrhea in Port Moresby (adjusted odds ratio, 4.0; 95% confidence interval, 2.0–7.9) and Lae (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–5.0).

Conclusions

There is a large unmet need among MSM and TGW in Papua New Guinea for chlamydia and gonorrhea detection and treatment. The high prevalence of HBV reinforces the importance of ensuring introduction and scale-up of HBV treatment and immunization. Urgent efforts are needed to introduce laboratory-based diagnosis for chlamydia and gonorrhea to ensure these populations have access to much needed treatment services.
A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: a feasibility study
Authors: Stanton Tasha R. , Karran Emma L. , Butler David S. , Hull Melissa J. , Schwetlik Sarah N. , Braithwaite Felicity A. , Jones Hannah G. , Moseley G. Lorimer , Hill Catherine L. , Tomkins-Lane Christy , Maher Carol , Bennell Kim
Published: September 2020

Introduction:

Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit.

Objectives:

To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis.

Methods:

Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wrist-worn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. A priori feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback).

Results:

Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had >75% valid wear-time. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of “physiotherapy”, that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness.

Conclusions:

Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.
Mechanism of exercise-induced analgesia: what we can learn from physically active animals
Authors: Lesnak Joseph B. , Sluka Kathleen A.
Published: September 2020

Physical activity has become a first-line treatment in rehabilitation settings for individuals with chronic pain. However, research has only recently begun to elucidate the mechanisms of exercise-induced analgesia. Through the study of animal models, exercise has been shown to induce changes in the brain, spinal cord, immune system, and at the site of injury to prevent and reduce pain. Animal models have also explored beneficial effects of exercise through different modes of exercise including running, swimming, and resistance training. This review will discuss the central and peripheral mechanisms of exercise-induced analgesia through different modes, intensity, and duration of exercise as well as clinical applications of exercise with suggestions for future research directions.