bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Family Rituals in Eating Behaviors in Hispanic Mothers
Authors: Coe Kathryn , Benitez Tanya , Tasevska Natasha , Arriola Anel , Keller Colleen
Published: November 2017

Food rituals often abruptly change when Hispanic families migrate to the United States. This report describes changes in rituals of food procurement, preparation, and presentation (food-PPP) in Hispanic women following migration to the United States. Focus groups and face-to-face interviews were conducted with 13 low-income, overweight/obese Hispanic women 27 to 40 years of age. Content analysis was used to analyze cultural and contextual sources for food-PPP. Changes in rituals and traditions in food-PPP occurred, including materials and ingredients for traditional meals. Food rituals may play a role in healthful eating and could, therefore, serve as leverage points for interventions designed to promote healthy eating behaviors.
Fostering Oral Hygiene Habits and Self-Regulation Skills
Authors: Gaeta Martha Leticia , Cavazos Judith , Cabrera Maria del Rosario , Rosário Pedro
Published: November 2017

The purpose of this study was to evaluate a program to promote self-regulation for self-care skills in preschool-aged children focused on oral habits and good oral health. Participants were 210 Mexican children aged 4 to 5 years who attended the Children's Assistance Community Centers (CAIC in Spanish). Findings showed that children who participated in the program, compared with those who did not, decreased significantly the teeth-bacteria plaque. The former also improved their self-regulation skills and dental hygiene habits. Data highlighted the key role of close adults in promoting young children's self-regulation for self-care focusing on dental hygiene habits.
Using a Cultural Framework to Assess Motivation for Physical Activity Among Older Hispanic Women
Authors: Perez Adriana , Fleury Julie
Published: November 2017

Culturally relevant strategies for intervention design and implementation, emphasizing strengths and resources, are essential to address cardiovascular health disparities among older Hispanic women. The purpose of this article is to present the process and results of focus group discussions conducted to understand the meaning of cultural, social, and contextual strengths to promote motivation for physical activity and cardiovascular health in this population. The PEN-3 model guided analysis of focus group data. Fifteen older Hispanic women (mean = 61, SD = 6) participated in 3 focus groups. Three interrelated domains were evaluated: (a) cultural identity, (b) relationships and expectations, and (c) cultural empowerment.
Pathway for the Management of Hyperglycemia in the Cardiac Care Unit
Authors: Hosseini Dehkordi Seyed Hamed , Albu Jeanine , Aziz Emad F. , Herzog Eyal
Published: November 2017

Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the “wheel” concept for insulin dosing. The “wheel” serves as a treatment guide. It is made up of 6 concentric circles. The core circle represents the goal of BG in critically ill patients, with inner circle showing the actual BG range of the patient. The 4 outer circles correspond to increasing rates of insulin infusion from tier 1 to tier 4. Simple guidelines are provided to facilitate conversion from insulin infusion to a subcutaneous insulin-delivery regimen in preparation for transfer from the cardiac care unit (CCU) setting. Our protocols also provide guidelines for management of diabetic ketoacidosis and hyperosmolar hyperglycemic states while at the same time creates a flowchart for activation of diabetes care team and their involvement in the multidisciplinary care of a patient in CCU with hyperglycemia and/or diabetes mellitus. This pathway provides a comprehensive and detailed, yet simple and practical algorithm for management of hyperglycemia in the CCU.
Impact of Sex on Long-term Clinical Outcomes After Percutaneous Coronary Intervention
Authors: Ghoreyshi-Hefzabad Seyed-Mohammad , Kassaian Seyed-Ebrahim , Kheirkhah-Sabetghadam Shahrbanoo , Jalali Arash , Poorhosseini Hamidreza , Movahed Mohammad Reza , Nematipour Ebrahim , Salarifar Mojtaba , Alidoosti Mohammad , Ghoreyshi- Hefzabad Seyedeharezoo , Alaeddini Farshid , Sadeghian Saeed , Lotfi-Tokaldany Masoumeh
Published: November 2017

Aims:

To evaluate the impact of sex on long-term clinical outcomes after percutaneous coronary intervention (PCI).

Methods:

In a large prospective cohort, 5664 patients (1716 women and 3948 men) who underwent PCI in a tertiary cardiac center between March 2007 and March 2010 were enrolled. Patients were followed up for median of 74.3 months. We compared the occurrence of long-term mortality, myocardial infarction (MI), and repeated revascularization between 2 sexes. Major adverse cardiac events were defined as a composite end point consisting of occurrence of all-cause mortality, nonfatal MI, or target vessel revascularization during follow-up period.

Results:

Women were older and had more conventional coronary artery disease risk factors, had smaller vessel diameter, and received drug-eluting stents more frequently than men. On the contrary, men were much more smokers and had higher frequency of acute coronary syndrome, multivessel disease, total coronary occlusion, and lower ejection fraction. After >6 years of follow-up, the all-cause mortality, nonfatal MI, target vessel revascularization, major adverse cardiac events, patient-oriented composite end point, and total repeat PCI were similar between 2 sexes. After adjusting for potential confounders, the total repeat PCI was the only observed difference that was significantly lower in women [11.2% in women vs. 12.4% in men, adjusted subdistributional hazard ratio=0.73 (95% confidence interval, 0.6–0.88); P = 0.001).

Conclusions:

During >6 years of follow-up, no significant difference was observed in major clinical outcomes between 2 sexes.
Troponin Limit of Detection Plus Cardiac Risk Stratification Scores to Rule Out Acute Myocardial Infarction and 30-Day Major Adverse Cardiac Events in ED Patients
Authors: Datlow Mitchell D. , Gray Kelly M. , Watts Adriel , Diercks Deborah B. , Mumma Bryn E.
Published: November 2017

When screening for acute myocardial infarction (AMI), troponin levels below the 99th percentile, including those below the limit of detection (LOD), are considered normal. We hypothesized that a low-risk HEART score (0–3) or ACS Pretest Probability Assessment <2% plus a single troponin below the LOD would rule out both AMI and 30-day major adverse cardiac events (MACE). We studied all patients who presented to a single academic emergency department and received a troponin I (Siemens Ultra Troponin I) from September 1, 2013, to November 13, 2013 (n=888). Demographic and clinical data were abstracted from the electronic medical record. Primary outcome was a final encounter diagnosis of myocardial infarction. Secondary outcome was 30-day MACE, defined as composite of myocardial infarction, revascularization, or death from a cardiac or uncertain etiology. Sensitivities of low-risk HEART score and ACS Pretest Probability <2% alone were 98% (95% confidence interval [CI], 89%–100%) and 96% (95% CI, 86%–100%) for AMI and 94% (95% CI, 86%–98%) and 95% (95% CI, 88%–99%), respectively, for 30-day MACE. When combined with troponin below the LOD, sensitivity for AMI was 100% (95% CI, 93%–100%; difference 2%; 95% CI, −2% to 6%) for low-risk HEART Score and 100% (95% CI, 93%–100%; difference 4%; 95% CI, −1.5% to 10%) for ACS Pretest Probability <2%. When combined with troponin below the LOD, sensitivity for 30-day MACE was 100% (95% CI, 95%–100%; difference 6%; 95% CI, 1%–12%) for low-risk HEART Score and 100% (95% CI, 95%–100%; difference 5%; 95% CI, 0.2%–10%) for ACS Pretest Probability <2%. Addition of a single troponin below the LOD to these scores improves sensitivity for 30-day MACE.
Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors
Authors: Kim Yeunjung , Hogan Kathryn , D’Onofrio Gail , Chekijian Sharon , Safdar Basmah
Published: November 2017

Background:

Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one’s own cardiovascular risk.

Methods:

A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors. Separately, the personalization of coronary risk factors was determined by having patients list their individual risk factors for having a heart attack. Primary outcome was the evaluation of ethnic disparities in awareness of cardiovascular risk factors and the patient’s misperceptions on personal risk factors. Secondary outcome was the assessment of access to information in the same population by gender and ethnicity.

Results:

Between October 2006 and April 2008, 1584 consecutive patients were screened, and 1051 patients were enrolled. Participants were 57.5% female and 62.8% self-identified White, 22.5% Black, and 11.5% Hispanic. Misperception about personal risk was significantly higher in non-White compared with the White participants for diabetes (in Blacks [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.08–5.57] and Hispanics [OR, 3.50; 95% CI, 1.49–8.20]) and for hyperlipidemia (in Hispanics [OR, 2.21; 95% CI, 1.19–4.10]). Although the majority (85%) had a primary care physician, Blacks and Hispanics were less likely to have access to information (OR, 0.25; 95% CI, 0.10–0.49; and OR, 0.71; 95% CI, 0.37–1.04, respectively).

Conclusions:

There are major gaps between awareness and personalization of risk in major modifiable coronary artery disease risk factors in different ethnic groups.
Efficacy of Implementation of a Chest Pain Center at a Community Hospital
Authors: Davis Alexandra , Chiu Jason , Lau Stanley K. , Kok Yih Jen , Wu Jonathan Y. H.
Published: November 2017

Introduction:

Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0–3) and high (7–10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention.

Objective:

This retrospective review and assessment sought to evaluate the efficacy of implementation of a Chest Pain Center (CPC) at a predominantly Asian-based community hospital in the United States. Additionally, this assessment sought to evaluate the effectiveness and safety of a HEART protocol in the first 4 months after its adoption.

Materials and Methods:

The facility implemented the CPC, an observation unit, in October 2016. ED physicians risk stratified patients using the HEART score. The guidelines allow ED physicians to stratify patients into 3 categories: to discharge low-risk patients, observe moderate-risk patients in the CPC, and admit high-risk patients. Patients in the CPC received additional diagnostic work-up under the care of ED physicians and cardiologists for less than 24 hours. In addition, CPC patients were followed-up 2 and 30 days after discharge.

Results:

A total of 172 patients presented at the ED with a chief complaint of chest pain. The majority of the patients were classified into the moderate-risk group (n = 101). Low-risk patients spent significantly less hours in the hospital than the moderate- and high-risk groups, and the high-risk group spent more time in the hospital than the moderate-risk group. The staff followed-up with 74 CPC patients through telephone calls to assess if patients were still experiencing chest pain and if they had followed-up with a cardiologist or primary care physician. The 2- and 30-day survival rates were 100% and 97%, respectively.

Discussion:

The data showed a significant reduction in total length of stay for all chest pain patients. This retrospective program evaluation demonstrated some evidence in using HEART score to safely risk stratify chest pain patients to the appropriate level of care. As healthcare moves from a fee-for-service environment to value-based purchasing, hospitals need to devise and implement innovative strategies to provide efficient, beneficial, and safe care for the patients.
Safety of a 1-hour Rule-out High-sensitive Troponin T Protocol in Patients With Chest Pain at the Emergency Department
Authors: Röttger E. , de Vries – Spithoven S. , Reitsma J. B. , Limburg A. , van Ofwegen – Hanekamp C. E. E. , Hoes A. W. , Poldervaart J. M.
Published: November 2017

Background:

The 1-hour rule-out high-sensitive cardiac troponin T protocol (hs-cTnT), in which a serial troponin measurement is performed 1 hour after the first to assess the possibility of acute coronary syndrome (ACS), has been implemented in the European guidelines in 2015. Our aim was to assess the safety of this protocol in low-risk patients in the Emergency Department (ED) when implemented in daily practice.

Methods:

Patients with acute chest pain presenting to the ED of our hospital and younger than 75 years were included (May 2013 to October 2014, The Netherlands). Hs-cTnT was measured at presentation (T0) and 1–1.5 hours after T0 (T1). Patients with a first troponin (T0) ≥ 0.012 ug/l were excluded. Primary endpoint was the 6-week occurrence of major adverse cardiac events (MACEs), defined as unstable angina, acute myocardial infarction (AMI), percutaneous coronary intervention, significant stenosis managed conservatively, coronary artery bypass grafting, and death.

Results:

Of the 374 analyzed patients, 16 patients (4.3%) developed 35 MACE. Of these 16 patients with endpoints, 3 were primarily discharged with noncardiac chest pain but returned within 6 weeks with unstable angina. Importantly, no patients experienced an AMI or died during follow-up.

Conclusion:

No AMIs or deaths occurred after introducing the 1-hour hs-cTnT protocol to rule-out ACS in chest pain patients, but other MACE such as unstable angina occurred. Our results suggest the protocol is safe to implement in the ED in The Netherlands.
PERIPAPILLARY PACHYCHOROID SYNDROME
Authors: Phasukkijwatana Nopasak , Freund K. Bailey , Dolz-Marco Rosa , Al-Sheikh Mayss , Keane Pearse A. , Egan CATHERINE A. , Randhawa Sandeep , Stewart Jay M. , Liu Qingyun , Hunyor Alex P. , KREIGER Allan , Nagiel Aaron , Lalane Robert , Rahimi Mansour , Lee Won Ki , Jampol Lee M. , Sarraf David
Published: November 2017

Purpose:

To describe the features of peripapillary pachychoroid syndrome (PPS), a novel pachychoroid disease spectrum (PDS) entity.

Methods:

Medical records of 31 eyes (16 patients) with choroidal thickening associated with intraretinal and/or subretinal fluid in the nasal macula extending from the disk were reviewed (patients with PPS). Choroidal thickness was compared with 2 age-matched cohorts: typical PDS (17 eyes with central serous chorioretinopathy or pachychoroid neovasculopathy) and 19 normal eyes.

Results:

The patients with PPS were 81% men aged 71 ± 7 years. Peripapillary pachychoroid syndrome eyes displayed thicker nasal versus temporal macular choroids, unlike PDS eyes with thicker temporal macular choroids (P < 0.0001). Peripapillary intraretinal and/or subretinal fluid was often overlying dilated Haller layer vessels (pachyvessels). Fundus autofluorescence and fluorescein angiography illustrated peripapillary pigmentary mottling without focal leakage. Most PPS eyes (70%) exhibited other PDS findings including serous pigment epithelial detachment or gravitational tracks. Indocyanine green angiography illustrated dilated peripapillary pachyvessels and choroidal hyperpermeability. The disk was usually crowded, with edema noted in 4/31 (13%) eyes and mild late fluorescein disk leakage identified in half of the cases. Choroidal folds (77%), short axial lengths (39% less than 23 mm), and hyperopia (86%) were common.

Conclusion:

Peripapillary pachychoroid syndrome is a distinct PDS variant, in which peripapillary choroidal thickening is associated with nasal macular intraretinal and/or subretinal fluid and occasional disk edema. Recognition of PPS is important to distinguish it from disorders with overlapping features such as posterior uveitis and neuro-ophthalmologic conditions.
PANRETINAL PHOTOCOAGULATION VERSUS RANIBIZUMAB FOR PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Jampol Lee M. , Odia Isoken , Glassman Adam R. , Baker Carl W. , Bhorade Anjali M. , Han Dennis P. , Jaffe Glenn J. , Melia Michele , Bressler Neil M. , Tanna Angelo P. ,   for the Diabetic Retinopathy Clinical Research Network
Published: November 2017

Purpose:

Compare changes in retinal nerve fiber layer (RNFL) thickness between eyes assigned to intravitreous ranibizumab or panretinal photocoagulation and assess correlations between changes in RNFL and visual field sensitivity and central subfield thickness.

Methods:

Eyes with proliferative diabetic retinopathy were randomly assigned to ranibizumab or panretinal photocoagulation. Baseline and annual follow-up spectral domain optical coherence tomography RNFL imaging, optical coherence tomography macular imaging, and automated static perimetry (Humphrey visual field 60–4 algorithm) were performed.

Results:

One hundred forty-six eyes from 120 participants were analyzed. At 2 years, for the ranibizumab (N = 74) and panretinal photocoagulation (N = 66) groups, respectively, mean change in average RNFL thickness was −10.9 ± 11.7 μm and −4.3 ± 11.6 μm (difference, −4.9 μm; 95% confidence interval [−7.2 μm to −2.6 μm]; P < 0.001); the correlation between change in RNFL thickness and 60-4 Humphrey visual field mean deviation was −0.27 (P = 0.07) and +0.33 (P = 0.035); the correlation between change in RNFL thickness and central subfield thickness was +0.63 (P < 0.001) and +0.34 (P = 0.005), respectively.

Conclusion:

At 2 years, eyes treated with ranibizumab had greater RNFL thinning than eyes treated with panretinal photocoagulation. Correlations between changes in RNFL thickness, visual field, and central subfield thickness suggest that the decrease in RNFL thickness with ranibizumab is likely due to decreased edema rather than loss of axons.
VITRECTOMY WITH SUBRETINAL TISSUE PLASMINOGEN ACTIVATOR AND GAS TAMPONADE FOR SUBFOVEAL HEMORRHAGE
Authors: Plemel David J. A. , Lapere Steven R.J. , Rudnisky Christopher J. , Tennant Matthew T. S.
Published: November 2017

Purpose:

To study the prognostic factors and clinical outcomes of patients who underwent pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and gas tamponade for the treatment of subfoveal hemorrhage (SFH).

Methods:

A retrospective noncomparative interventional case series.

Results:

Seventy-eight eyes from 77 patients were included. A total of 84.6% of eyes developed SFH from age-related macular degeneration. Partial or complete displacement of the SFH was achieved in 91.5% of eyes within 2 months of surgery. Visual acuity improved from 20/1,449 preoperatively to 20/390 after a mean follow-up time of 6.3 months, corresponding to approximately 5 lines of Snellen acuity improvement (P < 0.001). Better visual acuity was associated with the absence of age-related macular degeneration (P = 0.02) and less hemorrhage superior to the fovea (P < 0.001). Final visual acuity was not associated with the area of SFH (P = 0.17), use of anticoagulants (P = 0.14), or visibility of the ellipsoid layer by optical coherence tomography (P = 0.64). Nine patients (11.5%) developed a recurrence of SFH within the follow-up period. Recurrence of SFH was not associated with concurrent anticoagulant therapy (P = 0.52).

Conclusion:

An etiology other than age-related macular degeneration with less hemorrhage superior to the fovea predicts a better outcome in patients with SFH treated with pars plana vitrectomy, subretinal tissue plasminogen activator, and gas tamponade.
TIMING AND OUTCOME OF SURGERY FOR PERSISTENT MACULAR HOLE
Authors: Patel Rutul , Gopalakrishnan Mahesh , Giridhar Anantharaman
Published: November 2017

Purpose:

To evaluate the efficacy and optimum timing for resurgery in case of persistent macular hole (MH).

Methods:

Twenty-five eyes of 25 patients who underwent fluid–air exchange with intravitreal C3F8 for persistent MH after vitrectomy + internal limiting membrane peeling + SF6 were included in the study. Best-corrected visual acuity, optical coherence tomography features including base diameter and configuration of MH, and time duration between the two surgeries were noted.

Results:

Patients who underwent resurgery within 3 months of the first surgery had better anatomical closure rate compared with those who underwent resurgery after 3 months (P < 0.05). Significant improvement was seen in best-corrected visual acuity in eyes with closed MH. Eyes having MH with irregular edges on optical coherence tomography had better anatomical closure rates compared with the eyes having MH with round edges.

Conclusion:

Patients undergoing repeat gas injection within 3 months of the primary surgery for persistent MH have better anatomical closure rates compared with late intervention.
A CASE OF RELAPSING RETINAL PIGMENT EPITHELIAL DETACHMENT IN PERIPAPILLARY PACHYCHOROID PIGMENT EPITHELIOPATHY
Authors: Zhang Fuyan , Qiu Yuxing , Stewart Jay M.
Published: November 2017

Purpose:

To report the findings in a patient with peripapillary pachychoroid pigment epitheliopathy who demonstrated a retinal pigment epithelial detachment (PED) that was present at some times but not other times.

Methods:

A review of 24 months of the clinical course and findings on multimodal imaging, including color fundus photography, fundus autofluorescence, spectral domain optical coherence tomography, and enhanced depth imaging optical coherence tomography. Choroidal thickness was measured by exporting the optical coherence tomography images to ImageJ (National Institutes of Health) for analysis.

Results:

A 75-year-old Asian woman complaining of metamorphopsia had a relapsing PED but no intraretinal or subretinal fluid. Multimodal imaging demonstrated an orange-reddish appearance and hyperautofluorescence/hypoautofluorescence in the nasal macula, chronically thickened choroid located beneath the PED and peripapillary region, and variability in the presence of Sattler layer of the choroid, with its disappearance in the foveal region during exacerbation of the condition, and its emergence when the PED resolved.

Conclusion:

In pachychoroid pigment epitheliopathy, PED can develop and spontaneously resolve, and variations in choroidal thickness and the presence of Sattler layer may be an indicator of changes in disease activity.
Efficacy of Rebamipide Instillation for Contact Lens Discomfort With Dry Eye
Authors: Igarashi Tsutomu , Kobayashi Maika , Yaguchi Chiemi , Fujimoto Chiaki , Suzuki Hisaharu , Takahashi Hiroshi
Published: November 2017

Objective:

To examine the effects of rebamipide ophthalmic solution on the symptoms, signs, and cytokine concentrations in tear fluid among soft contact lens (SCL) wearers with Dry eye disease (DED).

Methods:

From November 2015 to June 2017, this open-label, single-arm study examined 40 eyes of 20 SCL wearers with DED who had been using daily disposable SCLs for >3 months (mean age, 30.0±8.33 years; range, 20–47 years). Signs, symptoms, and cytokine concentrations were assessed before and 4 weeks after starting 2% rebamipide ophthalmic solution 4 times/day. Dry eye disease was diagnosed according to: compromised tear dynamics (Schirmer test ≤5 mm or tear break-up time (TBUT) ≤5 sec); ocular surface abnormalities (positive vital staining with fluorescein or lissamine green); and presence of symptoms. Touch thresholds using a Cochet-Bonnet anesthesiometer were also determined for the cornea and conjunctivae. Symptoms were assessed using the 12-item Ocular Surface Disease Index questionnaire. Concentrations of cytokines in tear fluid were measured.

Results:

Significant improvements in signs were seen for TBUT, surface abnormalities, and touch thresholds. Ocular Surface Disease Index scores likewise improved significantly in all the 12 items. Of the cytokines measured, only interleukin-1β, interleukin-8, and monocyte chemotactic protein-1 were found in ≥60% of tear samples, with no significant differences in concentrations before and after rebamipide use.

Conclusions:

Rebamipide significantly improved all signs and symptoms in patients with DED who wore daily disposable SCLs. Rebamipide is effective for DED treatment with SCL wear.
Benign Reactive Lymphoid Hyperplasia of the Conjunctiva Treated With Cyclosporine
Authors: Parikh Rupin N. , Sandhu Harpal S. , Massaro-Giordano Giacomina , Goldstein Scott M. , O'Brien Joan M.
Published: November 2017

Purpose:

To describe a case of reactive lymphoid hyperplasia (RLH) of the conjunctiva responding to cyclosporine immunosuppressant monotherapy.

Methods:

A 66-year-old man with a 2-year history of biopsy-proven bilateral RLH presented for dry eye evaluation with chief complaints of burning, stinging, and irritation in both eyes. After slit-lamp examination and positive findings of matrix metalloproteinase 9 in the patient's tear film, he was diagnosed with meibomian gland dysfunction and tear-insufficiency dry eye disease. The patient was subsequently treated with topical cyclosporine (ophthalmic emulsion 0.5 mg/mL two times per day) in both eyes.

Results:

Examination at the 3-month follow-up visit revealed significant reduction of the RLH lesions bilaterally.

Conclusions:

This report represents the first case of benign ocular RLH responsive to topical cyclosporine therapy. We believe that cyclosporine could play a role in treating patients with benign ocular RLH and warrants further investigation to evaluate its full efficacy.
The Effect of Peripheral Vestibular Recovery on Improvements in Vestibulo-ocular Reflexes and Balance Control After Acute Unilateral Peripheral Vestibular Loss
Authors: Allum John H. J. , Scheltinga Alja , Honegger Flurin
Published: November 2017

Background:

Patients with an acute unilateral peripheral vestibular deficit (aUPVD), presumed to be caused by vestibular neuritis, show asymmetrical vestibular ocular reflexes (VORs) that improve over time. Questions arise regarding how much of the VOR improvement is due to peripheral recovery or central compensation, and whether differences in peripheral recovery influence balance control outcomes.

Methods:

Thirty patients were examined at aUPVD onset and 3, 6, and 13 weeks later with four different VOR tests: caloric tests; rotating (ROT) chair tests performed in yaw with angular accelerations of 5 and 20 degrees/s2; and video head impulse tests (vHIT) in the yaw plane. ROT and vHIT responses and balance control of 11 patients who had a caloric canal paresis (CP) more than 90% at aUPVD onset and no CP recovery (no-CPR) at 13 weeks in caloric tests were compared with those of 19 patients with CP recovery (CPR) to less than 30%, on average. Balance control was measured with a gyroscope system (SwayStar) recording trunk sway during stance and gait tasks.

Results:

ROT and vHIT asymmetries of no-CPR and CPR patients reduced over time. The reduction was less at 13 weeks (36.2% vs. 83.5% on average) for the no-CPR patients. The no-CPR group asymmetries at 13 weeks were greater than those of CPR patients who had normal asymmetries. The greater asymmetries were caused by weaker deficit side responses which remained deficient in no-CPR patients at 13 weeks. Contra-deficit side vHIT and ROT responses remained normal. For all balance tests, sway was slightly greater for no-CPR compared with CPR patients at aUPVD onset and 3 weeks later. At 13 weeks, only sway during walking eyes closed was greater for the no-CPR group. A combination of 5 degrees/s2 ROT and balance tests could predict at onset (90% accuracy) which patients would have no-CPR at 13 weeks.

Conclusions:

These results indicate that for ROT and vHIT tests, central compensation is observed in CPR and no-CPR patients. It acts primarily by increasing deficit side responses. Central compensation provides approximately 60% of the VOR improvement for CPR patients. The rest of the improvement is due to peripheral recovery which appears necessary to reduce VOR asymmetry to normal at 13 weeks on average. Balance control improvement is more rapid than that of the VOR and marginally affected by the lack of peripheral recovery. Both VOR and balance control measures at onset provide indicators of future peripheral recovery. For these reasons VOR and balance control needs to be tested at aUPVD onset and at 13 weeks.
Ocular Vestibular Evoked Myogenic Potentials: Where Are We Now?
Authors: Dlugaiczyk Julia
Published: November 2017

Objective:

Over the last decade, ocular vestibular evoked myogenic potentials (oVEMPs) have evolved as a new clinical test for dynamic otolith (predominantly utricular) function. The aim of this review is to give an update on the neurophysiological foundations of oVEMPs and their implications for recording and interpreting oVEMP responses in clinical practice.

Conclusion:

Different lines of anatomical, neurophysiological, and clinical evidence support the notion that oVEMPs measure predominantly contralateral utricular function, while cervical cVEMPs are an indicator of ipsilateral saccular function. Bone-conducted vibration (BCV) in the midline of the forehead at the hairline (Fz) or unilateral air-conducted sound (ACS) are commonly used as stimuli for oVEMPs. It is recommended to apply short stimuli with short rise times for obtaining optimal oVEMP responses. Finally, this review summarizes the clinical application and interpretation of oVEMPs, particularly for vestibular neuritis, Ménière's disease, superior canal dehiscence and “challenging” patients.
Menière and Friends: Imaging and Classification of Hydropic Ear Disease
Authors: Gürkov Robert
Published: November 2017

Background:

Over 75 years ago, endolymphatic hydrops was discovered as the pathologic correlate of Menière's disease. However, this pathologic finding could be ascertained only in postmortem histologic studies. Due to this diagnostic dilemma and the variable manifestation of the various audiovestibular symptoms, diagnostic classification systems based on clinical findings have been used hitherto.

Methods:

A review of the literature of magnetic resonance (MR) imaging of hydropic ear disease.

Results:

Recent developments of high resolution MR imaging of the inner ear have now enabled us to visualize in vivo endolymphatic hydrops in patients with suspected Menière's disease. The existing knowledge from temporal bone histologic studies and from the emerging evidence on imaging based evaluation of patients with suspected Menière's disease indicate that endolymphatic hydrops not only is responsible for the full-blown clinical triad of simultaneous attacks of auditory and vestibular dysfunction, but also for other clinical presentations such as “vestibular” and “cochlear Menière's disease.”

Conclusion:

As a consequence, we propose the term “Hydropic Ear Disease” as a new terminology which is based on symptomatic and imaging characteristics of these clinical entities to clarify and simplify their diagnostic classification.
The Role of Auditory Evoked Potentials in the Context of Cochlear Implant Provision
Authors: Hoth Sebastian , Dziemba Oliver Christian
Published: November 2017

Auditory evoked potentials (AEP) are highly demanded during the whole process of equipping patients with cochlear implants (CI). They play an essential role in preoperative diagnostics, intraoperative testing, and postoperative monitoring of auditory performance and success. The versatility of AEP's is essentially enhanced by their property to be evokable by acoustic as well as electric stimuli. Thus, the electric responses of the auditory system following acoustic stimulation and recorded by the conventional surface technique as well as by transtympanic derivation from the promontory (Electrocochleography [ECochG]) are used for the quantitative determination of hearing loss and, additionally, electrically evoked compound actions potentials (ECAP) can be recorded with the intracochlear electrodes of the implant just adjacent to the stimulation electrode to check the functional integrity of the device and its coupling to the auditory system. The profile of ECAP thresholds is used as basis for speech processor fitting, the spread of excitation (SOE) allows the identification of electrode mislocations such as array foldover, and recovery functions may serve to optimize stimulus pulse rate. These techniques as well as those relying on scalp surface activity originating in the brainstem or the auditory cortex accompany the CI recipient during its whole life span and they offer valuable insights into functioning and possible adverse effects of the CI for clinical and scientific purposes.
Evaluation of Cochlear Implant Receiver Position and Its Temporal Changes
Authors: Grupe Gloria , Rademacher Grit , Hofmann Solvig , Stratmann Andreas , Mittmann Philipp , Mutze Sven , Ernst Arneborg , Todt Ingo
Published: November 2017

Hypothesis:

It was the aim of this study to establish normative data regarding intended changes in cochlear implants (CI) receiver positioning by one surgeon over time.

Background:

With the increasing number of CI patients, the probability of needing magnetic resonance imaging (MRI) increases. The accessibility of cerebral structures is limited by MRI artifacts caused by CI. New studies show a dependence of the visibility of intracranial structures by the MRI sequences and the position of the CI receiver itself.

Methods:

Retrospective and interindividual investigation of topograms with regard to the nasion–external auditory canal–internal magnet angle and the distance between the internal magnet and the external auditory canal. We evaluated scans of 150 CI recipients implanted from 2008 until 2015.

Results:

The most common implant position in the years 2008 to 2015 was a nasion–external auditory canal–internal magnet angle between 121 and 140 degrees (mean, 127 degrees) and an internal magnet–external auditory canal distance between 61 and 80 mm (mean, 70 mm). Over time the nasion–external auditory canal–internal magnet angle increased and the internal magnet–external auditory canal distance decreased, both to a statistically significant degree. A difference between the manufacturers was not observed.

Conclusion:

The CI receiver position is important for an artifact-free examination of the internal auditory canal and the cochlea. The realization of the position over a time course supports awareness of artifact-related visibility limitations.
Cochlear Pericytes Are Capable of Reversibly Decreasing Capillary Diameter In Vivo After Tumor Necrosis Factor Exposure
Authors: Bertlich Mattis , Ihler Friedrich , Weiss Bernhard G. , Freytag Saskia , Strupp Michael , Canis Martin
Published: November 2017

Objective:

The aim of this work was to evaluate the effect of tumor necrosis factor (TNF) and its neutralization with etanercept on the capability of cochlear pericytes to alter capillary diameter in the stria vascularis.

Methods:

Twelve Dunkin–Hartley guinea pigs were randomly assigned to one of three groups. Each group was treated either with placebo and then placebo, TNF and then placebo, or TNF and then etanercept. Cochlear pericytes were visualized using diaminofluorescein-2-diacetate and intravasal blood flow by fluorescein-dextrane. Vessel diameter at sites of pericyte somas and downstream controls were quantified by specialized software. Values were obtained before treatment, after first treatment with tumor necrosis factor or placebo and after second treatment with etanercept or placebo.

Results:

Overall, 199 pericytes in 12 animals were visualized. After initial treatment with TNF, a significant decrease in vessel diameter at sites of pericyte somas (3.6 ±4.3%, n = 141) compared with placebo and downstream controls was observed. After initial treatment with TNF, the application of etanercept caused a significant increase (3.3 ±5.5%, n = 59) in vessel diameter at the sites of pericyte somata compared with placebo and downstream controls.

Conclusion:

We have been able to show that cochlear pericytes are capable of reducing capillary diameter after exposition to TNF. Moreover, the reduction in capillary diameter observed after the application of TNF is revertible after neutralization of tumor necrosis factor by the application of etanercept. It seems that contraction of cochlear pericytes contributes to the regulation of cochlear blood flow.
Patterns of Extended High-frequency Hearing Loss Following Stapes Surgery
Authors: Babbage Melissa J. , O’Beirne Greg A. , Bergin Michael J. , Bird Philip A.
Published: November 2017

Objective:

Thresholds in the extended high-frequency (EHF) range (> 8 kHz) often worsen after otherwise successful stapedectomy. The aims of this study were to document the prevalence of hearing loss from 0.25 to 16 kHz after stapedectomy and the relative rates of transient and permanent EHF hearing loss.

Study Design:

Prospective, observational, longitudinal.

Setting:

Tertiary referral center.

Patients:

Thirty-nine patients who underwent 44 primary or revision stapes surgeries.

Intervention:

Hearing thresholds were measured at 0.25 to 16 kHz preoperatively, and at approximately 1 week, 1, 3, 6, and 12 months postoperatively.

Main Outcome Measures:

Average threshold changes in bands of frequencies (0.25–1, 2–8, 9–11.2, 12.5–16 kHz) and the percentage of patients with a change in the highest frequency at which a hearing threshold could be measured were evaluated at each assessment.

Results:

A mean hearing loss was documented in the EHF range at all postoperative assessments. There was a decrease in the highest frequency at which a hearing threshold was measureable in 77% of patients at the first postoperative assessment, and despite some improvement over time, in 50% of patients 12 months postoperatively.

Conclusion:

There is a significant incidence of EHF loss after stapedectomy. Although partial recovery often occurs, more than half of patients retain an EHF hearing loss 12 months postoperatively. As hearing loss in the EHF range is more common than loss at 4 kHz, EHF measurements may be a more sensitive model to compare surgical factors and evaluate pharmacologic interventions.
Electrode Impedance Fluctuations as a Biomarker for Inner Ear Pathology After Cochlear Implantation
Authors: Choi June , Payne Matthew R. , Campbell Luke J. , Bester Christo W. , Newbold Carrie , Eastwood Hayden , O’Leary Stephen J.
Published: November 2017

Objectives/Hypothesis:

Cochlear implant surgery now aims to preserve residual low frequency hearing. The current research explores whether fluctuations in the electrical impedance of cochlear implant electrodes may act as a biomarker for pathological changes that lead to the delayed loss of residual hearing.

Study Design:

Secondary analysis of a double-blinded randomized trial, where methylprednisolone was administered intravenously before cochlear implantation with a view to preserving residual hearing.

Methods:

Seventy-four patients with residual hearing after cochlear implant surgery were investigated for an impedance “spike,” defined as a median rise of ≥4 kΩ across all electrodes from the baseline measurements. Spikes were related to objective and subjective hearing loss, dizziness, and tinnitus.

Results:

An impedance spike occurred in 14% (10/74) of enrolled patients. Three months after surgery, five patients exhibited spikes and three of these patients had a total loss of their residual hearing. 4.3% of the 69 patients without spikes lost residual hearing. At 1 year, 9 of 10 patients who exhibited spikes had lost all their residual hearing. 8.1% of the 37 patients who did not experience a spike lost their residual hearing. Seventy percent of patients exhibiting a spike also experienced vertigo. The administration of steroids at the time of surgery did not influence the occurrence of spikes.

Conclusion:

Our results suggest that there is a relationship between a spike and the loss of residual hearing. It seems that rises in impedance can reflect pathology within the inner ear and predict the future loss of residual hearing.
Usefulness of High-Resolution 3D Multi-Sequences for Peripheral Facial Palsy: Differentiation Between Bell's Palsy and Ramsay Hunt Syndrome
Authors: Kuya Junko , Kuya Keita , Shinohara Yuki , Kunimoto Yasuomi , Yazama Hiroaki , Ogawa Toshihide , Takeuchi Hiromi
Published: November 2017

Objective:

To investigate the usefulness of magnetic resonance imaging (MRI) including three-dimensional (3D) sequences in the differentiation between Bell's palsy (BP) and Ramsay Hunt syndrome (RHS).

Study Design:

A prospective study.

Setting:

Tertiary care center.

Patients:

Twenty patients: 15 patients with BP and five patients with RHS.

Intervention:

Diagnostic.

Main Outcome Measure:

Clinical diagnosis (BP or RHS).

Results:

The presence of hyperintensity on 3D-fluid-attenuated inversion recovery sequence (3D-FLAIR) and enhancement on gadolinium-enhanced (CE)-3D-FLAIR and CE-3D-T1-weighted image (3D-T1WI) along the internal auditory canal (IAC) wall were significantly associated with RHS (p < 0.05). Hyperintensity in the inner ear was observed on pre- and postcontrast 3D-FLAIR, and enhancement of the cranial nerve (CN)-VIII was observed only on CE-3D-FLAIR. The presence of these findings also showed significant relationships with RHS (p < 0.05). Moreover, thickening of the CN-VII in the fundus of the IAC in 3D-constructive interference on steady state sequence (3D-CISS) also showed a significant association with RHS (p < 0.05). In contrast, the presence of hyperintensity of the CN-VII in the fundus of the IAC on 3D-FLAIR did not demonstrate a significant relationship (p = 0.95), and enhancement in this region was observed in all cases on CE-3D-FLAIR and gadolinium-enhanced-three-dimensional-T1-weighted gradient echo sequence (CE-3D-T1WI).

Conclusions:

3D MRI sequences are useful for differentiating RHS from BP. In particular, the enhancement in the CN-VIII and/or along the IAC wall are valuable findings, and CE-3D-FLAIR is the most useful sequence to evaluate these findings. Thickening of the CN-VII on 3D-CISS is also an important finding.
Management of Sigmoid Sinus Associated Pulsatile Tinnitus: A Systematic Review of the Literature
Authors: Wang Alan C. , Nelson Avery N. , Pino Cassandra , Svider Peter F. , Hong Robert S. , Chan Eleanor
Published: November 2017

Objectives:

Although studies demonstrate 4 to 20% of patients with pulsatile tinnitus (PT) have associated sigmoid sinus anomalies, no consensus exists regarding optimal management. Our objective was to perform a systematic review exploring surgical and endovascular intervention of PT caused by sigmoid sinus anomalies.

Data Sources/Extraction:

A systematic review was performed using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines for reporting of results, with a target population encompassing patients with PT and either sigmoid sinus diverticulum or sigmoid wall dehiscence. From an initial search yielding 74 articles, 21 manuscripts met inclusion criteria.

Data Synthesis:

Of 139 patients, 90.4% were female. Mean age was 39.0 years. Diagnosis was sigmoid sinus diverticulum/aneurysm in 47.5% of patients, sigmoid sinus dehiscence in 35.3% of patients, and both in 17.3%. Sigmoid sinus wall reconstruction/resurfacing (SSW R/R) was used in 91.4% and endovascular procedures in 7.9% of patients. Postoperative recurrence was 3.5% (mean follow-up 21.1 m). Although there was no association between resolution rate and age or sex, right-sided PT resolved at a higher rate. For every increase in body mass index by 1 kg/m2, the odds of PT resolution increased 9.2%.

Conclusion:

PT as a result of sigmoid sinus diverticula, aneurysms, and dehiscence is a rare, but largely treatable condition. Available interventions include SSW R/R, endovascular intervention, and cardiac U-clip techniques. In SSW R/R, bone pate, unspecified soft-tissue graft, and bone cement had the highest rates of PT resolution. While temporalis fascia and autologous bone chips were the materials most commonly used, they had significantly lower rates of PT resolution compared with the other materials, with the exception of auricular cartilage and bone cement. Most episodes of recurrence are resolved with medical management or a revision procedure. This study serves to summarize the current state of knowledge on the treatment of pulsatile tinnitus across disciplines.
Diffusion of Bevacizumab Across Oncology Practices
Authors: Keating Nancy L. , Huskamp Haiden A. , Schrag Deborah , McWilliams John M. , McNeil Barbara J. , Landon Bruce E. , Chernew Michael E. , Normand Sharon-Lise T.
Published: November 2017

Background:

Technological advances can improve care and outcomes but are a primary driver of health care spending growth. Understanding diffusion and use of new oncology therapies is important, given substantial increases in prices and spending on such treatments.

Objectives:

Examine diffusion of bevacizumab, a novel (in 2004) and high-priced biologic cancer therapy, among US oncology practices during 2005–2012 and assess variation in use across practices.

Research Design:

Population-based observational study.

Setting:

A total of 2329 US practices providing cancer chemotherapy.

Participants:

Random 20% sample of 236,304 Medicare fee-for-service beneficiaries aged above 65 years in 2004–2012 undergoing infused chemotherapy for cancer.

Measures:

Diffusion of bevacizumab (cumulative time to first use and 10% use) in practices, variation in use across practices overall and by higher versus lower-value use. We used hierarchical models with practice random effects to estimate the between-practice variation in the probability of receiving bevacizumab and to identify factors associated with use.

Results:

We observed relatively rapid diffusion of bevacizumab, particularly in independent practices and larger versus smaller practices. We observed substantial variation in use; the adjusted odds ratio (95% confidence interval) of bevacizumab use was 2.90 higher (2.73–3.08) for practices 1 SD above versus one standard deviation below the mean. Variation was less for higher-value [odds ratio=2.72 (2.56–2.89)] than lower-value uses [odds ratio=3.61 (3.21–4.06)].

Conclusions:

Use of bevacizumab varied widely across oncology practices, particularly for lower-value indications. These findings suggest that interventions targeted to practices have potential for decreasing low-value use of high-cost cancer therapies.