bluuebunny/crossref_metadata_2025 huggingface dataset:
Sacral Neuromodulation in Patients With Low Anterior Resection Syndrome: The SANLARS Randomized Clinical Trial
Authors: Marinello Franco G. , Fraccalvieri Domenico , Planellas Pere , Adell Montse , Gil Julia , Kreisler Esther , Pellino Gianluca , Espín-Basany Eloy
Published: December 2023

BACKGROUND:

Sacral neuromodulation might be effective to palliate low anterior resection syndrome after rectal cancer surgery, but robust evidence is not available.

OBJECTIVE:

To assess the impact of sacral neuromodulation on low anterior resection syndrome symptoms, measured by validated scores and bowel diaries.

DESIGN:

Randomized, double-blind, two-phased, controlled, multicentric crossover trial (NCT02517853).

SETTINGS:

Three tertiary hospitals.

PATIENTS:

Patients with major low anterior resection score 12 months after transit reconstruction following rectal resection who had failed conservative treatment.

INTERVENTIONS:

Patients underwent advanced test phase by stimulation for 3 weeks and were implanted the pulse generator if 50% reduction in low anterior resection syndrome score was achieved, entering the randomized phase in which the generator was left active or inactive for 4 weeks. After a 2-week wash-out, the sequence was changed. After the crossover, all generators were left activated.

MAIN OUTCOME MEASURES:

The primary outcome was low anterior resection syndrome score reduction. Secondary outcomes included continence and bowel symptoms.

RESULTS:

After testing, 35 of 46 patients (78%) had ≥50% low anterior resection syndrome score reduction. during the crossover, all patients showed a reduction in scores and improved symptoms, with better performance if the generator was active. At 6- and 12-month follow-up, the mean reduction in low anterior resection syndrome score was -6.2 (-8.97; -3.43; p < 0.001) and -6.97 (-9.74; -4.2; p < 0.001), with St. Mark’s continence score -7.57 (-9.19; -5.95, p < 0.001) and -8.29 (-9.91; -6.66; p < 0.001). Urgency, bowel emptiness sensation, and clustering episodes decreased in association to quality of life improvement at 6- and 12-month follow-up.

LIMITATIONS:

The decrease in low anterior resection syndrome score with neuromodulation was underestimated due to unspecific measuring instrument. Possible carryover effect in sham stimulation sequence.

CONCLUSIONS:

Neuromodulation provides symptoms and quality of life amelioration, supporting its use in low anterior resection syndrome.
Pathologic Upstaging of Cutaneous Melanoma After Mohs Micrographic Surgery
Authors: Juhasz Margit , Young Jade N. , Azzawi Soraya , Leitenberger Justin , Bar Anna , Gharavi Nima M.
Published: December 2023

BACKGROUND

Mohs micrographic surgery (MMS) is used for melanoma in situ (MIS) and thin invasive melanomas, particularly on the head and neck, during which a debulk section is typically prepared. Tumor upstaging occurs if the debulking specimen meets criteria for an increased tumor (T) stage per the American Joint Committee on Cancer 8th edition compared with the initial biopsy. Upstaging can alter survival and recurrence outcomes, resulting in increased patient morbidity and mortality.

OBJECTIVE

To determine the rate of cutaneous melanoma upstaging during MMS.

MATERIALS AND METHODS

A multicenter study was performed. Information from electronic medical records from 3 dermatologic surgeons performing MMS for cutaneous melanoma were logged from January 1, 2017 to December 31, 2021. Deidentified information regarding patient demographics and tumor characteristics was recorded.

RESULTS

Three-hundred and ten cases of cutaneous melanoma treated with MMS were identified. 2.3% of cases were upstaged, ranging from T1a to T3a. No significant risk factors for upstaging were identified.

CONCLUSION

Our data demonstrate a lower rate of cutaneous melanoma upstaging during MMS than the current literature. Differences may be accounted for because of differing patient populations, cutaneous melanoma detection at an earlier clinical stage, and evolving melanoma histologic criteria.
Clinical and Optical Coherence Tomography Correlation of Vascular Conditions Treated With a Novel, Variable-Sequenced, Long-Pulsed, 532 and 1,064 nm Laser With Cryogen Spray Cooling
Authors: Wang Jordan V. , Bajaj Shirin , Himeles Jaclyn R. , Geronemus Roy G.
Published: December 2023

BACKGROUND

Patients frequently seek laser treatment for vascular conditions. More recently, a novel 532 and 1,064 nm laser was developed to offer greater flexibility.

OBJECTIVE

A prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling (DermaV, Lutronic, South Korea).

MATERIALS AND METHODS

Subjects with vascular conditions were enrolled for laser treatments. Clinical evaluations and optical coherence tomography (OCT) imaging were performed.

RESULTS

Thirteen subjects were enrolled. The mean age was 51.3 years, and 92.3% were women. Fitzpatrick skin types I–IV were included. Treatment indications included broken blood vessels, rosacea, port-wine birthmark, and spider angioma. For physician investigator grading, all subjects were graded as improved at both 30-day and 90-day follow-up. Blinded photographic review by 3 independent, blinded physicians had a mean of 89.7% of cases selected correctly with at least 2 of 3 in agreement for 100.0% of cases. Optical coherence tomography imaging showed significant reductions in vessel density (p= .018) and diameter (p= .003) of the superficial vascular plexus. No serious adverse events occurred.

CONCLUSION

A novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling can safely and effectively improve vascular conditions and lesions as determined by both clinical and OCT evaluation.
Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities
Authors: Sun Chao , Zhao Xingliang , Shi Lei , Fan Xiaofei , Qi Xiaolong
Published: December 2023

There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.
Heparin Dosing During Percutaneous Coronary Intervention and Obesity
Authors: Kreutz Rolf P. , Leon Isaac G. , Bain Eric R. , George Bistees , Phookan Sujoy , Prakash Anjali , Sinha Anjan K. , Breall Jeffrey A. , Zenisek Joseph R. , Frick Kyle A. , Jaradat Ziad A. , Abu Romeh Ibrahim S. , O'Leary Brian , Kalra Ankur , Kumar Ashish , Lee Michael S. , von der Lohe Elisabeth
Published: December 2023

Unfractionated heparin is the most common anticoagulant used during percutaneous coronary intervention. Practice guidelines recommend an initial weight-based heparin bolus dose between 70 and 100 U/kg to achieve target activated clotting time (ACT) of 250–300 seconds. The impact of severe obesity on weight-based heparin dosing is not well studied. We performed a retrospective analysis of 424 patients undergoing percutaneous coronary intervention who received heparin for anticoagulation. We collected detailed data on cumulative heparin administration and measured ACT values in this cohort. We performed separate analyses to identify clinical predictors that may affect dose–response curves. There was significant variability in dosing with mean dose of 103.9 ± 32-U/kg heparin administered to achieve target ACT ≥ 250 seconds. Women received higher initial heparin doses when adjusted for weight than men (97.6 ± 31 vs. 89 ± 28 U/kg, P = 0.004), and only 49% of patients achieved ACT ≥ 250 s with the initial recommended heparin bolus dose (70–100 U/kg). Lower heparin dose (U/kg) was required in obese patients to achieve target ACT. In multivariate linear regression analysis with ACT as dependent variable, after inclusion of weight-based dosing for heparin, body mass index was the only significant covariate. In conclusion, there is significant variability in the therapeutic effect of heparin, with a lower weight-adjusted heparin dose required in obese patients.
The menopause-related gut microbiome: associations with metabolomics, inflammatory protein markers, and cardiometabolic health in women with HIV
Authors: Wang Yi , Sharma Anjali , Weber Kathleen M. , Topper Elizabeth , Appleton Allison A. , Gustafson Deborah , Clish Clary B. , Kaplan Robert C. , Burk Robert D. , Qi Qibin , Peters Brandilyn A.
Published: December 2023

Objective

This study aimed to identify menopause-related gut microbial features, as well as their related metabolites and inflammatory protein markers, and link with cardiometabolic risk factors in women with and without HIV.

Methods

In the Women's Interagency HIV Study, we performed shotgun metagenomic sequencing on 696 stool samples from 446 participants (67% women with HIV), and quantified plasma metabolomics and serum proteomics in a subset (~86%). We examined the associations of menopause (postmenopausal vs premenopausal) with gut microbial features in a cross-sectional repeated-measures design and further evaluated those features in relation to metabolites, proteins, and cardiometabolic risk factors.

Results

Different overall gut microbial composition was observed by menopausal status in women with HIV only. We identified a range of gut microbial features that differed between postmenopausal and premenopausal women with HIV (but none in women without HIV), including abundance of 32 species and functional potentials involving 24 enzymatic reactions and lower β-glucuronidase bacterial gene ortholog. Specifically, highly abundant species Faecalibacterium prausnitzii, Bacteroides species CAG:98, and Bifidobacterium adolescentis were depleted in postmenopausal versus premenopausal women with HIV. Menopause-depleted species (mainly Clostridia) in women with HIV were positively associated with several glycerophospholipids, while negatively associated with imidazolepropionic acid and fibroblast growth factor 21. Mediation analysis suggested that menopause may decrease plasma phosphatidylcholine plasmalogen C36:1 and C36:2 levels via reducing abundance of species F. prausnitzii and Acetanaerobacterium elongatum in women with HIV. Furthermore, waist-to-hip ratio was associated with menopause-related microbes, metabolites, and fibroblast growth factor 21 in women with HIV.

Conclusions

Menopause was associated with a differential gut microbiome in women with HIV, related to metabolite and protein profiles that potentially contribute to elevated cardiometabolic risk.
Lymphatic Mapping in the Repair of Adult-acquired Buried Penis: Proof of Concept
Authors: Marantidis Joanna , Song David , Venkatesan Krishnan , Shaw Nathan M.
Published: December 2023

Adult-acquired buried penis (AABP) is an acquired clinical entity where a normal sized phallus is concealed by prepubic skin, fat, or subcutaneous tissue, often caused by obesity, lymphedema, or trauma. Surgical repair is the standard of care in management of AABP; however, up to 60% of patients have developed bothersome genital lymphedema postoperatively. Despite the rates of postoperative scrotal lymphedema, and lymphedema itself representing a risk for AABP, very little data exist on the role of lymphatic evaluation in this patient population. We present the previously unreported use of indocyanine green (ICG) for lymphatic mapping as an adjunct to buried penis repair. Using 0.1 mL 25 mg per mL of indocyanine green and SPY Portable Handled Imaging, lymph mapping is performed, identifying lymph channels that seem obstructed as possible targets for lymphovenous bypass. In addition, lymph mapping can be used as an adjunct to surgical resection so as to not disrupt the intact channels, reducing the risk of postoperative lymphedema. Through this article, we offer emerging clinical insight into the possible use of lymphovenous bypass, particularly in patients with AABP due to lymphedema or those who experience lymphedema as a complication of AABP repair.
Precision of a new SS-OCT biometer to measure anterior segment parameters and agreement with 3 instruments with different measurement principles
Authors: Venkataraman Abinaya Priya , Domínguez-Vicent Alberto , Selin Paulina , Brautaset Rune , Montés-Micó Robert
Published: December 2023

Purpose:

To evaluate the repeatability of a new swept source optical coherence tomography (SS-OCT)–based biometer to measure anterior segment parameters and to assess the agreement with 3 other imaging devices based on different measurement principles.

Setting:

Unit of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.

Design:

Prospective, comparative case series.

Methods:

3 consecutive measurements were obtained in unoperated eyes with the Eyestar900 (SS-OCT), Lenstar 900, MS-39, and Sirius. The following anterior segment parameters were evaluated: central corneal thickness (CCT), corneal diameter (CD), aqueous depth (AQD), and corneal power metrics. The repeatability limit (Rlim), coefficient of variation (CoV), and a repeated measures Bland-Altman analysis were performed.

Results:

74 eyes of 74 participants were measured. The Rlims for CCT, CD, and AQD were lower than 10 μm, 0.3 mm, and 0.10 mm for all devices, respectively. The corresponding CoVs for these parameters never exceeded 1.2%. The Rlim for the corneal power metrics never exceeded 0.60 diopter (D) for any of the instruments. Lenstar showed the best agreement with the MS-39 to measure CCT, CD, and AQD (limit of agreement interval, LoA: 15.54 μm, 0.55 mm, and 0.16 mm, respectively). The mean difference for keratometry parameters was lower than 0.3 D for all device comparisons, and the LoA interval ranged between 0.52 D and 1.21 D.

Conclusions:

The repeatability for measuring anterior segment parameters was good, and the agreement among all the instruments was good for CD and AQD measurements. However, for CCT and keratometer parameters, the instruments cannot be used interchangeably due to large LoA interval.
Development of a radiomics-based model to predict occult liver metastases of pancreatic ductal adenocarcinoma: a multicenter study
Authors: Zhao Ben , Xia Cong , Xia Tianyi , Qiu Yue , Zhu Liwen , Cao Buyue , Gao Yin , Ge Rongjun , Cai Wu , Ding Zhimin , Yu Qian , Lu Chunqiang , Tang Tianyu , Wang Yuancheng , Song Yang , Long Xueying , Ye Jing , Lu Dong , Ju Shenghong
Published: December 2023

Background:

Undetectable occult liver metastases block the long-term survival of pancreatic ductal adenocarcinoma (PDAC). This study aimed to develop a radiomics-based model to predict occult liver metastases and assess its prognostic capacity for survival.

Materials and Methods:

Patients who underwent surgical resection and were pathologically proven with PDAC were recruited retrospectively from five tertiary hospitals between January 2015 and December 2020. Radiomics features were extracted from tumors, and the radiomics-based model was developed in the training cohort using LASSO-logistic regression. The model’s performance was assessed in the internal and external validation cohorts using the area under the receiver operating curve (AUC). Subsequently, the association of the model’s risk stratification with progression-free survival (PFS) and overall survival (OS) was then statistically examined using Cox regression analysis and the log-rank test.

Results:

A total of 438 patients (mean [standard deviation] age, 62.0 [10.0] years; 255 [58.2%] male) were divided into the training cohort (n = 235), internal validation cohort (n = 100), and external validation cohort (n = 103). The radiomics-based model yielded an AUC of 0.73 (95% confidence interval [CI]: 0.66-0.80), 0.72 (95% CI: 0.62-0.80), and 0.71 (95% CI: 0.61-0.80) in the training, internal validation, and external validation cohorts, respectively, which were higher than the preoperative clinical model. The model’s risk stratification was an independent predictor of PFS (all P < 0.05) and OS (all P < 0.05). Furthermore, patients in the high-risk group stratified by the model consistently had a significantly shorter PFS and OS at each TNM stage (all P < 0.05).

Conclusion:

The proposed radiomics-based model provided a promising tool to predict occult liver metastases and had great significance in prognosis.
Low back pain-driven inpatient stays in the United States: a nationwide repeated cross-sectional analysis
Authors: Chen Lingxiao , Sun Qingyu , Chou Roger , Anderson David B. , Shi Baoyi , Chen Yujie , Liu Xinyu , Feng Shiqing , Zhou Hengxing , Ferreira Manuela L.
Published: December 2023

Background:

Low back pain (LBP)-driven inpatient stays are resource-intensive and costly, yet data on contemporary national trends are limited.

Materials and methods:

This study used repeated cross-sectional analyses through a nationally representative sample (US National Inpatient Sample, 2016–2019). Outcomes included the rate of LBP-driven inpatient stays; the resource utilization (the proportion of receiving surgical treatments and hospital costs) and prognosis (hospital length of stay and the proportion of nonroutine discharge) among LBP-driven inpatient stays. LBP was classified as overall, nonspecific, and specific (i.e. cancer, cauda equina syndrome, vertebral infection, vertebral compression fracture, axial spondyloarthritis, radicular pain, and spinal canal stenosis). Analyses were further stratified by age, sex, and race/ethnicity.

Results:

292 987 LBP-driven inpatient stays (weighted number: 1 464 690) were included, with 269 080 (91.8%) of these for specific LBP and 23 907 (8.2%) for nonspecific LBP. The rate of LBP-driven inpatient stays varied a lot across demographic groups and LBP subtypes (e.g. for overall LBP, highest for non-Hispanic White 180.4 vs. lowest for non-Hispanic Asian/Pacific Islander 42.0 per 100 000 population). Between 2016 and 2019, the rate of nonspecific LBP-driven inpatient stays significantly decreased (relative change: 46.9%); however, substantial variations were found within subcategories of specific LBP-significant increases were found for vertebral infection (relative change: 17.2%), vertebral compression fracture (relative change: 13.4%), and spinal canal stenosis (relative change: 19.9%), while a significant decrease was found for radicular pain (relative change: 12.6%). The proportion of receiving surgical treatments also varied a lot (e.g. for overall LBP, highest for non-Hispanic White 74.4% vs. lowest for non-Hispanic Asian/Pacific Islander 62.8%), and significantly decreased between 2016 and 2019 (e.g. for nonspecific LBP, relative change: 28.6%). Variations were also observed for other outcomes.

Conclusions:

In the US, the burden of LBP-driven inpatient stays (i.e. rates of LBP-driven inpatient stays, resource utilization, and prognosis among LBP-driven inpatient stays) is enormous. More research is needed to understand why the burden varies considerably according to the LBP subtype (i.e. nonspecific and specific LBP as well as subcategories of specific LBP) and the subpopulation concerned (i.e. stratified by age, sex, and race/ethnicity).
Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage
Authors: Scherer Florian , Beule Achim Georg , Lütkenhöner Bernd , Heitkötter Felix , Rudack Claudia
Published: December 2023

Objective

To compare two novel electrode montages for ocular, vestibular evoked myogenic potential using single-nasion reference electrodes with the clinical standard montage.

Study Design

Randomized crossover experiment.

Setting

Tertiary referral center.

Participants

Sixty healthy participants.

Intervention

Normal hearing and vestibular function were confirmed with an extensive test-battery. All ocular, vestibular evoked myogenic potential settings were measured with air-conducted tone bursts at 100-dB normal hearing level and a frequency of 500 Hz. Three electrode montages were measured in randomized order: the clinical standard montage (“S”), the nasion reference montage (“N”), and the nasion reference montage with a more lateral active electrode (“L”). Upgaze was standardized to 35 degrees.

Main Outcome Measures

Detection rate, latency of N1 and P1, peak-to-peak amplitude of N1 and P1, signal-to-noise ratio (SNR), asymmetry ratio (AR), concordance of expert assessment, and reliability.

Results

All electrode montages showed detection rates greater than 90%. Latencies for “L” were shorter than for “S” and “N.” Amplitudes and SNR for “S” and “N” were higher than for “L,” whereas the values for “S” and “N” did not differ significantly. For AR, no significant differences between the montages were assessed. Concordance of experts ranged from 78% for “L” and 89.8% for “N.” All montages provided excellent day-to-day reliability (intraclass correlation coefficient ≥0.9) for amplitudes and SNR.

Conclusions

Montage N could be a useful alternative to the clinical standard montage: although results are roughly equivalent, montage N requires one less electrode to do so.
Variability in Perioperative Steroid Therapy Regimen for Cochlear Implantation as It Relates to Hearing Preservation
Authors: Derdzakyan Nicole A. , Lava Christian X. , Hakimi Amir A. , Johns J. Dixon , Kim H. Jeffrey , Hoa Michael
Published: December 2023

Hypothesis

We aimed to identify practice trends and association between physician training and administration of perioperative steroids for cochlear implantation (CI) as it relates to hearing preservation.

Background

Perioperative steroid therapy regimens are postulated to protect residual hearing and improve hearing preservation outcomes in CI.

Methods

A 27-question online survey was developed by the senior authors using the Qualtrics Survey Tool, then distributed via email from September to November 2022 to otolaryngologists specializing in otology or neurotology and who practice in the United States or Canada.

Results

The survey was sent to 463 physicians, 162 (35.0%) of whom completed the survey. One hundred forty-four (31.1%) responses underwent analysis. All physicians administering preoperative steroids (n = 31) prefer preoperative oral prednisone. Of 143 physicians administering intraoperative steroids, 54.5% prefer intraoperative intravenous dexamethasone. More than half (77.6%) of 85 physicians administering postoperative steroids prefer postoperative oral prednisone. Postoperative steroid administration (p < 0.006) and taper utilization (p < 0.041) were greater among physicians who complete greater than 40 CIs annually (n = 47 [71.2%]; n = 30 [49.2%]) than physicians who complete up to 40 CIs annually (n = 37 [48.7%]; n = 20 [31.3%]), respectively. Physicians practicing for 5 to 20 years after residency are more prevalent in using postoperative steroid tapers than physicians practicing for fewer than 5 years after and more than 20 years after residency (n = 37 [51.4%] versus n = 14 [25.5%], p < 0.001).

Conclusion

Consensus is needed about the optimal steroid treatment for CI patients.

Level of Evidence

4.
An Investigation of the Impact of Expanding High-Deductible Health Plans on Patient Decision for Cochlear Implant Surgery and Postoperative Outcomes
Authors: Africa Robert E. , Quinlan Brian P. , McKinnon Brian J.
Published: December 2023

Hypothesis

After the expansion of high deductibles, patients will delay cochlear implant (CI) surgery to the end of the year, and the risk of postoperative known risks will increase.

Background

The Affordable Care Act was associated with increased enrollment in high-deductible health plans (HDHPs), which resulted in rising health insurance deductibles. Health insurance plans can cover a patient's cost of healthcare once the deductible is met. Patients have been shown to be economic rational decision makers and make decisions based on cost rather than health. They wait for their deductible to be met, typically at the end of the year, then proceed to have costly care. The goal of this study was to evaluate the impact of rising health insurance deductibles on the rate and postoperative outcomes of cochlear implantation and to assess changes by the Tax Cuts and Jobs Act.

Methods

TriNetX was used to accumulate summary data on patients who obtained a CI between 2005 and 2022 at the beginning (quarter 1) and the end of the year (quarter 4) from the electronic medical records of 75 healthcare organizations. The trends in average rate of cochlear implantation and resultant postoperative known risks or complications were statistically evaluated.

Results

After expansion of HDHPs, the rate of cochlear implantation between quarter 4 (19 cases per year) and quarter 1 (17 cases/year) was similar (p= 0.18). For all patient groups, the case volume significantly increased. Between quarter 4 and quarter 1, postoperative tinnitus was more common in the beginning of the year (risk ratio, 0.68; 95% confidence interval, 0.46–0.99).

Conclusions

The number of patients receiving CIs significantly increased despite the expansion of HDHPs. Tinnitus was a rare postoperative known risk in the beginning of the year. Patients are less likely concerned about cost of CI surgery because of the impact of hearing loss on quality of life.
Cochlear Implant Referral Criteria for the Spanish-Speaking Adult Population
Authors: Smeal Molly R. , Coto Jennifer , Prentiss Sandra , Stern Tina , VanLooy Lindsey , Holcomb Meredith A.
Published: December 2023

Objective

To evaluate the effectiveness of the “60/60 Guideline” in a diverse patient population.

Study Design

Retrospective review.

Setting

Tertiary referral center.

Patients

Data were collected for adult patients (18 years and older) who underwent a cochlear implant evaluation (CIE) between January 2016 and March 2021.

Main Outcome Measure(s)

Development of the “60/60 Guideline” has provided better clarity on when to refer English-speaking patients for a CIE. Our study evaluated the effectiveness of this referral tool in the Spanish-speaking population.

Results

In our group of patients who underwent a traditional CIE (n = 402), 209 met unaided and aided traditional cochlear implant (CI) candidacy criteria. Of the 193 individuals who did not meet both components of traditional candidacy criteria, a majority met the aided component (86%) but only 4.6% met the unaided component. When applying the 60/60 Guideline to patients who met traditional criteria, there is a sensitivity rating of 84.7% and a specificity index of 50.3%. For English and Spanish speakers who met traditional criteria but did not meet the 60/60 Guideline, a majority (83.3% English, 87.5% Spanish) had a better ear word recognition score (WRS) greater than 60%, suggesting the unaided WRS is the more restrictive component of the “60/60 Guideline.”

Conclusion

Application of the “60/60 Guideline” is an effective method to identify potential CI candidates in the English-speaking population; however, it was less effective in the Spanish-speaking population. Spanish-speaking adults should be referred for a CIE when better ear pure tone average is greater than 60 dB hearing loss, regardless of their unaided WRS. This study highlights the need for inclusion of nonlinguistic test measures in the CI referral criteria and test battery to reduce CI access barriers for patients who speak a language other than English.
Educational Benefit of the Three-Dimensional Exoscope Versus Operating Microscope in Otologic Surgery
Authors: Tu Nathan C. , Doerfer Karl , Costeloe Anya , Sioshansi Pedrom C. , Babu Seilesh
Published: December 2023

Objective

To compare observation of otologic surgery using a traditional operating microscope (OM) and a three-dimensional exoscope.

Study Design

Prospective, nonrandomized, noncontrolled study.

Setting

Tertiary care center.

Methods

Senior medical students and otolaryngology trainees observing otologic surgery performed with OM and exoscope were asked to complete a questionnaire comparing the two experiences. The key variables were image clarity, depth perception, observer's level of motion sickness during the surgery, the participant's understanding of middle ear anatomy, and their overall preference between OM and exoscope.

Results

Twenty-two observers participated in the study. Subjective clarity of the image was significantly better with the exoscope compared with the OM (9.7 ± 0.6 versus 6.9 ± 1.7, p = 0.0004) as well as the depth perception (9.25 ± 0.87 versus 5 ± 2.69, p = 0.0007). Observers subjectively had an improved understanding of middle ear anatomy after observing an exoscopic surgery, but not a microscopic surgery. All but one observer preferred the exoscope.

Conclusion

The three-dimensional exoscope may be a valuable educational tool for teaching trainees otologic surgery. More objective studies are needed in the future to assess the degree of improvement.
Effect of Cochlear Implantation on Social Life
Authors: Reddy Priyanka , Schneider Kara J. , Tamati Terrin N. , Moberly Aaron C.
Published: December 2023

Objective

Explore the effects of hearing loss on social life and identify residual social life deficits that remain after cochlear implantation.

Study Design

Retrospective review of prospectively obtained data.

Setting

Tertiary care adult neurotology center.

Patients

Adults between the ages of 35 and 83 years were included with either normal hearing (NH) or a cochlear implant (CI).

Interventions

CI and non-CI–specific quality-of-life (QOL) surveys focused on social and overall QOL.

Main Outcome Measure(s)

(1) The difference in QOL survey responses between NH and CI participants. (2) The relationship between CI-specific global and social QOL responses and non–CI-specific social QOL responses in CI users.

Results

A total of 51 participants were included: 31 CI users and 20 NH participants. Of the social QOL questionnaires, CI users reported significantly poorer scores on Self-Efficacy in Social Interactions than NH peers (p = 0.049). Both Self-Efficacy in Social Interactions scores and Social Isolation Questionnaire scores were significantly correlated with the CI-specific social domain of QOL (r = 0.64 and −0.58, respectively). Only the Self-Efficacy in Social Interactions scores had a moderate association with global CI QOL (r = 0.47).

Conclusions

CI users self-report similar social life outcomes as their NH peers with the exception of poorer self-efficacy in social situations. Moreover, self-efficacy in social interactions and social isolation were associated with social QOL in CI users, and self-efficacy in social interactions was associated with broader CI-related QOL. Findings support the relevance of individuals' perception of social life to their overall QOL with a CI.
Cortisol Sensitizes Cochlear Hair Cells to Gentamicin Ototoxicity Via Endogenous Apoptotic Pathway
Authors: Li Cong , Chen Liang , Li Yingying , Li Mengxin , Zhang Xiaoling , Cui Limei , Sun Yan , Song Xicheng
Published: December 2023

Hypothesis

The stress hormone cortisol affects aminoglycoside-induced ototoxicity.

Background

The widespread use of aminoglycosides is a prevalent cause of sensorineural hearing loss. Patients receiving aminoglycosides usually have elevated levels of circulating stress hormones due to disease or physiological stress; however, whether the stress hormone cortisol impacts aminoglycoside-mediated injury of cochlear hair cells has not been fully investigated.

Methods

House Ear Institute-Organ of Corti 1 (HEI-OC1) cells with or without cortisol pretreatment were exposed to gentamicin, we investigated the effect of cortisol pretreatment on gentamicin ototoxicity by assessing cell viability. Molecular pathogenesis was explored by detecting apoptosis and oxidative stress. Meanwhile, by inhibiting glucocorticoid receptors (GR) and mineralocorticoid receptors (MR), the potential roles of receptor types in cortisol-mediated sensitization were evaluated.

Results

Cortisol concentrations below 75 μmol/l did not affect cell viability. However, pretreatment with 50 μmol/l cortisol for 24 hours sensitized hair cells to gentamicin-induced apoptosis. Further mechanistic studies revealed that cortisol significantly increased hair cell apoptosis and oxidative stress, and altered apoptosis-related protein expressions induced by gentamicin. In addition, blockade of either GR or MR attenuated cortisol-induced hair cell sensitization to gentamicin toxicity.

Conclusion

Cortisol pretreatment increased mammalian hair cell susceptibility to gentamicin toxicity. Sensitization was related to the activation of the intrinsic apoptotic pathway and excessive generation of reactive oxygen species. Cortisol may exacerbate aminoglycoside ototoxicity.
The place of positive end expiratory pressure in ventilator-induced lung injury generation
Authors: Thornton Lauren T. , Kummer Rebecca L. , Marini John J.
Published: December 2023

Purpose of review

Describe the rationale for concern and accumulating pathophysiologic evidence regarding the adverse effects of high-level positive end expiratory pressure (PEEP) on excessive mechanical stress and ventilator-induced lung injury (VILI).

Recent findings

Although the inclusion of PEEP in numerical estimates of mechanical power may be theoretically debated, its potential to increase stress, strain, and mean airway pressure are not. Recent laboratory data in a variety of animal models demonstrate that higher levels of PEEP coupled with additional fluids needed to offset its impediment of hemodynamic function are associated with increased VILI. Moreover, counteracting end-tidal hyperinflation by external chest wall pressure may paradoxically improve respiratory mechanics, indicating that lower PEEP helps protect the small ‘baby lung’ of advanced acute respiratory distress syndrome (ARDS).

The potentially adverse effects of PEEP on VILI can be considered in three broad categories. First, the contribution of PEEP to total mechanical energy expressed through mechanical power, raised mean airway pressure, and end-tidal hyperinflation; second, the hemodynamic consequences of altered cardiac loading, heightened pulmonary vascular stress and total lung water; and third, the ventilatory consequences of compromised carbon dioxide eliminating efficiency. Minimizing ventilation demands, optimized body positioning and care to avoid unnecessary PEEP are central to lung protection in all stages of ARDS.
Setting positive end-expiratory pressure: does the ‘best compliance’ concept really work?
Authors: Menga Luca S. , Subirà Carles , Wong Alfred , Sousa Mayson , Brochard Laurent J.
Published: December 2023

Purpose of review

Determining the optimal positive end-expiratory pressure (PEEP) setting remains a central yet debated issue in the management of acute respiratory distress syndrome (ARDS).

The ‘best compliance’ strategy set the PEEP to coincide with the peak respiratory system compliance (or 2 cmH2O higher) during a decremental PEEP trial, but evidence is conflicting.

Recent findings

The physiological rationale that best compliance is always representative of functional residual capacity and recruitment has raised serious concerns about its efficacy and safety, due to its association with increased 28-day all-cause mortality in a randomized clinical trial in ARDS patients.

Moreover, compliance measurement was shown to underestimate the effects of overdistension, and neglect intra-tidal recruitment, airway closure, and the interaction between lung and chest wall mechanics, especially in obese patients. In response to these concerns, alternative approaches such as recruitment-to-inflation ratio, the nitrogen wash-in/wash-out technique, and electrical impedance tomography (EIT) are gaining attention to assess recruitment and overdistention more reliably and precisely.

The traditional ‘best compliance’ strategy for determining optimal PEEP settings in ARDS carries risks and overlooks some key physiological aspects. The advent of new technologies and methods presents more reliable strategies to assess recruitment and overdistention, facilitating personalized approaches to PEEP optimization.
Optimal positive-end expiratory pressure weaning in acute respiratory distress syndrome patients
Authors: McNamara Laura , Baedorf Kassis Elias
Published: December 2023

Purpose of review

Positive-end expiratory pressure (PEEP) is a tool in managing acute respiratory distress syndrome (ARDS). In this review, we discuss the various approaches to weaning PEEP after the acute phase of ARDS.

Recent findings

There is a paucity of research specifically looking at the differences between PEEP weaning protocols. Data in some populations though, particularly those with elevated BMI, suggest that a physiologic approach to PEEP weaning may be helpful. Use of various tools to optimize PEEP prior to and during spontaneous breathing trials (SBTs) may allow for improved alveolar recruitment and respiratory outcomes.

Although further prospective studies are warranted, we should consider using a physiologic approach to PEEP weaning in ARDS rather than a one size fits all model, which is currently the standard used in many clinical trials and throughout many ICUs.
Casein glycomacropeptide in phenylketonuria: does it bring clinical benefit?
Authors: Daly Anne , Ilgaz Fatma , Pinto Alex , MacDonald Anita
Published: December 2023

Purpose of review

Casein glycomacropeptide (CGMP) is a milk-derived bioactive sialyated phosphorylated peptide with distinctive nutritional and nutraceutical properties, produced during the cheese making process. It comprises 20–25% of total protein in whey products. CGMP is low in phenylalanine (Phe) and provides an alternative to Phe-free amino acids as a source of protein equivalent for patients with phenylketonuria (PKU). The amino acid sequence of CGMP is adapted by adding the amino acids histidine, leucine, tyrosine, arginine and tryptophan to enable its suitability in PKU. CGMP has potential antibacterial, antioxidative, prebiotic, remineralizing, digestion /metabolism and immune-modulating properties. The aim of this review is to assess the evidence for the role of CGMP in the management of PKU.

Recent findings

In PKU, there is no agreement concerning the amino acid composition of CGMP protein substitutes and consequently the nutritional composition varies between products. Although there is evidence in patients or animal models that CGMP has possible beneficial effects on gut microbiota and bone health, the results are inconclusive. Data on kinetic advantage is limited. Most studies report an increase in blood Phe levels with CGMP. Appropriate adaptations and reduction of dietary Phe intake should be made to compensate for the residual Phe content of CGMP, particularly in children. Data from short term studies indicate improved palatability of CGMP when compared to Phe-free amino acids.

In PKU, CGMP with supplementary amino acids, offers a safe low Phe nitrogen source. Current scientific evidence is unconvincing about its bioactive advantage in PKU. Further longitudinal research is necessary.
Proposal of Novel Binary Grading Systems for Cervical Squamous Cell Carcinoma
Authors: Stolnicu Simona , Praiss Aaron M. , Allison Douglas , Tessier-Cloutier Basile , Flynn Jessica , Iasonos Alexia , Hoang Lien , Terinte Cristina , Pesci Anna , Mateoiu Claudia , Lastra Ricardo R. , Kiyokawa Takako , Ali-Fehmi Rouba , Kheil Mira , Oliva Esther , Devins Kyle , Abu-Rustum Nadeem , Soslow Robert A.
Published: December 2023

We compared grading systems and examined associations with tumor stroma and survival in patients with cervical squamous cell carcinoma. Available tumor slides were collected from 10 international institutions. Broders tumor grade, Jesinghaus grade (informed by the pattern of tumor invasion), Silva pattern, and tumor stroma were retrospectively analyzed; associations with overall survival (OS), progression-free survival (PFS), and presence of lymph node metastases were examined. Binary grading systems incorporating tumor stromal changes into Broders and Jesinghaus grading systems were developed. Of 670 cases, 586 were reviewed for original Broders tumor grade, 587 for consensus Broders grade, 587 for Jesinghaus grade, 584 for Silva pattern, and 556 for tumor stroma. Reproducibility among grading systems was poor (κ = 0.365, original Broders/consensus Broders; κ = 0.215, consensus Broders/Jesinghaus). Median follow-up was 5.7 years (range, 0–27.8). PFS rates were 93%, 79%, and 71%, and OS rates were 98%, 86%, and 79% at 1, 5, and 10 years, respectively. On univariable analysis, original Broders (P < 0.001), consensus Broders (P < 0.034), and Jesinghaus (P < 0.013) grades were significant for OS; original Broders grade was significant for PFS (P = 0.038). Predictive accuracy for OS and PFS were 0.559 and 0.542 (original Broders), 0.542 and 0.525 (consensus Broders), 0.554 and 0.541 (Jesinghaus grade), and 0.512 and 0.515 (Silva pattern), respectively. Broders and Jesinghaus binary tumor grades were significant on univariable analysis for OS and PFS, and predictive value was improved. Jesinghaus tumor grade (P < 0.001) and both binary systems (Broders, P = 0.007; Jesinghaus, P < 0.001) were associated with the presence of lymph node metastases. Histologic grade has poor reproducibility and limited predictive accuracy for squamous cell carcinoma. The proposed binary grading system offers improved predictive accuracy for survival and the presence of lymph none metastases.
A Comparative Study of Two Topical Treatments for Photoaging of the Hands
Authors: Wyles Saranya , Jankov Laura Eaton , Copeland Karen , Bucky Louis P. , Paradise Chris , Behfar Atta
Published: December 2023

Background:

Multiple effective treatments exist for correction of skin photoaging. Topical L-ascorbic acid (vitamin C), a well-known antioxidant and topical human platelet extract (HPE), is a novel off-the-shelf cosmetic ingredient that has shown positive results in recent clinical studies. HPE is a leukocyte-depleted allogeneic product derived from United States–sourced, pooled, apheresed platelets produced with consistent batch quality, purity, and effect. The authors sought to characterize the effect of topical HPE (plated) intense serum (Rion Aesthetics) compared with vitamin C (C E Ferulic with 15% L-ascorbic acid; SkinCeuticals) in skin rejuvenation of dorsal hands after 12 to 26 weeks of twice-daily use.

Methods:

This prospective, longitudinal study sought to compare the effectiveness of 2 known treatments for skin rejuvenation. Evaluations at baseline and 6, 12, and 26 weeks included photographic documentation to assess common skin concerns related to aging.

Results:

For age-related skin appearance on the dorsal hands, topical HPE was noninferior to topical vitamin C for improvement in brown spot fractional area, wrinkle fractional area, and improvement in luminosity at 12 weeks after twice-daily topical use.

Conclusions:

HPE performed as well as vitamin C to rejuvenate the skin on the dorsal hands after 12 to 26 weeks of twice-daily topical use. Both topical serums may yield similar or superior results versus invasive procedures, such as intense pulsed light, in reducing brown spots on the dorsal hands. These topical products work equally well in both sexes. Skin improvements lasted through 6 months.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Nationwide Outcome of Tailored Surgery for Symptomatic Chronic Pancreatitis based on Pancreatic Morphology
Authors: Van Veldhuisen Charlotte L. , Leseman Charlotte A , De Rijk Fleur E.M. , Dekker E. Nicole , Wellens Martine J. , Michiels Nynke , Stommel Martijn W.J. , Krikke Christina , Hofker H. Sijbrand , Mieog J. Sven D. , Bouwense Stefan A. , Van Eijck Casper H. , Groot Koerkamp Bas , Haen Roel , Boermeester Marja A. , Busch Olivier R. , Van Santvoort Hjalmar C. , Besselink Marc G. ,   for the Dutch Pancreatitis Study Group
Published: December 2023

Objective:

To determine the nationwide use and outcome of tailored surgical treatment for symptomatic chronic pancreatitis (CP) as advised by recent guidelines.

Summary background data:

Randomized trials have shown that surgery is superior to endoscopy in patients with symptomatic CP, although endoscopy remains popular Recent guidelines advice to “tailor surgery” based on pancreatic morphology meaning that the least extensive procedure should be selected based on pancreatic morphology. However, nationwide, and multicenter studies On tailored surgery for symptomatic CP are lacking.

Methods:

Nationwide multicenter retrospective analysis of consecutive patients undergoing surgical treatment for symptomatic CP in all seven Dutch university medical centers (2010-2020). Outcomes included volume trend, major complications, 90-day mortality, postoperative opioid use and clinically relevant pain relief. Surgical treatment was tailored based on the size of the main pancreatic duct and pancreatic head (e.g. surgical drainage for a dilated pancreatic duct, and normal size pancreatic head).

Results:

Overall, 381 patients underwent surgery for CP: 127 surgical drainage procedures ( 33%; mostly extended lateral pancreaticojejunostomy), 129 duodenum-preserving pancreatic head resections (DPPHR, 34%, mostly Frey), and 125 formal pancreatic resections (33%, mostly distal pancreatectomy). The annual surgical volume increased slightly (Pearson r=0.744). Mortality (90-day) occurred in 6 patients (2%), and was non-significantly lower after surgical drainage (0%, 3%, 2%; P=0.139). Major complications (12%, 24%, 26%; P=0.012), postoperative pancreatic fistula grade B/C (0%, 3%, 22%; P=0.038), surgical reintervention (4%, 16%, 12%; P=0.006), and endocrine insufficiency ( 14%, 21%, 43%; P<0.001) occurred less often after surgical drainage. After a median follow-up of 11 months [IQR 3-23] good rates of clinically relevant pain relief ( 83%, 69%, 80%; P=0.082) were observed and 81% of opioid users had stopped using (83%, 78%, 84%, P=0.496).

Conclusion:

The use of surgery for symptomatic CP increased over the study period. Drainage procedures were associated with the best safety profile and excellent functional outcome, highlighting the importance of tailoring surgery based on pancreatic morphology.