bluuebunny/crossref_metadata_2025 huggingface dataset:
What we can learn from nonoperating room anesthesia registries: analysis of clinical outcomes and closed claims data
Authors: Yeh Tiffany , Beutler Sascha S. , Urman Richard D.
Published: April 2020

Purpose of review

The prevalence of procedures performed outside of the operating room is steadily growing around the world, especially in the United States. This review aims to discuss the risks and safety of anesthesia performed in remote locations based on an up-to-date literature review, with a focus on the results from closed claims and other database analyses.

Recent findings

The published literature in the last decade shows that there is an increase in nonoperating room anesthesia cases and that the highest number of these cases are in gastroenterology endoscopy suites. There are safety concerns in nonoperating room cases that involve both anesthesia and nonanesthesia providers. Specific complications found in closed claims analyses include airway compromise, aspiration pneumonia, and dental injuries.

The current literature demonstrates that procedures performed in the endoscopy suite make up the largest number of nonoperating room closed claims anesthesia cases. Oversedation and subsequent inadequate oxygenation/ventilation account for the majority of malpractice claims. Conclusions from the current literature emphasize the importance of complying with monitoring standards and having well prepared providers to improve patient outcomes in nonoperating room locations.
Point-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory
Authors: Van de Putte Peter , Vernieuwe Lynn , Bouchez Stefaan
Published: April 2020

Purpose of review

This review focuses on the use of point-of-care ultrasound (PoCUS) in the obstetric context for airway management and assessment of aspiration risk, the placement of neuraxial blocks and the diagnosis and follow-up of cardiorespiratory dysfunction.

Recent findings

Gastric ultrasound is a useful aspiration risk assessment tool in pregnant patients. Total gastric fluid assessment models and specific cut-offs between high-risk and low-risk stomachs are presented. Airway assessment is useful to detect specific changes in pregnancy and to guide airway management. Handheld ultrasound devices with automated neuraxial landmark detection capabilities could facilitate needle placement in the future. Lung and cardiac ultrasonography is useful in the management of preeclampsia, pulmonary arterial hypertension and peripartum cardiomyopathy.

Owing to its noninvasiveness, ease of accessibility and lack of exposure to radiation, PoCUS plays an increasing and essential role in aspiration risk assessment, airway management, neuraxial anaesthesia and cardiorespiratory diagnosis and decision-making during pregnancy.
NICU Nurses' Knowledge and Attitudes Regarding 2-Month Immunizations
Authors: Macintosh Janelle L. B. , Eden Lacy M. , (Beth) Luthy Karlen E. , Beckstrand Renea
Published: April 2020

Background:

Nurses are an integral part of the healthcare team. Parents rely on nurses for information regarding the plan of care for their child. Medically stable infants under supervision in a newborn intensive care unit (NICU) can and should be immunized.

Purpose:

The purpose of this study was to explore attitudes and knowledge in NICU nurses regarding 2-month immunizations.

Methods:

Participants were attendees of the National Association of Neonatal Nurses (NAAN) 33rd Annual Conference. Participants responded to a survey that focused on knowledge and attitudes regarding 2-month immunizations.

Findings/Results:

A total of 188 nurses attending the NAAN conference completed the survey. Most nurses had positive attitudes regarding immunizations. A majority (n = 117, 62.5%) of NICU nurses knew that immunizations should be given to medically stable infants in a NICU. However, as few as 27% of participants were able to identify recommended 2-month immunizations. Almost two-thirds of participants (n = 115, 61.1%) did not know current guidelines regarding minimum age at the time of administration of immunizations, although NPs were more likely to know current guidelines. Nurse practitioners were more comfortable talking family about immunizations and were more likely to view that the illnesses prevented by vaccines as serious.

Implications for Practice:

NICU nurses would benefit from continued education focused on Centers for Disease Control and Prevention (CDC) guidelines for 2-month immunizations. Additionally, as a primary source of information for parents, NICU nurses should be encouraged to practice teaching parents and family about immunizations. This practice could reinforce nurse knowledge.

Implications for Research:

Further research regarding the effect of education, simulation, and yearly reinforcement of CDC guidelines could further enlighten our knowledge on this topic.
Stage-specific Conditional Survival Among Young (Age Below 50 y) Versus Older (Age 50 y and Above) Adults With Colorectal Cancer in the United States
Authors: Sanford Nina N. , Ahn Chul , Beg Muhammad S. , Sanjeevaiah Aravind , Kazmi Syed A. , Folkert Michael R. , Aguilera Todd A. , Sher David J.
Published: April 2020

Background:

Conditional survival (CS) is a relevant prognostic measure and may be particularly important for young adult patients with colorectal cancer (CRC), whose incidence is rising. We sought to compare CS among young versus older adults with CRC.

Methods:

Patients diagnosed with CRC between 2004 and 2010 were identified from the Surveillance, Epidemiology, and End Results registry. Smoothed yearly hazards of death due to CRC, other causes and any cause were estimated, stratified by age at diagnosis (below 50 vs. 50 y and above) and stage (I-III vs. IV). Stage-specific conditional 5-year overall survival and cancer-specific survival given that patients had already survived 1 to 5 years after diagnosis was calculated.

Results:

Among 161,859 patients with median follow-up of 54 months, 35,411 (21.9%) were aged below 50 years. For older adults with nonmetastatic CRC, hazards of death due to noncancer causes exceeded that of rectal and colon cancer ∼6.1 and 3.8 years after diagnosis, respectively. Patients experienced improved CS over time with greater improvement seen for more advanced stages. However, young adults had less CS improvement over time than older adults. For example, the 5-year cancer-specific survival for stage IV colon cancer improved from 15.6% to 77.2% (change=61.6%) 0 to 5 years after diagnosis for older adults but only 20.3% to 67.7% (change=47.4%) for young adults.

Conclusions:

Prognosis for CRC improves over time for all patients, although the increase in survival appears to be less for young than older adults. Up to 10 years after diagnosis, the primary cause of death in young adults with CRC remains their incident cancer.
Syphilitic Chancre of the Lip
Authors: Calvo Davinia F. , Cassarino David , Fernandez-Flores Angel
Published: April 2020

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The primary stage of the disease (the chancre) mainly involves the genital areas. Extragenital areas are involved in 5%–14% of cases, many of which occur in the oral cavity. Among the extragenital locations, the lip is the most frequent; however, despite this, published cases of the chancre of the lip are few. We present a case of a chancre presenting on the lip of a nonimmunocompromised 55-year-old male patient with immunohistochemical confirmation.
Topical hemostatic and tissue-sealing agents in gynecologic surgery
Authors: Cullifer Rachel M. , Makai Gretchen , Pacis Michelle , Huynh Terri
Published: April 2020

Purpose of review

To review current topical hemostatic agent use and how it pertains to gynecologic surgery.

Recent findings

Recent literature suggests some benefit of topical hemostatic agents (THA). THAs confer reduced bleeding and shorter operating room time in women undergoing hysterectomy for cancer and in abdominal myomectomy. THA use in women undergoing ovarian cystectomy is associated with a decreased reduction in ovarian reserve. Potential complications of THA use include abscess formation, small bowel obstruction, inflammation, allergic reaction, and transmission of blood-borne pathogens. Evidence for use of THA in benign minimally invasive gynecologic surgery (MIGS) procedures is lacking.

Although evidence exists for the efficacy of THA in reducing blood loss and operating times across surgical subspecialties, specific, appropriate, and efficacious use of THAs in gynecologic surgery remains ill-defined. Knowledge of their mechanisms of action and potential complications should enable surgeons to optimize desired effects and minimize harm.
Lymphatic System Transfer for Lymphedema Treatment: Transferring the Lymph Nodes with Their Lymphatic Vessels
Authors: Yoshimatsu Hidehiko , Visconti Giuseppe , Karakawa Ryo , Hayashi Akitatsu
Published: April 2020

Background:

Vascularized lymph node transfer is the most common physiological procedure indicated for severe lymphedema. We describe a new physiological treatment strategy for lymphedema, lymphatic system transfer (LYST), which comprises transfer of the vascularized afferent lymphatic vessels along with their draining lymph nodes.

Methods:

All patients undergoing LYST for treatment of lymphedema from 2017 to 2018 were identified. Patient demographics, intraoperative factors, and postoperative outcomes were reviewed.

Results:

Three patients underwent LYST. Average patient age and body mass index were 65.3 years and 23.6 kg/m2, respectively. Indications for LYST were upper extremity lymphedema following mastectomy, radiation, and lymphadenectomy (2) and unilateral lower extremity lymphedema following total hysterectomy and bilateral pelvic lymphadenectomy (1). In all patients, lymphatic vessels could not be visualized by preoperative lymphoscintigraphy. All LYST flaps were procured from the groin region. A superficial circumflex iliac artery perforator flap, including the afferent lymphatic vessels and their draining lymph nodes, was elevated. A large portion of the skin paddle was deepithelialized, and the LYST flap was inset into a subcutaneous tunnel made in the lymphedematous limb. All LYST flaps survived completely. No donor site complications were observed. The average rate of estimated volume decrease in the patients at eighth month follow-up was 21.9%. Average follow-up was 11 months.

Conclusions:

Because the afferent lymphatic vessels are transferred with the lymph nodes, a presumably lesser degree of lymphangiogenesis is required for a LYST flap to commence its physiological function. Its real-time physiological lymphatic drainage is demonstrated in a video.
Surgical Outcomes in Prepectoral Breast Reconstruction
Authors: Urquia Lindsey N. , Hart Alexandra M. , Liu Daniel Z. , Losken Albert
Published: April 2020

Background:

Prepectoral breast reconstruction has reemerged as a popular option for prosthetic-based breast reconstruction. Recent published literature highlights good outcomes; however, techniques are evolving and options exist for different technologies. The aim of this study is to evaluate short-term complication rates of prepectoral reconstructions using Cortiva acellular dermal matrix.

Methods:

A multicenter retrospective study was conducted of all patients who underwent mastectomy with immediate direct-to-implant or 2-stage prepectoral breast reconstruction with Cortiva (RTI Surgical, Alachua, Fla.) between January 2016 and September 2018. The incidence of surgical complications was determined and studied against patient demographics and procedural details.

Results:

One-hundred eighteen patients met the inclusion criteria for a total of 183 individual breasts reconstructed with prepectoral implant. Average length of follow-up was 9.26 months (range, 1.0 month to 2.5 years). Thirty-two breasts (17.49%) experienced 1 or more complications. Prepectoral reconstruction was successful 89.07% of the time. Infection was the most common cause of both reoperation and implant failure, with 7.65% of all breasts requiring washout and 5.46% failing prosthetic reconstruction secondary to infection.

Conclusions:

Surgical outcomes for prepectoral breast reconstruction using 2-stage and direct-to-implant are similar and comparable to the literature for dual-plane reconstruction, with infection being the main cause of failure.
Povidone-iodine Does Not Affect Acellular Dermal Matrix Integration in Patients Undergoing 2-staged, Prepectoral, Breast Reconstructive Surgery
Authors: Gabriel Allen , Sigalove Steven , Pfaffenberger Maci , Eldenburg Elizabeth , Gold Rebecca , O’Rorke Erin , Maxwell G. Patrick
Published: April 2020

Background:

Povidone-iodine has been traditionally used as an antimicrobial agent to irrigate the breast pocket and rinse the prosthesis before placement in the pocket. Use of povidone-iodine with breast implants was banned from 2000 to 2017. During this period, acellular dermal matrix (ADM) was introduced to breast surgery. In nonclinical studies, povidone-iodine can impair collagen synthesis and kill fibroblasts. Cellular repopulation was critical for ADM integration. Whether povidone-iodine impacts ADM integration was unknown.

Methods:

Patients who underwent immediate, prepectoral, 2-staged breast reconstruction were included in this retrospective study. Study population was divided into povidone-iodine–treated patients and triple-antibiotic–treated patients. The breast pockets were rinsed with the antimicrobial agent, and the prostheses and ADMs were presoaked in the agent perioperatively. At implant exchange, the extent of ADM integration was clinically assessed. ADM integration was defined as >25% of matrix vascularization. ADM integration and postoperative complications were compared between the groups.

Results:

A total of 111 patients (257 reconstructions) were included—58 patients (111 reconstructions) were exposed to povidone-iodine and 53 patients (97 reconstructions) to triple-antibiotic solution. ADM integration was noted in 97% of breasts in each group. Integrated matrices appeared healthy, had no signs of foreign body reaction, and demonstrated punctate bleeding. Complications did not differ between the groups, including the rate of infections, seroma, and expander loss.

Conclusion:

Irrigation of the breast pocket and presoaking of the prosthesis and ADM with povidone-iodine appear to have no adverse consequences on clinical outcomes and did not impede matrix integration.
Hospital Burden of Migraine in United States Adults: A 15-year National Inpatient Sample Analysis
Authors: Law Huay-Zong , Chung Michael H. , Nissan George , Janis Jeffrey E. , Amirlak Bardia
Published: April 2020

Background:

Migraine headache is associated with high costs, but changes over time of inpatient burden in the United States are unknown. Understanding longitudinal trends is necessary to determine the costs of evolving inpatient treatments that target biological factors in the generation of pain such as vasodilation and aberrant activity of trigeminal neurotransmitters. We report the migraine hospital burden trend in the United States over 15 years.

Methods:

Data from the Nationwide Inpatient Sample of the Hospitalization Cost and Utilization Project databases were analyzed from 1997 to 2012. Inpatient costs were reported in dollars for the cost to the institution, whereas charges reflect the amount billed. These parameters were trended and the average annual percent change was calculated to illustrate year-to-year changes.

Results:

Overall discharges for migraine headache reached a low of 30,761 discharges in 1999, and peaked in 2012 with 54,510 discharges. Average length of stay decreased from 3.5 days in 1997 to 2.8 days in 2012. Total inpatient charges increased from $176 million in 1999 to $1.2 billion in 2012. Inpatient costs totaled $322 million in 2012, with an average daily cost of $2,111.

Conclusions:

Inpatient burden rapidly increased over the analyzed period, with hospital charges increasing from $5,939 per admission and $176 million nationwide in 1997, to $21,576 per admission and $1.2 billion nationwide in 2012. This trend provides context for research examining cost-effectiveness and quality of life benefits for current treatments. The study of these parameters together with better prevention and improved outpatient treatment may help alleviate the inpatient burden of migraine.
Restructuring Electrophysiology During the COVID-19 Pandemic: A Practical Guide From a New York City Hospital Network
Authors: Rubin Geoffrey A. , Wan Elaine Y. , Saluja Deepak , Thomas George , Slotwiner David J. , Goldbarg Seth , Chaudhary Salma , Turitto Gioia , Dizon Jose , Yarmohammadi Hirad , Ehlert Frederick , Rubin David A. , Morrow John P. , Waase Marc , Berman Jeremy , Kushnir Alexander , Abrams Mark P. , Halik Carolyn , Kumaraiah Deepa , Schwartz Allan , Kirtane Ajay , Kodali Susheel , Goldenthal Isaac , Garan Hasan , Biviano Angelo
Published: April 2020

The coronavirus disease 2019 crisis is a global pandemic of a novel infectious disease with far-ranging public health implications. With regard to cardiac electrophysiology (EP) services, we discuss the “real-world” challenges and solutions that have been essential for efficient and successful (1) ramping down of standard clinical practice patterns and (2) pivoting of workflow processes to meet the demands of this pandemic. The aims of these recommendations are to outline: (1) essential practical steps to approaching procedures, as well as outpatient and inpatient care of EP patients, with relevant examples, (2) successful strategies to minimize exposure risk to patients and clinical staff while also balancing resource utilization, (3) challenges related to redeployment and restructuring of clinical and support staff, and (4) considerations regarding continued collaboration with clinical and administrative colleagues to implement these changes. While process changes will vary across practices and hospital systems, we believe that these experiences from 4 different EP sections in a large New York City hospital network currently based in the global epicenter of the coronavirus disease 2019 pandemic will prove useful for other EP practices adapting their own practices in preparation for local surges.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY-GUIDED PHOTODYNAMIC THERAPY FOR ACUTE CENTRAL SEROUS CHORIORETINOPATHY
Authors: Hu Jie , Qu Jinfeng , Li Mengyang , Sun Guosheng , Piao Zhenyu , Liang Zhiqiao , Yao Yuou , Sadda SriniVas , Zhao Mingwei
Published: April 2020

Purpose:

To compare the anatomic results of optical coherence tomography angiography (OCTA)-guided half-dose photodynamic therapy (PDT) versus indocyanine green angiography (ICGA)-guided PDT in eyes with acute central serous chorioretinopathy.

Methods:

This study is a prospective, single-center, noninferiority, double-masked, randomized, controlled clinical trial. Fifty-one eyes of 45 patients with acute central serous chorioretinopathy were recruited, and randomized to an ICGA-guided group and an OCTA-guided group. The primary outcome measures were the rates of complete subretinal fluid (SRF) resolution at 1 month and 3 months.

Results:

Forty-six eyes of 40 patients finished the follow-up and were analyzed. In the OCTA-guided group, the SRF was completely resolved in 13 (56.5%) eyes within 1 month and in 21 (91.3%) eyes within 3 months. In the ICGA-guided group, the SRF was resolved in 16 (69.6%) of the eyes within 1 month and in 22 (95.7%) of the eyes by 3 months. Optical coherence tomography angiography-guided PDT was demonstrated noninferior to ICGA-guided PDT for SRF resolution rate at 3 months (P = 0.016), but not at 1 month (P = 0.311) for acute central serous chorioretinopathy patients. Subretinal fluid did not recur in any of the eyes in the OCTA-guided group, but did recur in 2 eyes (8.7%) of the ICGA-guided group during the 3-month follow-up period.

Conclusion:

Optical coherence tomography angiography-guided PDT seemed to be noninferior to ICGA-guided PDT for resolution of SRF at 3 months in eyes with acute central serous chorioretinopathy.
EFFECT OF PANRETINAL PHOTOCOAGULATION ON CORNEAL SENSATION AND TEAR FUNCTION IN PATIENTS WITH DIABETIC RETINOPATHY
Authors: Jamali Hossein , Eslami Jamshid , Kalashipour Farid , Nowroozzadeh Mohammad Hossein
Published: April 2020

Purpose:

To evaluate the early effects of panretinal photocoagulation (PRP) on corneal sensation and dry eye signs in patients with diabetic retinopathy.

Methods:

Fifty patients with Type 2 diabetes mellitus and very severe nonproliferative or non–high-risk proliferative diabetic retinopathy who required PRP for the treatment of their retinal condition were enrolled. All patients were treated using a pattern PRP device. Esthesiometry, tear breakup time test, Schirmer test, and corneal staining pattern were evaluated at baseline and 2 months after the last session of PRP.

Results:

Data from 88 eyes of 50 patients (41 right eyes and 47 left eyes) were analyzed. The mean tear breakup time test (right eyes) was decreased from 9.51 at baseline to 7.66 seconds after PRP (P < 0.001). The post-PRP eyes showed more advanced grades of corneal staining than pre-PRP assessment (P < 0.001). The average value of Schirmer test was 14.39 versus 12.29 mm (without anesthesia; P < 0.001) and 8.17 versus 7.15 mm (with anesthesia, P < 0.001) for baseline versus post-PRP measurements, respectively. The corneal sensation also showed decrease after laser therapy (4.93 versus 4.31 cm; P < 0.001).

Conclusion:

This study demonstrates that decreased corneal sensation and signs of dry eye are more common immediately after PRP for diabetic retinopathy. These conditions should be discussed with the patient preoperatively and managed postoperatively.
Visual outcomes of high-volume compared with low-volume manual small-incision cataract surgery in Nepal
Authors: Bhatta Subash , Patel Poorav J. , Awasthi Suresh , Pant Nayana , Pant Suresh Raj
Published: April 2020

Purpose:

To study whether manual small-incision cataract surgery (MSICS) in a high-volume setting gives acceptable postoperative visual outcomes.

Settings:

Geta Eye Hospital, Kailali, Nepal.

Design:

Single-center retrospective study.

Methods:

One-year records of all MSICS in adult patients without any other ocular comorbidity were analyzed retrospectively. Surgical outcomes of cataract cases when surgeons performed more than 72 surgeries (high volume) in a single operating session (1 day) were compared with when fewer than 30 surgeries (low volume) were performed in a single operating session (1 day).

Results:

Of 23 717 cases in the study, 20 574 patients (87%) had preoperative visual acuity of less than 3/60; 15 632 patients (66%) achieved good visual outcome (uncorrected distance visual acuity of 6/18 or better) postoperatively. Patients operated during high-volume months achieved good visual outcomes in 9930 cases (66.9%) as compared with 5702 (64.3%) in low-volume months. However, 6235 patients (61.7%) operated on during high-volume days had good visual outcomes as compared with 3053 (71.4%) during low-volume days; 175 patients in the high-volume group and 73 patients in the low-volume group (1.7% each) achieved visual acuity worse than 3/60. There were comparable posterior capsular rupture rates (423 [1.78%]) during high- and low-volume months, and 21 cases (0.09%) of postoperative endophthalmitis were noted.

Conclusions:

MSICS can be used to reduce large cataract backlogs in developing countries as good visual outcomes could be achieved in high-volume settings if standard protocols for quality control are followed.
Association Functional MRI Studies of Resting-State Amplitude of Low Frequency Fluctuation and Voxel-Based Morphometry in Patients With Occupational Noise-Induced Hearing Loss
Authors: Huang Ranran , Wang Aijie , Ba Xinru , Zhang Guowei , Li Chuanting , Liu Qiang
Published: April 2020

Objectives:

To investigate changes in brain functional activity among occupational noise-induced hearing loss (NIHL) with tinnitus patients, using resting-state brain magnetic resonance imaging (Rs-fMRI) and voxel-based morphometry (VBM).

Methods:

Mild (27) and Relative severe (15) patient groups, 30 matched healthy group, scanned by Rs-fMRI and T1WI 3D fast spoiled gradient echo, FSPGR, using voxel-based morphometry and amplitude of low frequency fluctuation to analyze the differences.

Results:

Brain gray matter volume was significantly different among the three groups in the left occipitotemporal lateral gyrus, the anterior cingulate gyrus, the bilateral angular gyrus, the precuneus, and near the midline area of the cerebellum. The Rs-fMRI changes showed that amplitude of low frequency fluctuation differed significantly among the three groups in the right superior temporal gyrus, the right inferior frontal gyrus, and the right angular gyrus.

Conclusion:

All this provides a new perspective for understanding the pathophysiological mechanism of occupational noise-induced hearing loss and provides some theoretical bases for subsequent treatment.
Risk of High-Grade Histopathology Diagnosed by Cervical Conization in Endocervical Curettage Cervical Intraepithelial Neoplasia 1: A Case-Control Study
Authors: Cong Qing , Xiao Jingjing , Tao Xiang , Sui Long
Published: April 2020

Objective

The aim of the study was to estimate risks of cervical intraepithelial neoplasia 2+ (CIN 2+) on loop electrosurgical excisional procedure (LEEP) specimens with the diagnosis of endocervical curettage (ECC) CIN 1 compared with biopsy CIN 1.

Materials and Methods

We performed a retrospective computer-based search for subjects enrolled in the Obstetrics and Gynecology Hospital of Fudan University. The case group comprised women with an ECC CIN 1 (ECC results of CIN 1 with colposcopy-directed biopsy results ≤CIN 1), and the control group comprised women with a biopsy CIN 1 (colposcopy-directed biopsy results of CIN 1 with negative ECC findings) diagnosis. Variables, including age, cytology, high-risk human papillomavirus, and ECC results, were included in univariate and multivariate logistic regression analyses. p < .05 was defined statistically significant.

Results

Overall, 1,195 women with ECC CIN 1 and/or biopsy CIN 1 diagnosis who underwent LEEP participated in the study. ECC CIN 1 comprised 400 women, with LEEP histopathology results revealing 104 (26.00%) CIN 2+. Biopsy CIN 1 comprised 795 women, with LEEP histopathology results showing 150 (18.87%) CIN 2+. Univariate logistic regression showed that cytology (p < .001) and ECC (p = .005) results differ significantly between less than CIN 2+ and CIN 2+. Multivariate logistic regression revealed that the cytology of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (OR = 4.73, 95% CI = 2.78–8.05, p < .001) and high-grade squamous intraepithelial lesions or worse (HSIL+, OR = 4.88, 95% CI = 3.00–7.94, p < .001), and ECC CIN 1 (OR = 1.80, 95% CI = 1.33–2.44, p < .001) were risk factors for CIN 2 + .

Conclusions

Endocervical curettage CIN 1 has a greater risk of CIN 2+ diagnosis than biopsy CIN 1, but high-grade cytology has a higher risk than ECC CIN 1.
Evolution in the Findings of Head-Impulse Tests During the Attacks of Menière's Disease
Authors: Lee Sun-Uk , Kim Hyo-Jung , Choi Jeong-Yoon , Koo Ja-Won , Yang Xu , Kim Ji-Soo
Published: April 2020

Objective:

To determine the vestibulo-ocular reflex (VOR) performance during the attacks of Menière's disease (MD) using video head-impulse tests (video-HITs) according to each ictal phase.

Study Design:

Retrospective case series review.

Methods:

We analyzed the results of video-HITs in 24 patients with unilateral definite MD during and between the attacks.

Results:

The head impulse gain of the VOR was usually normal (81%, 39 of the 48 semicircular canals [SCCs] in 16 patients) in the affected ear during the irritative or recovery phase, and did not differ from that for each SCC between the attacks (horizontal [HCs], p = 0.412; anterior [ACs], p = 0.920; posterior canals [PCs], p = 0.477). During the paretic phase, however, the head impulse gains of the VOR were equally normal (22/42, 52%) or decreased (20/42, 48%) for the affected ear (42 SCCs in 14 patients). The gains for the HCs were lower during the paretic phase than those between the attacks in the affected ear, while those for the ACs and PCs did not differ (HCs, p = 0.001; ACs, p = 0.158, PCs, p = 0.401). Covert saccades were more frequently observed even in the presence of normal VOR gains during the paretic phase as well.

Conclusion:

During the attacks of MD, HITs are usually normal during the irritative/recovery phases, but become positive in more than a half of the patients during the paretic phase. This evolution in the ictal findings of HITs may reflect characteristic ictal vestibular discharges in MD and should be considered in evaluating patients with MD according to each ictal phase during the attacks.
Initial Degree of Spontaneous Nystagmus Affects the Length of Hospitalization of Patients With Vestibular Neuritis
Authors: Kim Su Jin , Lee Ho Yun , Lee Min Young , Choi Jun Yong
Published: April 2020

Objective:

To assess factors predicting vestibular neuritis (VN) prognosis at an early stage.

Study Design:

Retrospective chart review.

Setting:

University hospital.

Patients:

Sixty-five patients with VN, between 2014 and 2018.

Interventions:

Bithermal caloric test, rotatory chair test, subjective visual horizontal and vertical, cervical visual myogenic evoked potential test, and visual head impulse test (vHIT).

Main Outcome Measures:

Hospitalization duration.

Results:

The mean hospitalization duration was 4.6 ± 1.4 days. Mean caloric weakness was 65.5 ± 20.6%. For the vHIT, gain in both anterior and horizontal semicircular canal (SCC) was statistically significantly different between the lesion and intact sides (p < 0.001). Backward conditional regression analysis revealed that a higher degree of spontaneous nystagmus (SN) (EXP[B] = 1.104, 95% confidence interval [CI] = 1.012–1.204, p = 0.026), and a lower caloric paresis (CP) value (EXP(B) = 1.033, 95% CI = 1.000–1.075, p = 0.047) were associated with 5 days or more of hospitalization. The cut-off value of SN was 12.05 degrees/s for increased hospital stay. Four weeks after discharge from hospital, five patients (8.9%) had persistent SN, and 19 (33.9%) and 28 (50.0%) had a positive HIT and nystagmus during head-shaking, respectively. Patients with persistent nystagmus at 1 month had more severe initial SN (p < 0.05).

Conclusion:

Only the degree of SN at the initial evaluation affected both the hospitalization period and the bed-side examination results at 1 month after discharge in patients with VN.
Influence of Cochlear Dead Regions on Hearing Outcome in Sudden Sensorineural Hearing Loss
Authors: Choi Ji Eun , Shim Hyun Joon , An Yong-Hwi , Yoo Shinyoung , Mun Seog-Kyun , Chang Mun Young , Park Min-Hyun , Jun Beom Cho , Moon Il Joon
Published: April 2020

Objective:

The aims of this multicenter study were to prospectively evaluate the prevalence of dead regions (DRs) in sudden sensorineural hearing loss (SSNHL) and compare the clinical characteristics and hearing outcomes of SSNHL according to the presence of DRs.

Study Design:

Prospective study.

Setting:

Multicenter study.

Patients and Methods:

The threshold-equalizing noise (TEN) test was prospectively performed on a total of 130 patients diagnosed with SSNHL. All patients received systemic steroid therapy and/or intratympanic steroid injection within 1 month after onset. Pure-tone audiograms and the TEN test were conducted before and after steroid treatment. Age, sex, side of affected ear, recurrence, onset of symptoms, presence of dizziness, and comorbid diseases were also collected. The prevalence of DRs in SSNHL and clinical factors related to the DRs were assessed. Hearing outcomes for SSNHL according to DRs were evaluated in 68 patients who followed a pure-tone audiogram.

Results:

The overall prevalence of one or more DRs in SSNHL evaluated using the TEN test was 20.8% (27/130 subjects) and the overall frequency-specific prevalence of DR was 6.7% (61/910 DRs). Although the DRs (+)and DR (−) groups had similar initial pure-tone thresholds, the DRs (+) group had significantly worse initial WRS compared to the DRs (−) group (p = 0.015). The presence of DRs was not associated with hearing recovery in a multivariate logistic regression model, but it was significantly associated with the degree of hearing gain in a multivariate linear regression model (p = 0.018).

Conclusions:

The presence of DRs can be considered one of the poor prognostic factors for SSNHL and the TEN test may contribute to assess the prognosis of SSNHL in clinical settings.
Novel Variants in Hearing Loss Genes and Associations With Audiometric Thresholds in a Multi-ethnic Cohort of US Patients With Cochlear Implants
Authors: Yoon Patricia J. , Sumalde Angelo Augusto M. , Ray Dylan C. , Newton Stephen , Cass Stephen P. , Chan Kenny H. , Santos-Cortez Regie Lyn P.
Published: April 2020

Objectives:

To investigate novel variants in hearing loss genes and clinical factors affecting audiometric outcomes of cochlear implant (CI) patients.

Background:

Approximately 50% of hearing loss has a genetic etiology, with certain genetic variants more prevalent in specific ethnic groups. Different variants and some clinical variables including inner ear malformations result in different prognoses or clinical outcomes after CI.

Methods:

Medical and genetic testing records of pediatric CI patients were reviewed for clinical variables. Minor allele frequencies of variants were obtained from Genome Aggregation Database (gnomAD) and variants were classified for pathogenicity. Standard statistical testing was done using Fisher's exact, Wilcoxon, and Spearman correlation tests.

Results:

Eighteen CI patients with genetic test results had pathogenic variants, including six patients with syndromic hearing loss and six patients with known GJB2 variants. Novel pathogenic variants were noted in CHD7, ADGRV1, and ARID1B, with variants in the latter two genes identified in Hispanic patients. Overall, carriage of genetic variants was associated with better pre-CI audiometric thresholds at 2000 Hz (p = 0.048). On the other hand, post-CI thresholds were significantly worse in patients with inner ear malformations, particularly in patients with atretic cochlear nerve canals.

Conclusion:

Four novel pathogenic variants were identified, which contributes to knowledge of allelic spectrum for hearing loss especially in Hispanic patients. In this cohort, carriage of pathogenic variants particularly of GJB2 variants was associated with better pre-CI audiometric thresholds, while patients with inner ear malformations had worse post-CI audiometric thresholds.
Clinical Performance of a Novel LIAISON Fecal Calprotectin Assay for Differentiation of Inflammatory Bowel Disease From Irritable Bowel Syndrome
Authors: Campbell James P. , Zierold Claudia , Rode Ashli M. , Blocki Frank A. , Vaughn Byron P.
Published: April 2020

Goal:

The goal of this study was to assess the clinical performance of an investigational in vitro fecal calprotectin immunoassay for differentiating inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS).

Background:

Fecal calprotectin is a stool biomarker that can assist in the detection of intestinal inflammation and is utilized to identify individuals who have a higher chance of having IBD and who require further invasive tests. Current assays exhibit variable performance.

Materials and Methods:

This study was a multicenter, cross-sectional analysis of prospectively collected stool samples from patients 4 years of age or older who presented with gastrointestinal (GI) symptoms and underwent colonoscopy for diagnostic confirmation. IBD was diagnosed based on clinical, endoscopic, and histologic findings. IBS was diagnosed based on Rome III Criteria and negative colonoscopy. Stool samples were extracted and tested on the DiaSorin LIAISON XL using the LIAISON Calprotectin Assay.

Results:

A total of 240 patients (67% female) were included in the study. In total, 102 patients had IBD (54% ulcerative colitis), 67 had IBS, and 71 had other GI disorders. Median fecal calprotectin levels were significantly higher in patients with IBD [522 μg/g; 95% confidence interval (CI): 354-970 μg/g] compared with IBS (34.5 μg/g; 95% CI: 19.7-44.2 μg/g, P<0.001) and other GI disorders (28.6 μg/g; 95% CI: 18.7-40.3 μg/g, P<0.001). Receiver operating characteristic curve analysis indicated a fecal calprotectin cutoff of 94 μg/g for distinguishing IBD from other GI disorders with an area under the curve of 0.964 (sensitivity=92.2%, specificity=88.4%).

Conclusion:

The automated LIAISON Calprotectin assay brings efficient calprotectin testing to the laboratory with a time to the first result of 35 minutes and is a sensitive marker for distinguishing IBD from IBS with a cutoff of ∼100 μg/g.
Familial hypercholesterolemia: is it time to separate monogenic from polygenic familial hypercholesterolemia?
Authors: Brandts Julia , Dharmayat Kanika I. , Ray Kausik K. , Vallejo-Vaz Antonio J.
Published: April 2020

Purpose of review

This review explores the concepts of monogenic and the so-called polygenic familial hypercholesterolemia and how the identification of familial hypercholesterolemia as a monogenic condition and its separation from polygenic primary hypercholesterolemia may have implications for clinical practice.

Recent findings

Through genetic testing, a mutation in any of the three known autosomal dominant familial hypercholesterolemia-causing genes is found in 60–80% of cases with a clinical diagnosis of definite familial hypercholesterolemia. As individuals with a polygenic basis for their hypercholesterolemia do not follow the same inheritance pattern observed in monogenic familial hypercholesterolemia, the use of family-based cascade screening in individuals with a polygenic origin is not recommend, as only 30% of relatives have an elevated LDL-C compared to the 50% in monogenic families. The presence of a causative monogenic mutation associates the highest cardiovascular risk vs. not having a mutation or having a polygenic background, providing prognostic information independent of LDL-C. It may also help assess intensity of interventions. Treatment adherence also seems to be higher after monogenic confirmation of hypercholesterolemia.

Knowledge about the genetic status of an individual with clinical familial hypercholesterolemia (monogenic vs. polygenic) can provide a more informed understanding to evaluating risk, managing disease and opportunities for screening strategies.
Homozygous familial hypercholesterolemia: what treatments are on the horizon?
Authors: Bajaj Archna , Cuchel Marina
Published: April 2020

Purpose of review

Homozygous familial hypercholesterolemia (HoFH) is a rare disorder associated with early atherosclerotic disease due to impairment of the LDL receptor (LDLR) pathway. Because of their molecular defect, current treatment options have limited success in bringing HoFH patient to LDL-C target and morbidity and mortality remain high. We review current and upcoming therapies directed at HoFH, including gene therapy.

Recent findings

Recent real-world studies have confirmed the strength in lomitapide as a treatment adjunct to statins and other lipid-lowering therapies in HoFH patients. The approval of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor monoclonal antibodies has also been a welcome addition to the treatment armamentarium offering an additional average reduction in LDL-C levels of 24% when added to background lipid-lowering therapies in this population. Although achieving adequate LDL-C levels in this population is difficult, there are several therapies on the horizon that may help more patients reach goal. Evinacumab, a monoclonal antibody against ANGPTL3, has been shown to substantially reduce LDL-C of an average of 49%, independently of residual LDLR activity. RNA interference targeting PCSK9 and ANGPTL3 shows promise in clinical trials. Adeno-associated virus-mediated gene transfer and gene editing techniques are in early clinical and preclinical development.

LDL-C lowering in HoFH patients remains very challenging. However, novel treatment options are emerging. Upcoming therapies directed at PCSK9 and ANPTL3 may offer additional LDL-C reduction, to help patients achieve adequate LDL-C levels. Gene therapy and gene editing techniques, if proven effective, may offer a unique opportunity to treat patients with a one-time treatment.
Telehealth Simulation With Graduate Nurse Practitioner Students
Authors: Emerson Margaret R. , Buchanan Lynne , Golden Amber
Published: April 2020

Background

Integration of telehealth preparation for nurse practitioner (NP) students varies across programs.

Problem

Nurse practitioner students had gaps in the preparation for using telehealth technology to deliver care and manage specific disorders.

Approach

The purpose of this article is to describe the development and implementation of a telehealth simulation training experience for NP students to prepare them for practice in rural settings.

Outcomes

Nurse practitioner students from various specialties completed the telehealth simulation training experience. The change in presimulation/postsimulation confidence and readiness scores were statistically significant.

Conclusion

This telehealth simulation training experience provided an opportunity for NP students to engage in activities to enhance their knowledge and preparation in providing care via telehealth in a rural setting.
Fatty Acid-binding Protein 4 Expression in Tumor Cells as a Potential Marker for Anaplastic Meningiomas
Authors: Lee Vanessa , Smith Thomas W. , Arikan Meltem Ç. , Zhang Liang , Çataltepe Oguz , Çataltepe Sule
Published: April 2020

Meningiomas are highly vascularized tumors originating from arachnoid cap cells of the leptomeninges. The majority of meningiomas are classified as World Health Organization (WHO) grade I and display a benign clinical course with a low risk of recurrence. In contrast, WHO grade III meningiomas carry a high risk of recurrence and poor prognosis. However, it is commonly recognized that histopathologic grading does not always reliably predict recurrence or progression of meningiomas. Fatty acid-binding protein 4 (FABP4) is a small molecular weight lipid chaperone that plays a proangiogenic role in vascular endothelial cells. FABP4 is not expressed in normal brain vasculature but is detected in some glioblastoma and arteriovenous malformations. The expression pattern of FABP4 in meningiomas have not been reported to date. We analyzed FABP4 expression in a cohort of paraffin-embedded meningioma specimens by immunohistochemistry and double immunofluorescence analyses. FABP4 expression was detected in a subset of endothelial cells in 47 of 48 meningioma samples analyzed. Interestingly, tumor cell-FABP4 expression was also detected in only 1 of 22 grade I, none of grade II, but 10 of 12 grade III meningiomas (P<0.0001). These results demonstrate that FABP4 is commonly expressed in meningioma vascular endothelial cells while tumor cell expression of FABP4 is primarily observed in anaplastic meningiomas. A combination of FABP4 immunostaining with histopathologic grading might provide a more accurate prediction of the biological behavior of meningiomas than histopathologic grading alone.
Factors Associated With Neurobehavioral Complications in Pediatric Abdominal Organ Transplant Recipients Identified Using Computable Composite Definitions*
Authors: Alcamo Alicia M. , Clark Robert S. B. , Au Alicia K. , Kantawala Sajel , Yablonsky Eric J. , Sindhi Rakesh , Mazariegos George V. , Aneja Rajesh K. , Horvat Christopher M.
Published: April 2020

Objectives:

Neurologic complications occur in up to 40% of adult abdominal solid organ transplant recipients and are associated with increased mortality. Comparable pediatric data are sparse. This study describes the occurrence of neurologic and behavioral complications (neurobehavioral complications) in pediatric abdominal solid organ transplant recipients. We examine the association of these complications with length of stay, mortality, and tacrolimus levels.

Design:

The electronic health record was interrogated for inpatient readmissions of pediatric abdominal solid organ transplant recipients from 2009 to 2017. A computable composite definition of neurobehavioral complication, defined using structured electronic data for neurologic and/or behavioral phenotypes, was created.

Setting:

Quaternary children’s hospital with an active transplant program.

Patients:

Pediatric abdominal solid organ transplant recipients.

Interventions:

None.

Measurements and Main Results:

Computable phenotypes demonstrated a specificity 98.7% and sensitivity of 63.0% for identifying neurobehavioral complications. There were 1,542 readmissions among 318 patients, with 65 (20.4%) having at least one admission with a neurobehavioral complication (total 109 admissions). Median time from transplant to admission with neurobehavioral complication was 1.2 years (interquartile range, 0.52–2.28 yr). Compared to encounters without an identified neurobehavioral complication, encounters with a neurobehavioral complication were more likely to experience ICU admission (odds ratio, 3.9; 2.41–6.64; p < 0.001), have longer ICU length of stay (median 10.3 vs 2.2 d; p < 0.001) and hospital length of stay (8.9 vs 4.3 d; p < 0.001), and demonstrate higher maximum tacrolimus level (12.3 vs 9.8 ng/mL; p = 0.001). Patients with a neurobehavioral complication admission were more likely to die (odds ratio, 5.04; 1.49–17.09; p = 0.009). In a multivariable analysis, type of transplant, ICU admission, and tacrolimus levels were independently associated with the presence of a neurobehavioral complication.

Conclusions:

Common electronic health record variables can be used to accurately identify neurobehavioral complications in the pediatric abdominal solid organ transplant population. Late neurobehavioral complications are associated with increased hospital resource utilization, mortality, and tacrolimus exposure. Additional studies are required to delineate the relationship between maximum tacrolimus level and neurobehavioral complications to guide therapeutic drug monitoring and dosing.