bluuebunny/crossref_metadata_2025 huggingface dataset:
Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia
Authors: Sullivan Elizabeth A. , Javid Nasrin , Duncombe Gregory , Li Zhuoyang , Safi Nadom , Cincotta Robert , Homer Caroline S. E. , Halliday Lesley , Oyelese Yinka
Published: August 2017

OBJECTIVE:

To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.

METHODS:

A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.

RESULTS:

Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7–2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8–10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.

CONCLUSION:

The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.
Partnering of Public, Academic, and Private Entities to Reestablish Maternal Mortality Review in Georgia
Authors: Lindsay Michael K. , Goodman David , Csukas Seema , Cota Pat , Loucks Tammy L. , Ellis Jane E. ,   for the Georgia Maternal Mortality Review Committee
Published: August 2017

The pregnancy-related mortality ratio in the United States has increased over the past 25 years. Georgia's pregnancy-related mortality ratio is among the highest in the United States. Confronted with this harsh reality, Georgia reestablished maternal mortality review as one strategy to address its high maternal mortality. To achieve a comprehensive process for review of maternal deaths involved securing the knowledge, resources, and support of physician experts, public health agencies and professional organizations as well as representatives in the state legislature. The six key steps in successfully reinstating maternal mortality review were 1) establishing a maternal mortality advisory committee, 2) developing a defined methodology for comprehensive case identification, 3) convening an introductory maternal mortality review committee meeting, 4) securing legislative protection for the committee, 5) conducting a mock mortality review, and 6) completing a formal first-year case review and producing a summary report of initial findings. This first case review revealed the leading causes of pregnancy-related deaths in Georgia as hemorrhage, hypertension, cardiac disease, embolism, and seizures. Our objective in this commentary is to share our experiences and advocate for engaging public, private, and academic partners in working on complex and multifactorial public health issues such as high maternal mortality.
The role of depression and personality traits in patients with melanoma: a South-European study
Authors: Gogas Helen J. , Karalexi Maria A. , Dessypris Nick , Antoniadis Antonios G. , Papadopoulos Fotis , Petridou Eleni T.
Published: August 2017

We explored the potential association of depression history and personality, evaluated through a robust questionnaire tool, namely the Eysenck Personality Scale, with disease risk and progression among Greek patients. A total of 106 melanoma patients and their 1 : 1 sex-matched controls were interviewed on the basis of a questionnaire comprising phenotypic, sociodemographic, lifestyle and medical history variables, as well as information on history of lifetime major depression. The Eysenck Personality Questionnaire, measuring the four personality dimensions (extraversion, neuroticism, psychoticism, lie), was thereafter completed. Adjusted odds ratios (ORs) for melanoma risk were derived through multiple logistic regression analyses, whereas potential predictors of survival were explored using Cox proportional hazards models. Sun sensitivity score [OR: 1.55, 95% confidence interval (CI): 1.16–2.06] and major depression history (OR: 5.72, 95% CI: 1.38–23.73) were significantly associated with melanoma, whereas inverse associations of extraversion (OR: 0.90, 95% CI: 0.83–0.97) and psychoticism score (OR: 0.88, 95% CI: 0.78–1.00) were noted. These associations were more pronounced and remained solely among female patients; notably, decreased extraversion (OR: 0.86, 95% CI: 0.76–0.98) and psychoticism score (OR: 0.63, 95% CI: 0.43–0.91), as well as increased depression history (OR: 10.69, 95% CI: 1.43–80.03) were evident. Cox-derived hazard ratios showed nonsignificant associations of depression history and personality with disease outcome. Our data support the hypotheses that depression history and personality are associated with melanoma risk. No effect on survival after cancer diagnosis was observed. If confirmed in future studies, these associations may contribute toward better understanding the etiology of melanoma, enhancing health-related quality of life.
Patient, Hospital, and Geographic Disparities in Laparoscopic Surgery Use Among Surveillance, Epidemiology, and End Results–Medicare Patients With Colon Cancer
Authors: Ratnapradipa Kendra L. , Lian Min , Jeffe Donna B. , Davidson Nicholas O. , Eberth Jan M. , Pruitt Sandi L. , Schootman Mario
Published: August 2017

BACKGROUND:

Surgical resection is the primary treatment for colon cancer, but use of laparoscopic approaches varies widely despite demonstrated short- and long-term benefits.

OBJECTIVE:

The purpose of this study was to identify characteristics associated with laparoscopic colon cancer resection and to quantify variation based on patient, hospital, and geographic characteristics.

DESIGN:

Bayesian cross-classified, multilevel logistic models calculated adjusted ORs and CIs for patient, surgeon, hospital, and geographic characteristics and unexplained variability (predicted vs. observed values) using adjusted median odds ratios for hospitals and counties.

SETTINGS:

The Surveillance, Epidemiology, and End Results–Medicare claims database (2008–2011) supplemented with county-level American Community Survey (2008–2012) demographic data was used.

PATIENTS:

A total of 10,618 patients ≥66 years old who underwent colon cancer resection were included.

MAIN OUTCOME MEASURES:

Nonurgent/nonemergent resections for colon cancer patients ≥66 years old were classified as laparoscopic or open procedures.

RESULTS:

Patients resided in 579 counties and used 950 hospitals; 47% of patients underwent laparoscopic surgery. Medicare/Medicaid dual enrollment, age ≥85 years, and higher tumor stage and grade were negatively associated with laparoscopic surgery receipt; proximal tumors and increasing hospital size and surgeon caseload were positively associated. Significant unexplained variability at the hospital (adjusted median OR = 3.31; p < 0.001) and county levels (adjusted median OR = 1.28; p < 0.05) remained after adjustment.

LIMITATIONS:

This was an observational study lacking generalizability to younger patients without Medicare or those with Health Maintenance Organization coverage and data set did not reflect national hospital studies or hospital volume. In addition, we were unable to account for specific types of comorbidities, such as obesity, and had broad categories for surgeon caseload.

CONCLUSIONS:

Determining sources of hospital-level variation among poor insured patients may help increase laparoscopic resection to maximize health outcomes and reduce cost. See Video Abstract at http://links.lww.com/DCR/A363.
Outcomes of Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects
Authors: Coltro Pedro S. , Busnardo Fábio F. , Mônaco Filho Franklin C. , Olivan Marcelo V. , Millan Lincoln S. , Grillo Victor A. , Marques Carlos F. , Nahas Caio S. , Nahas Sérgio C. , Ribeiro Ulysses , Gemperli Rolf
Published: August 2017

BACKGROUND:

There are many previous reports for using the internal pudendal artery perforator flap in vulvovaginal reconstruction; however, reports of this flap for perineal reconstruction after abdominoperineal excision of the rectum are scarce.

OBJECTIVE:

The purpose of this study was to evaluate the outcomes of immediate internal pudendal artery perforator flap reconstruction for irradiated abdominoperineal resection defects.

DESIGN:

This was a prospective case series.

SETTINGS:

This flap could represent a step forward over other perineal flap approaches or primary closure.

PATIENTS:

A total of 73 consecutive patients with anorectal tumors were included.

INTERVENTIONS:

The study included immediate perineal reconstruction using 122 internal pudendal artery perforator flaps after abdominoperineal excision of the rectum.

MAIN OUTCOME MEASURES:

Dimensions of the perineal defect (in centimeters squared), hospital stay (days), healing time (days), and postoperative complications (Clavien–Dindo grades) were measured.

RESULTS:

The means of the perineal defect, hospital stay, and healing time were 51.62 cm2, 15.94 days, and 38.52 days. The higher the patient BMI, the longer healing time (p= 0.02); Clavien–Dindo complications grades III to IV were greater in patients with perineal defect ≥60 cm2(p= 0.03; OR = 10.56); postoperative complications were higher both in patients with anal squamous cell carcinoma (p= 0.005; OR = 6.09) and in patients with comorbidities (p= 0.04; OR = 2.78); hospital stay (p= 0.001) and healing time (p< 0.001) were higher in patients who had postoperative complications. The complete perineal wound healing at 12 weeks was achieved by 95% of patients, and our 30-day mortality rate was 4%.

LIMITATIONS:

As a nonrandomized study, our results have to be interpreted with caution.

CONCLUSIONS:

Multiple previously described advantages associated with internal pudendal artery perforator flap were also observed here, reinforcing the idea that it is reliable, versatile, and a useful option for perineal reconstruction after abdominoperineal excision of the rectum. Therefore, we propose that this flap could be considered as the first choice for perineal reconstruction in selected patients with moderate and some large defects after abdominoperineal excision of the rectum. SeeVideo Abstractat http://links.lww.com/DCR/A367.
Squamous Cancers of the Rectum Demonstrate Poorer Survival and Increased Need for Salvage Surgery Compared With Squamous Cancers of the Anus
Authors: Kulaylat Audrey S. , Hollenbeak Christopher S. , Stewart David B.
Published: August 2017

BACKGROUND:

Squamous cell cancers of the anus are rare GI malignancies for which neoadjuvant chemoradiation is the first-line treatment for nonmetastatic disease. Squamous cancers of the rectum are far less common, and it is unclear to what degree chemoradiotherapy improves their outcomes.

OBJECTIVE:

The purpose of this study was to compare stage-specific survival for anal and rectal squamous cancers stratified by treatment approach.

DESIGN:

This was a retrospective cohort study.

SETTINGS:

The study was conducted at Commission on Cancer designated hospitals.

PATIENTS:

Patients (2006–2012) identified in the National Cancer Database with pretreatment clinical stage I to III cancers who underwent chemoradiotherapy, with and without subsequent salvage surgical resection (low anterior resection or abdominoperineal resection), ≥12 weeks after chemoradiotherapy were included in the study.

MAIN OUTCOME MEASURES:

Overall survival and the need for salvage surgery were measured.

RESULTS:

Anal cancers (n = 11,224) typically presented with stage II (45.7%) or III (36.3%) disease, whereas rectal cancer stages (n = 1049) were more evenly distributed (p < 0.001). More patients with rectal cancer underwent low anterior or abdominoperineal resections 12 weeks or later after chemoradiotherapy versus those undergoing abdominoperineal resection for anal cancer (3.8% versus 1.2%; p < 0.001). Stage I and II rectal cancer was associated with poorer survival compared with anal cancer (stage I, p = 0.017; stage II, p < 0.001); survival was similar for stage III disease. Salvage surgery for anal cancer was associated with worse survival for stage I to III cancers; salvage surgery did not significantly affect survival for rectal cancer.

LIMITATIONS:

This was a retrospective study without cancer-specific survival measures.

CONCLUSIONS:

Squamous rectal cancers are associated with significantly worse survival than squamous cancers of the anus for clinical stage I and II disease. Despite both cancers exhibiting squamous histology, rectal cancers may be less radiosensitive than anal cancers, as suggested by the greater incidence of salvage surgery that does not appear to significantly improve overall survival. See Video Abstract at http://links.lww.com/DCR/A422.
Quality of Local Excision for Rectal Neoplasms Using Transanal Endoscopic Microsurgery Versus Transanal Minimally Invasive Surgery: A Multi-institutional Matched Analysis
Authors: Lee Lawrence , Edwards Kimberly , Hunter Iain A. , Hartley John E. , Atallah Sam B. , Albert Matthew R. , Hill James , Monson John R.
Published: August 2017

BACKGROUND:

There are no data comparing the quality of local excision of rectal neoplasms using transanal endoscopic microsurgery and transanal minimally invasive surgery.

OBJECTIVE:

The purpose of this study was to compare the incidence of tumor fragmentation and positive margins for patients undergoing local excision of benign and malignant rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery.

DESIGN:

This was a multi-institutional cohort study using coarsened exact matching.

SETTINGS:

The study was conducted at high-volume tertiary institutions with specialist colorectal surgeons.

PATIENTS:

Patients undergoing full-thickness local excision for benign and malignant rectal neoplasms were included.

INTERVENTIONS:

Transanal endoscopic microsurgery and transanal minimally invasive surgery were the included interventions.

MAIN OUTCOME MEASURES:

The incidence of poor quality excision (composite measure including tumor fragmentation and/or positive resection margin) was measured.

RESULTS:

The matched cohort consisted of 428 patients (247 with transanal endoscopic microsurgery and 181 with transanal minimally invasive surgery). Transanal minimally invasive surgery was associated with shorter operative time and length of stay. Poor quality excision was similar (8% vs 11%; p = 0.233). There were also no differences in peritoneal violation (3% vs 3%; p = 0.965) and postoperative complications (11% vs 9%; p = 0.477). Cumulative 5-year disease-free survival for patients undergoing transanal endoscopic microsurgery was 80% compared with 78% for patients undergoing transanal minimally invasive surgery (log rank p = 0.824). The incidence of local recurrence for patients with malignancy who did not undergo immediate salvage surgery was 7% (8/117) for transanal endoscopic microsurgery and 7% (7/94) for transanal minimally invasive surgery (p = 0.864).

LIMITATIONS:

All of the procedures were also performed at high-volume referral centers by specialist colorectal surgeons with slightly differing perioperative practices and different time periods.

CONCLUSIONS:

High-quality local excision for benign and rectal neoplasms can be equally achieved using transanal endoscopic microsurgery or transanal minimally invasive surgery. The choice of operating platform for local excisions of rectal neoplasms should be based on surgeon preference, availability, and cost. See Video Abstract at http://links.lww.com/DCR/A382.
Hormone therapy use in the Canadian Longitudinal Study on Aging: a cross-sectional analysis
Authors: Costanian Christy , Edgell Heather , Ardern Chris I. , Tamim Hala
Published: August 2017

Objective:

The aim of the study was to assess the prevalence and factors associated with hormone therapy (HT) use among Canadian women.

Methods:

Baseline data from the Tracking cohort of the Canadian Longitudinal Study on Aging (CLSA) was used for this analysis. The main outcome was HT use among women aged 45-85 years, defined as current, past, and never users. Multinomial logistic regression models were used to examine the differences between current, past, and never HT users in terms of sociodemographic, health behavior, and health-related variables.

Results:

Overall, 9.5% of the sample reported current use of HT, whereas 21.9% reported past use. The main factors associated with a lower likelihood of current HT use were older age (>80 y), nonwhite ethnic background, current employment, regular smoking, obesity, and breast cancer. By contrast, alcohol consumption, and the presence of allergies or mood disorders were positively associated with current HT use.

Conclusions:

These findings provide a recent national picture of HT use in Canada that may be used to inform opportunities for improved physician–patient communication regarding menopause management.
TREATMENT PATTERNS AND 2-YEAR VISION OUTCOMES WITH BEVACIZUMAB IN DIABETIC MACULAR EDEMA
Authors: Fong Donald S. , Luong Tiffany Q. , Contreras Richard , Jimenez Jennifer J. , Custis Peter H. , Patel Vaishali , Campbell Joanna H.
Published: August 2017

Purpose:

To assess health care utilization and vision outcomes over 2 years in patients receiving bevacizumab treatment in clinical practice for diabetic macular edema.

Methods:

Patients with newly diagnosed diabetic macular edema who received an intravitreal bevacizumab injection within 12 months of initial diagnosis were identified from Kaiser Permanente's 350,000 patients with diabetes mellitus treated between 2008 and 2013. Snellen best-corrected visual acuity (BCVA), number of intravitreal injections, and patient characteristics were abstracted from the electronic record. The main outcome measure was change in BCVA.

Results:

Three hundred and nine patients met the inclusion criteria and had 2 years of follow-up after their first bevacizumab injection. These patients had a mean of 3.1 injections (range, 1–17) during the 2-year follow-up. Mean BCVA improvement was 5.4 letters at 12 months and 5.3 letters at 24 months. Only 29.8% of patients demonstrated ≥3 lines of vision improvement from baseline, whereas 12.3% had ≥3 lines of vision loss from baseline at 24 months.

Conclusion:

This is the largest U.S. clinical practice–based study of bevacizumab use in diabetic macular edema. Consistent with national studies, the frequency of injection was low. Average BCVA improvement was lower than in anti–vascular endothelial growth factor trials. Significant BCVA improvement was achieved in approximately 30% of patients with newly diagnosed diabetic macular edema.
HOLE-DOOR SIGN
Authors: Kumar Vinod , Yadav Bhupendra
Published: August 2017

Purpose:

To describe a novel intraoperative finding during pars plana vitrectomy for macular hole using operating microscope-integrated spectral domain optical coherence tomography that predicts the closure of macular hole.

Methods:

Twenty-five eyes of 25 patients with macular hole, who underwent 25-gauge pars plana vitrectomy over a period of 16 months at a tertiary eye care center by a single surgeon, were recruited in this retrospective interventional study. All eyes were assessed with intraoperative spectral domain optical coherence tomography before and after internal limiting membrane peeling. The patients were assessed in terms of best-corrected visual acuity, preoperative minimal hole diameter, and type of hole closure.

Results:

After the internal limiting membrane was peeled, vertical pillars of tissue were seen at the edges of hole projecting into the vitreous cavity. This appearance was similar to that of an open door over the macular hole and was termed “hole-door sign.” Hole-door sign was seen in 15 of 25 eyes (60%). All the eyes with hole-door sign had Type-1 closure of macular hole (100%), whereas only 6 of 10 eyes (60%) without hole-door sign had Type-1 closure of the macular hole.

Conclusion:

Hole-door sign is a novel intraoperative finding that predicts postoperative Type-1 closure of macular hole. This may add to the utility of intraoperative optical coherence tomography in clinical practice.
VISUAL AND ANATOMICAL OUTCOMES AFTER DIABETIC TRACTION AND TRACTION-RHEGMATOGENOUS RETINAL DETACHMENT REPAIR
Authors: Storey Philip P. , Ter-Zakarian Anna , Philander Shannon A. , Olmos de Koo Lisa , George Meena , Humayun Mark S. , Rodger Damien C. , Ameri Hossein
Published: August 2017

Purpose:

To evaluate visual and anatomical outcomes of diabetic tractional retinal detachment repaired with pars plana vitrectomy.

Methods:

Operative records were used to retrospectively identify all patients with tractional retinal detachments secondary to proliferative diabetic retinopathy surgically repaired with pars plana vitrectomy between November 1, 2009, and January 1, 2015 at the LAC + USC (Los Angeles County + University of Southern California) Medical Center.

Results:

A total of 403 eyes with diabetic tractional retinal detachment in 359 patients were included. Successful reattachment of the retina was achieved in 87.6% of eyes after one surgery and 92.6% of eyes at the final follow-up. Best-corrected visual acuity at the final follow-up improved two or more lines in 56.3% of eyes, was stable in 23.8% of eyes, and decreased two or more lines in 19.9% of eyes. Eyes repaired with 23-gauge and 25-gauge vitrectomy systems had similar success rates as eyes treated with 20-gauge instrumentation (P = 0.73). Eyes receiving silicone oil tamponade had lower single-surgery reattachment rates (77.6% vs. 87.6%; P = 0.013), lower reattachment rates at the final follow-up (85.7% vs. 92.6%; P = 0.048), and higher rates of vision loss (34.7% vs. 19.9%; P < 0.0001) but were more likely to have concurrent rhegmatogenous detachment (47.0% vs. 21.3%; P < 0.0001) and macula involving detachment (74.5% vs. 60.0%; P < 0.0001).

Conclusion:

In this large, single-center retrospective study of patients with advanced diabetic tractional retinal detachment, vitrectomy achieved excellent anatomical outcome and improved or stabilized vision in 80.1% of eyes. Smaller gauge vitrectomy systems were found to have similar outcomes to 20-gauge instrumentation.
Incidence of Serotonin Syndrome With Combined Use of Linezolid and Serotonin Reuptake Inhibitors Compared With Linezolid Monotherapy
Authors: Karkow Diana C. , Kauer Jill F. , Ernst Erika J.
Published: August 2017

Purpose

Linezolid is a monoamine oxidase inhibitor that may increase the risk of serotonin syndrome in patients receiving combination selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). The objective of this study was to compare the incidence of serotonin syndrome when linezolid was administered alone and in combination with SSRIs or SNRIs.

Methods

This was a retrospective case-control study of adult inpatients admitted to the University of Iowa Hospitals and Clinics who received linezolid between January 2010 and December 2014. Patients who received linezolid with or within 14 days of an SSRI or SNRI were eligible for inclusion in the combination therapy group. Patients who received linezolid alone were matched by age and gender to patients in the combination therapy group, and 3 monotherapy patients were included for each combination therapy patient. Clinical features consistent with serotonin syndrome were assessed using the Sternbach and Hunter criteria.

Results

A total of 348 patients were included in this study, of which 87 received combination therapy and 261 received linezolid monotherapy. One patient given combination therapy (1.1%) and 1 patient given linezolid monotherapy (0.4%) were determined to have a diagnosis of serotonin syndrome (P= 0.438; relative risk, 3.00; 95% confidence interval, 0.19–47.45). In both cases, signs and symptoms of serotonin syndrome reversed upon discontinuation of linezolid therapy.

Conclusions

There was no significant difference in the incidence of serotonin syndrome when linezolid was used alone or in combination with an SSRI or SNRI, and the overall incidence of serotonin syndrome was low.
Sensitivity and Specificity of Clinical and Laboratory Otolith Function Tests
Authors: Kumar Lokesh , Thakar Alok , Thakur Bhaskar , Sikka Kapil
Published: August 2017

Objective:

To evaluate clinic based and laboratory tests of otolith function for their sensitivity and specificity in demarcating unilateral compensated complete vestibular deficit from normal.

Study Design:

Prospective cross-sectional study.

Setting:

Tertiary care hospital vestibular physiology laboratory.

Subjects:

Control group—30 healthy adults, 20–45 years age; Case group-15 subjects post vestibular shwannoma excision or post-labyrinthectomy with compensated unilateral complete audio-vestibular loss.

Intervention:

Otolith function evaluation by precise clinical testing (head tilt test—HTT; subjective visual vertical—SVV) and laboratory testing (headroll-eye counterroll—HR-ECR; vesibular evoked myogenic potentials—cVEMP).

Main Outcome Measure:

Sensitivity and specificity of clinical and laboratory tests in differentiating case and control subjects.

Results:

Measurable test results were universally obtained with clinical otolith tests (SVV; HTT) but not with laboratory tests. The HR-ECR test did not indicate any definitive wave forms in 10% controls and 26% cases. cVEMP responses were absent in 10% controls.

HTT test with normative cutoff at 2 degrees deviations from vertical noted as 93.33% sensitive and 100% specific. SVV test with normative cutoff at 1.3 degrees noted as 100% sensitive and 100% specific. Laboratory tests demonstrated poorer specificities owing primarily to significant unresponsiveness in normal controls.

Conclusions:

Clinical otolith function tests, if conducted with precision, demonstrate greater ability than laboratory testing in discriminating normal controls from cases with unilateral complete compensated vestibular dysfunction.
The Effect of Citalopram Versus a Placebo on Central Auditory Processing in the Elderly
Authors: Polanski Jose Fernando , Soares Alexandra Dezani , Pereira Liliane Desgualdo , Laercio de Mendonça Cruz Oswaldo
Published: August 2017

Objective:

Evaluate the effects of therapy with citalopram on the central auditory processing in the elderly measured by central auditory tests.

Study Design:

Prospective, randomized, double-blind, placebo-controlled study.

Setting:

Tertiary referral center.

Patients:

Thirty-nine patients older than 60 years with normal hearing thresholds or symmetrical sensorineural hearing loss up to 70 dBHL, word-recognition score equal to or better than 70%, and diagnosed with central auditory processing disorders completed the study. They underwent the mini-mental state examination, as a way to screen those with the possibility of dementia; they also underwent the Beck depression inventory, for screening individuals with depression.

Intervention:

Citalopram 20 mg/d or placebo for 6 months.

Main Outcome Measure: The central auditory tests were applied to the selection of individuals with auditory processing disorders and repeated after 6 months’ treatment. The tests were sound localization, speech in noise, dichotic digits test, pitch pattern sequence, duration pattern test, and gaps-in-noise.

Results:

Comparisons of central auditory tests pre- and posttreatment in groups showed: sound localization (p = 0.022), pitch pattern sequence humming (p = 0.110), pitch pattern sequence nomination (p = 0.355), duration pattern test humming (p = 0.801), duration pattern test nomination (p = 0.614), and gaps-in-noise (p = 0.230). Dichotic tests in right and left ears respectively: speech in noise (p = 0.949; p = 0.722), dichotic digits test (p = 0.943; p = 0.513).

Conclusion: There was no clinical effect with the use of citalopram in central auditory processing tests of the subjects.
Oral Administration of Clinical Stage Drug Candidate SENS-401 Effectively Reduces Cisplatin-induced Hearing Loss in Rats
Authors: Petremann Mathieu , Tran Van Ba Christophe , Broussy Audrey , Romanet Charlotte , Dyhrfjeld-Johnsen Jonas
Published: August 2017

Hypothesis:

SENS-401, an oral clinical-stage drug, may reduce cisplatin-induced hearing loss and cochlear damage in an in vivo model.

Background:

Cisplatin is commonly associated with hearing loss, causing significant learning and behavioral difficulties in the pediatric cancer population, and for which there are currently no clinical solutions. SENS-401 has previously been shown to improve acoustic trauma-induced hearing loss in vivo.

Methods:

The effect of SENS-401 (R-azasetron besylate) on cisplatin IC50 values was evaluated in a panel of cisplatin-sensitive cell lines (NIH:OVCAR-3, SK-N-AS, NCI-H460, FaDu). Auditory brainstem response and distortion product otoacoustic emission tests were performed in a rat model of cisplatin-induced hearing-loss (8 mg/kg, day 1) at baseline, and after 14 days of SENS-401 (6.6, 13.2, 26.4 mg/kg/d). Cochlear outer hair cells were counted after immunolabeling for myosin-VIIa.

Results:

Cisplatin cytotoxicity was not impacted by the addition of SENS-401 (up to 10 μM) in any of the cell types evaluated. In vivo, all SENS-401 doses significantly improved auditory brainstem response threshold shift (up to 30 dB) and distortion product otoacoustic emission amplitude loss (up to 19 dB) over placebo. Body weight and survival were not significantly different between rats receiving placebo and those receiving 26.4 mg/kg SENS-401. Significantly more surviving outer hair cells were present after SENS-401 treatment compared with placebo (p < 0.001), with up to 11-fold more in the basal turn of the cochlea.

Conclusion:

In vivo and in vitro data support the otoprotective potential and tolerability of SENS-401 without impacting chemotherapeutic potential. Oral SENS-401 is a promising candidate for treating cisplatin-induced ototoxicity.
Exploring the Influence of Nurse Work Environment and Patient Safety Culture on Attitudes Toward Incident Reporting
Authors: Yoo Moon Sook , Kim Kyoung Ja
Published: August 2017

OBJECTIVE

The aim of this study was to explore the influence of nurse work environments and patient safety culture on attitudes toward incident reporting.

BACKGROUND

Patient safety culture had been known as a factor of incident reporting by nurses. Positive work environment could be an important influencing factor for the safety behavior of nurses.

METHODS

A cross-sectional survey design was used. The structured questionnaire was administered to 191 nurses working at a tertiary university hospital in South Korea.

RESULTS

Nurses’ perception of work environment and patient safety culture were positively correlated with attitudes toward incident reporting. A regression model with clinical career, work area and nurse work environment, and patient safety culture against attitudes toward incident reporting was statistically significant. The model explained approximately 50.7% of attitudes toward incident reporting.

CONCLUSION

Improving nurses’ attitudes toward incident reporting can be achieved with a broad approach that includes improvements in work environment and patient safety culture.
The Utility of Immunohistochemistry in Mycobacterial Infection
Authors: Solomon Isaac H. , Johncilla Melanie E. , Hornick Jason L. , Milner Danny A.
Published: August 2017

Mycobacterium species are slow growing bacteria that cause significant morbidity and mortality worldwide. Because of the relative rarity of mycobacterial infections, potential for detection of nonpathogenic environmental contaminants, and substantial costs associated with molecular diagnostics, effective screening methods are needed to identify samples most suitable for molecular testing. While anatomic pathology specimens can be utilized to identify characteristic histologic inflammatory patterns and to directly visualize mycobacteria through histochemical (acid fast bacilli [AFB]) stains, the utility of immunohistochemistry (IHC) in this setting is unknown. A cohort of 121 cases previously referred for mycobacterial sequencing, including 12 Mycobacterium tuberculosis (MTB), 42 nontuberculosis mycobacteria (NTM), and 67 cases negative for mycobacteria by polymerase chain reaction (PCR), were stained with an antimycobacteria antibody, and the results were compared with histology, AFB stains, PCR, and cultures. IHC was positive in 50% MTB, 81% NTM, and 49% of cases negative for mycobacteria by sequencing, with excellent (>90%) concordance with AFB stains. Organisms were identifiable by IHC using a 10× objective in the majority of cases. Negative PCR with positive IHC was attributed to paucity of organisms in 30/33 cases, and positive PCR with negative IHC was most often associated with MTB. IHC is highly sensitive for NTM but has a lower sensitivity for MTB, suggesting that cases with a high clinical and histologic suspicion for MTB should be sent for PCR even when AFB and IHC are negative. Incorporation of IHC into a screening algorithm for molecular testing has the potential for significant savings of cost and time.
Ultrasound-Assisted Reduction of Displaced and Shortened Fractures by Pediatric Emergency Physicians
Authors: Scheier Eric , Balla Uri
Published: August 2017

Pediatric emergency physicians at Kaplan Medical Center regularly reduce forearm fractures under point-of-care ultrasound guidance in the pediatric emergency department. We present 3 children who arrived at our department with shortened, angulated forearm fractures within the span of a single week. We report on the successful reduction of these fractures under point-of-care ultrasound and on the maintenance of anatomic alignment at follow-up 1 week postreduction.
Cauda Equina Syndrome Due to Vigorous Back Massage With Spinal Manipulation in a Patient With Pre-Existing Lumbar Disc Herniation
Authors: Yang Si-Dong , Chen Qian , Ding Wen-Yuan
Published: August 2017

Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4–5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.
Fms-Like Tyrosine Kinase-3 Ligand Attenuates Local and Systemic Infection in a Model of Post-Burn Pneumonia
Authors: Hundeshagen Gabriel , Cui Weihua , Musgrove Lindsay , Cherry Aaron , Lee Seung-Jin , Cox Robert A. , Toliver-Kinsky Tracy
Published: August 2017

Background:

Burn injury induces immunosuppression and promotes infection with opportunistic pathogens. Pneumonia and sepsis are leading causes of post-burn morbidity and mortality. Fms-like tyrosine kinase-3 ligand (Flt3L) improves local and systemic resistance to P aeruginosa-associated burn wound infection. This study evaluates the effects of post-burn prophylactic Flt3L treatment on local and systemic infection and inflammation in a murine model of pneumonia and sepsis.

Methods:

Mice received a severe scald burn, were treated with Flt3L or vehicle (CTR) for 5 days, and inoculated trans-nasally with P aeruginosa. Lung, blood, and spleen were harvested at 24 and 48 h postinoculation (p.i.) to assess infection (bacterial burden, bacteremia, distant organ manifestation) and inflammation (interleukin-6 (IL-6) and myeloperoxidase (MPO) levels). Histology correlated infection and inflammation parameters with morphology. Survival at various bacterial concentrations was monitored for 14 days p.i.

Results:

Bacterial burden was significantly reduced in lung and spleen of Flt3L-treated mice. Flt3L treatment was associated with decreased signs of pulmonary inflammation (reduced wet weight and IL-6 levels), lower incidences of bacteremia and septic distant organ manifestation, and reduced systemic inflammation (IL-6 and MPO). Histologically, reduced alveolar and peribronchiolar neutrophil and lymphocyte infiltration indicated attenuated pulmonary inflammation after Flt3L treatment. Overall survival was comparable between groups for all doses of P aeruginosa, but mortality delayed in the Flt3L-treated group.

Conclusion:

Prophylactic treatment with Flt3L could augment antimicrobial therapy of post-burn pneumonia through improvement of the initial host response to challenge with P aeruginosa, attenuate local, and systemic inflammation as well as septic pathogen dissemination.
Surgical Treatment of Colon Cancer of the Splenic Flexure: A Systematic Review and Meta-analysis
Authors: Martínez-Pérez Aleix , Brunetti Francesco , Vitali Giulio C. , Abdalla Solafah , Ris Frédéric , de’Angelis Nicola
Published: August 2017

This is a systematic review and meta-analysis on the surgical treatments of splenic flexure carcinomas (SFCs). Medline, EMBASE, and Scopus were searched from January 1990 to May 2016. Studies of at least 5 patients comparing extended right colectomy (ERC) versus left colectomy (LC) and/or laparoscopy versus open surgery for SFCs were retrieved and analyzed. Overall, 12 retrospective studies were selected, including 569 patients. ERC was performed in 23.2% of patients, whereas LC in 76.8%. Pooled data suggested that ERC and LC had similar oncologic quality of resection and postoperative outcomes. Laparoscopy was used in 50.6% of patients (conversion rate: 2.5%) and it was associated with significantly shorter time to oral diet, fewer postoperative complications, and shorter hospital stay than open surgery. In conclusion, the optimal extent of SFC surgical resection, that is, ERC or LC remains under debate. However, laparoscopy provides better postoperative outcomes and fewer postoperative complications than open surgery.
Physiological and ecological implications of ocean deoxygenation for vision in marine organisms
Authors: McCormick Lillian R. , Levin Lisa A.
Published: August 2017

Climate change has induced ocean deoxygenation and exacerbated eutrophication-driven hypoxia in recent decades, affecting the physiology, behaviour and ecology of marine organisms. The high oxygen demand of visual tissues and the known inhibitory effects of hypoxia on human vision raise the questions if and how ocean deoxygenation alters vision in marine organisms. This is particularly important given the rapid loss of oxygen and strong vertical gradients in oxygen concentration in many areas of the ocean. This review evaluates the potential effects of low oxygen (hypoxia) on visual function in marine animals and their implications for marine biota under current and future ocean deoxygenation based on evidence from terrestrial and a few marine organisms. Evolutionary history shows radiation of eye designs during a period of increasing ocean oxygenation. Physiological effects of hypoxia on photoreceptor function and light sensitivity, in combination with morphological changes that may occur throughout ontogeny, have the potential to alter visual behaviour and, subsequently, the ecology of marine organisms, particularly for fish, cephalopods and arthropods with ‘fast’ vision. Visual responses to hypoxia, including greater light requirements, offer an alternative hypothesis for observed habitat compression and shoaling vertical distributions in visual marine species subject to ocean deoxygenation, which merits further investigation.

This article is part of the themed issue ‘Ocean ventilation and deoxygenation in a warming world’.
Ocean (de)oxygenation from the Last Glacial Maximum to the twenty-first century: insights from Earth System models
Authors: Bopp L. , Resplandy L. , Untersee A. , Le Mezo P. , Kageyama M.
Published: August 2017

All Earth System models project a consistent decrease in the oxygen content of oceans for the coming decades because of ocean warming, reduced ventilation and increased stratification. But large uncertainties for these future projections of ocean deoxygenation remain for the subsurface tropical oceans where the major oxygen minimum zones are located. Here, we combine global warming projections, model-based estimates of natural short-term variability, as well as data and model estimates of the Last Glacial Maximum (LGM) ocean oxygenation to gain some insights into the major mechanisms of oxygenation changes across these different time scales. We show that the primary uncertainty on future ocean deoxygenation in the subsurface tropical oceans is in fact controlled by a robust compensation between decreasing oxygen saturation (O2sat) due to warming and decreasing apparent oxygen utilization (AOU) due to increased ventilation of the corresponding water masses. Modelled short-term natural variability in subsurface oxygen levels also reveals a compensation between O2satand AOU, controlled by the latter. Finally, using a model simulation of the LGM, reproducing data-based reconstructions of past ocean (de)oxygenation, we show that the deoxygenation trend of the subsurface ocean during deglaciation was controlled by a combination of warming-induced decreasing O2satand increasing AOU driven by a reduced ventilation of tropical subsurface waters.

This article is part of the themed issue ‘Ocean ventilation and deoxygenation in a warming world’.
Patterns of deoxygenation: sensitivity to natural and anthropogenic drivers
Authors: Oschlies Andreas , Duteil Olaf , Getzlaff Julia , Koeve Wolfgang , Landolfi Angela , Schmidtko Sunke
Published: August 2017

Observational estimates and numerical models both indicate a significant overall decline in marine oxygen levels over the past few decades. Spatial patterns of oxygen change, however, differ considerably between observed and modelled estimates. Particularly in the tropical thermocline that hosts open-ocean oxygen minimum zones, observations indicate a general oxygen decline, whereas most of the state-of-the-art models simulate increasing oxygen levels. Possible reasons for the apparent model-data discrepancies are examined. In order to attribute observed historical variations in oxygen levels, we here study mechanisms of changes in oxygen supply and consumption with sensitivity model simulations. Specifically, the role of equatorial jets, of lateral and diapycnal mixing processes, of changes in the wind-driven circulation and atmospheric nutrient supply, and of some poorly constrained biogeochemical processes are investigated. Predominantly wind-driven changes in the low-latitude oceanic ventilation are identified as a possible factor contributing to observed oxygen changes in the low-latitude thermocline during the past decades, while the potential role of biogeochemical processes remains difficult to constrain. We discuss implications for the attribution of observed oxygen changes to anthropogenic impacts and research priorities that may help to improve our mechanistic understanding of oxygen changes and the quality of projections into a changing future.

This article is part of the themed issue ‘Ocean ventilation and deoxygenation in a warming world’.
Proposed revision to the taxonomy of the genus Pestivirus, family Flaviviridae
Authors: Smith Donald B. , Meyers Gregor , Bukh Jens , Gould Ernest A. , Monath Thomas , Scott Muerhoff A. , Pletnev Alexander , Rico-Hesse Rebecca , Stapleton Jack T. , Simmonds Peter , Becher Paul
Published: August 2017

We propose the creation of seven new species in the genus Pestivirus (family Flaviviridae) in addition to the four existing species, and naming species in a host-independent manner using the format Pestivirus X. Only the virus species names would change; virus isolates would still be referred to by their original names. The original species would be re-designated as Pestivirus A (original designation B
ovine viral diarrhea virus 1), Pestivirus B (Bovine viral diarrhea virus 2), Pestivirus C (Classical swine fever virus) and Pestivirus D (Border disease virus). The seven new species (and example isolates) would be Pestivirus E (pronghorn pestivirus), Pestivirus F (Bungowannah virus), Pestivirus G (giraffe pestivirus), Pestivirus H (Hobi-like pestivirus), Pestivirus I (Aydin-like pestivirus), Pestivirus J (rat pestivirus) and Pestivirus K (atypical porcine pestivirus). A bat-derived virus and pestiviruses identified from sheep and goat (Tunisian sheep pestiviruses), which lack complete coding region sequences, may represent two additional species.
An analysis by metabolic labelling of the encephalomyocarditis virus ribosomal frameshifting efficiency and stimulators
Authors: Ling Roger , Firth Andrew E.
Published: August 2017

Programmed −1 ribosomal frameshifting is a mechanism of gene expression whereby specific signals within messenger RNAs direct a proportion of ribosomes to shift −1 nt and continue translating in the new reading frame. Such frameshifting normally depends on an RNA structure stimulator 3′-adjacent to a ‘slippery’ heptanucleotide shift site sequence. Recently we identified an unusual frameshifting mechanism in encephalomyocarditis virus, where the stimulator involves a trans-acting virus protein. Thus, in contrast to other examples of −1 frameshifting, the efficiency of frameshifting in encephalomyocarditis virus is best studied in the context of virus infection. Here we use metabolic labelling to analyse the frameshifting efficiency of wild-type and mutant viruses. Confirming previous results, frameshifting depends on a G_GUU_UUU shift site sequence and a 3′-adjacent stem-loop structure, but is not appreciably affected by the ‘StopGo’ sequence present ~30 nt upstream. At late timepoints, frameshifting was estimated to be 46–76 % efficient.