bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-country analysis of higher education institutions’ efficiency: The role of strategic positioning
Authors: Agasisti Tommaso , Berbegal-Mirabent Jasmina
Published: September 2020

Universities are highly heterogeneous institutions and this diversity needs to be acknowledged when assessing their performance. Using an unbalanced panel that covers a 3-year period (2011–3) with 761 observations coming from 307 universities located in 8 European countries, this study examines the extent to which strategic choices regarding international positioning and scope determine how efficient universities are in the allocation of their internal resources. Three main groups of universities are identified, according to their internationalisation and scope: world-class, flagship, and regional. Next, we model universities’ objective function as a mix of teaching, research, and third mission endeavours, and calculate efficiency scores. A meta-frontier analysis based on data envelopment analysis is used. This approach allows comparing efficiency frontiers across groups and relative to a common frontier. Policy implications within and between groups are discussed.
Close Relationships in Close Elections
Authors: Lee Byungkyu
Published: September 2020

Close elections are rare, but most Americans have experienced a close election at least once in their lifetime. How does intense politicization in close elections affect our close relationships? Using four national egocentric network surveys during the 1992, 2000, 2008, and 2016 election cycles, I find that close elections are associated with a modest decrease in network isolation in Americans’ political discussion networks. While Americans are more politically engaged in close elections, they also are less likely to be exposed to political dissent and more likely to deactivate their kinship ties to discuss politics. I further investigate a potential mechanism, the extent of political advertising, and show that cross-cutting exposure is more likely to disappear in states with more political ads air. To examine the behavioral consequence of close elections within American families, I revisit large-scale cell phone location data during the Thanksgiving holiday in 2016. I find that Americans are less likely to travel following close elections, and that families comprised of members with strong, opposing political views are more likely to shorten their Thanksgiving dinner. These results illuminate a process in which politicization may “close off” strong-tied relationships in the aftermath of close elections.
A Fig Deal: A Global Look at Fig Mosaic Disease and its Putative Associates
Authors: Preising Stephanie , Borges Darlan Ferreira , de Queiroz Ambrósio Márcia Michelle , da Silva Washington Luís
Published: September 2020

Fig mosaic disease (FMD) is a complex viral disease with which 12 viruses, including a confirmed causal agent, fig mosaic emaravirus (FMV), and three viroids are associated worldwide. FMD was first described in California in the early 1930s. Symptoms include foliar chlorosis, deformation, and mosaic patterns. FMD is disseminated by vegetative propagation, seed transmission, and vectors, including a mite, Aceria ficus. Management of the disease in fig orchards relies on scouting and elimination of infected trees. In this review, we focus on the distribution of the FMD-associated viruses and viroids by summarizing worldwide surveys and their genome structure. We also determined the full-length sequence of FMV and fig badnavirus 1 (FBV-1) isolates from Connecticut and compared the virus and viroid sequences from fig isolates. We suggest important areas of research including determining the potential synergistic effect of multiple viruses, elucidating the full-length genome sequence of each associated virus, and relating virus titer to phenotypic changes in Ficus carica.
Preferences for Tobacco Cessation Information and Support During Covid-19
Authors: Pettigrew Simone , Jun Min , Roberts Ian , Bullen Chris , Nallaiah Kellie , Rodgers Anthony
Published: September 2020

Objective:

To identify how best to provide smoking cessation advice and support during the Covid-19 pandemic. Preferences were assessed in relation to: (i) specific forms of tobacco cessation support (eg, nicotine replacement therapy (NRT) and various counseling formats); (ii) information sources (eg, government officials, doctors); and (iii) channels via which to receive relevant information (eg, television, social media).

Methods:

An online survey was administered to adults who smoke tobacco in Australia (n = 604) and the UK (n = 600). Descriptive analyses were conducted to identify levels of interest in cessation support and information provision. Differences in responses according to demographic characteristics and smoking history were assessed.

Results:

Around half of the respondents were interested in receiving personal counseling and/or participating in a text support program over the next month. By far the most popular delivery mechanism for personal counseling was email. Three-quarters of the sample expressed an interest in receiving free, home-delivered NRT. The most popular information sources nominated by respondents seeking more information about smokers’ Covid-related risks were government departments and their doctor/general practitioner. Television and online news sources were the most preferred information dissemination channels.

Conclusions:

The substantial levels of interest expressed in accessing various forms of cessation assistance within the next month suggest that Covid-19 may be increasing receptiveness to quitting. The strong interest in free, home-delivered NRT indicates that this may be a useful mechanism for facilitating quit attempts during the pandemic.
The NADase enzyme CD38: an emerging pharmacological target for systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis
Authors: Peclat Thais Ribeiro , Shi Bo , Varga John , Chini Eduardo Nunes
Published: September 2020

Purpose of review

Here we review recent literature on the emerging role of nicotinamide adenine dinucleotide (NAD+) metabolism and its dysfunction via the enzyme CD38 in the pathogenesis of rheumatologic diseases. We evaluate the potential of targeting CD38 to ameliorate NAD+-related metabolic imbalance and tissue dysfunction in the treatment of systemic sclerosis (SSc), systemic lupus erythematous (SLE), and rheumatoid arthritis (RA).

Recent findings

In this review, we will discuss emerging basic, preclinical, and human data that point to the novel role of CD38 in dysregulated NAD+-homeostasis in SSc, SLE, and RA. In particular, recent studies implicate increased activity of CD38, one of the main enzymes in NAD+ catabolism, in the pathogenesis of persistent systemic fibrosis in SSc, and increased susceptibility of SLE patients to infections. We will also discuss recent studies that demonstrate that a cytotoxic CD38 antibody can promote clearance of plasma cells involved in the generation of RA antibodies.

Recent studies identify potential therapeutic approaches for boosting NAD+ to treat rheumatologic diseases including SSc, RA, and SLE, with particular attention to inhibition of CD38 enzymatic activity as a target. Key future directions in the field include the determination of the cell-type specificity and role of CD38 enzymatic activity versus CD38 structural roles in human diseases, as well as the indicators and potential side effects of CD38-targeted treatments.
Cytokines and inflammatory mediators as promising markers of polymyositis/dermatomyositis
Authors: Cerezo Lucie Andrés , Vencovský Jiří , Šenolt Ladislav
Published: September 2020

Purpose of review

Idiopathic inflammatory myopathies (IIMs), known also as myositis, represent challenging group of heterogeneous muscle disorders characterized by symmetric proximal muscle weakness and evidence of muscle inflammation. The purpose of this review is to provide important updates on cytokines and inflammatory mediators related to myositis.

Recent findings

In the past 5 years, multiple studies brought a fresh insight into the pathogenesis of myositis by introducing new factors or further characterizing the role of the well established mediators in myositis. Among the mediators reviewed in this article, special attention was paid to interferons, C-X-C motif chemokine ligand 10, interleukin-18 and the IL23/Th17 axis. Some of the recent work has also focused on the nontraditional cytokines, such as adipokines, myokines, S100 proteins, High Mobility Group Box 1 or B-cell activating factor and on several anti-inflammatory mediators. Moreover, microRNAs and their potential to reflect the disease activity or to regulate the inflammatory processes in myositis have recently been subject of intensive investigation. Some of the above-mentioned mediators have been proposed as promising clinical biomarkers or therapeutic targets for myositis.

Several recent studies contributed to a better understanding of the pathogenesis of myositis and highlighted the clinical significance of certain inflammatory mediators. Application of these new findings may help to develop innovative approaches for patients’ phenotyping, disease activity monitoring and potentially novel therapies.
Cardiac involvement in inflammatory myopathies and inherited muscle diseases
Authors: Lilleker James B. , Roberts Mark , Diederichsen Louise
Published: September 2020

Purpose of review

To examine recent developments relating to cardiac involvement in the adult idiopathic inflammatory myopathies (IIM) and those inherited muscle diseases which may present in adulthood and mimic IIM.

Recent findings

Cardiac involvement is a common feature of IIM and inherited muscle diseases. Frequency according to disease subtype varies, with serotype having particular influence in IIM, and genotype in the inherited muscle diseases. Innovative techniques for examining cardiac function have been investigated further, including speckle-tracking echocardiography and cardiac magnetic resonance tomography. The present work has highlighted a likely underestimate of the burden of cardiac disease to date. The complex relationship between IIM, atherosclerosis, and traditional cardiovascular risk factors has been further elucidated. Consensus recommendations for managing patients with inherited muscle diseases and prominent cardiac involvement have been recently published. In addition to supportive care, disease modifying treatments are increasingly becoming available for inherited muscle diseases which may also improve cardiac outcomes.

Cardiac involvement is associated with significant morbidity and mortality. We suggest having a low threshold for considering the possibility of cardiac involvement in all patients with muscle disease.
Transforming a PICU Into an Adult ICU During the Coronavirus Disease 2019 Pandemic: Meeting Multiple Needs
Authors: Levin Amanda B. , Bernier Meghan L. , Riggs Becky J. , Zero Stephanie D. , Johnson Emily D. , Brant Katelyn N. , Dwyer Joe G. , Potter Caroline J. , Pustavoitau Aliaksei , Lentz Thomas A. , Warren Emily H. , Milstone Aaron M. , Schwartz Jamie McElrath
Published: September 2020

We describe the process converting half of our 40-bed PICU into a negative-pressure biocontainment ICU dedicated to adult coronavirus disease 2019 patients within a 1,003-bed academic quaternary hospital. We outline the construction, logistics, supplies, provider education, staffing, and operations. We share lessons learned of working with a predominantly pediatric staff blended with adult expertise staff while maintaining elements of family-centered care typical of pediatric critical care medicine. Critically ill coronavirus disease 2019 adult patients may be cared for in a PICU and care may be augmented by implementing elements of holistic, family-centered PICU practice.
Does Pulmonary Aspergillosis Complicate Coronavirus Disease 2019?
Authors: Beer Karlyn D. , Jackson Brendan R. , Chiller Tom , Verweij Paul E. , Van de Veerdonk Frank L. , Wauters Joost
Published: September 2020

Objectives:

Aspergillus coinfection in coronavirus disease 2019 patients has rarely been described but may be occurring among coronavirus disease 2019 patients admitted to ICUs. Previous reports of viral coinfections with Aspergillus, including influenza-associated pulmonary aspergillosis, suggest that coronavirus disease 2019–associated aspergillosis is plausible. This report aims to summarize what is known about coronavirus disease 2019 complicated by Aspergillus, introduces coronavirus disease 2019–associated pulmonary aspergillosis as a possible clinical entity, and describes reasons clinical suspicion of Aspergillus is warranted in the critical care setting.

Data Sources:

We summarize the available evidence suggesting the existence of Aspergillus coinfection among severe coronavirus disease 2019 patients. This includes published coronavirus disease 2019 patient case series, a case description, and a review of potential biologic mechanisms.

Study Selection:

Reports of coronavirus disease 2019 patient attributes were selected if they included clinical, microbiologic, or radiologic signs of invasive fungal infection.

Data Extraction:

Data included in summary tables were identified through a literature search for coronavirus disease 2019–associated pulmonary aspergillosis.

Data Synthesis:

We present descriptive data extracted from coronavirus disease 2019–associated pulmonary aspergillosis case series current at the time of article submission.

Discussion:

Pulmonary aspergillosis is known to occur among influenza patients requiring intensive care and is associated with increased mortality. If Aspergillus coinfections are occurring among coronavirus disease 2019 patients, early clinical suspicion and testing are needed to understand the epidemiology of these infections and prevent associated mortality. As the coronavirus disease 2019 pandemic unfolds, reports on the existence of this coinfection are needed, and opportunities to contribute cases of Aspergillus coinfection among coronavirus disease 2019 patients to an ongoing registry are described.
Dexmedetomidine-Associated Hyperpyrexia in Three Critically Ill Patients With Coronavirus Disease 2019
Authors: Czepiel Kathryn S. , Lucas Alexandra T. , Whalen Michael J. , Mojica James E.
Published: September 2020

Objectives:

To present three patients with severe coronavirus disease 2019 infection who developed life-threatening hyperpyrexia while being treated with dexmedetomidine for sedation.

Data Sources:

Clinical records.

Study Selection:

Case report.

Data Extraction:

Relevant clinical information.

Data Synthesis:

We describe three patients, a 60-year-old female, 43-year-old female, and 46-year-old male, who were hospitalized in surge ICUs during the coronavirus disease 2019 pandemic in the early spring of 2020. All developed hyperpyrexia, defined as a temperature above 41.1°C, following an increase in dexmedetomidine dosing to above 1.5 µg/kg/hr. Fevers resolved following discontinuation of dexmedetomidine.

Conclusions:

While the exact mechanism of hyperpyrexia remains unclear, findings in this study suggest that high doses of dexmedetomidine infusion are associated with hyperpyrexia in a seemingly dose-dependent fashion in critically ill patients with coronavirus disease 2019. Coronavirus disease 2019 infection causes a hyperinflammatory state characterized by pro-inflammatory cytokine dysregulation. Dexmedetomidine, a centrally acting alpha-2 agonist, may alter hypothalamic temperature regulation through disturbances in neurotransmitter expression and metabolism. We postulate that the use of high-dose dexmedetomidine in a hyperinflammatory state may increase the risk of developing hyperpyrexia in this severe disease state.
Disseminated Multifocal Intracerebral Bleeding Events in Three Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation As Rescue Therapy
Authors: Bihlmaier Karl , Coras Roland , Willam Carsten , Grampp Steffen , Jabari Samir , Eichhorn Philip , Haller Florian , Kuramatsu Joji , Schwab Stefan , Castellanos Ixchel , Birkholz Torsten , Schüttler Jürgen , Altmeppen Jürgen , Schiffer Mario , Herbst Larissa
Published: September 2020

Objectives:

To describe three coronavirus disease 2019 patients suffering from acute respiratory distress syndrome under venovenous extracorporeal membrane oxygenation therapy and tight anticoagulation monitoring presenting a novel pattern of multifocal brain hemorrhage in various degrees in all cerebral and cerebellar lobes.

Design:

Clinical observation of three patients. Post mortem examinations.

Setting:

Two ICUs at the University Hospital Erlangen.

Patients:

Three patients (medium age 56.6 yr, two male with hypertension and diabetes, one female with no medical history) developed severe acute respiratory distress syndrome on the basis of a severe acute respiratory syndrome coronavirus 2 infection. All required mechanical ventilation and venovenous extracorporeal membrane oxygenation support.

Interventions:

Clinical observation, CT, data extraction from electronic medical records, and post mortem examinations.

Main Results:

We report on an unusual multifocal bleeding pattern in the white matter in three cases with severe acute respiratory distress syndrome due to coronavirus disease 2019 undergoing venovenous extracorporeal membrane oxygenation therapy. Bleeding pattern with consecutive herniation was found in CT scans as well as in neuropathologic post mortem examinations. Frequency for this unusual brain hemorrhage in coronavirus disease 2019 patients with extracorporeal membrane oxygenation therapy at our hospital is currently 50%, whereas bleeding events in extracorporeal membrane oxygenation patients generally occur at 10–15%.

Conclusions:

Multifocality and high frequency of the unusual white matter hemorrhage pattern suggest a coherence to coronavirus disease 2019. Neuropathological analyses showed circumscribed thrombotic cerebrovascular occlusions, which eventually led to microvascular and later on macrovascular disseminated bleeding events. However, signs of cerebrovascular inflammation could not be detected. Polymerase chain reaction analyses of brain tissue or cerebrospinal fluid remained negative. Increased susceptibility for fatal bleeding events should be taken into consideration in terms of systemic anticoagulation strategies in coronavirus disease 2019.
Temperature Trajectory Subphenotypes Correlate With Immune Responses in Patients With Sepsis
Authors: Bhavani Sivasubramanium V. , Wolfe Krysta S. , Hrusch Cara L. , Greenberg Jared A. , Krishack Paulette A. , Lin Julie , Lecompte-Osorio Paola , Carey Kyle A. , Kress John P. , Coopersmith Craig M. , Sperling Anne I. , Verhoef Philip A. , Churpek Matthew M. , Patel Bhakti K.
Published: September 2020

Objectives:

We recently found that distinct body temperature trajectories of infected patients correlated with survival. Understanding the relationship between the temperature trajectories and the host immune response to infection could allow us to immunophenotype patients at the bedside using temperature. The objective was to identify whether temperature trajectories have consistent associations with specific cytokine responses in two distinct cohorts of infected patients.

Design:

Prospective observational study.

Setting:

Large academic medical center between 2013 and 2019.

Subjects:

Two cohorts of infected patients: 1) patients in the ICU with septic shock and 2) hospitalized patients with Staphylococcus aureus bacteremia.

Interventions:

Clinical data (including body temperature) and plasma cytokine concentrations were measured. Patients were classified into four temperature trajectory subphenotypes using their temperature measurements in the first 72 hours from the onset of infection. Log-transformed cytokine levels were standardized to the mean and compared with the subphenotypes in both cohorts.

Measurements and Main Results:

The cohorts consisted of 120 patients with septic shock (cohort 1) and 88 patients with S. aureus bacteremia (cohort 2). Patients from both cohorts were classified into one of four previously validated temperature subphenotypes: “hyperthermic, slow resolvers” (n = 19 cohort 1; n = 13 cohort 2), “hyperthermic, fast resolvers” (n = 18 C1; n = 24 C2), “normothermic” (n = 54 C1; n = 31 C2), and “hypothermic” (n = 29 C1; n = 20 C2). Both “hyperthermic, slow resolvers” and “hyperthermic, fast resolvers” had high levels of G-CSF, CCL2, and interleukin-10 compared with the “hypothermic” group when controlling for cohort and timing of cytokine measurement (p < 0.05). In contrast to the “hyperthermic, slow resolvers,” the “hyperthermic, fast resolvers” showed significant decreases in the levels of several cytokines over a 24-hour period, including interleukin-1RA, interleukin-6, interleukin-8, G-CSF, and M-CSF (p < 0.001).

Conclusions:

Temperature trajectory subphenotypes are associated with consistent cytokine profiles in two distinct cohorts of infected patients. These subphenotypes could play a role in the bedside identification of cytokine profiles in patients with sepsis.
Microsurgical Clipping of Intracranial Aneurysms in the Endovascular Era
Authors: Harker Pablo , Vranic Justin , Patel Aman B.
Published: September 2020

The treatment of intracranial aneurysms (IA) began in the late 19th century. Some degree of controversy has always surrounded the best treatment modality for IA. Cushing and Dandy debated about cervical carotid ligation as the only surgical alternative before the introduction of microsurgical clipping. In the early 21st century, the debate has centered on surgical versus^ endovascular techniques. With the advent of newer endovascular techniques and devices, there has been a dramatic shift in treatment paradigms toward endovascular intervention that is preferred by both physicians and patients. However, there will always be a need for microsurgical cerebrovascular expertise since some aneurysms cannot or should not be embolized. This creates a difficult conundrum as only the most complex of aneurysms will require open surgery, but the lack of volume and training will be a challenge in teaching and maintaining the surgical expertise required to safely treat them. The purpose of this review is to discuss the history of IA treatment and critically evaluate the current state of the art of IA treatment, with a specific focus on the necessary role microsurgical clipping continues to play in the current treatment landscape.
Urinary neprilysin for early detection of acute kidney injury after cardiac surgery
Authors: Bernardi Martin H. , Wagner Ludwig , Ryz Sylvia , Puchinger Juergen , Nixdorf Larissa , Edlinger-Stanger Maximilian , Geilen Johannes , Kainz Matthias , Hiesmayr Michael J. , Lassnigg Andrea
Published: September 2020

BACKGROUND

Acute kidney injury (AKI) predicts adverse outcomes after cardiac surgery. The accuracy of using changes in serum creatinine for diagnosis and grading of AKI is limited in the peri-operative cardiac surgical setting and AKI may be underdiagnosed due to haemodilution from cardiopulmonary bypass priming and the need for intra-operative and postoperative volume resuscitation.

OBJECTIVES

To determine whether the urinary biomarker neprilysin can be used as a marker for the early detection of AKI after cardiac surgery.

DESIGN

Prospective, observational cohort study.

SETTING

Austrian tertiary referral centre.

PATIENTS

96 Patients undergoing elective cardiac surgery with cardiopulmonary bypass.

MAIN OUTCOME MEASURES

Differences and discriminatory power of neprilysin levels early after cardiac surgery and on postoperative day 1 between patients with or without AKI, as defined by the Kidney Disease Improving Global Outcomes Group.

RESULTS

AKI was found in 27% (n=26). The median neprilysin levels on postoperative day 1 were significantly higher in the AKI than in the non-AKI group, 4.0 [interquartile range (IQR): 2 to 6.25] vs. 2.0 ng ml−1 [IQR: 1.0 to 4.5], P = 0.0246, respectively. In addition, the median neprilysin levels at the end of surgery were significantly different between both groups, 5.0 [IQR: 2.0 to 9.0] vs. 2.0 ng ml−1 [IQR: 1.0 to 4.0], P = 0.0055, respectively. The discriminatory power of neprilysin for detecting early AKI corresponded to an area under the curve of 0.77 (95% confidence interval, 0.65 to 0.90).

CONCLUSION

Urinary neprilysin has potential as a biomarker for the early detection of AKI after cardiac surgery and has comparable discriminatory power to recently studied AKI biomarkers.

TRIAL REGISTRATION

The trial was registered at ClinicalTrials.gov (NCT03854825, https://clinicaltrials.gov/ct2/show/NCT03854825).
Effect of Intraocular Pressure on Aerosol Density Generated by Noncontact Tonometer Measurement
Authors: Tang Yuan , Li Chunchun , Chen Yanyan , Chen Zhangyan , Zhang Peihua , Wang Aisun , Huang Xiaoqiong , Qu Jia , Li Mengchen , Ma Siwen , Vasudevan Balamurali
Published: September 2020

Precis:

Aerosols generated by a noncontact tonometer (NCT) were quantified. There was a positive correlation between aerosols and intraocular pressure (IOP), and the concentration of aerosols beside the air jet port was the highest.

Purpose:

To investigate the effects of IOP on the aerosol density generated during the use of an NCT and provide references and suggestions for daily protection of ophthalmic medical staff during the coronavirus disease-19 (COVID-19) outbreak.

Objective and Methods:

This cross-sectional clinical trial included 214 eyes of 140 patients from a hospital in Wenzhou city, Zhejiang Province. All subjects’ IOPs were measured by an NCT (39 eyes with low IOP, 90 eyes with normal IOP, 37 eyes with moderately high IOP, and 48 eyes with very high IOP) between March 7 and June 17, 2020. The density of particulate matter (PM) 2.5 and PM10 generated during the process of IOP measurement with an NCT was analyzed. IOP values were recorded simultaneously. The aerosols generated during different IOP measurements were plotted in scatter plots.

Results:

PM2.5 was generated more at the air jet port of the tonometer during the process of IOP measurement (H=2.731, P=0.019). Larger quantities of PM2.5 and PM10 were generated when the IOP was higher, and these differences were statistically significant (PM2.5: H=119.476, P<0.001; PM10: H=160.801, P<0.001). Linear correlation analysis with one variable demonstrated that IOP had significantly positive correlations with PM2.5 (r=0.756, P<0.001) and PM10 (r=0.864, P<0.001).

Conclusions:

Aerosols can be generated while using an NCT to measure IOP, and aerosols and IOP are positively correlated. Patients with moderately high IOP or very high IOP tend to generate more aerosols during the IOP measurement. The concentration of aerosols beside the air jet port was the highest.
US Food and Drug Administration Seeks Input From Healthcare Technology Management Community on Medical Device Supply Disruption During COVID-19 Pandemic
Authors: Morabito Julie
Published: September 2020

The US Food and Drug Administration (FDA) is currently seeking information from the clinical community about existing and anticipated disruptions in the supply of medical devices related to COVID-19. This information is important to FDA's fulfillment of its mission to ensure that healthcare providers and patients have continued access to safe and effective medical products. Insights from the clinical community, including clinical engineers and biomedical equipment technicians, bring device supply issues experienced on the front lines to FDA's attention so that the FDA can develop effective strategies to prevent and mitigate medical device supply concerns in its continued response to the COVID-19 public health emergency. Here, we describe the public health impact of the clinical perspective and the type of information that the FDA is seeking regarding current or anticipated medical device supply concerns. Information about how to have your voice heard on this important matter is included at the end of this article.
Time for an Evolution in Anesthesia Drug Delivery
Authors: Jense Ryan J. , Johnson Martha C. , Lam Leo L. , Bowdle Andrew
Published: September 2020

Since its inception, anesthesiology has centered its engineering research and development on volatile anesthetics—hence the ubiquity of the modern gas anesthesia machine and the resulting dominance of volatile anesthetics. Despite volatile anesthetics' preeminence, intravenous medications have become increasingly important components in anesthetic practice. This evolution invites a fundamental redesign of the anesthesia machine to include the latest best practices in the delivery of intravenous medications.
Cochlear Implantation in Cases of Inner Ear Malformation: A Novel and Simple Grading, Intracochlear EABR, and Outcomes of Hearing
Authors: Minami Shujiro B. , Yamamoto Nobuko , Hosoya Makoto , Enomoto Chieko , Kato Hidetoshi , Kaga Kimitaka
Published: September 2020

Objective:

To propose a simple grading of inner ear malformation (IEM) and investigate intracochlear electrical auditory brainstem response (EABR) and outcomes for hearing in terms of the novel grading system.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Sixty patients with IEMs who received cochlear implants.

Intervention:

Grading according to observation of modiolus deficiency and/or internal auditory canal (IAC) cochlear nerve deficiency (CND).

Main Outcome Measure:

Intracochlear EABR and categories of auditory performance (CAP) scores were assessed; children in school were categorized according to the type of school attended.

Results:

Among 60 patients, 38% were classified as Grade I (modiolus present + normal cochlear nerve), 22% as grade II (modiolus deficiency + normal cochlear nerve), 33% as grade III (modiolus present + IAC CND), and 7% as grade IV (modiolus deficiency + IAC CND). During the operation, 93% of Grade I, 36% of Grade II, 23% of Grade III, and 50% of Grade IV patients showed typical EABR waves. CAP scores of 4 or more were obtained from 91% of Grade I, 62% of Grade II, 35% of Grade III, and 25% of Grade IV. Whereas none of children in Grades III and IV entered main stream school, 55% of Grade I and 25% of Grade II entered mainstream schools.

Conclusions:

Outcomes of hearing with cochlear implantations in IEM children depend on the severity of IEM and IAC CND. Our novel grading of IEM is simple and can be useful for understanding the severity of IEM.
Y90 selective internal radiation therapy and peptide receptor radionuclide therapy for the treatment of metastatic neuroendocrine tumors: combination or not?
Authors: Yilmaz Ebru , Engin Müge Nur , Özkan Zeynep Gözde , Kovan Bilal , Büyükkaya Fikret , Poyanli Arzu , Sağlam Sezer , Başaran Mert , Türkmen Cüneyt
Published: September 2020

Background

Peptide receptor radionuclide therapy and selective internal radiation therapy are effective radionuclide therapy modalities for unresectable metastatic neuroendocrine tumor patients that cannot be controlled with somatostatin analogs. The present study is intended to evaluate the therapeutic efficacy and toxicity of the combined therapy of selective internal radiation therapy and peptide receptor radionuclide therapy and stand-alone selective internal radiation therapy in patients with neuroendocrine tumor, a liver-dominant disease.

Methods

This cohort consists of 27 patients with metastatic neuroendocrine tumor and liver-dominant disease. They were grouped as the patients who were treated with selective internal radiation therapy for unresectable liver metastasis (n = 15) and the patients who received a combination of selective internal radiation therapy and peptide receptor radionuclide therapy (n = 12) for hepatic and extrahepatic metastasis. Treatment efficacy and treatment-associated toxicity were retrospectively assessed in both groups.

Results

The objective treatment response and stable disease were found in 13 patients (86.6%) in the selective internal radiation therapy group and eight patients (66.6%) in the selective internal radiation therapy + peptide receptor radionuclide therapy group. The median overall survival rate was found to be 34.9 months, in the selective internal radiation therapy group and 67.5 months in the selective internal radiation therapy + peptide receptor radionuclide therapy group (P = 0.217). The median progression-free survival data was not reached, and the mean values of progression-free survival were 53.1 ± 9.9 months in the selective internal radiation therapy group, and 27.2 ± 5.9 months in the selective internal radiation therapy + peptide receptor radionuclide therapy group (P = 0.561). Temporary lymphopenia was the most common side effect. Grade 1–2 hepatotoxicity was observed to be 6.6% in the selective internal radiation therapy group, while it was not observed in selective internal radiation therapy + peptide receptor radionuclide therapy group.

Conclusions

In the neuroendocrine tumors with liver-dominant metastatic disease, personalized selective internal radiation therapy and peptide receptor radionuclide therapy and their combinations result in increased survival rates. Selective internal radiation therapy alone could be an effective treatment in patients with liver-limited and -dominant disease.
Diagnostic performance of F-18 fluorodeoxyglucose PET/computed tomography for diagnosis of polymyalgia rheumatica: a meta-analysis
Authors: Kim Keunyoung , Kim Seong-Jang
Published: September 2020

Objective

The purpose of the current study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) PET/computed tomography (CT) for diagnosis of polymyalgia rheumatic (PMR) through a meta-analysis.

Methods

The PubMed, Cochrane and EMBASE database, from the earliest available date of indexing up to 29 February 2020, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for diagnosis of PMR.

Results

Across the 11 results of seven studies selected for analysis (684 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.76 [95% confidence interval (CI), 0.67–0.83] with heterogeneity (I
2 = 74.9, P < 0.001) and a pooled specificity of 0.87 (95% CI, 0.82–0.91) with heterogeneity (I
2 = 61.2, P < 0.001). Likelihood ratio syntheses gave an overall positive likelihood ratio of 5.7 (95% CI, 4.3–7.7) and negative likelihood ratio of 0.28 (95% CI, 0.2–0.38). The pooled diagnostic odds ratio was 21 (95% CI, 13–32). The hierarchical summary receiver operating characteristic curve indicated the areas under the curve as 0.93 (95% CI, 0.90–0.95).

Conclusion

The current meta-analysis showed a moderate sensitivity and specificity of F-18 FDG PET/CT for the diagnosis of PMR. Currently, the literature on the use of F-18 PET/CT for the diagnosis of PMR is limited. Thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-18 FDG PET/CT for the detection of PMR.
A correlation study of ischiocavernosus muscle injury with different types of pelvic fractures and erectile dysfunction after pelvic fracture
Authors: Chen Zongping , Song Tao , Zhuang Yongxiang , Yan Yong , Liu Tong , Mao Kaiyi , Li Xu , Zou Chenghong , Wen Xin , Yao Yuhong , Chen Chao , Zhao Sicong
Published: September 2020

Objective:

To explore the correlation between ischiocavernosus muscle injury (ICMI) with different types of pelvic fractures and erectile dysfunction (ED) after pelvic fracture.

Design:

Retrospective analysis of a prospective database.

Setting:

The study was carried out at the affiliated hospital of Zunyi Medical University.

Patients/participants:

A total of 776 male patients with pelvic fracture, aged 18 to 67 years, were recruited for this study by retrospective analysis, and based on the diagnosis of ED and the presence of ICMI, the participants were divided into ED and non-ED groups as well as ICMI and non-ICMI groups.

Intervention:

No.

Main outcome measurements:

ICMI, the type of pelvic fracture, International Index of Erectile Function-5 scores. Computed tomography/magnetic resonance imaging scans, electromyography (motor unit potential) was used to diagnose ICMI.

Results:

The International Index of Erectile Function-5 score was 19.7 ± 5.9. The incidence of ED was 27.3%, the duration time of ED was 30 ± 23 months, and the incidence of reversible ED was 39.6% and of irreversible ED was 60.4%. The incidence of ICMI was 29.4%, among which the incidence of unilateral injury was 57.9%, and the incidence of bilateral injury was 42.1%. Among all pelvic fractures, the incidence of pubic ramus fracture was 88.1%. Bilateral pubic ramus fractures, bilateral fractures of the ischial ramus, and ICMI were independent risk factors for ED after pelvic fracture. Bilateral pubic ramus fractures and pubic symphysis separation were independent risk factors for ICMI. Unilateral ICMI was an independent risk factor for reversible ED, while bilateral ICMI was an independent risk factor for irreversible ED.

Conclusions:

ICMI is associated with ED and may be a cause for ED, while pubic ramus fracture, ischial ramus fracture, and pubic symphysis separation may be the main causes of ICMI. Unilateral ICMI may be the main risk factor for transient ED, and bilateral ICMI may be the main risk factor for permanent ED.
Undiagnosed Normocephalic Pancraniosynostosis Presenting as Bilateral Abducens Nerve Palsy
Authors: Baron Marissa E. , Dvoracek Lucas A. , Bykowski Michael R. , Goldstein Jesse A. , Losee Joseph E.
Published: September 2020

Primary pancraniosynostosis is a rare variant of craniosynostosis in which the major cranial sutures prematurely fuse. Single-suture craniosynostosis is often recognized early in life due to an abnormal head shape. In contrast, primary pancraniosynostosis may be diagnosed later in life due to a grossly normal head shape and size. As such, these children can present with symptoms related to chronically elevated intracranial pressure (eg, vision loss or cognitive impairment). This report highlights a patient with primary pancraniosynostosis associated with unique neurologic sequelae—namely, bilateral abducens nerve palsy. A 9-year-old boy presented to the ophthalmologist with a 1-month history of double vision, drifting of his right eye toward the nasal bridge, and intracranial hypertension evident with papilledema. Physical examination was notable for mild bitemporal narrowing. A computed tomography study demonstrated radiologic thumbprinting, diffuse osseous sclerosis, and fusion of the bilateral coronal, sagittal, metopic, and lambdoid sutures. The patient underwent emergent cranial vault expansion with fronto-orbital advancement. Papilledema had resolved 4 months following surgery. At 2-year follow-up, abducens nerve palsy and head shape were significantly improved. This study brings attention to an unreported presenting symptom of pancraniosynostosis (bilateral abducens nerve palsy). This information may lead to quicker diagnosis and treatment of pancraniosynostosis-induced intracranial hypertension, which is critical to prevent long-term sequelae.
A Meta-Analysis of Palatal Repair Timing
Authors: Wlodarczyk Jordan R. , Brannon Brooke , Munabi Naikhoba C. O. , Wolfswinkel Erik M. , Nagengast Eric S. , Yao Caroline A. , Magee William
Published: September 2020

Developing midface hypoplasia is common after palatoplasty and has been hypothesized to be influenced by the timing of hard palate repair. This meta-analysis assesses the risk of developing midface hypoplasia based on age at hard palate repair. A Pubmed PRISMA systematic review and meta-analysis was completed for literature focused on palatoplasty and midface hypoplasia published between 1970 and 2019. Cephalometric data were extracted and categorized by age at hard palate repair: <6, 7 to 12, 13 to 18, 19 to 24, and 25 to 83 months. Analysis of these groups and a control were compared using independent T-tests and Spearman correlation coefficients. SNA angles for each group were 77.9 ± 3.1° (<6 months), 77.7 ± 4.2° (7–12 months), 78.7 ± 4.2° (13–18 months), 75.1 ± 4.2° (19–24 months), 75.5 ± 4.8° (25–83 months), and were statistically different than the control group 82.4 ± 3.5° (P < 0.0001). Hard palate repair at 13 to 18 months had a statistically significant greater SNA angle than all other groups except for the repair at <6 months group (P = 0.074). As age at hard palate closure increased beyond 18 months, the SNA decreased, corresponding to a more hypoplastic maxilla (Spearman's correlation coefficient −0.381, P = 0.015). Analysis suggests that younger age at the time of repair is less likely to create in midface hypoplasia in adulthood. Minimizing midface hypoplasia in cleft palate patients by optimizing algorithms of care is a practical way to decrease the burden of disease on patients, families and medical systems. Further studies are needed to evaluate the role of technique on outcomes.

Level of Evidence: IV
Two-Stage Repair of Bilateral Cleft Lip: Indications for This Treatment Strategy
Authors: Madaree Anil
Published: September 2020

Background:

The aesthetic outcomes of a bilateral cleft lip (BCL) are inferior to that of unilateral cases. With this in mind, the authors reviewed our BCL outcomes in patients having a 2-stage repair. Strategies in repair protocols may be employed to improve outcomes in a particular group of patients.

Methods:

All patients who had a 2-stage repair of BCL in the last 17 years were reviewed. This protocol strategy was specifically employed in patients who had a complete cleft lip on one side and an incomplete cleft lip on the opposite side. The complete side was repaired first followed by the incomplete side a minimum of 6 weeks later. The outcomes in patients undergoing the 2-stage repair in this cohort were assessed. There were 25 patients in this group with 15 males and 10 females. The age at the first stage ranged from 3 to 9 months.

Results:

It was found that the results in this group resulted in better aesthetic outcomes than patients who had a single-stage repair. There was less stigmata of a tension type repair and a more harmonious relationship between the upper and lower lips.

Conclusion:

It is recommended that a 2-stage strategy be employed in repair of BCL if one side is complete and the other is incomplete.
Does Surgical Specialty Impact Mandibular Fracture Outcomes?
Authors: Sun Alexander , Nguyen Kevin , Mehta Sumarth K. , Allam Omar , Park Kitae Eric , Alperovich Michael
Published: September 2020

Purpose:

Maxillofacial trauma is treated by two medical specialties, plastic surgery (PRS) and otolaryngology (ENT). Differences in training exposure and practice patterns exist between specialties, but their respective outcomes have never been compared.

Methods:

Mandible fracture data were reviewed from the National Surgical Quality Improvement Program from 2005 to 2016. Demographics variables, repair types, and adverse outcomes were compared between PRS and ENT.

Results:

From 2005 to 2016, one thousand two hundred eighty-two cases were identified with 756 cases managed by ENT and 526 cases managed by PRS. Mean patient age was 34.6 years for both specialties (P = 0.95). Patient demographics between both cohorts were not statistically different except for higher rates of hypertension among ENT patients (10.2% for ENT versus 6.7% for PRS, P = 0.027) and higher rates of smoking history among PRS patients (46.8% versus 52.3%, P = 0.055). Mean operative time (131.3 versus 124.0 min, P = 0.090) had a trend toward being longer for ENT and mean length of stay (1.3 versus 2.0, P = 0.002) was significantly longer for PRS. Despite a greater proportion of high ASA class patients in the ENT group (P = 0.012) and patients with dirty/infected wounds in the PRS group (P = 0.013), there were no significant differences in 30-day readmission rates, 30-day reoperation rates, or wound infection rates.

Conclusions:

No significant differences in 30-day readmission rates, reoperation rates, or wound infection rates for mandible fracture management exist between specialties. Despite differences in training between PRS and ENT, both specialties have comparable perioperative outcomes for mandible fracture management.
Endoscopic Per-oral Pyloromyotomy for Gastroparesis: Initial Experience and Postoperative Comparison to Predicted Complications Following Laparoscopic Pyloromyotomy as Calculated by the ACS Risk Calculator
Authors: Ward Marc A. , Hasan Salman S. , Whitfield Edward P. , Ogola Gerald O. , Leeds Steven G.
Published: September 2020

Introduction:

Per-oral endoscopic pyloromyotomy (POP) is a promising new therapy in the treatment of gastroparesis, where the pyloric muscle is cut using an endoscopic tunneling technique. This study was designed to report outcomes from our initial experience and compare the rate of complications to the laparoscopic equivalent using the American College of Surgeons (ACS) risk calculator.

Methods:

Patients who underwent POP between August 2018 to May 2019 were prospectively followed in a database approved by the institutional review board. Preoperatively, patients were evaluated objectively with a 4-hour gastric emptying study (GES). Following POP, all patients were invited for repeat GES 3 months postoperatively. The same cohort was entered into the ACS risk calculator using laparoscopic pyloromyotomy (LPM) as the selected procedure. Complication risk of LPM was then compared with the actual complication rate of POP.

Results:

There were 11 patients that met study criteria (median age 52). Sixty-four percent (7/11) of patients agreed to do repeat GES postoperatively. Of those, 6 of 7 (86%) had normal GES (<10% emptying at 4 h) and the mean improvement was 36.4%. All patients were entered into the ACS risk calculator in which LPM (CPT code 43800) was used as a control. The postoperative complication rate was less than the median predicted risk of LPM in all categories including overall complications (0% vs. 10.05%), return to the operating room, (0% vs. 2.68%), and sepsis (0% vs. 1.42%). The rate of readmission (9% vs. 6.29%, P=0.65) was higher in the POP group than LPM predicted. Length of stay for all patients was significantly shorter than predicted (1.8 vs. 4.6 d, P<0.001).

Conclusions:

All POP patients had objective improvement in their GES and 86% had normal GES following this procedure. POP had significantly lower morbidity and reduced length of stay compared with that predicted of the laparoscopic equivalent using the ACS risk calculator.
Cost-effectiveness of Surgical Treatment Pathways for Prolapse
Authors: Wang Rui , Hacker Michele R. , Richardson Monica
Published: September 2020

Objective

To evaluate the cost-effectiveness of surgical treatment pathways for apical prolapse.

Study Design

We constructed a stochastic Markov model to assess the cost-effectiveness of vaginal apical suspension, laparoscopic sacrocolpopexy, and robotic sacrocolpopexy. We modeled over 5 and 10 years, with 9 pathways accounting for up to 2 separate surgical repairs, recurrence of symptomatic apical prolapse, reoperation, and complications, including mesh excision. We calculated costs from the health care system’s perspective.

Results

Over 5 years, compared with expectant management, all surgical treatment pathways cost less than the willingness-to-pay threshold of US $50,000 per quality adjusted life-years. However, among surgical treatments, all but 2 pathways were dominated. Of the remaining 2, laparoscopic sacrocolpopexy followed by vaginal repair for apical recurrence was not cost-effective compared with the vaginal-only approach (incremental cost-effectiveness ratio [ICER], >$500,000). Over 10 years, all but the same 2 pathways were dominated. However, starting with the laparoscopic approach in this case was more cost-effective with an ICER of US $6,176. If the laparoscopic approach was not available, starting with the robotic approach similarly became more cost-effective at 10 years (ICER, US $35,479).

Conclusions

All minimally invasive surgical approaches for apical prolapse repair are cost-effective when compared with expectant management. Among surgical treatments, the vaginal-only approach is the only cost-effective option over 5 years. However, over a longer period, starting with a laparoscopic (or robotic) approach becomes cost-effective. These results help inform discussions regarding the surgical approach for prolapse.