bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended Reality International Grand Rounds: An Innovative Approach to Medical Education in the Pandemic Era
Authors: Salavitabar Arash , Popov Vitaliy , Nelson Jeremy , Benedict Michelle D. , Inniss Donovan A. , Mahajan Arushi P. , Cohen Mark S. , Owens Sonal T.
Published: February 2022

Problem

While bedside training has always presented its own unique challenges, the COVID-19 pandemic era has intensified barriers to suitable provider and trainee experiences for both patient care and medical education.

Approach

This project introduced an innovative solution with the Extended Reality International Grand Rounds, a collaboration between the University of Michigan Center for Medical and Surgical Extended Reality and Imperial College London. Three complex cases were presented to trainees through a wireless, extended reality (XR) headset and augmented by holographic visual aids and expert commentary. This pilot rounding experience was performed through the first-person view of one clinician at the bedside.

Outcomes

In 2020, 140 attendees participated in XR International Grand Rounds, and 82 (59%) and 61 (44%) completed pre- and postsurveys, respectively. Survey analysis showed that the majority of respondents (65, 79.3%) had very little to no baseline experience with XR technologies and nearly all (75, 91.5%) agreed that the development and implementation of XR curricula are important in medical training, indicating an unmet need. Nearly all respondents (59, 96.7%) found value in the ability to visualize patients’ clinical findings in the XR rounding experience and 60 (98.4%) found value in the ability to visualize patient-specific imaging and test findings in an XR format. Limiting exposure to high-risk patients and care team members with this innovative format was believed to be important to 79 (96.3%) respondents at baseline and that perception was unchanged following the event.

Next Steps

This solution to a long-standing dilemma, newly stressed by a unique era in medicine, was a successful collaboration using state-of-the-art XR technology. Next steps will include introducing more advanced physical exam visualization and detection and comprehensive evaluation of the patient experience, as well as expanding the international experience in a format that is scalable to other interested institutions.
The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment
Authors: Liu Clifford Z. , Wang Eileen , Nguyen Don , Sun Mary D. , Jumreornvong Oranicha
Published: February 2022

The COVID-19 pandemic has resulted in an alarming increase in hate incidents directed toward Asian Americans and Pacific Islanders (AAPIs), including verbal harassment and physical assault, spurring the nationwide #StopAsianHate movement. This rise in anti-Asian sentiment is occurring at a critical time of racial reckoning across the United States, galvanized by the Black Lives Matter movement, and of medical student calls for the implementation of antiracist medical curricula. AAPIs are stereotyped by the model minority myth, which posits that AAPIs are educated, hardworking, and therefore able to achieve high levels of success. This myth acts as a racial wedge between minorities and perpetuates harm that is pervasive throughout the field of medicine. Critically, the frequent aggregation of all AAPI subgroups as one monolithic community obfuscates socioeconomic and cultural differences across the AAPI diaspora while reinforcing the model minority myth. Here, the authors illustrate how the model minority myth and data aggregation have negatively affected the recruitment and advancement of diverse AAPI medical students, physicians, and faculty. Additionally, the authors discuss how data aggregation obscures health disparities across the AAPI diaspora and how the model minority myth influences the illness experiences of AAPI patients. Importantly, the authors outline specific actionable policies and reforms that medical schools can implement to combat anti-Asian sentiment and support the AAPI community.
Gender Minority Persons' Perceptions of Peer-Led Support Groups
Authors: Klotzbaugh Ralph , Fawcett Jacqueline
Published: February 2022

Literature addressing gender minority health has documented adverse behavioral health outcomes. “Gender minority” recognizes identities that include, but are not limited to, transgender and gender nonconforming. Although gender minority affirmative counseling exists, most continue to focus on pathology and diagnosis, leading people in the gender minority community to mistrust services. Sources of social support can ameliorate gender minority psychological distress by providing an environment that affirms gender identities. The purpose of this study was to identify gender minority peoples' perceptions of their experiences in a peer-led support group. The themes were then interpreted within the context of Roy's Adaptation Model.
Single dose IV Antibiotic for Low-Energy Extremity Gunshot Wounds
Authors: Nguyen Mai P. , Savakus Jonathan C. , Simske Natasha M. , Reich Michael S. , Furdock Ryan , Golob Joseph F. , McDonald Amy A. , Como John J. , Vallier Heather A.
Published: February 2022

Objective:

To prospectively determine infection rate following low-energy extremity GSWs with a single dose IV antibiotic protocol.

Summary Background Data:

Previous work suggests that a single IV antibiotic dose, without formal surgical debridement, mitigates infection risk.

Methods:

Over 35 months 530 adults with low-energy GSWs to the extremities were included. Three hundred fifty-two patients (66%) had ≥30 days follow-up. Patients were administered a single dose of first-generation IV cephalosporin antibiotics, and those with operative fractures received 24-hour perioperative antibiotics. Injury characteristics, treatment, protocol adherence, and outcomes (infection) were assessed between the protocol group (single-dose antibiotics) and the non-protocol group (no antibiotics or extra doses of antibiotics).

Results:

Compliance with the single-dose protocol occurred in 66.8%, while 33.2% received additional antibiotics or no antibiotics. The deep infection rate requiring surgical debridement was 0.8%, while the combined rate of all infections was 11.1%. Age, sex, injury location, multiple injuries, fracture presence, and type of surgery did not affect infection rate. Adherence to the antibiotic protocol was associated with a reduction in infection risk (odds ratio = 0.39, 95% confidence interval 0.19–0.83, P = 0.01). Receipt of additional antibiotics outside of our single-dose protocol did not predict further reduction in rate of infection (P = 0.64).

Conclusions:

A standardized protocol of single-dose IV antibiotic appears effective in minimizing infection after low-energy GSW to the extremities.

Level of Evidence:

Therapeutic Level II.
Assessing Public Interest in Elective Surgery During the COVID-19 Pandemic
Authors: Snyder Austin , Lanuti Michael , Muniappan Ashok , Price Melissa C. , Som Avik , Little Brent P.
Published: February 2022

Objective:

To determine trends in internet search volume for elective surgery terms during the first peak of the coronavirus disease 2019 (COVID-19) pandemic using Google Trends data.

Background:

Postponement of much-needed elective and urgent oncologic surgeries takes a toll on patients and the health care system. The COVID-19 pandemic has led to a decline in elective surgery volume, partially due to the cancellation of elective surgeries at the start of the pandemic.

Methods:

We performed a cross-sectional analysis of internet search volume trends for elective surgery terms during the first peak of the COVID-19 pandemic using Google Trends data and compared to a control group of terms representing common urgent and oncologic surgeries.

Results:

Search volume for elective surgery terms (“knee replacement,” “spinal fusion,” “hip replacement,” “laminectomy,” “cataract surgery”) revealed a decrease of up to 54% compared to the prepandemic period, a significantly greater decrease than search volume for urgent and oncologic surgery terms (“C-section,” “cholecystectomy,” “CABG,” “colectomy,” “lobectomy,” and “mastectomy”).

Conclusions:

The first phase of the COVID-19 pandemic led to sharp declines in search volume for essential elective surgical procedures, which may have been partially due to the cancellation of elective surgeries, but patient factors such as a temporary decline in interest in elective surgery might have also played a role. Attention to internet search volume may be used during future public health crises to monitor public engagement and interest in important health topics, including preventive health measures such as cancer screening.
An Exploratory Investigation of Pupillometry As a Measure of Tinnitus Intrusiveness on a Test of Auditory Short-Term Memory
Authors: Barrett Doug J.K. , Souto David , Pilling Michael , Baguley David M.
Published: February 2022

Objectives:

The purpose of the current study was to investigate the potential of pupillometry to provide an objective measure of competition between tinnitus and external sounds during a test of auditory short-term memory.

Design:

Twelve participants with chronic tinnitus and twelve control participants without tinnitus took part in the study. Pretest sessions used an adaptive method to estimate listeners’ frequency discrimination threshold on a test of delayed pitch discrimination for pure tones. Target and probe tones were presented at 72 dB SPL and centered on 750 Hz±2 semitones with an additional jitter of 5 to 20 Hz. Test sessions recorded baseline pupil diameter and task-related pupillary responses (TEPRs) during three blocks of delayed pitch discrimination trials. The difference between target and probe tones was set to the individual’s frequency detection threshold for 80% response-accuracy. Listeners with tinnitus also completed the Tinnitus Handicap Inventory (THI). Linear mixed effects procedures were applied to examine changes in baseline pupil diameter and TEPRs associated with group (tinnitus versus control), block (1 to 3) and their interaction. The association between THI scores and maximum TEPRs was assessed using simple linear regression.

Results:

Patterns of baseline pupil dilation across trials diverged in listeners with tinnitus and controls. For controls, baseline pupil dilation remained constant across blocks. For listeners with tinnitus, baseline pupil dilation increased on blocks 2 and 3 compared with block 1. TEPR amplitudes were also larger in listeners with tinnitus than controls. Linear mixed effects models yielded a significant group by block interaction for baseline pupil diameter and a significant main effect of group on maximum TEPR amplitudes. Regression analyses yielded a significant association between THI scores and TEPR amplitude in listeners with tinnitus.

Conclusions:

Our data indicate measures of baseline pupil diameter, and TEPRs are sensitive to competition between tinnitus and external sounds during a test of auditory short-term memory. This result suggests pupillometry can provide an objective measure of intrusion in tinnitus. Future research will be required to establish whether our findings generalize to listeners across a full range of tinnitus severity.
Describing Intersectional Health Outcomes
Authors: Mahendran Mayuri , Lizotte Daniel , Bauer Greta R.
Published: February 2022

Background:

Intersectionality theoretical frameworks have been increasingly incorporated into quantitative research. A range of methods have been applied to describing outcomes and disparities across large numbers of intersections of social identities or positions, with limited evaluation.

Methods:

Using data simulated to reflect plausible epidemiologic data scenarios, we evaluated methods for intercategorical intersectional analysis of continuous outcomes, including cross-classification, regression with interactions, multilevel analysis of individual heterogeneity (MAIHDA), and decision-tree methods (classification and regression trees [CART], conditional inference trees [CTree], random forest). The primary outcome was estimation accuracy of intersection-specific means. We applied each method to an illustrative example using National Health and Nutrition Examination Study (NHANES) systolic blood pressure data.

Results:

When studying high-dimensional intersections at smaller sample sizes, MAIHDA, CTree, and random forest produced more accurate estimates. In large samples, all methods performed similarly except CART, which produced less accurate estimates. For variable selection, CART performed poorly across sample sizes, although random forest performed best. The NHANES example demonstrated that different methods resulted in meaningful differences in systolic blood pressure estimates, highlighting the importance of selecting appropriate methods.

Conclusions:

This study evaluates some of a growing toolbox of methods for describing intersectional health outcomes and disparities. We identified more accurate methods for estimating outcomes for high-dimensional intersections across different sample sizes. As estimation is rarely the only objective for epidemiologists, we highlight different outputs each method creates, and suggest the sequential pairing of methods as a strategy for overcoming certain technical challenges.
Development and Current Role of Sodium Glucose Cotransporter Inhibition in Cardiorenal Metabolic Syndrome
Authors: Clements Jennifer N.
Published: February 2022

Sodium–glucose cotransporter-2 inhibitors were approved as adjunct therapy for the management of type 2 diabetes and have become a high-level recommendation for this population with cardiorenal metabolic syndrome. In addition, evidence continues to grow supporting this class of medications for people with heart failure and chronic kidney disease, regardless of diabetes status. This narrative review summarizes the sodium–glucose cotransporter inhibitors for cardiorenal metabolic syndrome.
Therapeutic Drug Monitoring for Rufinamide in Japanese Patients With Epilepsy: Focus on Drug Interactions, Tolerability, and Clinical Effectiveness
Authors: Yamamoto Yoshiaki , Inoue Yushi , Usui Naotaka , Imai Katsumi , Kagawa Yoshiyuki , Takahashi Yukitoshi
Published: February 2022

Background:

The purposes of this study were to assess drug interactions between rufinamide and concomitant antiepileptic drugs (AEDs) and to identify the therapeutic window for rufinamide.

Methods:

Serum samples (n = 1531) were obtained from 178 patients (aged 2–57 years), and clinical records were retrospectively reviewed to evaluate the safety and efficacy of rufinamide (mean observation time, 1073 ± 846 days).

Results:

Rufinamide exhibited linear pharmacokinetics at doses of up to 60 mg/kg (range, 50–3200 mg/d). Concomitant use of the enzyme-inducing AEDs such as phenytoin, carbamazepine, and phenobarbital reduced rufinamide concentrations by 43.4%, 13.2%, and 30.3%, respectively. By contrast, concomitant use of valproate significantly elevated rufinamide concentrations. Clinical response was seen in 41 patients (23.0%), with a median therapeutic concentration (interquartile range) of 20.6 mcg/mL (13.3–27.0). There was no difference in the therapeutic concentrations between seizure types, but patients with tonic/atonic seizures tended to have higher rufinamide concentrations. During the study period, adverse events were reported in 64 patients (35.8%), including somnolence, gastrointestinal disorders, dizziness, and irritability/behavior disorders. Conditional logistic regression analysis showed that patients administered a concentration greater than 20 mcg/mL had an 8.6-fold higher incidence of adverse events.

Conclusions:

Therapeutic drug monitoring for rufinamide is clinically useful for predicting drug interactions between rufinamide and concomitant AEDs. When a patient has tonic/atonic seizures, careful titration is required for concentrations greater than 20 mcg/mL.
The Impact of and Barriers to Cardiac Rehabilitation Following Cardiac Surgery in the Adult With Congenital Heart Disease
Authors: Jacobsen Roni M. , Beacher Daniel , Beacher Laura , Earing Michael G. , Ginde Salil , Bartz Peter J. , Cohen Scott
Published: February 2022

Introduction:

There is a paucity of literature evaluating the impact of and barriers to participation in cardiac rehabilitation (CR) in the adult congenital heart disease population. The aims of this study were to evaluate the impact of CR on physical activity and health-related quality of life, as well as to evaluate the barriers to participation in CR in a post-operative adult congenital heart disease population.

Methods:

Patients ≥18 yr of age seen in the Wisconsin Adult Congenital Heart Disease Program and post–open sternotomy surgery from 2010-2015 were eligible for inclusion. Subjects were mailed a novel physical activity survey and the validated EuroQOL-5D 3L health questionnaire. A retrospective medical record review was performed to extract demographic and clinical data.

Results:

One hundred thirty-five patients underwent open sternotomy surgery from 2010-2015. Of these, 22 were excluded because of intellectual disability, three opted out, and three survey packets were returned to the sender. A total of 54 of the remaining 107 patients returned completed surveys. Of these, 47 (87%) were referred to CR. Thirty-five patients completed the entire CR program (74%). Those who completed CR were more likely to develop a home/independent exercise program (P = .027). Barriers to completing CR included insurance coverage, psychiatric disease, and a perception that CR would not be of benefit.

Conclusion:

Completing CR was associated with developing a home/independent exercise program in post-sternotomy adult patients with congenital heart disease. Barriers to participating in and completing CR in this population could lead to an improved completion rate if modified.
POSTERIOR SEGMENT OCULAR FINDINGS IN CRITICALLY ILL PATIENTS WITH COVID-19
Authors: Romero-Castro Rosa M. , Ruiz-Cruz Matilde , Alvarado-de la Barrera Claudia , González-Cannata María G. , LUNA-VILLALOBOS Yara A. , García-Morales Ana K. , Ablanedo-Terrazas Yuria , González-Navarro Mauricio , Ávila-Ríos Santiago
Published: February 2022

Purpose:

To describe ophthalmological fundoscopic findings in patients with COVID-19 admitted to the intensive care unit of the largest third-level referral center for COVID-19 in Mexico City.

Methods:

In this cross-sectional single-center study, consecutive patients admitted to the intensive care unit with a diagnosis of COVID-19 underwent fundus examination with an indirect ophthalmoscope. Clinical photographs were taken using a posterior-pole camera. We explored the association between ocular manifestations and demographic characteristics, inflammatory markers, hemodynamic factors, and comorbidities.

Results:

Of 117 patients examined, 74 were men; the median age was 54 years (range: 45–63 years). Forty-two patients had ophthalmological manifestations (unilateral in 23 and bilateral in 19), and 10 of these patients had more than one ophthalmological manifestation. Ocular findings were papillitis (n = 13), cotton wool spots (n = 12), retinal hemorrhages (n = 5), retinal nerve fiber layer edema (n = 8), macular whitening (n = 5), retinal vascular tortuosity (n = 4), papillophlebitis (n = 3), central retinal vein occlusion (n = 1), and branch retinal vein occlusion (n = 1). Ocular fundus manifestations were not associated with demographic characteristics, inflammatory markers, hemodynamic factors, or comorbidities.

Conclusion:

More than one-third of patients with severe COVID-19 had ophthalmological manifestations. The most frequent fundoscopic findings were optic nerve inflammation, microvasculature occlusion, and major vascular occlusions. We recommend long-term follow-up to prevent permanent ocular sequelae.
Good Goals Matter
Authors: García-Grau Pau , McWilliam R. A. , Bull Kerry , Foster John
Published: February 2022

Functional plans in early childhood intervention need to include contextualized, meaningful, and measurable goals and include timelines and criteria for generalization. In addition, they must address children's and families' needs and priorities. The Routines-Based Interview has had a positive impact on the functionality of goals identified in the child's individualized plan. In Australia, where Noah's Ark Inc. is implementing the Routines-Based Interview and developing functional and participation-based goals, families' perceptions of child performance on functional issues and their satisfaction with the performance were measured. We analyzed (a) the functionality of goals, (b) changes in parents' perceptions of child performance and satisfaction after 6 months of intervention, and (c) the moderating effect of family goals. We found acceptable overall goal functionality, although measurement criteria are still a component that needs attention. Noteworthy changes in performance and satisfaction scores were found after the intervention, and the percentage of family goals moderated the influence of the context and meaningfulness of intervention goals on parents' perceptions of child's difference in performance. This effect was greater with more family goals on a plan.
Predictive Factors for Concurrent Tegmen Dehiscence in Superior Canal Dehiscence Syndrome
Authors: Formeister Eric J. , Zhang Lisa , Dent James , Aygun Nafi , Carey John P.
Published: February 2022

Objectives:

To describe factors predictive of tegmen dehiscence in subjects with superior semicircular canal dehiscence syndrome (SCDS).

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

Subjects with SCDS who underwent middle fossa craniotomy (MFC) for plugging/resurfacing.

Main Outcome Measures:

Operative and radiographic findings of tegmen dehiscences, preoperative low frequency air-bone gaps (LF-ABGs), ocular vestibular evoked myogenic potential (oVEMP) amplitudes, size of superior semicircular canal dehiscence (SCD), and history of obesity or obstructive sleep apnea (OSA).

Results:

One hundred thirty six patients (avg. age, 50.6 yr, 55.1% female) underwent MFC for repair of SCDS. Tegmen dehiscences were commonly found intraoperatively (tegmen tympani dehiscence [TTD] in 19.9% [11% with dural contact of ossicles], tegmen mastoideum dehiscence [TMD] in 28.7%). There were no differences in preoperative LF-ABGs and preoperative oVEMP amplitudes with respect to tegmen status. The sensitivity and specificity of computed tomography (CT) for predicting an intraoperatively confirmed TTD was 85 and 74%, respectively, and 44 and 79% for TMD. History of obesity and OSA did not differ between those with and without tegmen dehiscences. The presence of contralateral SCD and increasing cross-sectional area of SCD were both significantly associated with concurrent tegmen defects.

Conclusions:

Obesity, OSA, preoperative oVEMP, and LF-ABG do not differ between those with SCD alone and those with SCD and concurrent tegmen dehiscences. Likewise, CT scans have relatively low sensitivity for identifying tegmen dehiscences. The presence of concurrent tegmen defects is more common in subjects with larger SCD cross-sectional areas and contralateral SCD.
Anatomical Variations of the Epitympanum and the Usable Space for Middle Ear Implants Analyzed With CT-assisted Imaging Using a Tablet-based Software
Authors: Grueninger Ivo , Lippl Lisa , Canis Martin , Simon Florian , Spiro Judith E. , Spiegel Jennifer L. , Hempel John Martin , Müller Joachim , Volgger Veronika
Published: February 2022

Objective:

To evaluate interindividual anatomical variations of the epitympanum and the usable space for implantation of active middle ear implants (AMEI) as well as the usefulness of a tablet-based software to assess individual anatomy on computed tomography (CT) scans.

Patients:

CT scans of 126 patients, scheduled for cochlea implantation (50.8% men; 0.6–90.0 yr) without middle ear malformations or previous middle ear surgery and with slice thickness ≤0.7 mm were analyzed.

Main Outcome Measures:

Since no standardized measurements to assess the size of the epitympanum are available, relevant distances were defined according to anatomical landmarks. Three independent raters measured these distances using a tablet-based software. Interrater correlation was computed to evaluate the quality of the measurement process. Descriptive data were analyzed for validation and for evaluation of interindividual anatomical variations. Influence of age and sex on the taken measurements was assessed.

Results:

No relevant correlation between age or sex and the anatomy of the epitympanum was found. Interrater correlation ranged from Spearman's ρ = 0.3–0.9 and there were significant differences between individual rater results for various combinations. Descriptive data revealed high interindividual anatomical variance of the epitympanum, especially regarding the distance between incus and skull base.

Conclusion:

The reported descriptive data regarding the anatomy of the epitympanum emphasizes the importance of preoperative planning, especially since the height of the epitympanum showed great interindividual variance potentially limiting implantation of AMEIs. The herein used tablet-based software seems to be convenient for preoperative assessment of individual anatomy in the hand of otosurgeons.
Patient Sentiments Influencing Management Strategy for Single-sided Deafness
Authors: Fritz Christian G. , Dwyer Sarah M. , Renker Jaclyn M. , Luryi Alexander L. , Doerfer Karl W. , Bojrab Dennis I. , Hong Robert S. , Babu Seilesh C.
Published: February 2022

Objective:

Assess opinions that influence treatment choice for single sided deafness (SSD).

Study Design:

Retrospective chart review.

Setting:

Tertiary neurotology referral center.

Patients:

Patients with SSD were recruited between December 2020 and February 2021. Included patients were self-selected by voluntary completion of the study questionnaire.

Main Outcome Measure(s):

Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for Adults (HHIA), and a questionnaire containing 25 areas of inquiry relevant to management strategy decision making.

Results:

In comparison to the surgical management group, patients opting for nonsurgical amplification were significantly more concerned about device visibility (p = 0.005, 1.32 ± 0.22 versus 2.67 ± 0.37), undergoing surgery (p = 0.017, 1.64 ± 0.23 versus 2.89 ± 0.51), and the thought of harboring an implanted device (p = 0.003, 1.46 ± 0.22 versus 2.82 ± 0.35). Patients with a major hearing handicap (grade 2–4) placed significantly less emphasis on out-of-pocket costs (p = 0.049, 2.38 ± 0.17 versus 2.94 ± 0.21) and were less concerned about experiencing discomfort from the device (p = 0.033, 3.13 ± 0.11 versus 3.56 ± 0.16) or ease of device use (p = 0.040, 3.20 ± 0.13 versus 3.63 ± 0.13) when compared with the minor handicap group.

Conclusions:

Lingering concerns about device visibility, undergoing surgery, and harboring an implanted device underscore the need for thorough patient counseling during SSD device selection consultations. These efforts should aim to address esthetic and surgical risk concerns while emphasizing the potential for improvements in quality of life.
Prolonged Insertion Time Reduces Translocation Rate of a Precurved Electrode Array in Cochlear Implantation
Authors: van der Jagt Annerie M. A. , Briaire Jeroen J. , Boehringer Stefan , Verbist Berit M. , Frijns Johan H. M.
Published: February 2022

Hypothesis:

Insertion speed during cochlear implantation determines the risk of cochlear trauma. By slowing down insertion speed tactile feedback is improved. This is highly conducive to control the course of the electrode array along the cochlear contour and prevent translocation from the scala tympani to the scala vestibuli.

Background:

Limiting insertion trauma is a dedicated goal in cochlear implantation to maintain the most favorable situation for electrical stimulation of the remaining stimulable neural components of the cochlea. Surgical technique is one of the potential influencers on translocation behavior of the electrode array.

Methods:

The intrascalar position of 226 patients, all implanted with a precurved electrode array, aiming a mid-scalar position, was evaluated. One group (n = 113) represented implantation with an insertion time less than 25 seconds (fast insertion) and the other group (n = 113) was implanted in 25 or more seconds (slow insertion). A logistic regression analysis studied the effect of insertion speed on insertion trauma, controlled for surgical approach, cochlear size, and angular insertion depth. Furthermore, the effect of translocation on speech performance was evaluated using a linear mixed model.

Results:

The translocation rate within the fast and slow insertion groups were respectively 27 and 10%. A logistic regression analysis showed that the odds of dislocation increases by 2.527 times with a fast insertion, controlled for surgical approach, cochlear size, and angular insertion depth (95% CI = 1.135, 5.625). We failed to find a difference in speech recognition between patients with and without translocated electrode arrays.

Conclusion:

Slowing down insertion speed till 25 seconds or longer reduces the incidence of translocation.
Cochlear Implantation in Neurofibromatosis Type 2: Experience From the UK Neurofibromatosis Type 2 Service
Authors: Smith Matthew E. , Edmiston Rachel , Trudel Mathieu , Freeman Simon , Stapleton Emma , Axon Patrick , Donnelly Neil , Tysome James R. , Bance Manohar , Obholzer Rupert , Jiang Dan , Mackeith Samuel , Ramsden James , O’Driscoll Martin , Mawman Deborah , Buttimore Juliette , Nunn Terry , Humphries Jane , Evans Dafydd Gareth , Lloyd Simon K.W.
Published: February 2022

Objective:

To review the outcomes of cochlear implants (CI) in patients with neurofibromatosis type 2 (NF2) in a large cohort, and identify factors associated with poor hearing benefit.

Study Design:

Fifteen-year retrospective national observational case series.

Setting:

United Kingdom regional NF2 multidisciplinary teams.

Patients:

Consecutive patients with NF2 receiving a CI.

Interventions:

CI for hearing rehabilitation.

Main outcome measures:

1) Audiometric performance at 9 to 12 months after implantation using City University of New York (CUNY) sentence recognition score, and Bamford- Kowal-Bench (BKB) word recognition score in quiet (BKBq), and in noise (BKBn). 2) CI use at most recent review.

Results:

Sixty four consecutive patients, median age 43 years, were included. Nine to 12 months mean audiometric scores were: CUNY 60.9%, BKBq 45.8%, BKBn 41.6%. There was no difference in audiometric outcomes between VS treatment modalities. At most recent review (median 3.6 years from implantation), 84.9% with device in situ/available data were full or part-time users. Between 9 and 12 months and most recent review there was an interval reduction in mean audiometric scores: CUNY −12.9%, BKBq −3.3%, BKBn −4.9%. Larger tumor size and shorter duration of profound hearing loss were the only variables associated with poorer audiometric scores. Tumor growth at the time of surgery was the only variable associated with CI non-use. Individual patient response was highly variable.

Conclusions:

CI can provide significant and sustained auditory benefits to patients with NF2 independent of tumor treatment modality, with the majority of those implanted becoming at least part-time users. Larger datasets are required to reliably assess the role of independent variables.
Etiology, pathological characteristics, and clinical management of black pleural effusion
Authors: Yousaf Zohaib , Ata Fateen , Chaudhary Haseeb , Krause Florian , Illigens Ben Min-Woo , Siepmann Timo
Published: February 2022

Background:

Pleural effusion is characterized by excessive fluid collection in the pleural cavity. Black pleural effusion (BPE) is a rare entity with only limited scientific data. We aimed to review the current literature on black pleural effusion to characterize demographics, etiology, clinical presentation, pathological findings, available treatment strategies, and prognosis of this rare condition.

Methods:

We performed a systematic review of case reports and series and synthesized data on demographics, manifestations, management, and outcomes of patients with BPE. We searched Cochrane Library, PubMed, SCOPUS, and Google Scholar for any date until January 10, 2021. All studies (n = 31) that reported black pleural effusion in patients were added to the review. Prospective Register of Systematic Reviews registration number: CRD42020213839. Summary and descriptive analysis was performed on Jamovi version 1.2.

Results:

The mean age of 32 patients with BPE was 53 years, with male predominance (69%). The commonest risk factor was smoking (n = 9) followed by alcohol intake (n = 8). Dyspnea was the commonest symptom (n = 24, 75%). Pleural fluid was mostly exudative (n = 21). The commonest associated diagnosis was malignancy (n = 14), with 50% secondary to metastatic melanoma. The commonest intervention was therapeutic thoracocentesis (n = 25, 78%), and the effusion recurred in half of the cases where recurrence was reported (n = 13). In our review, we found the mortality rate to be at 20.8% (n = 20.8%). 58.3% of the patients were successfully treated and discharged home (n = 14).

Conclusion:

Although rare, BPE appears to be a relevant symptom as it seems to be frequently associated with modifiable risk factors and underlying malignancy. Our systematic review substantiates a vital research gap as observational research is imperative to characterize BPE further and form a basis for designing tailored diagnostic, preventive, and therapeutic strategies for BPE.
Impact of endoscopic ultrasonography on the accuracy of T staging in esophageal cancer and factors associated with its accuracy
Authors: Wang Mingbo , Zhu Yonggang , Li Zhenhua , Su Peng , Gao Wenda , Huang Chao , Tian Ziqiang
Published: February 2022

The sensitivity and specificity of endoscopic ultrasound (EUS) for esophageal cancer are variable. The aim of the present study was to determine the accuracy of EUS for the T staging of esophageal cancer and to explore the factors that affect the accuracy.

This was a retrospective study of patients with esophageal cancer who underwent EUS between January 2018 and September 2019 at the author's hospital. All patients underwent EUS, surgery, and pathological examination. The diagnostic value of ultrasound-based T (uT) staging was evaluated using the pathological T (pT) staging as the gold standard.

Finally, 169 patients were included. Among the 169 patients, 37 were overstaged by EUS, 33 were understaged, and 99 were correctly staged. The overall accuracy of EUS was 58.6%. Sensitivity was low, at 0% to 70.8% depending upon the pT stage, but specificity was higher, at 71.0% to 100.0%, also depending upon the pT stage. The multivariable analysis revealed that highly differentiated tumors (odds ratio = 9.167, P = .041) and pT stage ≥T2 (odds ratio = 2.932, P = .004) were independent factors of accurate uT stage.

The staging of esophageal cancer using EUS has low sensitivity but high specificity. Highly differentiated tumors and pT stage ≥2 tumors were associated with the accuracy of uT staging.
Real-world comparison of mono and dual combination therapies of metformin, sulfonylurea, and dipeptidyl peptidase-4 inhibitors using a common data model
Authors: Lee Kyung Ae , Jin Heung Yong , Kim Yu Ji , Kim Sang Soo , Cho Eun-Hee , Park Tae Sun
Published: February 2022

The comparative effectiveness of oral hypoglycemic agents on glycemic control and chronic complications in clinical practice is unknown in Korea. This study aimed to compare glycemic control and the incidence of hypoglycemia and chronic complications among adult patients with type 2 diabetes prescribed metformin, dipeptidyl peptidase-4 inhibitors (DPP4I), and sulfonylurea (SU) as monotherapy or dual combination therapy.

We retrospectively analyzed propensity-matched cohort data from 3 national university hospitals in Korea. All electronic health records were transformed into a unified Observational Medical Outcomes Partnership Common Data Model and analyzed using ATLAS, an open-source analytical tool, and R software. Glycemic control was assessed as the first observation of a reduction in glycosylated hemoglobin (HbA1c) level below 7% after prescription of the drug. Differences in the incidence of chronic complications were compared based on the first observation of each complication. Glycemic control and chronic complications were evaluated in patients who maintained the same prescription for at least 3 and 12 months, respectively.

Patients who received metformin had lower hazard of reaching HbA1c levels below 7% as compared with those who received SU, and had higher hazard compared with those who received DPP4I (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.75–0.98; and HR, 1.68; 95% CI, 1.42–1.99, respectively). The incidence of hypoglycemia was significantly higher in the SU group than in the metformin and DPP4I groups (metformin vs SU; HR, 0.30; 95% CI, 0.21–0.43; SU vs DPP4I; HR, 4.42; 95% CI, 2.35–8.31). Metformin + DPP4I had similar hazard of reaching HbA1c levels below 7% compared with metformin + SU (HR, 1.19; 95% CI, 0.99–1.43) and the incidence of hypoglycemia was significantly lower in the metformin + DPP4I group (HR 0.13; 95% CI 0.05–0.30). There was no significant difference in the analysis of the occurrence of chronic complications.

SU followed by metformin was effective, and both drugs showed an increased hazard of reaching HbA1c levels below 7% compared with DPP4I. Metformin + DPP4I is comparatively effective for HbA1c level reduction below 7% compared with metformin + SU. Hypoglycemia was high in the SU-containing therapy.
Mechanical model of steady-state and inflammatory conditions in patients with relapsing polychondritis
Authors: Shimizu Jun , Suzuki Noboru
Published: February 2022

Relapsing polychondritis (RP) is a multisystem inflammatory disorder, considered to associate with immune aberration.

Increased T helper type-1 cell-related cytokines were reported in RP patients. mRNA expressions of a regulatory T cell cytokine interleukin (IL)-10 increased, whereas pro-inflammatory cytokines IL1β and IL6 mRNA expressions decreased in freshly isolated peripheral blood mononuclear cells of RP patients compared with those in healthy individuals. Upon in vitro stimulation with mitogen, IL10 mRNA expressions decreased, and IL1β and IL6 mRNA expressions increased in RP patients.

This short-time dynamic change of gene expressions from anti-inflammatory to pro-inflammatory features of immune cells may be associated with the “relapsing” disease course of patients with RP. IL1β mRNA expressions of peripheral blood mononuclear cells exhibited positive correlations with serum matrix metalloproteinase (MMP)-3 concentrations in patients with respiratory involvement. Such positive correlation was not found in those without respiratory involvement.

In a metagenomic analysis, an altered composition of gut microbes was found, suggesting that microbe metabolites such as short-chain fatty acids may affect T cell responses of the patients.

In this review, the relationships among RP-related inflammatory molecules were summarized. The data support a hypothesis that the immune conditions are different between steady-state and inflammation in RP patients.
Asymptomatic gastric tuberculosis in the gastric body mimicking an isolated microscopic erosion
Authors: Zhang Wenguang , Song Fusheng , Zhang Zhimei , Yang Jun , Zhao Linlin
Published: February 2022

Introduction:

Gastric tuberculosis is rarely seen in clinical practice, which occurs mostly secondary to lung tuberculosis, intestinal tuberculosis, and other common tuberculosis. Gastric tuberculosis rarely presents as a single microscopic superficial erosion. We recently diagnosed such a case, hence reporting it herein.

Patient concerns:

A 40-year-old female patient was admitted with a chief complaint of painful enlarged cervical lymph nodes. She had no other symptoms or any previous history of remarkable diseases.

Diagnosis:

Physical examination found multiple enlarged cervical lymph nodes. Computer tomography revealed multiple circular well-defined soft tissue masses in the bilateral carotid sheath spaces. A cervical lymph node biopsy showed caseous necrosis with infiltration of neutrophils and lymphocytes, and most importantly, mycobacteria through staining for acid fast bacilli. Routine gastroscopy showed a 0.5 cm × 0.5 cm well-defined erosion on the large curvature of the gastric body. Gastric biopsy revealed chronic granulomatous inflammation with mycobacteria through staining for acid fast bacilli. The patient was diagnosed as having cervical lymph node tuberculosis and gastric tuberculosis.

Interventions and outcomes:

She received 6 months of standard anti-tuberculosis therapy. The enlarged cervical lymph nodes shrank in size and the pain was relieved.

Conclusions:

Gastroscopy should be performed to look for gastric tuberculosis if the patient presents primary tuberculosis in other organs/tissues such as cervical lymph nodes. If any small erosion is found, a biopsy is justified for checking the possibility of gastric tuberculosis.
Comparison of cyclophosphamide and calcineurin inhibitors for idiopathic membranous nephropathy
Authors: Li Kang , Yu Yanqiu , Gao Yuan , Gao Junjie
Published: February 2022

Background:

Idiopathic membranous nephropathy (IMN) is one of the leading causes of nephrotic syndrome in adults. We performed a protocol for systematic review and meta-analysis to compare the efficacy and safety of cyclophosphamide (CTX) with calcineurin inhibitors (CNIs) in the treatment of IMN.

Methods:

PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and 3 Chinese databases (WanFang Data, Chongqing VIP and China National Knowledge Infrastructure) were searched from inception through January 2022 to identify randomized controlled trials that compared CTX with CNIs for patients with IMN. Systematic review and meta-analysis of the data will be performed in RevMan software (version 5.3) according to the preferred reporting items of systematic reviews and meta-analysis guidelines. Two authors independently performed the literature searching, data extraction, and quality evaluation. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials.

Results:

The results will be submitted to a peer-reviewed journal once completed.

Conclusion:

The conclusion of our research will provide evidence to help physicians to decide between CTX and CNIs therapy regimens for IMN patients.

Open Science Framework registration number:

10.17605/OSF.IO/G584K
Colonic Function Investigations in Children
Authors: Rybak Anna , Martinelli Massimo , Thapar Nikhil , Van Wijk Michiel P. , Vandenplas Yvan , Salvatore Silvia , Staiano Annamaria , Benninga Mark A. , Borrelli Osvaldo
Published: February 2022

Disorders of colonic motility, most often presenting as constipation, comprise one of the commonest causes of outpatient visits in pediatric gastroenterology. This review, discussed and created by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Motility Working Group, is a practical guide, which highlights the recent advances in pediatric colonic motility testing including indications, technical principles of the tests, patient preparation, performance and basis of the results’ analysis of the tests. classical methods, such as colonic transit time (cTT) with radiopaque markers and colonic scintigraphy, as well as manometry and novel techniques, such as wireless motility capsule and electromagnetic capsule tracking systems are discussed.
Endoluminal Functional Lumen Imaging Probe Is Safe in Children Under Five Years Old
Authors: Hoskins Brett , Almazan Erik , Mogul Douglas , Ng Kenneth
Published: February 2022

Background:

Endoluminal functional lumen imaging probe (EndoFLIP) is a minimally invasive, novel device that uses high‐resolution impedance planimetry to measure important parameters of the gastrointestinal lumen that aid in the diagnosis of esophageal disorders. EndoFLiP is approved by the US Food and Drug Administration (FDA) for children 5 years and older. We sought to compare its safety and luminal characteristics between children under 5 years of age with children 5 years and older.

Methods:

A single‐center retrospective review was performed to identify all patients < 21 years of age who underwent esophagogastroduodenoscopy (EGD) with EndoFLIP between October 2017 and November 2020. Results: Sixty‐seven EGDs with EndoFLIP were performed in 56 patients, including 14 that were done in children < 5 years and 53 in children ≥5years. The median age in the < 5‐year group was 1.7years (interquartile range [IQR], 0.9–4.4) and the youngest patient was 1 month old. The median age in ≥5‐year group was 14.3 years (IQR, 8.2–16.2). Median procedure times were similar (32 minutes [IQR, 25–48] for the < 5‐year group; 28 minutes [IQR, 20–33] for ≥5‐year group; P = 0.08). There were no adverse events or unplanned hospitalizations in either group. At 30 mL inflation, the pressure of the lower esophageal sphincter (LES) was statistically different between the 2 groups (P = 0.02).

Conclusion:

EndoFLIP appears to be safe for use in our small cohort of children < 5 years of age and may be an important tool in the management of esophageal disorders in this age group. There was no difference in procedure time between our 2 age groups and there were no procedure‐related complications.
Evaluation of the Melbourne Rapid Fields Test Procedure
Authors: Harris Paul Alan , Johnson Chris A. , Chen Yuan , Fann Hannah , Gafford Gabrielle , Kim Ye Ji , Mezgebu Ellilta D.
Published: February 2022

SIGNIFICANCE

Both the Melbourne Rapid Fields (MRF) tablet and home versions are easy-to-use, portable, and low-cost and accurate methods of evaluating visual fields.

PURPOSE

This study aimed to investigate the clinical capabilities of the MRF perimetry test by comparing it with the Humphrey Field Analyzer (HFA), determine MRF consistency, assess the influence of refractive error, ascertain ambient illumination effects, and evaluate the consistency between the tablet and Internet Web site versions of the MRF.

METHODS

Forty healthy young participants with normal visual function (33 female, 7 male; average age, 24 years) underwent two MRF office-based tablet, two HFA tests, and two MRF Web site–based tests, one in our laboratory and one at home on their own computer using the 24-2 test pattern each time. An additional six healthy participants with normal visual function performed the 24-2 test with varying amounts of blur.

RESULTS

The average individual sensitivity values of MRF and HFA were within 4.02 dB (right eye) and 4.15 dB (left eye). The dynamic range of the MRF was smaller (30 dB) than that of the HFA. When sensitivity values greater than 30 dB were excluded, the sensitivity differences were within 2.2 dB (right eye) and 2.46 dB (left eye) of each other. Only a small number of cases produced reliability values (false positives, false negatives, fixation losses) that were outside of normal limits. There was a high correlation between test results obtained with the tablet version of the MRF test when compared with the Internet-based Web site version.

CONCLUSIONS

Quantitative visual field testing and perimetric screening procedures can be performed effectively and can provide results that are comparable with bowl perimeter test results.