bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal Growth in Patients With Juvenile Idiopathic Scoliosis Treated With Boston Brace
Authors: Heemskerk Johan L. , Wijdicks Sebastiaan P.J. , Altena Mark C. , Castelein René M. , Kruyt Moyo C. , Kempen Diederik H.R.
Published: February 2020

Study Design.

Retrospective comparative cohort.

Objective.

The aim of this study was to determine whether spinal growth is restricted by brace treatment in patients with juvenile idiopathic scoliosis (JIS).

Summary of Background Data.

Spinal fusion can negatively affect spinal growth if performed before the growth spurt. Brace treatment is often given in this young population to control the spinal deformity while allowing spinal growth. It is unknown whether the applied pressure of brace treatment on spine results in growth restriction. The aim of the study is to evaluate spinal growth in braced JIS patients.

Methods.

A total of 49 JIS patients treated with Boston brace were retrospectively selected from a scoliosis database. T1-T12/T1-S1 perpendicular and freehand (height following the curvature of the spine) height were measured on radiographs of patients that had reached skeletal maturity and were matched with 49 controls without scoliosis. Spinal growth was calculated from brace initiation until cessation and was compared with normal spinal growth values as reported by Dimeglio.

Results.

The mean age of diagnosis was 7.4 years. The age of the braced scoliosis patients at skeletal maturity was 17.5 years. The average T1-T12 and T1-S1 freehand height measured by following the curvature of the scoliosis was 29.3 cm (±2.4) and 47.2cm (±4.0), respectively, and was not significant different from the control group. Brace treatment was initiated at a mean age of 11.2 and the mean age of cessation was 14.8. Spinal growth (freehand) during brace treatment was 1.10 cm/year for the thoracic spine and 1.78 cm/year for the full spine and was not significant different from normal values.

Conclusion.

No significant influence of bracing on spinal growth could be detected in this cohort of JIS patients. The spinal height measurements at skeletal maturity were similar to matched controls. In addition, spinal growth did not significantly differ from Dimeglio normal growth data, indicating that the effect of bracing on spinal growth is absent or minimal.

Level of Evidence: 3
Surgical Strategies: Cement Spacer for Staged First Metatarsophalangeal Arthrodesis After Failed Arthroplasty
Authors: O’Donnell Seth W. , Vaughn Joshua J. , Sangeorzan Adam P. , DeFontes Kenneth W. , Bluman Eric M.
Published: February 2020

Revision arthrodesis following surgery for first metatarsophalangeal arthritis (hallux rigidus) is a complex problem. Failed implants, arthroplasty, primary fusion, or infection may result in bone loss with abnormal soft tissue tensions. This requires technically challenging revision surgery necessitating debridement of nonviable bone, culture, and bone grafting of resultant defects. We describe a 2-stage technique for first metatarsophalangeal arthrodesis in the setting of osteolysis, infection, or bone loss. This staged technique allows for the restoration of appropriate soft tissue tension through the use of a temporary cement spacer before structural grafting.
Early Tracheostomy in Severe Traumatic Brain Injury Patients: A Meta-Analysis and Comparison With Late Tracheostomy
Authors: de Franca Sabrina Araujo , Tavares Wagner M. , Salinet Angela S. M. , Paiva Wellingson S. , Teixeira Manoel J.
Published: February 2020

Objectives:

To elucidate the impact of early tracheostomy on hospitalization outcomes in patients with traumatic brain injury.

Data Sources:

Lilacs, PubMed, and Cochrane databases were searched. The close-out date was August 8, 2018.

Study Selection:

Studies written in English, French, Spanish, or Portuguese with traumatic brain injury as the base trauma, clearly formulated question, patient’s admission assessment, minimum follow-up during hospital stay, and minimum of two in-hospital outcomes were selected. Retrospective studies, prospective analyses, and case series were included. Studies without full reports or abstract, commentaries, editorials, and reviews were excluded.

Data Extraction:

The study design, year, patient’s demographics, mean time between admission and tracheostomy, neurologic assessment at admission, confirmed ventilator-assisted pneumonia, median ICU stay, median hospital stay, mortality rates, and ICU and hospital costs were extracted.

Data Synthesis:

A total of 4,219 studies were retrieved and screened. Eight studies were selected for the systematic review; of these, seven were eligible for the meta-analysis. Comparative analyses were performed between the early tracheostomy and late tracheostomy groups. Mean time for early tracheostomy and late tracheostomy procedures was 5.59 days (sd, 0.34 d) and 11.8 days (sd, 0.81 d), respectively. Meta-analysis revealed that early tracheostomy was associated with shorter mechanical ventilation duration (–4.15 [95% CI, –6.30 to –1.99]) as well as ICU (–5.87 d [95% CI, –8.74 to –3.00 d]) and hospital (–6.68 d [95% CI, –8.03 to –5.32 d]) stay durations when compared with late tracheostomy. Early tracheostomy presented less risk difference for ventilator-associated pneumonia (risk difference, 0.78; 95% CI, 0.70–0.88). No statistical difference in mortality was found between the groups.

Conclusions:

The findings from this meta-analysis suggest that early tracheostomy in severe traumatic brain injury patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient’s early rehabilitation and discharge.
Melatonin, Ramelteon, Suvorexant, and Dexmedetomidine to Promote Sleep and Prevent Delirium in Critically Ill Patients
Authors: Fontaine Gabriel V. , Der Nigoghossian Caroline , Hamilton Leslie A.
Published: February 2020

Sleep plays an important role in the recovery of critically ill patients. However, patients in the intensive care unit (ICU) often suffer sleep disturbances and abnormal circadian rhythms, which may increase delirium and lengthen ICU stay. Nonpharmacologic strategies for preventing and treating sleep disturbances and delirium, such as overnight eye masks and ear plugs, are usually employed first, given the lack of adverse effects. However, a multimodal approach to care including pharmacotherapy may be necessary. Despite the limited available data supporting their use, medications such as melatonin, ramelteon, suvorexant, and dexmedetomidine may promote sleep and improve a variety of patient-centric outcomes such as delirium. This narrative review focuses on these nonbenzodiazepine agents used for sleep in the ICU. Practical application of each of these agents is described for when providers choose to utilize one of these pharmacotherapies to promote sleep or prevent delirium.
Vertical Midface Lifting: An Improved Technique for Asians
Authors: Zou Chong , Liu Yuanbo , Wang Xiangyue , Wang Tailing , Wang Jiaqi
Published: February 2020

BACKGROUND

Treatment of the aging midface is increasingly deemed a key part of facial and periorbital rejuvenation. Compared with Westerners, Asians tend to have a relatively prominent zygoma and mandibular angle, thicker dermis, and greater propensity for scar formation.

OBJECTIVE

This study was performed to review our surgical method of vertical midface lifting in Asian patients and evaluate the clinical outcomes.

METHODS AND MATERIALS

This retrospective observational study involved 116 Asian women who complained of an aged midface. All patients underwent midface rejuvenation surgery with one lower eyelid incision and 2 small frontal–temporal incisions. Clinical results were assessed objectively using photographs and subjectively by a patient satisfaction survey.

RESULTS

All patients recovered well without major complications. High patient satisfaction (94%) was attained. The improvement scores as evaluated by the panel demonstrated a higher level of improvement for the malar eminence (8.3 ± 0.6), nasojugal groove (8.0 ± 0.8), and nasolabial fold (7.9 ± 0.7) than for the lower face (6.2 ± 1.0).

CONCLUSION

Our vertical midface lift technique is safe and effective for older Asian patients with a midface aging appearance.

LEVEL OF EVIDENCE

Therapeutic IV.
My Quest, a Community-Based mHealth Intervention to Increase Physical Activity and Promote Weight Loss in Predominantly Rural-Dwelling, Low-Income, Alabama Women
Authors: Griffin Jamie B. , Struempler Barb , Funderburk Katie , Parmer Sondra M. , Tran Cecilia , Wadsworth Danielle D.
Published: February 2020

Rural-dwelling, overweight/obese, limited-resource individuals and women have the lowest leisure-time physical activity rates among Americans. This community-based, single-group pre- posttest study sought to increase physical activity, step counts, and promote weight loss in 104 low-income women (84% rural). Analyses included nonparametric and repeated-measures analyses of variance to determine physical activity behaviors, step counts, and weight loss. Results show, from pre- to postintervention, participants improved self-reported step counts, physical activity goal setting and behaviors, and body weight. This study adds support that text message programs can reach a high-risk, limited-resource, predominantly rural population to promote physical activity and weight loss.
Impacts of interactions between ADH1B and ALDH2 genotypes on alcohol flushing, alcohol reeking on the day after drinking, and age distribution in Japanese alcohol-dependent men
Authors: Yokoyama Akira , Yokoyama Tetsuji , Matsui Toshifumi , Mizukami Takeshi , Kimura Mitsuru , Matsushita Sachio , Higuchi Susumu , Maruyama Katsuya
Published: February 2020

Objective:

This study sought to evaluate the impacts of interactions between thealcohol dehydrogenase-1B(rs1229984) genotype and thealdehyde dehydrogenase-2(rs671) genotype on alcohol flushing, alcohol reeking on the day after drinking, and the age distribution in alcohol-dependent patients.

Methods:

The study subjects were 4107 Japanese alcohol-dependent men who underwentalcohol dehydrogenase-1Bandaldehyde dehydrogenase-2genotyping: 4051 patients were asked about their current or former tendency to experience facial flushing after drinking a glass of beer, and 969 patients were asked about whether they had ever been told that they reeked of alcohol more than 12 hours after they had stopped drinking.

Results:

Current, former, and never flushing were reported in 3.5, 14.9, and 81.5%, respectively, of the subject, and alcohol reeking after more than 12 hours in 36.1% of the subjects. The fast-metabolizingADH1B*2(+) genotype (*1/*2or*2/*2) and the inactiveALDH2*2(+) genotype (*1/*2or*2/*2) affected the multivariate odds ratios for current or former flushing [odds ratio, 95% confidence interval = 2.27 (1.79–2.86) and 23.0 (18.6–28.5), respectively, vs. *2(−) genotype] and for alcohol reeking [0.39 (0.29–0.52) and 1.56 (1.09–2.25), respectively, vs. *2(−) genotype]. An age-dependent decrease in theADH1B*2(−) andALDH2*2(−) combination from 32.3% in the 30–39-year age group to 12.5% in the 70–79-year age group and an age-dependent increase in theADH1B*2(+) andALDH2*2(−) combination from 52.5% in the 30–39-year age group to 70.5% in the 70–79-year age group were observed (P< 0.0001 for trend). The frequencies of theADH1B*2(−) andALDH2*2(+) combination (4.7–6.2%) and theADH1B*2(+) andALDH2*2(+) combination (8.9–12.0%) did not change markedly with increasing age.

Conclusion:

Interactions between thealcohol dehydrogenase-1Bandaldehyde dehydrogenase-2genotypes modified alcohol flushing, alcohol reeking on the day after drinking, and the age distribution. These findings support the protective roles of theADH1B*2(+) andALDH2*2(+) genotypes against the development of alcohol dependence.
Defining a New Leadership Model to Stay Relevant in Healthcare
Authors: Kaplan Gary S.
Published: February 2020

Because the healthcare landscape is in a state of extreme disruption, the ability to adapt is essential for organizations and their leadership teams. Players outside the sector, changing workforce and patient demographics, new technologies, cost pressures, and other influences are challenging hospital and health systems’ abilities to perform as expected.

Amid this ambiguity, a lack of urgency is preventing organizations from adjusting to a business environment in flux. Never has it been more important for leaders to show courage, learn, and guide their organizations to the front lines of innovation. In today’s world, being a learning organization—one in which leaders and team members lean together into change, rather than back away—is crucial to remaining relevant. To quote philosopher Eric Hoffer, “In times of change, learners inherit the earth while the learned find themselves beautifully equipped to deal with a world that no longer exists.”

At Virginia Mason, a health system based in Seattle, Washington, our management methodology—the Virginia Mason Production System—allows the organization to be a nimble responder to change. It also empowers individuals across the enterprise, regardless of job or title, to assume hands-on roles in accomplishing our collective vision to transform healthcare. This “we culture” shines a bright light on improvement opportunities and provides the framework needed for collaborative, interdisciplinary efforts to develop solutions.
The Susceptibility to Other Infectious Diseases Following Measles During a Three Year Observation Period in Switzerland
Authors: Behrens Lynn , Cherry James D. , Heininger Ulrich ,   for the Swiss Measles Immune Amnesia Study Group
Published: February 2020

Background:

Measles virus infection leads to significant immunosuppression. In developing countries, this translates to an increased nonspecific mortality, whereas its effects in developed countries are less clear.

Methods:

We performed a cohort study to investigate whether children hospitalized with measles (cases) between 2000 and 2015 in Switzerland would have a higher frequency of hospital admissions due to other infectious diseases thereafter than children who did not have measles (controls). Cases were identified by ICD-10 discharge diagnoses for measles and/or keyword search and matched to 2 controls by time of hospitalization, age and sex. All hospitalizations ≤3 years after original admission, infectious or noninfectious in origin, were identified in cases and controls.

Results:

One hundred thirteen cases (56% males), mean age 9.0 years (range 2 weeks–17.8 years), and 196 controls were identified. Twelve rehospitalizations due to an infectious disease occurred in 11 cases and 6 in 6 controls (episode rates 0.106 versus 0.031 per person; ratio 3.47; 95% CI: 1.20–11.3; P = 0.012) in 3 years of follow-up. Of these, 9 and 3 occurred in cases and controls, respectively, during year 1 [ratio 5.20 (95% CI: 1.30–29.88; P = 0.012)]. Infectious diseases following measles affected various organ systems, were neither particularly severe nor fatal and revealed no specific pattern.

Conclusions:

The increased risk for nonspecific infectious disease hospitalizations supports the concept of immunologic amnesia after measles. Universal immunization against measles provides additional benefit beyond protection against measles itself.
The Clinical and Parasitologic Follow-up of Trypanosoma cruzi–infected Children in a Nonendemic Country
Authors: Simón Marina , Iborra M. Asunción , Carrilero Bartolomé , Romay-Barja María , Vázquez Cristina , Gil-Gallardo Luis J. , Segovia Manuel
Published: February 2020

Background:

Chagas disease has become a global health problem, with the pediatric population being especially vulnerable. Our aim was to describe the clinical-epidemiologic aspects of disease in this population, as well as tolerance and adherence to treatment and the subsequent evolution of the disease.

Methods:

A prospective study involving 949 children 0–14 years of age screened from 2007 to 2018. Diagnosis was performed by polymerase chain reaction and/or microhematocrit in <1-year-old children or serology in those ≥1 year of age. After diagnosis, children were examined for the clinical manifestation of Chagas disease and were treated with benznidazole. Treatment response was monitored by polymerase chain reaction and serology.

Results:

Forty children were infected (4.2% of the population screened). Twelve children were diagnosed during the acute phase (≤1-year-old), 3 of whom were symptomatic, and 28 (4- to 14-year-olds) were in the chronic phase: 18 in the indeterminate phase and 10 presented cardiac and/or digestive involvement. Regarding treatment, 10 (25.6%) children had side effects (6 mild, 2 moderate and 2 severe reactions), leading to treatment interruption in 3 of them. No side effects were detected in ≤1-year-old children (P < 0.05). Cure was confirmed in 29.4% of the children during follow-up, and the age of the children at treatment (≤1 year) was clearly associated with the effectiveness of treatment (P < 0.05).

Conclusions:

Effectiveness and safety of treatment were optimum in ≤1-year-old children. Increased side effects, cardiac and/or digestive disorder incidence and lower treatment effectiveness were detected in older children, highlighting the need for early screening.
False-positive Results of Quantiferon-Tb-Gold Assay in Children
Authors: Quintana-Ortega Cristian , Mendez-Echevarria Ana , del Rosal Teresa , Gonzalez-Muñoz Miguel , Baquero-Artigao Fernando
Published: February 2020

We present a pediatric case series describing false-positive QuantiFERON-TB Gold In-tube (QFT-GIT) assay (QIAGEN, Germany) results observed in a tertiary hospital in Spain (2013–2018). During the study period, 7 of 737 test results were considered false-positives: 4 children with chronic medical conditions, 1 Mycobacterium lentiflavum lymphadenitis, 1 infant born to a mother with pulmonary tuberculosis, and 1 child exposed to a noninfectious tuberculosis patient. Data regarding interferon-gamma release assays false-positive results in children are scarce, and more studies are necessary to determine the rates of false-positive results in low-prevalence settings.
Targeted Multidrug Resistant Organism Antimicrobial Prophylaxis and Postoperative Infections in Pediatric Cardiothoracic Surgical Patients
Authors: Cies Jeffrey J. , Palladino Christina , Mahmood Hera , Moore Wayne S. , Chopra Arun
Published: February 2020

Background:

To determine if receiving targeted antimicrobial (AM) prophylaxis has an effect on the rate of postoperative infections in patient’s colonized with a multidrug resistant organism (MDRO) undergoing cardiothoracic surgery (CTS).

Methods:

Single-center, retrospective medical record review of pediatric patients from birth to 18 years of age undergoing CTS from January 2013 to September 2018. Demographic data collected included age, specific MDRO, site of MDRO colonization, type of surgery, perioperative AM agent and type of infection. Patients were stratified into 2 groups, MDRO+ and MDRO–. Demographic and clinical characteristics were compared between groups with a Student’s t test for continuous variables and a χ2, Fisher exact test or Mann–Whitney U test for noncontinuous variables. A 2-sided significance level of α = 0.05 was used to determine statistical significance. All analyses were performed using IBM SPSS Version 24 (SPSS Inc., Chicago, IL).

Results:

Fifty patients (26 males/24 females) were included in the MDRO (+) group and 295 patients (168 males/127 females) in the MDRO (–) group. The median age was 0.48 years (interquartile range 0.24–1 year) and 0.9 years (interquartile range 0.19–8 years) in the MDRO (+) and MDRO (–) groups, P = 0.003. 2 of 50 (4%) MDRO (+) patients and 15 of 295 (5.1 %) MDRO (–) patients developed an infection, P = 1. 10 of 50 (20%) MDRO (+) patients received targeted AM toward the MDRO and none developed an infection. Of the 2 MDRO (+) patients with infection, 1 was infected with the MDRO. For MDRO (+) patients, there was no difference in the rate of infection whether targeted AM therapy was received, P = 1.

Conclusions:

There was no difference in the rate of postoperative infection between MDRO (+) and MDRO (–) patients. Additionally, these preliminary pediatric data suggest targeting AM agents to a specific MDRO does not impact the rate of postoperative infection in children undergoing CTS. Larger studies are warranted to confirm these findings.
Unilateral Streptococcus pneumoniae microbial keratitis after small-incision lenticule extraction
Authors: Huang Sonia , Sun Michelle T. , Gupta Aanchal
Published: February 2020

A 25-year-old woman had bilateral small-incision lenticule extraction (SMILE) for myopic astigmatism. Three days after the procedure, she noted pain, redness, tearing, and photophobia of the left eye. The uncorrected distance visual acuity (UDVA) was 6/12. Slitlamp examination revealed 2 anterior stromal infiltrates at the SMILE interface, haze, and an epithelial defect in the left eye. The right eye was normal. The patient was initially treated empirically with fortified antibiotics before culture returned positive for Streptococcus pneumoniae. Treatment was adjusted according to sensitivities to chloramphenicol (Chlorsig) and vancomycin. As visual acuity further deteriorated to counting fingers, oral prednisolone and prednisolone forte were begun, and vancomycin 5% irrigation of the interface was performed. Postoperatively, there was improvement of the clinical picture with resolution of the corneal infiltrates, improvement of interface inflammation, and improvement of the patient's vision. At the 9-month postoperative follow-up her UDVA in the left eye was 6/7.5.
Development of two different pharmacogenomics detection methods for second-generation antipsychotic drugs quetiapine and aripiprazole
Authors: Zhang Lichen , Zhang Xingyu , Zhang Xiaoqing , You Guoling , Fu Qihua
Published: February 2020

Objective:

Second-generation antipsychotics are widely used in mental illness, but the treatment effects and side effects are affected by single nucleotide polymorphisms (SNPs) of related genes. Quetiapine and aripiprazole are two frequently used secondgeneration antipsychotic drugs. The aim of this study was to develop two different SNP detection methods for four SNP alleles associated with the pharmacokinetics of quetiapine and aripiprazole, based on high-resolution melting (HRM) and multicolor melting curve assay (MMCA) respectively.

Methods:

Whole genome DNA samples were obtained from 240 healthy people (107 females and 133 males) without genetic diseases. HRM methods were established using four kinds of specific primers and a saturated fluorescent dye. Each SNP allele with their own primers was detected in a single reaction. In the MMCA method, a multiplex polymerase chain reaction with 4 different-colored fluorescent probes was established to detect four SNP alleles in a single reaction. All experimental protocols were approved by the Ethics Committee of the Shanghai Children’s Medical Center, China (SCMC-201015) on November 22, 2010.

Results:

Two detection methods for the pharmacogenomics of quetiapine and aripiprazole, based on HRM and MMCA respectively, were established in this study. The single-target HRM method can be completed in 96 minutes, whereas the quadruplex MMCA method takes 133 minutes. It was found that the results of HRM and MMCA for the four SNP alleles had 100% coincidence with Sanger sequencing in the 240 samples.

Conclusion:

This study developed two methods for the detection of four pharmacogenomic SNP alleles that correlated with quetiapine and aripiprazole. Both methods are rapid, cost-saving, highly accurate and potentially facilitate rational use of second-generation antipsychotics for clinical medication.
Robot-assisted laparoscopic ureteral reconstruction for ureter endometriosis: Case series and literature review
Authors: Hung Zhi-Chen , Hsu Tzu-Hsiang , Jiang Ling-Yu , Chao Wei-Ting , Wang Peng-Hui , Chen Wei-Jen , Huang Eric Yi-Hsiu , Chen Yi-Jen , Lin Alex T. L.
Published: February 2020

Background:

The aim of this report was to review experience from a single hospital in treating ureteral obstruction related to endometriosis with robot-assisted laparoscopic ureteral reconstruction.

Methods:

This retrospective analysis study (Canadian Task Force classification II-3) was conducted at an academic tertiary hospital. Five female patients with hydronephrosis without significant elevation of serum creatinine levels were enrolled. Ureteral endometriosis with obstruction was suspected on radiological images. Previous treatment with double-J stenting with or without medical treatment had failed in all of the patients. We performed robot-assisted laparoscopic segmental resection for ureteral endometriosis and reconstructed the ureter through ureteroureterostomy (RUU) or ureteroneocystostomy (RUC). The involved ureters included left lower ureter in three patients and right lower ureter in two patients. RUU was performed in four patients and RUC in one patient. All of the operations were completed smoothly without complications.

Results:

All ureteral endometrioses were successfully resected, and follow-up sonography or intravenous pyelography showed resolution of hydronephrosis in all of the patients.

Conclusion:

Our experience proves the feasibility and efficacy of a robot-assisted approach for this rare situation with good outcomes.
A Descriptive Analysis of Body Composition Among Forest Firefighters in Spain
Authors: Crespo-Ruiz Beatriz , Esteban García Paula , Fernández-Vega Cristina , Crespo-Ruiz Carmen , Rivas-Galan Shai
Published: February 2020

Objective:

To determine the body composition profile of forest firefighters. Data were collected from 701 forest firefighters.

Methods:

We have carried out this analysis using a bioimpedance scale BC-601 of the brand Tanita® ISO 9001 Certified.

Results:

Obtained values of body mass index 24.85 in women and 27.83 in men. The visceral fat index was 5 in women and 9 in men. In both cases, taking as reference the values proposed by the WHO, women are within a low-moderate risk of cardiovascular or metabolic diseases. Men are at a moderate-high risk.

Conclusions:

The values obtained in the analysis show that forest firefighters have a moderate risk of cardiovascular and metabolic diseases in the future. It is effective to propose future works that elaborate specific physical activity plans to improve their health profile.
Age as a Factor of Growth in Mastoid Thickness and Skull Width
Authors: Almuhawas Fida Abdulaziz , Dhanasingh Anandhan E. , Mitrovic Dijana , Abdelsamad Yassin , Alzhrani Farid , Hagr Abdulrahman , Al Sanosi Abdulrahman
Published: February 2020

Objectives:

To understand the growth rate of mastoid thickness and skull width associated with the age for both normal and malformed inner-ear anatomy groups. Also, to determine if there is any mathematical relation between cochlear size as measured by the “A” value against the age, mastoid thickness, and skull width.

Methods:

Ninety-two computed tomography image datasets of human temporal bone were made available that contained normal (n = 44) and malformed inner-ear (n = 48) anatomies. The age of the subjects ranged from 6 months to 79 years. CE marked OTOPLAN preplanning otology software was used to load the patient's preoperative images for making all the measurements including mastoid thickness, skull width, and the cochlear size as measured by the “A” value. Mastoid thickness was measured both in axial and coronal planes starting from the cochlear entrance to the skull surface, with the line in plane with the basal turn of the cochlea. Skull width was measured from side to side in both axial and coronal planes from the image slice that gave the highest width. The cochlear size in terms of basal turn diameter “A” was measured from “Cochlear View” in the oblique coronal plane.

Results:

Mastoid thickness and skull width increased with age in a logarithmic manner. The mastoid thickness increased from a minimum of 17 mm to around 34 mm and the skull width increased from 105 mm to around 146 mm as the age increased from 6 months to 20 years. At the age of around 20, both the mastoid thickness and skull width reached the plateau and thereafter with a very little growth. The skull width was linearly correlated with the mastoid thickness conveying the fact that bigger the head size is, thicker will be the mastoid. The size of the cochlea as measured by the “A” value did not have any meaningful correlation with the age, mastoid thickness, and skull width. This conveys the message that the cochlear size is independent of the overall size of head and the age of patient.

Conclusions:

Mastoid thickness and skull width increased with age, while the cochlear size was independent of age, mastoid thickness, and the size of the skull.
Hearing Preservation in Elderly Cochlear Implant Recipients
Authors: Bourn Stephanie , Goldstein Mary Rose , Jacob Abraham
Published: February 2020

Objective:

Examine hearing preservation rates in cochlear implant recipients 72 years and older.

Study Design:

Retrospective case series.

Setting:

Tertiary otology/neurotology practice.

Patients:

Cochlear implant recipients 72 years and older who are candidates for hearing preservation and were implanted between April 2017 and June 2018

Intervention:

Surgical/rehabilitative.

Main Outcome Measures:

Hearing was measured preoperatively and 6 months after cochlear implantation.

Results:

Between April 2017 and June 2018, 125 cochlear implant operations were performed by the senior author (A.J.). Of these patients, 62 were over age 72 and comprehensive pre- and postoperative residual hearing data were available on 24 patients. Although several methods for calculating hearing preservation are evaluated, our practice has found that hearing preservation techniques should be used in all patients having even a single frequency ≤85 dB HL between 125 and 2000 Hz before surgery. Using this method, 60% of recipients had at least one postoperative threshold ≤85 dB HL, and more importantly, over 80% of these patients subsequently used an electroacoustic MAP.

Conclusion:

Despite concerns about cochlear fragility in elderly patients, preservation of residual hearing is feasible in cochlear implant recipients 72 years and older. This suggests that the vast majority of patients, including an elderly cohort, can benefit from soft surgery techniques.
The Pretragal Superficial Musculoaponeurotic System Fascia: A New Graft Material for Transcanal Tympanoplasty
Authors: Lin Ming-Yee , Chang Ting-Shou , Liao Jia-Bin
Published: February 2020

Objective:

To compare outcomes of transcanal endoscopic tympanoplasty reconstructed using pretragal superficial musculoaponeurotic system (SMAS) fascia versus temporalis fascia.

Study Design:

Retrospective patient review and posttreatment questionnaire survey.

Setting:

Tertiary referral center.

Patients:

Sixty adult patients with chronic dry tympanic membrane perforation.

Interventions:

Patients underwent transcanal endoscopic type I tympanoplasty reconstructed using the SMAS fascia between September 2017 and May 2018; outcomes were compared with a matched cohort of patients where the temporalis fascia was used.

Main Outcome Measures:

Tympanic membrane closure rate, audiogram threshold, duration of procedure, and donor site scar satisfaction survey.

Results:

Sixty patients were included in this study and were evenly divided into the SMAS and temporalis fascia groups. These cohorts were matched for age, sex, side of lesion, perforation size, and preoperative hearing level. The closure rate was 96.7% (29/30) and 93.3% (28/30) (p = 1.0), mean hearing gain was 8.3 ± 6.4 dB versus 8.2 ± 7.1 dB for air-conduction (p = 0.970) and 7.6 ± 5.1 dB versus 8.2 ± 6.8 dB for air-bone gap (p = 0.716), and mean surgical duration was 137.3 ± 23.0 versus 132.2 ± 27.3 minutes (p = 0.432) for the SMAS and temporalis fascia groups, respectively; there were no statistically significant differences for all the parameters listed. The posttreatment questionnaire survey revealed significantly higher acceptance of the SMAS fascia method.

Conclusion:

This preliminary outcome report of SMAS fascia grafting in transcanal endoscopic type I tympanoplasty showed equivalent surgical outcomes and better cosmetic satisfaction compared with the temporalis fascia. The SMAS fascia is a reasonable alternative to conventional techniques for transcanal tympanoplasty.
The splice c.1815G>A variant in KIAA0586 results in a phenotype bridging short-rib-polydactyly and oral-facial-digital syndrome
Authors: Cocciadiferro Dario , Agolini Emanuele , Digilio Maria Cristina , Sinibaldi Lorenzo , Castori Marco , Silvestri Evelina , Dotta Andrea , Dallapiccola Bruno , Novelli Antonio
Published: February 2020

Introduction:

KIAA0586 variants have been associated to short-rib thoracic dysplasia, an autosomal recessive skeletal ciliopathy characterized by a narrow thorax, short limbs, and radiological skeletal abnormalities.

Patient concerns:

Patients 1 and 2 were two Roma Gypsy siblings presenting thoracic dysplasia and a combination of oral cavity anomalies.

Diagnosis:

A custom NGS gene panel, including genes associated to skeletal ciliopathies, identified the homozygous KIAA0586 splicing variant c.1815G>A (p.Gln605Gln) in both siblings, confirming the clinical diagnosis of short-rib-polydactyly.

Intervention:

Patients were transferred to neonatal intensive care unit and received life-support treatment.

Outcomes:

Patients 1 and 2 died after few hours and 1 month of birth, respectively, because of respiratory failure related with the disease.

Conclusion:

We report two patients affected by short-rib polydactyly syndrome and overlapping phenotype with oral-facial-digital syndrome associated with the c.1815G>A variant in KIAA0586, suggesting a quite peculiar genotype–phenotype correlation.
Pulmonary edema following diuretic therapy
Authors: Liu Lixia , Zhang Qian , Zhang Tao , Wu Xinhui , Sun Lixiao , Li Bin , Wang Xiaoting , Chao Yangong , Hu Zhenjie
Published: February 2020

Introduction:

Diuretics are a commonly used for the treatment of acute pulmonary edema. However, inappropriate administration of diuretic drugs can result in clinical treatment failure and cause acute pulmonary edema. This is due to rapid decreases in intravascular volume as a result of diuretic treatment. To date, the clinical phenomenon of inappropriate use of diuretics leading to acute pulmonary edema remains unexplored and unrecognized. Here, we report the first case of this problem—pulmonary edema following diuretic therapy.

Patient concerns:

A 71-year-old male patient who was intubated and transferred to the intensive care unit (ICU) due to respiratory failure was initially diagnosed with pneumonia as a complication of acute respiratory distress syndrome (ARDS). After treatments including antibiotics, lung protective ventilation strategies, and restrictive fluid management, his respiratory symptoms improved. However, the patient's dyspnea became more severe after experimental diuretic therapy.

Diagnosis:

A point-of-care ultrasound (POCUS) examination showed increased extravascular lung water retention during a hypovolemic state. After full examinations and analysis, the diagnosis of acute pulmonary edema was determined.

Interventions:

The most likely cause of acute pulmonary edema was left ventricular (LV) hyperdynamic status due to a hypovolemic status caused by excessive diuretic therapy. Consequently, we administrated intravenous fluids and a β-receptor blocker to the patient.

Outcomes:

Following these treatment, the patient's respiratory distress improved remarkably.

Conclusion:

We report the first case of pulmonary edema following diuretic therapy to stress the need of physicians to follow guidelines of clinical practice. Maintaining an appropriate volume status and treatment of β-receptor blockers is the key to reversing the progress of this adverse effect. In this process, POCUS is a reliable diagnostic tool to identify the cause of acute pulmonary edema and can increase the accuracy of clinical evaluations. It is likely that a wider use of POCUS will help physicians to obtain a faster, and more accurate, diagnosis of the etiology of acute pulmonary edema, thus allowing a more appropriate therapy.
A statistical analysis of the correlations among various types of clinical indexes for patients with chronic hepatitis B
Authors: Wang Jie , Pu Yonglan , Gong Yinhua , Li Zhonghua , Zhu Xiaofang
Published: February 2020

Hepatitis B virus (HBV) is one of the commonest chronic infections, especially in Asia and Africa, which put a heavy burden worldwide. With the advanced knowledge of HBV, early detection, primary care, and hepatology have made huge progression than before. However, the relationship between gender, age, and different key parameters in HBV patients remains to be determined.

In this study, we measured various physiological and biochemical indexes in a large cohort of HBV patients as well as healthy control. We investigated the strength of correlations among those indexes and reported instantaneous imaging results. Moreover, we examined the effects of various grouping modes such as by gender or age on liver stiffness measurement (LSM) and controlled attenuation parameters (CAPs). We compared their diagnostic values for hepatic fibrosis in HBV patients.

The results showed that specimens from a healthy control were obviously clustering tightly together, while the specimens from the HBV patients were clustering into several subgroups. Direct bilirubin (DB), total bilirubin (TB), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) occurred together with the diagnosis of HBV. Furthermore, groups categorized by Gender had significant effects on fibrotouch measurement not only in HBV patients but also in healthy control.

Our research was to evaluate the actual effects of various parameters on Fibrotouch and make improvement of the critical value of those medical indexes.
Can diffusion weighted imaging be used as an alternative to contrast-enhanced imaging on magnetic resonance enterography for the assessment of active inflammation in Crohn disease?
Authors: Cansu Aysegul , Bekircavusoglu Suleyman , Oguz Sukru , Bulut Eser , Fidan Sami
Published: February 2020

The present study aimed to investigate the potential use of T2-weighted sequences with diffusion weighted imaging (DWI) in magnetic resonance (MR) enterography instead of conventional contrast-enhanced MR imaging (MRI) sequences for the evaluation of active inflammation in Crohn disease.

Two-hundred thirteen intestinal segments of 43 patients, who underwent colonoscopy within 2 weeks before or after MR enterography were evaluated in this retrospective study. DWI sequences, T2-weighted sequences, and contrast-enhanced T1-weighted sequences were acquired in the MR enterography scan after cleaning of the bowel and using an oral contrast agent. First, the intestinal segments that had active inflammation in MR enterography were qualitatively evaluated in T2-weighted and contrast-enhanced T1-weighted sequences and then MR activity index (MRAI 1) and MRAI 2 were formed with and without contrast-enhanced sequences in 2 separate sessions.

The correlation coefficient between contrast enhanced and DWI MR enterography scores (MRAI 1 and MRAI 2) of intestinal inflammation was 0.97 for all segments. In addition, separate correlation coefficients were calculated for terminal ileum, right colon, transverse colon, left colon, and rectum, and there was a strong correlation between the MRAI 1 and MRAI 2 scores of each segment (r = 0.86–0.97, P < .001). On the other hand, MR enterography had 88.7% sensitivity, 97.9% specificity, 95.5% positive predictive value, 94.6% negative predictive value, and 94.8% accuracy for detection of active inflammation in all intestinal segments in Crohn disease.

DWI and T2-weighted sequences acquired with cleaning of the bowel can be used instead of contrast-enhanced MRI sequences for the evaluation of active inflammation in Crohn disease.
The mediating role of inflammation in the association between cigarette smoking and intima-media thickness
Authors: Wang Tao , Jiang Chao Qiang , Xu Lin , Zhang Wei Sen , Zhu Feng , Jin Ya Li , Thomas G. Neil , Cheng Kar Keung , Lam Tai Hing
Published: February 2020

Cigarette smoking is associated with thicker carotid intima-media thickness (IMT), probably partly through inflammatory pathways. However, to what extent does inflammation mediate the smoking-carotid atherosclerosis association is unclear. We investigated the mediating effect of inflammation on the association between cigarette smoking and carotid IMT, and quantified the respective contributions of inflammatory markers to this association.

A total of 1752 participants from Guangzhou Biobank Cohort Study-Cardiovascular Disease Sub-cohort (GBCS-CVD) were included. Using causal mediation analysis under the counterfactual framework, we decomposed total effects of cigarette smoking on IMT into indirect effects (through inflammatory response) and direct effects (not through inflammatory response).

After adjusting for traditional risk factors, the indirect effects of per 109/L increment in leukocyte and granulocyte, per mg/L increment in high-sensitivity C-reactive protein (hs-CRP), and per mg/dL increment in fibrinogen on carotid IMT was 0.0028 mm (95% confidence interval [CI], 0.0011–0.0047), 0.0019 mm (95% CI, 0.0006–0.0034), 0.0017 mm (95% CI, 0.0006–0.003), and 0.001 mm (95% CI, 0.0001–0.0021), respectively. No evidence for a mediating role of lymphocyte was found. The proportion of the smoking-IMT association mediated by leukocyte, granulocyte, hs-CRP, and fibrinogen was 12.57% (95% CI, 8.50%–22.11%), 8.50% (95% CI, 5.76%–15.09%), 7.64% (95% CI, 5.20%–13.79%), and 4.48% (95% CI, 3.04%–8.03%), respectively. Restricting data analysis to men showed similar results.

The effects of cigarette smoking on IMT were partly mediated by leukocyte, hs-CRP, and fibrinogen. The mediating role of leukocyte was likely mainly driven by higher granulocyte.
β2-microglobulin is an independent indicator of acute kidney injury and outcomes in patients with intracerebral hemorrhage
Authors: Wang Rui , Hu Hongtao , Hu Shuang , He Hong , Shui Hua
Published: February 2020

Acute kidney injury (AKI), a serious complication in critically ill patients, is associated with poor clinical outcomes. We explored the hypothesis that β2-microglobulin (β2-MG) is an independent indicator of AKI development and outcomes in patients with intracerebral hemorrhage (ICH) in the neurosurgical intensive care unit (NICU).

Patients with ICH (n = 403) admitted to the NICU of Zhongnan Hospital, Wuhan University, between January 1, 2015 and December 31, 2016 were prospectively enrolled in this single-center, observational study. The primary outcome was the incidence of AKI, secondary outcomes were in-hospital mortality and 1-year mortality (from time of admission).

The overall AKI incidence, in hospital, was 35.2%; patients were diagnosed with stage 1 (22.1%), 2 (5.7%), and 3 (7.4%) AKI. β2-MG levels predicted AKI with an area under the curve of 0.712 (95% confidence interval [CI], 0.652–0.772) and a cut-off of 2026.85 μg/L (sensitivity, 57.5%; specificity, 79.4%). Compared with the group having lower β2-MG values, the group with higher values (β2-MG >2123.50 μg/L) had significantly higher risks of AKI (odds ratio, 2.606; 95% CI, 1.315–5.166), in-hospital mortality (hazard ratio [HR], 2.548; 95% CI, 1.318–4.924), and 1-year mortality (HR, 3.161; 95% CI, 1.781–5.611) in adjusted analyses.

β2-MG levels predict AKI development and outcomes in patients with ICH in the NICU.
A case report on transient global ventricular wall thickening secondary to acute myocarditis
Authors: Xu Tiantian , Hu Hongjie
Published: February 2020

Introduction:

Transient left ventricular wall thickening is known to develop in the acute phase of myocarditis, with several reports documenting this unusual mode of myocarditis. Diagnosing myocarditis can be challenging because symptoms, clinical exam findings, electrocardiogram results, biomarkers, and echocardiogram results are often non-specific. Therefore, cardiac magnetic resonance imaging has become the primary non-invasive imaging tool in patients with suspected myocarditis.

Patient concerns and diagnosis:

A 51-year-old male was referred to our hospital with a 20-day history of fever. Initial echocardiogram demonstrated diffuse concentric left ventricular hypertrophy with depressed left ventricular diastolic function, previously misdiagnosed as restrictive cardiomyopathy. Cardiac magnetic resonance imaging (MRI) showed global ventricular wall thickening, and the negative delayed enhancement made hypertrophic cardiomyopathy and myocardial amyloidosis less likely. This information, along with laboratory analyses, led to a diagnosis of acute myocarditis.

Interventions and outcomes:

The patient underwent a treatment regimen, including a prescription of levofloxacin and other supporting treatments. During the period following, the patient experienced a few minor episodes of atypical chest pain with spontaneous remission. The patient was discharged after 8 days of hospitalization. A cardiac MRI evaluation was repeated after 17 months, this time showing that the wall thickness had returned to normal; the myocarditis resolved without sequela.

Conclusions:

In summary, we report on a case of transient global ventricular wall thickening secondary to acute myocarditis, which rarely has been described previously. Our study demonstrates that transient ventricular wall thickening related to myocardial interstitial edema also can involve the right ventricular wall, a fact that is important in diagnosis and differential diagnosis. Cardiovascular magnetic resonance currently is considered the most comprehensive and accurate diagnostic tool in patients with suspected myocarditis.
Treatment response of bevacizumab combination chemotherapy in recurrent glioblastoma
Authors: Huang Yu-Kai , Lieu Ann-Shung
Published: February 2020

Treatment options for recurrent glioblastoma are rare, with their response uncertain. This study aimed to determine the response of chemotherapy including bevacizumab in combination with vincristine and carboplatin for glioblastoma at first recurrence in a single-institution cohort.

Clinical data of patients who received chemotherapy including bevacizumab, vincristine, and low-dose carboplatin for recurrent glioblastoma between 2008 and 2014 were analyzed. Differences between those who received combination chemotherapy (chemotherapy-positive) and those who did not (chemotherapy-negative) were estimated by Fisher exact test or Wilcoxon rank-sum test, as appropriate. Survival curves were estimated using the Kaplan–Meier method, and differences between survival curves were estimated by the log-rank test. Univariate analysis of treatment response for all recurrent glioblastoma patients and secondary recurrence patients under different conditions were evaluated using Wilcoxon rank-sum test or the Kruskal–Wallis test.

Although mortality rates were similar between the chemotherapy-negative and chemotherapy-positive groups (26.7% vs 28.6%), median overall survival was significantly longer in the chemotherapy-positive group than the chemotherapy-negative group (P = .006). There were no chemotherapy-related serious complications such as gastrointestinal perforation, serious bleeding, or new-onset seizure during chemotherapy, whereas others side effects including proteinuria and hypertension were more common albeit well controlled by medication.

This study revealed combination regimen of bevacizumab, vincristine, and low-dose carboplatin as a potentially effective therapeutic approach in recurrent glioblastoma. More in-depth understanding of the mechanism underlying this combination treatment and potential contribution of alternative genetic therapeutic in recurrent glioblastoma is necessary.