bluuebunny/crossref_metadata_2025 huggingface dataset:
The Importance of Extended High-Frequency Speech Information in the Recognition of Digits, Words, and Sentences in Quiet and Noise
Authors: Polspoel Sigrid , Kramer Sophia E. , van Dijk Bas , Smits Cas
Published: November 2021

Objectives:

In pure-tone audiometry, hearing thresholds are typically measured up to 8 kHz. Recent research has shown that extended high-frequency (EHF; frequencies >8 kHz) speech information improves speech recognition. However, it is unclear whether the EHF benefit is present for different types of speech material. This study assesses the added value of EHF information for speech recognition in noise for digit triplets, consonant–vowel–consonant (CVC) words, and sentences; and for speech recognition in quiet for CVC.

Design:

Twenty-four young adults with normal-hearing thresholds up to 16 kHz performed a listening experiment in quiet and in noise in a within-subject repeated measures design. Stimuli were presented monaurally. Steady state speech-shaped noise at a fixed signal to noise ratio was used for measurements in noise. Listening conditions varied only in terms of available EHF information. Stimuli were presented in three different conditions: (1) both speech and noise broadband, (2) speech broadband and noise low-pass filtered at 8 kHz, and (3) both speech and noise low-pass filtered at 8 kHz. In the speech-in-quiet experiment, stimuli (CVC) were high-pass filtered at 3 kHz and presented in two conditions: (1) with EHF information and (2) without EHF information.

Results:

In the speech-in-noise experiment, for all speech material, the highest scores were achieved in the condition where the noise was low-pass filtered at 8 kHz and speech unfiltered; the lowest scores were obtained in the condition where both speech and noise were low-pass filtered at 8 kHz. Adding speech frequencies above 8 kHz improved the median recognition scores by 75.0%, 21.8%, and 23.8% for digit triplets, words, and sentences, respectively, at a fixed signal to noise ratio. In the speech-in-quiet experiment, median recognition scores were 7.8% higher in the condition where the EHF information was available, as opposed to when it was not.

Conclusions:

Speech information for frequencies above 8 kHz contributes to speech recognition in noise. It also contributes to speech recognition in quiet when information below 3 kHz is absent. Our results suggest that EHFs may be relevant in challenging listening conditions and should be measured in pure-tone audiometry to get a complete picture of a person’s hearing. Further, results of speech recognition tests may vary when different recording and/or measurement equipment is used with different frequency responses above 8 kHz.
An Economic Evaluation of Australia’s Newborn Hearing Screening Program: A Within-Study Cost-Effectiveness Analysis
Authors: Sharma Rajan , Gu Yuanyuan , Sinha Kompal , Ching Teresa Y. C. , Marnane Vivienne , Gold Lisa , Wake Melissa , Wang Jing , Parkinson Bonny
Published: November 2021

Objectives:

Hearing loss is one of the most prevalent congenital disorders among children. Many countries have implemented universal newborn hearing screening (UNHS) for the early diagnosis and treatment of hearing loss. Despite widespread implementation, the value for money of UNHS is unclear due to lack of cost and outcomes data from rigorous study designs. The objective of this research is to conduct a within-study cost-effectiveness analysis of UNHS compared with targeted screening (targeting children with risk factors of hearing loss) from the Australian healthcare system perspective. This evaluation is the first economic evaluation to assess the cost-effectiveness of UNHS compared to targeted screening using real-world data from a natural experiment.

Design:

The evaluation assumed the Australian healthcare system perspective and considered a time horizon of 5 years. Utilities were estimated using responses to the Health Utilities Index Mark III. Screening costs were estimated based on the Victorian Infant Hearing Screening Program. Ongoing costs were estimated based on administrative data, while external data sources were used to estimate costs related to hearing services. Missing data were handled using the multiple imputation method. Outcome measures included quality-adjusted life years (QALYs) and four language and communication-related outcomes: Peabody Picture Vocabulary Test, Wechsler Nonverbal Scale of Ability, Progressive Achievement Test, and comprehensive, expressive, and total language scores based on the Preschool Language Scale.

Results:

On average, the UNHS cost an extra Australian dollar (A$)22,000 per diagnosed child and was associated with 0.45 more QALYs per diagnosed child compared with targeted screening to 5 years, resulting in an incremental cost-effectiveness ratio (ICER) of A$48,000 per QALY gained. The ICERs for language outcomes lay between A$3,900 (for expressive language score) and A$83,500 per one-point improvement in language score (for Wechsler Nonverbal Scale of Ability). UNHS had a 69% probability of being more cost-effective compared to targeted screening at a willingness to pay threshold of A$60,000 per QALY gained. ICERs were most sensitive to the screening costs.

Conclusions:

The evaluation demonstrated the usefulness of a within-study economic evaluation to understand the value for money of the UNHS program in the Australian context. Findings from this evaluation suggested that screening costs were the key driver of cost-effectiveness results. Most outcomes were not significantly different between UNHS and targeted screening groups. The ICER may be overestimated due to the short follow-up period. Further research is warranted to include long-term resource use and outcome data, late diagnosis, transition and remission between severity levels, and timing of diagnosis and treatment.
Reliability of the Pedar in-shoe system for plantar pressure measurement in diabetic patients with and without neuropathy: a prospective study
Authors: Forogh Bijan , Raissi Gholam Reza , Soleymanzadeh Hosnieh , Bagherzadeh Cham Masumeh
Published: November 2021

Background:

The aim of this study was to evaluate within and between days’ reliability of the Pedar in-shoe system (Novel GmbH, Munich, Germany) to measure plantar pressure in diabetic patients with and without neuropathy.

Methods:

Forty-seven diabetic patients were divided into diabetic without neuropathy, and with mild, moderate, and severe neuropathy groups based on Toronto Clinical Neuropathy Score. Plantar pressure measurement was taken twice a day to assess within the same day’s reliability and after a mean of 7 days to evaluate between different days’ reliability.

Results:

Intraclass correlation coefficients (ICC) analysis indicated excellent reliability (ICC ≥0.75) in tests within the same day in all groups. Mean pressure and pressure time integral showed excellent levels of ICC reliability in the tests between different days’ in the diabetic group without neuropathy and with mild neuropathy (ICC ≥0.75) and fair-to-excellent in the diabetic group with moderate and severe neuropathy (ICC ≥0.40). Reliability of contact area between different days were excellent in all groups (ICC ≥0.75).

Conclusions:

The results indicated that the Pedar in-shoe system was a reliable measure of plantar pressure within the same day and between different days in diabetic patients with and without neuropathy. The level of reliability was altered with a change of the neuropathy severity.

Level of Evidence:

Level III.
Hands-free dressing for primary total knee arthroplasty: a retrospective cohort analysis
Authors: Koshy Nidhin , Eapen Febi C. , Das Bishwa Ranjan , Kamat Yogeesh D.
Published: November 2021

The postoperative wound management of elective total knee arthroplasty (TKA) poses challenges of allowing rehabilitation with knee movement as well as maintenance of a barrier dressing. The authors undertook a retrospective analysis of wound dressings in 103 primary TKA undertaken in our specialist center over 3 years. The authors went through a chronological change in dressing technique with the purpose of avoidance of dressing change unless necessary. In the initial period, 26 dressings were undertaken with Primapore (Smith & Nephew, Memphis, TN, traditional group). Subsequently, 77 dressings were undertaken with gauze and Tegaderm (3M, Pune, India) transparent films (modified group) and divided into two chronological subgroups: A and B. The authors analyzed parameters such as the rate of change of dressings, amount of soakage, blisters, surgical site infections, and loss of adhesiveness between the two groups. The modified group allowed full postoperative rehabilitation with knee flexion and required significantly less changing with fewer complications. Avoidance of the traditional wound check by our hands-free method has a progressive learning curve and is a viable technique to decrease wound related complications.
Calcified lumbar disc prolapse technical note and management algorithm: a prospective study
Authors: Ibrahim Fady Michael Fahmy , Khattab Mohamed Fawzy
Published: November 2021

Background:

The literature lacks sufficient data about management of symptomatic calcified lumbar disc prolapse. The authors introduced a practical algorithm for surgical management of patients after failed conservative measures.

Methods:

A prospective study of 32 patients was conducted between 2012 to 2018. Patients had symptomatic calcified lumbar disc prolapse. Eight patients had unilateral radicular pain, four patients had unilateral claudication pain, nine patients had bilateral claudication pain, and 11 patients had mechanical back pain together with claudication symptoms. Preoperative motor examination revealed one patient with preoperative unilateral foot drop, two patients had preoperative unilateral weak ankle dorsiflexion, and 11 patients had weak extensor halluces longus extension. Fifteen patients had fusion surgery, 11 patients had unilateral decompression, and six patients had bilateral decompression surgery. Functional assessment of patients was done by Oswestry Disability Index (ODI), and radicular pain was assessed by visual analog scale (VAS).

Results:

There were 19 men and 13 women. The mean age was 39.2 yr. The mean operative time for unilateral decompression was 59 min, and bilateral decompression was 80 min. The mean operative time for fusion surgery was 126.4 min. Three patients had intraoperative dural tears. One patient had postoperative ankle dorsiflexion in comparison to preoperative examination, four patients had immediate postoperative lower-limb dysesthesia. The ODI and VAS postoperative improvements were statistically significant when compared with the preoperative values. The mean follow-up was 28.4 mo.

Conclusions:

The results of this study were encouraging in the adoption of the proposed algorithm for management of symptomatic calcified lumbar disc prolapse.

Level of Evidence:

Level III.
Retrospective case series of inverted V-shape tenotomy of gastrocnemius and recession of soleus at the musculotendinous junction for the treatment of fixed equinus deformity in children with cerebral palsy
Authors: Odeh Rabea , Odeh Munzir
Published: November 2021

Background:

The authors describe results of a surgical percutaneous procedure for gastrocnemius-soleus lengthening at musculotendinous junction using a one-cut inverted V-shape technique for equinus correction in patients with cerebral palsy (CP).

Methods:

This was a retrospective case-series study of 52 patients with spastic CP between November 2001 and November 2016. Gross Motor Function Classification System (GMFCS) levels (II-IV) were involved. Statistical analysis was carried out for ankle dorsiflexion angles with knee extended and flexed, popliteal angle, and Gillette Functional Assessment Questionnaire (FAQ). Failure was determined by recurrence of equinus deformity or developing crouch gait due to overlengthening.

Results:

A mean age of 7 yr was recorded, with a minimum follow-up of 1 yr. A total number of 88 feet were operated upon, including several children who had bilateral deformities. Twelve (23%) patients were operated previously by either percutaneous or open tendo-Achilles lengthening. Success was achieved in 44 patients (85%), and eight patients (15%) had failure. Noncompliance with physical therapy and night splinting were the determined causes of failure for patients who had recurrence. GMFCS level-IV was a particular risk of failure (75%). No patient developed postoperative crouch gait caused by an over-lengthened tendo-Achilles. The improvement in the outcome measures were clinically significant in the successful group.

Conclusions:

The authors’ percutaneous gastrocnemius-soleus lengthening one-cut technique is a safe, cosmetic, and economic day-case surgery. It has low recurrence rate, with minimal risk of developing a crouched gait from overlengthening.

Level of Evidence:

Level IV.
Management of unicondylar tibial plateau fractures: a review
Authors: Warren Daniel , Domingue Grayson , Riehl John T.
Published: November 2021

Unicondylar tibial plateau fracture (TPF) is a common orthopaedic injury. Although some are treated nonsurgically with excellent results, many are treated operatively to achieve improved patient outcomes. Commonly utilized surgical treatment options include open reduction internal fixation (ORIF) and percutaneous treatment which may include arthroscopic reduction internal fixation (ARIF). The most used classification remains the Schatzker fracture classification. This article presents a review of the epidemiology, relevant anatomy, biomechanics, clinical presentation, diagnosis, and management of tibial plateau fractures.
Decreased mRNA expression level of FOXP3 correlate with TNF-α in peripheral blood mononuclear cells (PBMCs) from rheumatoid arthritis patients: a case control study
Authors: Patel Sipahee Lal , Prakash Jaya , Gupta Varsha
Published: November 2021

Background:

Forkhead box P3 (FOXP3), a transcription factor is thought to be the master regulator of regulatory T (Treg) cells in maintaining peripheral tolerance and autoimmunity. The number and functional capabilities have been reported to be low in several diseases including RA, which affects the immune regulatory action of Treg cells. Proinflammatory cytokines such as tumor necrosis factor α (TNF-α), are important in RA pathogenesis, but the influence on Treg cells is poorly understood.

Methods:

In the present study, the messenger RNA (mRNA) expressions of FOXP3 and TNF-α in a group of patients with RA (N=23) and a healthy control group (N=17) were studied in peripheral blood mononuclear cells (PBMCs). PBMCs were chosen as they are practical samples in which changes caused by disease or therapy can be conveniently monitored.

Results:

Expression of FOXP3 was lower (P<0.0001, 0.76 folds) and TNF-α gene expression was higher (P<0.0001, 2.28 folds) in RA patients when compared with the healthy control group. However, a statistically significant correlation could not be established between the FOXP3 and disease activity, but relative mRNA expression of FOXP3 and TNF-α showed a statistically significant correlation (P<0.0283) in RA patients when compared with the healthy control group.

Conclusions:

The results suggested that decreased expression of FOXP3 gene and increased level of TNF-α expression in the presence of rheumatoid factor antibodies (RF) may impair the activity of Treg cells with higher TNF-α levels when compared with patients who were negative for RF.

Level of Evidence:

Level II.
Moderately elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) in patients with no clinical signs or symptoms of infection is not a contraindication for total knee arthroplasty: a retrospective cohort study
Authors: Yeganeh Ali , Amiri Shayan , Moghtadaei Mehdi , Otoukesh Babak , Solati Ahmadreza , Daneshmand Seyedehsan
Published: November 2021

Background:

It is unclear whether patients with elevated preoperative levels of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) are more prone to periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). The authors aimed to determine how preoperative moderate elevation of ESR or CRP in patients without clinical signs or symptoms of infection is associated with the risk of PJI after TKA surgery.

Methods:

In a prospective study, 315 patients who were elected for unilateral TKA were included, including 237 patients with preoperative normal ESR and CRP, 46 patients with moderate preoperative elevation of ESR (less than 50 mm/hr), and 32 patients with moderate preoperative elevation of CRP (less than 24 mg/dL). Patients with both ESR and CRP elevation were not included in the study. Primary TKA was done using a standard medial parapatellar approach under general anesthesia.

Results:

Overall rate of infection was 0.3% (1 in 320 patients) at a mean follow-up period of 19±5.3 mo. This infection occurred in a patient with normal preoperative ESR and CRP (1 in 237 patients, 0.4%). No infection occurred in 78 patients in either the ESR-elevated or the CRP-elevated group. Accordingly, the rate of infection was not significantly different between the two groups (P=0.83).

Conclusions:

Moderate preoperative elevations of ESR or CRP do not increase the rate of periprosthetic joint infection in patients undergoing total knee arthroplasty.

Level of Evidence:

Level III.
Evaluation and treatment of shoulder injuries in tennis players: a review
Authors: Cirino Carl M. , Colvin Alexis C.
Published: November 2021

Tennis, one of the most popular sports in the United States, requires both strenuous aerobic and anaerobic effort, placing competitors at risk of significant fatigue and subsequently faulty mechanics. Repetitive stress on the upper extremity especially when serving contributes to the high incidence of chronic shoulder injuries as well as acute injuries. Shoulder injuries may include scapular dyskinesis, glenohumeral internal rotation deficit, internal impingement, and labral, biceps, or rotator cuff lesions. Physical therapy and rehabilitation are the mainstays of treatment. When surgical treatment is necessary, prolonged recovery and difficulty with a return to pre-injury levels of competition can occur. This review focuses on the most common shoulder injuries seen in tennis players, with an emphasis on evaluation and treatment.
Immunostained Frozen Sections Vs Traditional Permanent Paraffin Sections for Lentigo Maligna Treated With Mohs Micrographic Surgery
Authors: Punchihewa Nisal , Odhavji Sonya , Upjohn Edward , Bekhor Philip
Published: November 2021

BACKGROUND

Mohs micrographic surgery (MMS) has risen in popularity as a management option for treating lentigo maligna (LM) because of its ability to accurately detect subclinical spread while conserving tissue. The primary concern for opponents of MMS in melanoma remains the difficulty associated with interpretation of frozen sections compared with traditional paraffin sections; this has been made easier with the advent of immunostaining.

OBJECTIVE

Our study aims to assess the concordance in clearance reporting of LM in immunostained frozen sections compared with permanent paraffin sections and hematoxylin and eosin staining.

METHODS

We conducted a retrospective analysis of 38 LM cases treated by MMS between 2017 and 2020 in Melbourne, Australia. Immunostained frozen sections were assessed by a Mohs surgeon, whereas permanent paraffin sections were assessed by an external dermatopathologist.

RESULTS

We report 86% agreement in reporting of LM in immunostained frozen sections compared with permanent paraffin sections. In 5/38 cases, permanent paraffin sections were reported as clear for LM, but the Mohs surgeon had detected positive margins, requiring further excision.

CONCLUSION

For LM treated with MMS, there is a high agreement of clearance reporting between immunostained stained frozen sections and permanent paraffin sections without immunostaining; however, immunostained frozen sections may be more sensitive.
Physical exercise attenuates stress-induced hypertension in rats but not the impairments on the myocardial mechanics
Authors: Silva Ariana A. , Perilhão Mauro S. , Portes Leslie Andrews , Serra Andrey J. , Tucci Paulo Jose Ferreira , Leopoldo André Soares , dos Santos Leonardo , Bocalini Danilo S.
Published: November 2021

Background:

Acute and chronic stresses have become a health problem in the contemporary society, and prolonged exposure to stressful events are related to the pathogenesis of cardiovascular diseases. Physical exercise is a well-recognized effective nonpharmacological therapy for cardiovascular diseases and stress-induced injuries. Thus, this study evaluated the effect of exercise on the cardiac remodelling of chronically stressed rats.

Methods and results:

Wistar adult rats were used (n = 10 each group) and chronic stress protocol consisted of restricting movement in individual rodent restrainers (60 min, 5 days/week, 12 weeks); and exercise consisted of swimming sessions in a pool (60 min, 5 days/week, 12 weeks). During protocol, blood pressure was measured in conscious rats, and at the end cardiac morphology/function was assessed. Animals exposed to stress exhibited continuous rise in blood pressure from the sixth week, but exercise attenuated it. Similarly, restrained rats increased serum corticosterone compared with nonstressed rats, but exercise also prevented it. No changes were found in cardiac mass, but chronic stress not only impaired the steady state contractions of the cardiac muscle, but also reduced inotropic responses to stretching, increasing calcium and beta-adrenergic receptor stimulation. Despite this, exercise was unable to prevent these functional impairments induced by stress, and instead, the association of stress and physical exercise worsened myocardial compliance.

Conclusion:

Despite the known benefits to the cardiovascular system, our results indicate that aerobic swimming exercise for 12 weeks reduced blood pressure but did not impede the chronic stress-induced myocardial damages in rats.
LPIN1 is a new target gene for essential hypertension
Authors: Fujiwara Akira , Ozawa Moe , Sumida Koichiro , Hirawa Nobuhito , Yatsu Keisuke , Ichihara Nao , Haze Tatsuya , Komiya Shiro , Ohki Yuki , Kobayashi Yusuke , Wakui Hiromichi , Tamura Kouichi
Published: November 2021

Background:

We previously showed Lipin1 (LPIN1) to be a candidate gene for essential hypertension by genome-wide association studies. LPIN1 encodes the Lipin 1 protein, which contributes to the maintenance of lipid metabolism and glucose homeostasis. However, little is known about the association between LPIN1 and blood pressure (BP).

Methods:

We evaluated the BP of LPIN1-deficient [fatty liver dystrophy (fld)] mice and explored related mechanisms.

Results:

Fld mice have very low expression of LPIN1 and exhibit fatty liver, hypertriglyceridemia, insulin resistance and peripheral neuropathy. Fld mice had significantly elevated SBP and heart rate (HR) throughout the day as measured by a radiotelemetric method. Diurnal variation of SBP and HR was also absent in fld mice. Furthermore, urinary excretion of adrenaline and noradrenaline by fld mice was significantly higher compared with that of control mice. The BP response of fld mice to clonidine (a centrally acting α2-adrenergic receptor agonist) was greater than that of control mice. However, levels of Angiotensinogen and Renin 1 mRNA and urinary nitric oxide excretion were comparable between the two groups. The decrease in SBP at 8 weeks after fat grafting surgery was significantly greater in the transplant group compared with the sham operated group.

Conclusion:

The elevated BP in fld mice may result from activation of the sympathetic nervous system through decreased levels of adipose cytokines. These results indicate that LPIN1 plays a crucial role in blood pressure regulation and that LPIN1 is a new target gene for essential hypertension.
Incident aortic root dilatation in the general population: findings from the Pamela study
Authors: Cuspidi Cesare , Facchetti Rita , Quarti-Trevano Fosca , Dell’Oro Raffaella , Tadic Marijana , Mancia Giuseppe , Grassi Guido
Published: November 2021

Aim:

We sought to assess the long-term changes in aortic root diameter in a population-based sample, focusing on new-onset aortic root dilatation, as well as on the demographic and clinical variables independently related to this dynamic process.

Methods:

A total of 1122 participants with measurable echocardiographic parameters at baseline and after a 10-year follow-up were included in the analysis. Sex-specific upper limits of normality for absolute aortic root diameter, aortic root diameter indexed to body surface area (BSA) and to height were derived from 712 healthy normotensive PAMELA participants.

Results:

Over the 10-year follow-up, new aortic root dilatation occurred in 3.4% (aortic root /BSA), 4.4% (aortic root /height) and 7.3% (absolute aortic root), respectively. No substantial relationship was observed between baseline office and ambulatory blood pressure (BP) or their changes over time and incident aortic root /BSA and aortic root /height dilatation. Baseline aortic root diameter and left ventricular mass index (LVMI) emerged as important predictors of aortic root dilation, regardless of the diagnostic criteria used. This was also the case for the 10-year change in LVMI. The strength of association between nonhemodynamic variables and new-onset aortic root dilatation was variable, depending on the definition of the aortic phenotype.

Conclusion:

The incidence of aortic root dilatation in a general middle-aged population is a relatively infrequent but not so rare event and scarcely influenced by both office and out-office BP. On the contrary, it is strongly related to LVMI (and its variations over time). From a clinical perspective, this underlines that LVH prevention and regression can reduce the risk of aortic root dilatation in the community.
Automated detection of squint as a sensitive assay of sex-dependent calcitonin gene–related peptide and amylin-induced pain in mice
Authors: Rea Brandon J. , Davison Abigail , Ketcha Martin-Junior , Smith Kylie J. , Fairbanks Aaron M. , Wattiez Anne-Sophie , Poolman Pieter , Kardon Randy H. , Russo Andrew F. , Sowers Levi P.
Published: November 2021

We developed an automated squint assay using both black C57BL/6J and white CD1 mice to measure the interpalpebral fissure area between the upper and lower eyelids as an objective quantification of pain. The automated software detected a squint response to the commonly used nociceptive stimulus formalin in C57BL/6J mice. After this validation, we used the automated assay to detect a dose-dependent squint response to a migraine trigger, the neuropeptide calcitonin gene–related peptide, including a response in female mice at a dose below detection by the manual grimace scale. Finally, we found that the calcitonin gene–related peptide amylin induced squinting behavior in female mice, but not males. These data demonstrate that an automated squint assay can be used as an objective, real-time, continuous-scale measure of pain that provides higher precision and real-time analysis compared with manual grimace assessments.
The effects of acupuncture and related techniques on patients with rheumatoid arthritis: A systematic review and meta-analysis
Authors: Lu Ho-Lin , Chang Ching-Mao , Hsieh Po-Chun , Wang Jia-Chi , Kung Yen-Ying
Published: November 2021

Background:

One new type of acupuncture and related techniques (ACNRT) is increasingly used by rheumatoid arthritis (RA) patients to control their disease and improve their quality of life. However, the efficacy of using ACNRT in combination with western medicine (WM) for this purpose remains unknown.

Methods:

Randomized controlled trials of ACNRT and WM treatments for RA from January 1, 2000, to January 31, 2021, were searched for in the databases PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials, as well as in three Chinese databases: China National Knowledge Infrastructure, Wanfang Data, and Airiti Library. The primary outcomes consisted of inflammatory markers including C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor. The secondary outcomes were clinical characteristics including pain visual analog scale (VAS) score, Disease Activity Score (DAS-28), swollen joints count (SJC), tender joints count (TJC), morning stiffness, and the results of a health assessment questionnaire. The three types of ACNRT used in the focal trials were acupuncture, moxibustion, and electro-acupuncture. Two qualified researchers extracted data from these trials’ results and independently assessed their risk of bias. Statistical analyses were performed using Comprehensive Meta-Analysis V3 software.

Results:

A total of 12 RCTs with 874 patients met the inclusion criteria. As compared with the patients who received WM treatment alone, those who were given integrated ACNRT/WM treatment showed greater reductions in CRP (weighted mean difference [WMD]: −6.299; 95% CI: −9.082 to −3.517), ESR (WMD: −6.563; 95% CI: −8.604 to -4.522), VAS (WMD: −1.089; 95% CI: −1.575 to −0.602), DAS-28 (WMD: −0.633; 95% CI: −1.006 to −0.259), SJC (WMD: −1.921; 95% CI: −3.635 to −0.207), and TJC (WMD: −1.491; 95% CI: −2.941 to −0.042).

Conclusion:

This meta-analysis of RA provides reliable evidence in favor of ACNRT plus WM. However, longer term, high-quality, repeatable, multicenter randomized controlled trials with larger sample sizes are needed.
Nutrition support for acute kidney injury 2020-consensus of the Taiwan AKI task force
Authors: Hung Kai-Yin , Chen Shu-Tzu , Chu Yu-Ying , Ho Guanjin , Liu Wei-Lun
Published: November 2021

Background:

We used evidence-based medicine to suggest guidelines of nutritional support for Taiwanese patients with acute kidney injury (AKI).

Methods:

Our panel reviewed the medical literature in group meetings to reach a consensus on answering clinical questions related to the effects of the nutritional status, energy/protein intake recommendations, timing of enteral, and parenteral nutrition supplementation.

Results:

Markers of the nutritional status of serum albumin, protein intake, and nitrogen balance had positive relationships with low mortality. A forest plot of the comparison of mortality between a body mass index (BMI) of <18.5 and ≥18.5 kg/m2 was produced using data from seven observational studies which showed that a lower BMI was associated with higher mortality. The energy recommendation of 20–30 kcal/kg body weight (BW)/day was determined to be valid for all stages of AKI. The protein recommendation for noncatabolic AKI patients is 0.8–1.0 g/kg BW/day, and 1.2–2.0 g/kg BW/day is the same as that for the underlying disease that is causing AKI. Protein intake should be at least 1.5 g/kg BW/day and up to 2.5 g/kg BW/day in patients receiving continuous renal replacement therapy. Considering that patients with AKI often have other critical comorbid situations, early enteral nutrition (EN) is suggested, and parenteral nutrition is needed when >60% energy and protein requirements cannot be met via the enteral route in 7–10 days. Low energy intake is suggested in critically ill patients with AKI, which should gradually be increased to meet 80%–100% of the energy target.

Conclusion:

By examining evidence-based research, we provide practicable nutritional guidelines for AKI patients.
Tissue selecting technique for adult women with low rectovaginal fistula
Authors: Ju Man , Wang Xiuli , Xia Chaofeng , Ju Yingdong
Published: November 2021

Background:

This study aimed to assess the effect of tissue selecting technique (TST) on low rectovaginal fistula (RVF) repair.

Methods:

Patients with low RVF were included in the prospective study from August 2009 and January 2013 in xx hospital. Patients assigned to the TST or control groups based on the different surgical methods. Surgical success, complications, and quality of life were evaluated. Patients were followed up for 1–3 years.

Results:

A total of 81 patients were included in the study. Foutry-one were in the TST group, and 40 were in the control group. Surgery was successful in 100% of patients who underwent TST, and in 95% of patients who underwent the classical perineal approach. Less patients experienced pain (72% vs 90%, p = 0.04) and edema (6% vs 25%, p < 0.001) in the TST group compared with the control group. In addition, the QOL score was significantly higher in the TST group (122 ± 21 vs 111 ± 12, p = 0.02).

Conclusion:

The TST stapler approach appears to be appropriate for the treatment of low RVF in adults.
Lateral Skull Base Chordoma Mimicking a Paraganglioma
Authors: Patel Vir , Hwa Tiffany P. , Kaufman Adam C. , Kolster Rachel A. , Bigelow Douglas C.
Published: November 2021

We present an unusual case of chordoma arising entirely from the lateral skull base with imaging features suggestive of a paraganglioma. Clinical history, management, histopathology, and imaging characteristics are described, including a review of gallium-dotate PET scanning somatostatinreceptor-positive tumors. We further provide a review of management options, including a summary of our approach with surgical biopsy via retrosigmoid and resection via transtemporal approaches. Based on radiologic characteristics and location, lateral skull base chordoma may arise with isolated lateral skull base involvement and has the potential to be misidentified as a glomus jugulare on initial workup.
Implications of Phase Changes in Extracochlear Electrocochleographic Recordings During Cochlear Implantation
Authors: Suntinger Katharina , Huber Alexander , Röösli Christof , Sijgers Leanne , Veraguth Dorothe , Pfiffner Flurin , Dalbert Adrian
Published: November 2021

Objective:

To assess the prevalence and implications of phase changes in extracochlear electrocochleography (ECochG) recordings during cochlear implantation.

Materials and Methods:

Extracochlear ECochG recordings were performed before and after insertion of the cochlear implant (CI) electrode by a recording electrode placed on the promontory. Acoustic stimuli were tone bursts at 250, 500, 750, and 1,000 Hz. The pure tone average (PTA) was determined before and approximately 4 weeks after surgery.

Results:

Extracochlear ECochG recordings in 69 ears of 68 subjects were included. At 250 Hz, the mean phase change was 43° (n = 50, standard deviation (SD) 44°), at 500 Hz 36° (n = 64, SD 36°), at 750 Hz 33° (n = 42, SD 39°), and at 1,000 Hz 22° (n = 54, SD 27°). Overall, in 48 out of 210 ECochG recordings a phase change of ≥45° (23%) was detectable. Ears with an amplitude drop >3 dB and a phase change ≥45° (n = 3) had a complete or near complete loss of residual cochlear function in all cases. A phase change of ≥90° in one recording was not associated with a larger amplitude change of the ECochG signal (1.9 dB vs. −0.9 dB, p = 0.1052, n = 69), but with a significantly larger postoperative hearing loss (17 dB vs. 26 dB, p = 0.0156, n = 69).

Conclusions:

Phase changes occur regularly in extracochlear ECochG recordings during cochlear implantation. Phase changes of ≥90° with or without amplitude changes in the ECochG signal are associated with a larger postoperative hearing loss and could therefore represent an independent marker for cochlear trauma or changes of inner ear mechanics relevant for the postoperative hearing outcome.
Insertion Depth and Cochlear Implant Speech Recognition Outcomes: A Comparative Study of 28- and 31.5-mm Lateral Wall Arrays
Authors: Canfarotta Michael W. , Dillon Margaret T. , Brown Kevin D. , Pillsbury Harold C. , Dedmon Matthew M. , O’Connell Brendan P.
Published: November 2021

Objectives:

1) To compare speech recognition outcomes between cochlear implant (CI) recipients of 28- and 31.5-mm lateral wall electrode arrays, and 2) to characterize the relationship between angular insertion depth (AID) and speech recognition.

Study Design:

Retrospective review.

Setting:

Tertiary academic referral center.

Patients:

Seventy-five adult CI recipients of fully inserted 28-mm (n = 28) or 31.5-mm (n = 47) lateral wall arrays listening with a CI-alone device.

Interventions:

Cochlear implantation with postoperative computed tomography.

Main Outcome Measures:

Consonant-nucleus-consonant (CNC) word recognition assessed with the CI-alone at 12 months postactivation.

Results:

The mean AID of the most apical electrode contact for the 31.5-mm array recipients was significantly deeper than the 28-mm array recipients (628° vs 571°, p < 0.001). Following 12 months of listening experience, mean CNC word scores were significantly better for recipients of 31.5-mm arrays compared with those implanted with 28-mm arrays (59.5% vs 48.3%, p = 0.004; Cohen's d = 0.70; 95% CI [0.22, 1.18]). There was a significant positive correlation between AID and CNC word scores (r = 0.372, p = 0.001), with a plateau in performance observed around 600°.

Conclusions:

Cochlear implant recipients implanted with a 31.5-mm array experienced better speech recognition than those with a 28-mm array at 12 months postactivation. Deeper insertion of a lateral wall array appears to confer speech recognition benefit up to ∼600°, with a plateau in performance observed thereafter. These data provide preliminary evidence of the insertion depth necessary to optimize speech recognition outcomes for lateral wall electrode arrays among CI-alone users.
Use of Auditory Training and Its Influence on Early Cochlear Implant Outcomes in Adults
Authors: Dornhoffer James R. , Reddy Priyanka , Ma Cheng , Schvartz-Leyzac Kara C. , Dubno Judy R. , McRackan Theodore R.
Published: November 2021

Objective:

Assess associations between postcochlear implant (CI) auditory training and early outcomes related to speech recognition and CI quality of life (CIQOL).

Study Design:

Longitudinal, prospective cohort.

Setting:

Tertiary academic center.

Patients:

Seventy-two adults undergoing cochlear implantation for bilateral severe-to-profound hearing loss.

Interventions:

Self-reported use of three categories of auditory training post-CI activation: (1) face-to-face training (e.g., speech pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) computer-based training (e.g., interactive software).

Main Outcome Measures:

Change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 3-month post-CI.

Results:

Of 72 patients, 52 (72.2%) used an auditory training resource. Of all patients, 18.4% used face-to-face training, 58.3% passive home-based training, and 33.3% computer-based training. At 3 months post-CI, use of any training was associated with greater improvement in speech recognition (d-range = 0.57–0.85) and global and domain-specific CIQOL scores, except entertainment (d-range = −0.33 to 0.77). Use of computer-based training demonstrated the greatest effect, with larger improvements in speech recognition (CNCp: d = 0.69[0.03,1.35]; CNCw: d = 0.80[0.14,1.46]; AzBio: d = 1.11[0.44,1.77]) and global and all domain-specific CIQOL scores (d-range = 0.05–1.35). Controlling for age, sex, household income, and use of multiple training resources, computer-based training remained the strongest positive predictor of speech recognition and CIQOL improvement, with significant associations with CNCp (ß = 33.07[1,43,64.719]), AzBio (ß = 33.03[5.71,60.35]), and CIQOL-global (ß = 10.92[1.15,20.70]) score improvement.

Conclusions:

Our findings provide preliminary evidence-based recommendations for use of specific auditory training resources for new adult CI recipients. Auditory training, especially self-directed computer software, resulted in improved speech recognition and CIQOL outcomes after 3 months and are widely available for CI users.
Evaluation of the Quality of Online Information on Sudden Sensorineural Hearing Loss
Authors: Simani Liam , Oron Yahav , Handzel Ophir , Eta Rani Abu , Warshavsky Anton , Horowitz Gilad , Muhanna Nidal , Ungar Omer J.
Published: November 2021

Objective:

To evaluate the quality of leading Internet resources of information on sudden sensorineural hearing loss (SSNHL).

Study Design:

Cross-sectional descriptive design.

Settings:

An online search by means of the Google search engine.

Methods:

An online search was conducted using terms related to SSNHL. We defined “quality” according to scaled readability measures (Flesch Reading Ease [FRE] and Flesch-Kincaid Grade-Level [FKGL]), as well as “understandability” and “actionability” (Patient Education Materials Assessment Tool), and Clinical Practice Guideline (CPG) adherence. Scoring was performed by two independent physicians.

Results:

The 10 most frequently encountered patient education websites were analyzed. The average FRE score was “fairly difficult” (mean 57.28, median 55.55, range 46.4–71.8) and the average FKGL score was “standard” (mean 9th grade, median 9th grade, range 5th–10th grade). Nine websites were understandable (mean 83%, median 84%, range 69–100%), and seven had good actionability scores (mean 73%, median 75%, range 50–100%). Most websites conformed with the CPG for patient education at a reasonable level (mean 5.6, median 5.5, range 3–7). Notably, all websites encouraged seeking medical help.

Conclusion:

Internet resources for patient education on SSNHL vary in quality and are generally understandable to the average layman. There is still much room for better, more comprehensive and easier-to-read information to improve patients’ medical knowledge about their condition.

Level of Evidence: 1
Characterization and Development of Universal Ventricular Assist Device: Computational Fluid Dynamics Analysis of Advanced Design
Authors: Goodin Mark S. , Showalter Michael S. , Horvath David J. , Kuban Barry D. , Flick Christine R. , Polakowski Anthony R. , Fukamachi Kiyotaka , Karimov Jamshid H.
Published: November 2021

We are developing a universal, advanced ventricular assist device (AVAD) with automatic pressure regulation suitable for both left and right ventricular support. The primary goal of this computational fluid dynamics (CFD) study was to analyze the biventricular performance of the AVAD across its wide range of operating conditions.

An AVAD CFD model was created and validated using in vitro hydraulic performance measurements taken over conditions spanning both left ventricular assist device (LVAD) and right ventricular assist device (RVAD) operation. Static pressure taps, placed throughout the pump, were used to validate the CFD results. The CFD model was then used to assess the change in hydraulic performance with varying rotor axial positions and identify potential design improvements. The hydraulic performance was simulated and measured at rotor speeds from 2,300 to 3,600 revolutions/min and flow rates from 2.0 to 8.0 L/min. The CFD-predicted hydraulic pressure rise agreed well with the in vitro measured data, within 6.5% at 2300 rpm and within 3.5% for the higher rotor speeds. The CFD successfully predicted wall static pressures, matching experimental values within 7%. High degree of similarity and circumferential uniformity in the pump’s flow fields were observed over the pump operation as an LVAD and an RVAD. A secondary impeller axial clearance reduction resulted in a 10% decrease in peak flow residence time and lower static pressures on the secondary impeller. These lower static pressures suggest a reduction in the upwards rotor forces from the secondary impeller and a desired increase in the pressure sensitivity of the pump.

The CFD analyses supported the feasibility of the proposed AVAD’s use as an LVAD or an RVAD, over a wide range of operating conditions. The CFD results demonstrated the operability of the pump in providing the desired circumferential flow similarity over the intended range of flow/speed conditions and the intended functionality of the AVAD’s automated pressure regulation.
Oncostatin M: a Potential Biomarker to Predict Infection in Patients with Left Ventricular Assist Devices
Authors: Setiadi Hendra , El-Banayosy Ahmed M. , George Susan , Schmidtke David W. , El-Banayosy Aly , Horstmanshof Douglas A. , Long James W.
Published: November 2021

Infection is a serious adverse event limiting left ventricular assist device (LVAD) therapy in advanced heart failure patients, but a reliable means to identify patients at increased risk of infection is still lacking. We hypothesized that preoperative elevated levels of plasma Oncostatin M (OSM), a cytokine marker of leukocyte activation and inflammation, would be predictive of subsequent infection. We measured plasma OSM in 41 LVAD patients one day before LVAD implantation and postoperatively over two months. Preoperative plasma OSM levels were normal in 27 patients (group A, 4.9 ± 3.2 pg/ml) but elevated in 14 patients (group B, 1649.0 ± 458.9 pg/ml) (p = 0.003). Early postoperative levels rose in both groups and declined rapidly in group A, with group B declining slowly over two months. Significantly more infections developed in group B than group A patients over two months postimplantation (p = 0.004). No other routine clinical assessment or laboratory testing afforded this differentiation. These findings suggest that preoperative plasma OSM levels may assist in identifying patients at increased risk of infections after LVAD implantation.
Advanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome
Authors: Somhorst Peter , Gommers Diederik , Endeman Henrik
Published: November 2021

Purpose of review

To summarize the current knowledge about the application of advanced monitoring techniques in coronavirus disease 2019 (COVID-19).

Recent findings

Due to the heterogeneity between patients, management of COVID-19 requires daily monitoring of and/or aeration and inspiratory effort. Electrical impedance tomography can be used to optimize positive end-expiratory pressure, monitor the response to changes in treatment or body position and assess pulmonary perfusion and ventilation/perfusion matching. Lung ultrasound is more readily available and can be used to measure and monitor recruitment, provide an indication of diaphragm function and pulmonary perfusion disturbances. Esophageal pressure measurements enable the calculation of the transpulmonary pressure and inspiratory effort in order to prevent excessive stress on the lung. While esophageal pressure measurements are the golden standard in determining inspiratory effort, alternatives like P
0.1, negative pressure swing during a single airway occlusion and change in central venous pressure are more readily available and capable of diagnosing extreme inspiratory efforts.

Although there is little data on the effectiveness of advanced monitoring techniques in COVID-19, regular monitoring should be a central part of the management of COVID-19-related acute respiratory distress syndrome (C-ARDS).