bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of chronic pain on driving behaviour: a systematic review
Authors: Vaezipour Atiyeh , Oviedo-Trespalacios Oscar , Horswill Mark , Rod J.E. , Andrews Nicole , Johnston Venerina , Delhomme Patricia
Published: June 2021

Driving is a complex task that requires both the ability to rapidly identify potential hazards and respond appropriately to driving situations to avoid crashing. A great deal of research has sought to increase road safety by focusing on risky behaviours, very few of which have explored the effects of chronic pain (CP) on driving behaviour. This systematic review aimed to assess driving behaviour and motor vehicle crash risk in drivers with CP. Four databases (Embase, PubMed, Scopus, and PsycINFO) were searched using relevant search terms. From 8543 studies, 22 studies met the eligibility criteria for inclusion in this review. A driving behaviour framework, based on the Michon model of driving behaviour, is proposed to map the effect of CP on driving behaviour. Findings suggest that drivers with CP engage in risk-compensatory strategies that are positive from a precautionary perspective. However, there is considerable variability in the use of such strategies across different samples, suggesting that there are significant barriers and facilitators involved in these decisions. Moreover, our findings provide some evidence that CP could increase crash risk and change driving behaviour. Evidence-based recommendations for practitioners and policymakers are proposed regarding the risks of driving in individuals experiencing CP. Future research into CP in driving could benefit from having a unified evidence-based approach to determine behaviour at all levels of the driving task.
A Single-Blind Randomized Comparison of Lithium and Lamotrigine as Maintenance Treatments for Managing Bipolar II Disorder
Authors: Parker Gordon , Ricciardi Tahlia , Tavella Gabriela , Hadzi-Pavlovic Dusan
Published: June 2021

Purpose/Background

No study to date has compared lithium and lamotrigine as maintenance mood stabilizers for bipolar II disorder. The aim of this study was to evaluate and compare these two medications in terms of their maintenance efficacy and side effect profile, thus evaluating their comparative cost/benefit profile.

Methods/Procedures

Forty-four subjects with a newly diagnosed bipolar II disorder were randomly assigned to receive either lithium or lamotrigine treatment in a 20-week single-blinded study. Subjects received either slow-release lithium progressively up-titrated to achieve a serum level of 0.8 mEq/L, or lamotrigine increased progressively to a maintenance dose of 200 mg/d. Our primary outcome measure examined daily data on hypomanic and depressive symptoms. Secondary measures evaluated hypomanic and depressive symptom severity, global functioning, and global improvement in hypomanic and depressive symptoms.

Findings/Results

We terminated the trial principally because of severe ongoing side effects experienced by many of those receiving lithium, and with additional concerns about initial severe side effects (including psychosis) experienced by several assigned to lamotrigine. Analyses of study completer data for 28 participants suggested comparable efficacy of both medications; however, lamotrigine had a distinctly lower rate of severe side effects across the study. We calculated that if study trends on outcome measures were valid, then an extremely large sample would be required to demonstrate superiority of either drug, thus making it unlikely that any such adequately powered study will be mounted in the future.

Implications/Conclusions

The small sample size limits any definitive conclusions, but our data suggest that lithium and lamotrigine are likely to have equal efficacy as mood stabilizers for those with a bipolar II condition but that, as maintenance treatments, lithium has more distinctive side effects.
Lung Cancer Mortality in the Swiss Working Population
Authors: Bovio Nicolas , Wild Pascal , Guseva Canu Irina
Published: June 2021

Objective:

To assess the effect of occupational exposures on lung cancer mortality in Switzerland after adjustment for non-occupational lung carcinogens.

Methods:

Using data on 4,351,383 Swiss residents, we used negative binomial regression to assess the effect occupation on lung cancer mortality between 1990 and 2014, accounting for socio-demographic factors, predicted probabilities of smoking and measured environmental radon exposure.

Results:

After adjustment, male machine operators and workers in mining, stone working and building materials manufacturing showed the highest risk. Women working in electrical engineering, electronics, watchmaking, vehicle construction and toolmaking, and transport occupations also remained at high risk. Radon exposure had no effect on lung cancer mortality, while smoking demonstrated a significant effect in both sexes.

Conclusions:

The results suggest the presence of occupational exposures to lung carcinogens in addition to non-occupational factors.
Evaluation of the Role of KIM-1 in Detecting Early Nephrotoxicity in Lead-Exposed Workers
Authors: Hussein Abo-Bakr Abbas , Ahmed Manal Hassan , Kamal Manal Mohamed , Ayesh Narges Abd-El-Atey , Fouad Marwa Mohammed
Published: June 2021

Objectives:

Lead nephropathy usually starts silent. This study aimed to evaluate using kidney injury molecule 1 (KIM-1) as an early nephrotoxicity predictor of long-term low-level occupational lead exposure.

Methods:

History, examination, and laboratory investigations including: blood lead, urinary KIM-1, serum uric acid, creatinine, urea, sodium, potassium, serum albumin, and urine analysis were done on 35 lead-exposed workers and a matched control group.

Results:

Higher blood lead levels were found among the exposed group compared to the control one. No statistically significant difference was found regarding renal failure manifestations or standard renal functions (uric acid, blood urea, and creatinine). Urinary KIM-1 was statistically significantly increased among the exposed group.

Conclusion:

Renal adverse effects were associated to lead fumes exposure. KIM-1 can be used as biomarker for detecting early renal affection among lead-exposed workers.
Heart Rate Variability in Different Levels of Burnout—Cross-Sectional Study of Different Occupational Groups Heart Rate Variability and Burnout
Authors: Thielmann Beatrice , Karlsen Håvard R. , Darius Sabine , Böckelmann Irina
Published: June 2021

Objectives:

The aim of this study was a subjective and objective stress analysis of occupational groups.

Methods:

The study examined 414 employees with patients or children contact on work. The age ranged from 22 to 63 years. Subjective stress was measured using the Maslach Burnout Inventory and objective stress with heart rate variability (HRV).

Results:

Twenty-one percent of subjects showed a high level of exhaustion, 12.9% a high level of cynicism and low performance. There were significant group differences between cynicism levels in meanNN (P = .008) and meanHR (P = .002). There were no significant differences in HRV for exhaustion and professional efficacy.

Conclusions:

The health-impairing manifestations of the three dimensions of the burnout syndrome are not associated with the lower HRV. However, healthy subjects from a “screening” study who had not been clinically diagnosed with burnout were examined here.
Diagnosis and treatment of obstructive sleep apnea and its impact on cardiovascular disease
Authors: Maher Lisa L.M. , Coke Lola A.
Published: June 2021

Obstructive sleep apnea (OSA) is a prevalent disorder that has direct correlation to cardiovascular disease. Understanding the etiology and symptoms of this condition as it relates to cardiovascular disease can improve comprehensive health assessments and determine the use of appropriate screening tools. This case-based approach follows a patient through assessment, diagnosis, and treatment options. Although lifestyle behavior changes are recommended for all patients, other options, such as positive airway pressure therapy, oral appliances, implantable therapy, surgery, and pharmacological and oxygen therapies, exist and should be explored as treatment options. Yearly follow-up provides the best method for long-term treatment success. Treatment of OSA reduces the incidence of cardiac comorbidities and improves cardiovascular health.
Stapedotomy Removing Only the Stapes Head and Not the Entire Stapes Superstructure: Long-term Results
Authors: Malafronte Giuseppe , Trusio Antonio , Motta Giovanni , Filosa Barbara
Published: June 2021

Objective:

To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results.

Study Design:

Prospective study.

Patients:

The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical.

Results:

No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant.

Conclusion:

The Malafronte's stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.
Hyperbaric Oxygen Therapy Versus Intratympanic Steroid for Salvage Treatment of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis
Authors: Lei Xia , Feng Yanyan , Xia Ling , Sun Changling
Published: June 2021

Objective:

The aim of this meta-analysis is to compare the efficacy of hyperbaric oxygen therapy (HBOT) and intratympanic steroids (ITS) as salvage treatment for patients with refractory sudden sensorineural hearing loss (SSNHL).

Data Sources:

Electronic search was performed in the PubMed, Embase, Cochrane Library, CNKI, and Wan Fang databases to June 1, 2020.

Methods:

For each outcome measure, a forest plot was generated and a pooled relative risk (RR) or mean difference (MD) was calculated. Potential publication bias in the meta-analysis was assessed using funnel plot.

Results:

The numbers of cases with hearing improvements and pure tone averages (PTA) changes after salvage treatment were entered into the R software to calculate the pooled effect of HBOT compared with ITS. When pooling the results of the studies reporting the proportion of patients with hearing improvement, a fixed-effects model was used. We calculated the RR and found no significant difference when HBOT compared with ITS (RR = 1.09, 95% confidence interval [CI]: 0.83–1.42, p = 0.55). With respect to the PTA changes, a fixed-effects model was used. The improvement in the PTA (in dB) was calculated in MD and no significant difference was found between the two groups (MD = 0.55, 95% CI: –1.76–2.86, p = 0.64).

Conclusion:

Both HBOT and ITS offer some benefits for refractory SSNHL patients, and there were no significant differences in hearing outcomes between the two modalities. Future RCTs that include large samples are needed to demonstrate superiority of one of the treatments.
High-Fidelity Surgical Middle Ear Simulator: A Pilot Study
Authors: Shim Timothy , Chillakuru Yeshwant , Darwish Christina , Sparks Andrew , Kim Sunny , Wiedermann Joshua , Monfared Ashkan
Published: June 2021

Objectives:

To assess a middle ear simulator as a surgical training tool among a cohort of novice trainees.

Study Design:

Prospective pilot study.

Setting:

The George Washington University Hospital (tertiary care academic hospital).

Participants:

Twenty one medical students and physician assistant students completed the protocol. Each student produced four recordings over 10 attempts. The two raters were attending surgeons from the George Washington University Hospital.

Interventions:

Stapedotomies performed on a high-fidelity middle ear simulator. Participants were assessed at baseline with a Purdue pegboard test and trained with video and a low fidelity middle ear simulator.

Main Outcome Measures:

Two experts rated recordings on scales based upon a validated objective skills assessment test (OSAT) format.

Results:

Inter-rater reliability was strong across all stapedotomy skills scores and global rating scores. Participants demonstrated statistically significant improvement up to the third recording (seventh attempt), but the scores on the fourth recording (tenth attempt) were not significantly different from the third. One participant failed to improve in score over 10 attempts. Pegboard test performance was not correlated with score improvement. Low-fidelity trial time was significantly correlated to stapedotomy and global rating scores.

Conclusions:

This pilot study serves as the first investigation of this middle ear simulator amongst a cohort of trainees. A high-fidelity middle ear simulator may serve as a measurement tool to select future surgical trainees, customize training pathways, and assess surgical capacity before graduation.
Comparing Transcanal Endoscopic Ear Surgery to Post-Auricular Microscope-Guided Surgery in Pediatric Ossiculoplasty: Hearing Outcomes and Post-Operative Pain
Authors: Kwinter Adam , Purcell Patricia L. , Leonard Colin G. , James Adrian L.
Published: June 2021

Objective:

This study compares post-operative hearing outcomes and morbidity after pediatric total ossicular replacement prosthesis (TORP) ossiculoplasty with transcanal totally endoscopic ear surgery (TEES) versus a post-auricular microscope-guided (PAM) approach.

Patients:

Forty-four children who underwent ossiculoplasty with titanium TORP after previous cholesteatoma surgery

Intervention:

Ossiculoplasty using TEES or PAM approach.

Main outcome measures:

Hearing outcome after ossiculoplasty was determined by post-operative air-bone gap (ABG) on audiogram nearest to 1 year after surgery. Post-operative morbidity was measured by total number of opiate doses the child received during hospital stay, along with the highest documented post-operative pain score. Comparisons were made with Mann–Whitney U test.

Results:

Hearing data were available for 41 patients: 21 had undergone TEES (median preoperative ABG 39 dB) and 20 had PAM surgery (median preoperative ABG 39 dB). Post-operatively at 1 year, ABG closed significantly in each group (TEES 21 dB, p = 0.003; PAM 23 dB, p = 0.01), and there was no difference between groups (p = 0.6). 57% who underwent TEES and 50% who underwent PAM surgery experienced serviceable hearing post-operatively, defined as air conduction pure-tone average (PTA) ≤ 30 dB HL. Visual analogue pain scores from 0 (no pain) to 10 (worst pain imaginable) were available for 13 who underwent TEES and 18 who underwent PAM surgery. In children undergoing TEES, only two reported pain above 0, with the highest pain score being 4. Children undergoing PAM surgery had a median pain score of 3 (median difference = 3, p < 0.001). Children undergoing TEES required fewer weight appropriate doses of opiate analgesic (median = 0) than children who underwent PAM surgery (median = 1) (median difference = 1, p = 0.003). Children undergoing TEES had a significantly shorter surgical time (median 135 min) than those who underwent PAM surgery (median 168 min) (median difference = 33 min, p = <0.006).

Conclusion:

Hearing outcomes in TORP ossiculoplasty are similar in TEES and PAM surgery, and TEES may decrease post-operative pain.
The Influence of Ciprofloxacin–Dexamethasone Ear Drops on Perforation Closure Rates After Endoscopic Tympanoplasty
Authors: Sharma Sunil D. , James Adrian L.
Published: June 2021

Objective:

Topical ciprofloxacin and dexamethasone have both been shown to disrupt healing of tympanic membrane perforations in animal models. There have been no clinical studies evaluating the effect of ciprofloxacin–dexamethasone (CD) ear drops on success of tympanoplasty. We compare perforation closure rates in pediatric endoscopic tympanoplasty with and without use of postoperative CD.

Study design:

Retrospective comparative cohort study.

Setting:

Tertiary referral centre.

Patients:

One hundred sixty-two totally endoscopic tympanoplasties with porcine-derived collagen graft in children, mean age 12.0 years (range 2.3–17.9 yrs).

Intervention:

Prescription of CD versus no ear drops in the immediate postoperative period.

Main outcome measure:

Perforation closure rate 2 months after totally endoscopic tympanoplasty.

Results:

Postoperative CD was given to 65 (40%) ears and no drops given to the remainder. Overall, successful closure of tympanic membrane perforation was achieved in 140 (86%) of ears. The closure rate was not significantly different in those ears given CD postoperatively than those not given CD (54/65 [83%] vs 86/97 [89%], Fisher's p = 0.35). Multiple logistical regression revealed no confounding effect of other variables on outcome including age, revision surgery, graft position, or type of postoperative packing material.

Conclusions:

Our results reveal no harm or benefit with prescription of drops containing ciprofloxacin and dexamethasone on success of perforation closure after tympanoplasty. Allocation to treatment in this retrospective study was nonrandomized and was predominantly based on a change in practice. No other variables are known to have influenced this finding but a randomized prospective study could be justified for more reliable evidence.
Hearing Outcomes for an Underwater Endoscopic Technique for Transmastoid Repair of Superior Semicircular Canal Dehiscence
Authors: Creighton Francis X. , Zhang Lisa , Ward Bryan , Carey John P.
Published: June 2021

Objectives:

To compare hearing outcomes between traditional microsurgical transmastoid repairs and underwater, endoscopic transmastoid repairs of superior semicircular canal dehiscence syndrome (SCDS).

Methods:

A retrospective review of 14 patients undergoing transmastoid repair of SCDS between 2013 and 2017. Preoperative, immediate (7–10 d) postoperative, and long-term (>6 wk) postoperative speech discrimination scores, pure-tone averages, as well as pure-tone air conduction and bone conduction thresholds were obtained at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz. Hearing threshold changes were all calculated as preoperative thresholds subtracted from postoperative threshold at each frequency. Wilcoxon rank-sum tests were conducted to assess changes in postoperative hearing thresholds at both the immediate and long-term postoperative period between those undergoing the traditional transmastoid technique and the underwater, endoscopic transmastoid technique.

Results:

Our results demonstrate patients who underwent underwater transmastoid repairs had significantly less increase in their high-frequency bone conduction thresholds at both time periods, indicating less sensorineural hearing loss, compared to the traditional microscopic repair (p = 0.02 [effect size, r = 0.4], p = 0.006 [r = 0.6]). At long-term follow-up, there was also significantly improved pure-tone averages in the patients in the underwater repair cohort compared to the traditional group (p = 0.004 [r = 0.6]). There were no differences in air-bone gaps at any frequency or any time period between the two cohorts.

Conclusions:

Preliminary findings show that the underwater endoscopic technique may prevent sensorineural hearing loss during transmastoid repair of SCDS.
Underwater Endoscopic Ear Surgery for Closure of Cholesteatomatous Labyrinthine Fistula With Preservation of Auditory Function
Authors: Yamauchi Daisuke , Honkura Yohei , Kawamura Yoshinobu , Shimizu Yuichi , Sunose Tomoki , Hara Yosuke , Ohta Jun , Suzuki Jun , Kawase Tetsuaki , Katori Yukio
Published: June 2021

Objective:

To analyze the outcomes of the underwater endoscopic ear surgery (UWEES) technique for closure of cholesteatomatous labyrinthine fistula (LF) with preservation of auditory function.

Study Design:

Retrospective case review study.

Setting:

Tertiary referral center.

Patients:

A total of 12 patients with cholesteatomatous LF.

Intervention:

Surgical method of closure using UWEES for cholesteatomatous LF to minimize inner ear damage. Artificial cerebrospinal fluid (CSF) was used as the perfusate, except for earlier cases when saline was employed.

Main Outcome Measures:

Comparison of bone conductance hearing level (BCHL) before and after surgery. A change of BCHL less than 10 dB was defined as successful preservation of bone conductance hearing.

Results:

All cases of LF were treated successfully by closure using the UWEES technique. Seven cases were type I, one was type IIa, and four were type III according to the Milewski and Dornhoffer classification of LF. The average LF size was 3.1 mm (1–7 mm). Eleven patients were evaluated and their bone conductance hearing was well preserved in all of them (11/11). One patient was too young for preoperative evaluation of BCHL, but hearing preservation was verified 2 years later at the age of 6 years. Remarkably, none of the patients complained of vertigo, except for only a slight manifestation on postoperative day 1.

Conclusion:

The UWEES technique was effective for closure of cholesteatomatous LF with preservation of auditory function.
Congenital Unilateral Hearing Loss: Characteristics and Etiological Analysis in 121 Patients
Authors: Acke Frederic R. E. , Van Hoecke Helen , De Leenheer Els M. R.
Published: June 2021

Objective:

To describe the characteristics and etiological analysis in patients with congenital unilateral hearing loss.

Study design:

Retrospective cohort analysis.

Setting:

Tertiary referral center.

Patients:

Children with permanent congenital unilateral hearing loss born between 2007 and 2018. Patients were referred after universal newborn hearing screening or by a colleague to confirm the diagnosis and perform etiological examinations.

Main outcome measures:

Hearing loss type, severity, and evolution linked with the results of etiological testing.

Results:

In the 121 included children, aural atresia is the leading cause of congenital unilateral hearing loss (32%), followed by structural anomalies (19%) and cCMV (13%), whereas 24% remained idiopathic after etiological work-up. Severity is mainly moderately severe (33% with 56–70 dB hearing loss, majority aural atresia) or profound (31% with > 90 dB hearing loss, predominantly cochlear nerve deficiency). Syndromic features were present in 26%. Although discussed with all parents, only 26% of the children regularly used hearing amplification.

Conclusions:

Congenital conductive unilateral hearing loss is mainly caused by aural atresia, which proportion in congenital unilateral hearing loss proved higher than previously reported. Cochlear nerve deficiency and cCMV are the predominant etiologies of congenital unilateral sensorineural hearing loss. Etiological work-up in affected patients is mandatory as it might impact the approach, and syndromic features should be actively searched for.
Magnetic Resonance Imaging in Patients With Hearing Implants – Follow-up on Prevalence and Complications
Authors: Loth Andreas G. , Fischer Kathrin , Hey Anna Katharina , Weiß Roxanne , Leinung Martin , Burck Iris , Linke Albrecht , Kramer Sabine , Stöver Timo , Helbig Silke
Published: June 2021

Objective:

To examine the number of magnetic resonance imaging (MRI) examinations performed in patients with hearing implants and to quantify side effects or complications related to this procedure.

Study Design:

Questionnaire.

Setting:

Tertiary referral center, academic hospital.

Patients:

One thousand four hundred sixty-onepatients with an implanted hearing system.

Intervention:

Patients were asked to complete a questionnaire either during a visit to the clinic (304) or by mail contact (1,157) between February 2018 and March 2019.

Main Outcome Measures:

Number of examinations by means of MRI per patient and number of side effects or complications.

Results:

A total of 711 questionnaires were returned. After excluding nonvalid information on the questionnaire, 12.8% of patients were identified who had undergone an MRI after having received their hearing implant. Within this group of 91 patients, the most common precaution undertaken was a head bandage (69%). Side effects were mainly pain (37%), followed by anxiety (15%) and tinnitus (9%). The MRI had to be aborted in 14% and dislocation of the magnet occurred in 7% of examinations.

Conclusions:

Our data indicate that patients undergoing hearing implant surgery need better information about the limitations and requirements of MRI. The occurrence of side effects is likely as only half of the patients in our study group were completely free of symptoms. Dislocation of the implant magnet was observed in several cases, hence patients and physicians need to be educated about this potential complication.
Cortical Auditory Plasticity Following Cochlear Implantation in Children With Auditory Neuropathy Spectrum Disorder: A Prospective Study
Authors: Saki Nader , Nikakhlagh Soheila , Moridi Babak , Karimi Majid , Aghayi Azam , Bayat Arash
Published: June 2021

Objectives:

The cortical auditory evoked potential (CAEP) can provide an insight into the maturation of the central auditory nervous system by recording the auditory cortex responses to speech stimuli. This study aimed to explore the central auditory system development in children with auditory neuropathy spectrum disorder (ANSD) using cochlear implants (CIs) and to find the correlation of CAEP biomarkers with speech perception.

Methods:

This study was performed on 23 children with prelingual deafness, diagnosed with ANSD, as well as 23 children with prelingual deafness, without ANSD as the control group. All children underwent unilateral CI before the age of 3 years. Children with ANSD were classified into two groups, based on their CAEP results prior to implantation: children with a clear CAEP response (ANSD-I) and children without an identifiable CAEP (ANSD-II). The P1 component of CAEPs and speech intelligibility rating (SIR) were recorded before the initial device activation (baseline) and at 6, 12, and 24 months postimplantation.

Results:

The P1 CAEP responses were present in all children in the control group, while they were recorded in only 52% of ANSD children before the CI surgery. The longitudinal analysis revealed a significant reduction in the P1 latency and a significant improvement in the P1 amplitude across different time points in all study groups. However, the P1 latency and P1 amplitude were significantly shorter and larger in the control group than the ANSD group, respectively. Also, children in the ANSD-I group exhibited a slightly shorter P1 latency, a larger P1 amplitude, and a higher SIR score than the ANSD-II group after 2 years of follow-up. The P1 CAEP latency was significantly correlated with the SIR score.

Conclusion:

The CAEP can be used as an objective indicator of auditory cortical maturation and a predictor of speech perception performance in implanted children with ANSD.
Validation of Numerically Predicted Shear Stress-dependent Dissipative Losses Within a Rotary Blood Pump
Authors: Strauch Carsten , Escher Andreas , Wulff Sebastian , Kertzscher Ulrich , Zimpfer Daniel , Thamsen Paul Uwe , Granegger Marcus
Published: June 2021

Computational fluid dynamics find widespread application in the development of rotary blood pumps (RBPs). Yet, corresponding simulations rely on shear stress computations that are afflicted with limited resolution while lacking validation. This study aimed at the experimental validation of integral hydraulic properties to analyze global shear stress resolution across the operational range of a novel RBP. Pressure head and impeller torque were numerically predicted based on Unsteady Reynolds-averaged Navier-Stokes (URANS) simulations and validated on a testbench with integrated sensor modalities (flow, pressure, and torque). Validation was performed by linear regression and Bland-Altman analysis across nine operating conditions. In power loss analysis (PLA), in silico hydraulic power losses were derived based on the validated hydraulic quantities and balanced with in silico shear-dependent dissipative power losses. Discrepancies among both terms provided a measure of in silico shear stress resolution. In silico and in vitro data correlated with low discordance in pressure (r = 0.992, RMSE = 1.02 mmHg), torque (r = 0.999, RMSE = 0.034 mNm), and hydraulic power losses (r = 0.990, RMSE = 0.015W). PLA revealed numerically predicted dissipative losses to be up to 34.4% smaller than validated computations of hydraulic losses. This study confirmed the suitability of URANS settings to predict integral hydraulic properties. However, numerical credibility was hampered by lacking resolution of shear-dependent dissipative losses.
Variability in Blood Pressure Assessment in Patients Supported with the HeartMate 3TM
Authors: Cowger Jennifer A. , Estep Jerry D. , Rinde-Hoffman Debbie A. , Givertz Michael M. , Anderson Allen S. , Jacoby Daniel , Chen Leway , Brieke Andreas , Mahr Claudius , Hall Shelley , Ewald Gregory A. , Dirckx Nick , Baker Andrew T. , Pinney Sean P.
Published: June 2021

Targeted blood pressure (BP) control is a goal of left ventricular assist device medical management, but the interpretation of values obtained from noninvasive instruments is challenging. In the MOMENTUM 3 Continued Access Protocol, paired BP values in HeartMate 3 (HM3) patients were compared from arterial (A)-line and Doppler opening pressure (DOP) (319 readings in 261 patients) and A-line and automated cuff (281 readings in 247 patients). Pearson (R) correlations between A-line mean arterial (MAP) and systolic blood pressures (SBP) were compared with DOP and cuff measures according to the presence (>1 pulse in 5 seconds) or absence of a palpable radial pulse. There were only moderate correlations between A-line and noninvasive measurements of SBP (DOP R = 0.58; cuff R = 0.47) and MAP (DOP R = 0.48; cuff R = 0.37). DOP accuracy for MAP estimation, defined as the % of readings within ± 10 mmHg of A-line MAP, decreased from 80% to 33% for DOP ≤ 90 vs. >90 mmHg, and precision also diminished (mean absolute difference [MAD] increased from 6.3 ± 5.6 to 16.1 ± 11.4 mmHg). Across pulse pressures, cuff MAPs were within ±10 mmHg of A-line 62.9%–68.8% of measures and MADs were negligible. The presence of a palpable pulse reduced the accuracy and precision of the DOP-MAP estimation but did not impact cuff-MAP accuracy or precision. In summary, DOP may overestimate MAP in some patients on HM3 support. Simultaneous use of DOP and automated cuff and radial pulse may be needed to guide antihypertensive medication titration in outpatients on HM3 support.
Real-World Performance of High-Flux Dialyzers in Patients With Hypoalbuminemia
Authors: Zhou Meijiao , Ficociello Linda H. , Mullon Claudy , Mooney Ann , Williamson Don , Anger Michael S.
Published: June 2021

There is little research on factors that influence the choice of dialyzer in patients undergoing hemodialysis. In patients at risk for poorer outcomes, including those with hypoalbuminemia, understanding how this choice impacts clinical parameters could inform patient management. The objective of this real-world analysis was to evaluate the use and performance of four single-use (i.e., nonreuse [NR]), high-flux Optiflux dialyzers with varying surface areas (F160NR [1.5 m2], F180NR [1.7 m2], F200NR [1.9 m2], and F250NR [2.5 m2]) in patients (N = 271) with baseline hypoalbuminemia (≤3.5 g/dl) receiving hemodialysis at a medium-sized dialysis organization. Thrice weekly, in-center dialysis was delivered for 6 months without adjustments to the hemodialysis prescription. Larger dialyzers were more frequently used in men, patients with higher body mass indices, and those with diabetes. Increases in serum albumin from baseline (month 1) to month 6 (p < 0.05) were observed with all dialyzer sizes. A mean increase in hemoglobin of 0.31 g/dl was also observed (p < 0.001). Among patients exhibiting increased serum albumin levels (n = 177), reductions in the neutrophil-to-lymphocyte ratio, a marker of inflammation, were observed (mean: 0.90; p < 0.001). These results support the use of high-flux dialyzers in patients with hypoalbuminemia.
Telemonitoring and Care Program for Left Ventricular Assist Device Patients During COVID-19 Outbreak: A European Experience
Authors: Mariani Silvia , Schöde Alexandra , Homann Katharina , Feueriegel Silke , Nöth Sandra , Warnke Katharina , Bounader Karl , Andreeva Alexandra , Li Tong , Dogan Günes , Haverich Axel , Schmitto Jan D.
Published: June 2021

Coronavirus disease 2019 (COVID-19) radically modified the organization of healthcare systems with shutdown of routine activities and outpatient clinics. Herein, we report our institutional experience with a Telemonitoring and Care Program (TC-Program) to monitor and support left ventricular assist device (LVAD) patients during COVID-19 outbreak. This single-arm cohort study analyzed 156 patients who entered the TC-Program at our institution between April and August 2020. The TC-Program was based on routine phone calls to patients and a 24/7 emergency line. In November 2020, patients were asked for feedback on the TC-Program and checked for survival, transplant, or explant. The primary endpoint was the rate of TC-Program-driven interventions. Patients (males: 82.8%) were 61 years old (interquartile range [IQR]: 53.0–67.5) and on LVAD support for 1,266 days (IQR: 475–2,211). Patients were included in the TC-Program for a median time of 99 days (min:15, max:120) and received a median number of six phone calls (min:1, max:14). Twenty-three patients (14.7%) were referred for clinical evaluation after phone contact. Two patients (1.27%) were diagnosed with COVID-19: one of them died after intensive care, and one remained paucisymptomatic and recovered. Three patients asked to exit the program considering it not useful while the others gave high rates in terms of usefulness (median: 9, IQR: 8–10), information (median: 9, IQR: 8–10), good medical care (median: 9, IQR: 8–10), and psychologic support (median: 8, IQR: 7–10). A TC-Program based on the four ICSA principles (Inform, Care, Support, and Adapt) is feasible in LVAD patients and can be rapidly implemented during the COVID-19 pandemic.
Unclassifiable, or simply unclassified interstitial lung disease?
Authors: O’Callaghan Marissa , Bonella Francesco , McCarthy Cormac
Published: June 2021

Purpose of review

Unclassifiable interstitial lung disease (ILD) comprises a subset of ILDs which cannot be classified according to the current diagnostic framework. This is a likely a heterogeneous group of diseases rather than a single entity and it is poorly defined and hence problematic for prognosis and therapy.

Recent findings

With increased treatment options for progressive fibrosing ILD it is increasingly relevant to correctly categorise ILD.

This review article will summarise the definition and reasons for a diagnosis of unclassifiable ILD, the current management options and possible future approaches to improve diagnosis and differentiation within this broad subset. Finally, we will describe the implications of the labelling of unclassifiable ILD in clinical practice and research and whether the term ‘unclassified’ should be used, implying a less definitive diagnosis.
Patient perception of receiving a thyroid cancer diagnosis
Authors: Jensen Catherine B. , Pitt Susan C.
Published: June 2021

Purpose of review

This review describes the current state of the literature on patients’ perceptions of receiving a diagnosis of thyroid cancer. The evaluation progresses from people's understanding about thyroid cancer in general to the lived experiences of those receiving an initial diagnosis or one of recurrence. The implications on patients’ quality of life and treatment decisions are also discussed.

Recent findings

Receiving a diagnosis of thyroid cancer often elicits intense and immediate emotions of shock and fear evoked by the word ‘cancer,’ which may be related to lack of knowledge about thyroid cancer specifically. Describing thyroid cancer as the ‘good cancer’ in an attempt to reassure patients is not necessarily reassuring and can inadvertently minimize the impact of a patient's diagnosis. Fear and worry about cancer in general and the possibility for recurrence contribute to lasting psychological distress and decreased quality of life. Patients’ perceptions of their diagnosis and resulting emotional reactions influence treatment decision-making and have the potential to contribute to decisions that may over-treat a low-risk thyroid cancer.

Understanding patients’ experience of receiving a thyroid cancer diagnosis is critical because their emotional reactions can have a profound impact on treatment decision-making and quality of life.
Painful chronic pancreatitis - new approaches for evaluation and management
Authors: Yadav Dhiraj , Palermo Tonya M. , Phillips Anna E. , Bellin Melena D. , Conwell Darwin L.
Published: June 2021

Purpose of review

Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis.

Recent findings

Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy.

Several lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
Manuscript Review at the Journal of Pediatric Gastroenterology and Nutrition
Authors: Kumar Prerna , Ravindra Aditya , Wang Yanzhi , Belli Dominique C. , Heyman Melvin B. , Gupta Sandeep K.
Published: June 2021

Objective:

Given the importance of scholarly work in academic medicine, better understanding of the manuscript review process (MRP) is useful for authors, reviewers, and editorial boards. We aim to describe the MRP at the Journal of Pediatric Gastroenterology and Nutrition (JPGN), assess the correlation between editor decisions and reviewer recommendations, and provide transparency to this process.

Methods:

All manuscripts submitted in 2018 to JPGN were included in this analysis. Data included reviewers’ manuscript scores and recommendations, time spent on each review by reviewers, the editor's rating of the reviewers’ reviews, the editor's first decision, and final outcome. Data were collated using the JPGN manuscript submission website, Editorial Manager.

Results:

1023 manuscripts were submitted to JPGN in 2018 and included in this analysis. Of these, 486 manuscripts had at least two peer reviewers. The recommendations of the two reviewers were in agreement 43% of the time. Intra‐class correlation (ICC) between the two reviewers suggests moderate agreement (ICC = 0.40). When both reviewers agreed to Not Reject (289/486), the editor agreed in 93% of cases (269/289). When both reviewers agreed to Reject (55/486), the editor agreed 100% of the time (55/55). The reviewers disagreed in about one‐third of submissions (142/486), and the editor recommended to Reject in two‐thirds of these cases (95/142). Overall, inter‐reviewer agreement strongly correlated with the editor's initial decision (P < 0.001).

Conclusions:

The editor most often agreed with reviewers’ assessments when there was concordance between the two reviewers’ recommendations. About a third of peer reviews result in discordant recommendations between the two reviewers.
Pediatric Collagenous Gastritis: Clinical and Histologic Outcomes in a Large Pediatric Cohort
Authors: Beinvogl Beate C. , Goldsmith Jeffrey D. , Verhave Menno
Published: June 2021

Objective:

The aim of the study was to present the clinical characteristics, treatment, and outcomes of pediatric collagenous gastritis (CG).

Method:

This is a retrospective cohort study. Patients were identified via query of the institutional pathology database. Clinical data was obtained by review of medical records.

Results:

Forty patients (57.5% female) were identified, mean age 11.3 ± 3.7 years (2–16years). Isolated CG was present in 66.7%, coexisting collagenous duodenitis (CD) in 17.5%, collagenous colitis (CC) in 7.5%, and collagenous ileitis in 2.5%. Atopic comorbidities were found in 25%, autoimmune comorbidities in 12.5%.

Presenting Symptoms:

Abdominal pain (77.5%), vomiting (65%), anemia (57.5%), nausea (55.5%), diarrhea (32.5%), anorexia (25.0%), weight loss (25%), gastrointestinal bleed (22.5%), poor growth (20%), poor weight gain (12.5%).

Endoscopic Findings:

All had abnormal endoscopic findings on esophago-gastro-duodenoscopy (EGD), most commonly gastric nodularity (77.5%), visible blood (20%), erosions/superficial ulcerations (10%), ulcers (7.5%). Histologically, all patients had increased subepithelial collagen deposition.

Treatment:

A variety of medications aimed towards inflammation and symptomatic treatment were used. Patients with anemia received iron supplementation and responded. Otherwise, there was no significant association of clinical or histologic improvement with specific treatments.

Clinical and Histologic Outcomes:

87.5% reported improvement or resolution of symptoms at the last follow-up (34.8 ± 27.0 months). Persistent sub-epithelial collagen was noted in 73.1% on the last EGD.

Conclusions:

Despite persistent findings of increased sub-epithelial collagen deposition during the follow-up period, most patients with CG show remission or resolution of clinical symptoms. Anemia responds to iron supplementation in all patients.
The hepatitis E virus prevalence in autoimmune hepatitis: a systematic literature review on conducted researches
Authors: Yousefi Parastoo , Soltani Saber , Gholami Ali , Esghaei Maryam , Keyvani Hossin , Mokhtary-Irani Golnaz , Jafarzadeh Mehrzad , Ghahfarokhi Azam Dehghani , Jalilian Shahram , Tabibzadeh Alireza
Published: June 2021

Background and aim:

Autoimmune hepatitis (AIH) is an autoimmune liver disease that occurs predominantly in female gender. Increased serum IgG levels, the presence of autoantibodies and distinct histological features in the lake of other reason liver disease characterize AIH. HEV is a single-stranded RNA virus of the Orthohepevirus genus. Person to person transmission is rare and the main route of transmission of HEV is fecal-oral due to polluted water which is the main cause. The aim of the current systematic review is to investigate the published literature in the field of the HEV prevalence in AIH patients.

Materials and methods:

The conducted search was performed in electronic databases including EMBASE, Scopus, PubMed and Science Direct for terms, ‘hepatitis’, ‘autoimmune hepatitis’, ‘HEV’, ‘Hepatitis E virus’ and ‘Hepatitis E infection’. The search was performed without any date limitation in 14 February 2019.

Results:

Search implementation strategies leads to 10 768 studies in all of the assessed databases. The screening and full text assessment leads to eight research studies and eight case reports in this field. The investigation included 11O7 AIH patients and 760 controls. The age range was 18–79 years and the female gender reports more in all analyses. Research studies in the field of the HEV prevalence in AIH mostly focused in the anti-HEV IgG evaluation by Immunoassay technics. The anti-HEV IgG prevalence ranged from 7.7 to 50% in AIH patients.

Conclusion:

The anti-HEV IgG prevalence seems to be highly variable based on the geographical location and patient's population in AIH. Further studies in this field are required for clear conclusion about the HEV role in AIH development.
Racial and Economic Adversity Differences in Stress Markers and Immune Function Among Urban Adolescents
Authors: Ford Jodi L. , Browning Christopher R. , Boch Samantha J. , Kertes Darlene A. , Tarrence Jake , Way Baldwin M. , Schmeer Kammi K.
Published: June 2021

Background

Exposure to racism and associated adversities, such as poverty, is hypothesized to contribute to racial inequities in health via stress and immune pathways. Furthermore, the effects of adversity may be more salient during sensitive developmental periods. Our study examined racial differences in stress and immune biomarkers during adolescence and the effects of exposure to economic adversity at distinct developmental time periods and cumulatively in accounting for potential racial differences.

Methods

Secondary analysis of the Adolescent Health and Development in Context study was conducted. Data were derived from self-administered surveys; interviews; smartphone-based, geographic-explicit ecological momentary assessment; stress biomarkers (evening salivary cortisol over six nights and hair cortisol); and immune biomarkers (salivary shedding of Epstein-Barr virus [EBV] DNA among EBV-positive adolescents). Current socioeconomic status measures included annual household income and caregiver education. Caregivers also reported experiences of bankruptcy, difficulty paying bills, receipt of food stamps/Supplemental Nutrition Assistance Program/electronic benefit transfer, and job loss when the child was of ages birth–5 years, 6–10 years, and 11 years or older. An affirmative response to any item was defined as exposure to economic adversity for that developmental time period (yes/no). A cumulative economic adversity measure was calculated as the sum of exposures across developmental periods (0 = never exposed to 3 = exposed across all time periods). Descriptive and multivariable regression analyses were conducted, accounting for covariates.

Results

Black/African American adolescents had higher salivary cortisol concentration, higher hair cortisol concentration, and an increased odd of salivary shedding of EBV DNA compared to White adolescents. Racial differences were not attenuated by the current socioeconomic status or economic adversity (developmental period or cumulatively).

Discussion

Our study provides evidence that stress and immune biomarkers differ by race as early as adolescence and may be one pathway through which racism and associated adversities contribute to racial health inequities. Further research on the contribution of multiple adversities beyond poverty to racial inequities in physiological stress and health is critical for informing effective prevention and intervention efforts.