bluuebunny/crossref_metadata_2025 huggingface dataset:
Psilocin and ketamine microdosing: effects of subchronic intermittent microdoses in the elevated plus-maze in male Wistar rats
Authors: Horsley Rachel R. , Páleníček Tomáš , Kolin Jan , Valeš Karel
Published: March 2018

Short-term moderate doses of serotonergic and dissociative hallucinogens can be useful in the treatment of anxiety. Recently, a trend has developed for long-term intermittent ‘microdosing’ (usually one-tenth of a ‘full’ active dose), with reports of long-lasting relief from anxiety and related disorders; however, there is no scientific evidence for the efficacy of therapeutic microdosing nor to show its lasting effects. The objective of this study was to test for lasting effects on anxiety in rats after microdosing with ketamine or psilocin. Over 6 days, Wistar rats (N=40) were administered ketamine (0.5 or 3 mg/kg), psilocin (0.05 or 0.075 mg/kg), or saline on three occasions. A 5-min elevated plus-maze test was conducted 48 h after the final drug treatment (n=8). Dependent variables were entries (frequency), spent time (%), and distance traveled (cm) in each zone, as well as total frequency of rears, stretch-attend postures, and head dips. Statistical analyses of drug effects used separate independent one-way analysis of variance and pair-wise comparisons using independent t-tests. Statistical effects were modest or borderline and were most consistent with a mildly anxiogenic profile, which was significant at lower doses; however, this conclusion remains tentative. The lower doses of ketamine and psilocin produced comparable effects (to one another) across each variable, as did the higher doses. This pattern of effects may suggest a common (e.g. neurotransmitter/receptor) mechanism. We conclude that microdosing with hallucinogens for therapeutic purposes might be counter-productive; however, more research is needed to confirm our findings and to establish their translational relevance to clinical ‘psychedelic’ therapy.
hsa-miR-320d and hsa-miR-582, miRNA Biomarkers of Aortic Dissection, Regulate Apoptosis of Vascular Smooth Muscle Cells
Authors: Shen Hong , Lu Shuyang , Dong Lili , Xue Yuan , Yao Chenling , Tong Chaoyang , Wang Chunsheng , Shu Xianhong
Published: March 2018

Abnormal expression of microRNAs (miRNAs) has been associated with aortic dissection (AD). Next-generation sequencing was performed to identify the differentially expressed miRNAs in aortic tissue samples between AD and nondiseased individuals. Selected miRNAs, which showed significant variation between the 2 groups, were then transfected into human aortic vascular smooth muscle cells, and assessed for effects on cell migration and induced apoptosis. The changes in gene expression pattern in human aortic vascular smooth muscle cells transfected with the miRNAs were also investigated. Among the 314 miRNAs detected in the aortic tissues from both AD and normal subjects, 46 showed significantly different expression patterns. Only 7 of these differentially expressed miRNAs were found to be enriched in AD, whereas the majority had diminished. hsa-miR-320d and hsa-miR-582 were 2 representative miRNAs that exhibited a decrease of greater than 10-fold. Transfection of hsa-miR-320d and hsa-miR-582 did not affect the migration capability of the vascular smooth muscle cells, but remarkably enhanced the staurosporine and tumor necrosis factor-α–induced apoptosis by 15% and 29%, respectively. Furthermore, the transfection of both miRNAs affected the expression of a vast multitude of genes, most of which were related to apoptotic pathways. The fluorescence reporter assays demonstrated that hsa-miR-320d and hsa-miR-582 bind the 3′ UTR region of TRIAP1 and NET1 genes, respectively. These results suggest that hsa-miR-320d and hsa-miR-582 may serve as putative biomarkers for AD research.
Tissue selective estrogen complex (TSEC): a review
Authors: Pickar James H. , Boucher Matthieu , Morgenstern Diana
Published: March 2018

Objective:

This review describes historical development of selective estrogen receptor modulators (SERMs) and their combination with estrogens, termed a tissue selective estrogen complex (TSEC), and considers the potential for future TSEC development.

Methods:

This narrative review is based on literature identified on PubMed and the TSEC research and development experience of the authors.

Results:

SERMs have estrogenic and antiestrogenic effects in various tissues; however, no single agent has achieved an optimal balance of agonist and antagonist effects for the treatment of menopausal symptoms. Clinically, a number of SERMs protect against osteoporosis and breast cancer but can exacerbate vasomotor symptoms. Estrogens alleviate menopausal hot flushes and genitourinary symptoms as well as reduce bone loss, but the addition of a progestogen to menopausal hormone therapy to protect against endometrial cancer increases vaginal bleeding risk, breast tenderness, and potentially breast cancer. The search for an effective menopausal therapy with better tolerability led to the investigation of TSECs. Clinical development of a TSEC consisting of conjugated estrogens/bazedoxifene increased understanding of the importance of a careful consideration of the combination's components and their respective doses to balance safety and efficacy. Bazedoxifene is an estrogen receptor agonist in bone but an antagonist/degrader in the endometrium, which has contributed to its success as a TSEC component. Other oral TSEC combinations studied thus far have not demonstrated similar endometrial safety.

Conclusions:

Choice of SERM, selection of doses, and clinical trial data evaluating safety and efficacy are key to ensuring safety and adequate therapeutic effect of TSECs for addressing menopausal symptoms.
A randomized, double-blind, placebo-controlled trial of Chinese herbal medicine capsules for the treatment of premature ovarian insufficiency
Authors: Cao Xiao-jing , Huang Xuchun , Liu Jian , Ma Fei , Zeng Yuyan , Chen Changqian , Wang Ji-ju , Nie Guangning , Wang Xiao-yun
Published: March 2018

Objective:

This study was conducted to evaluate the treatment effectiveness of Chinese herbal medicine capsules containing the Yangyin Shugan formula (YYSG) in premature ovarian insufficiency (POI).

Methods:

One-hundred forty-six women with POI participated in this stratified, randomized, double-blind, placebo-controlled clinical trial. Participants in two groups (n = 73 in each)—the YYSG group and control group—underwent treatment for 12 weeks. Outcome measures included the Chinese version Menopause-Specific Quality of Life questionnaire (CMS), serum levels of basal follicle-stimulating hormone (bFSH), basal estradiol, and anti-Mullerian hormone (AMH), the antral follicle count (AFC), and ovarian peak systolic velocity (PSV; cm/s).

Results:

Treatment with YYSG significantly reduced the total scores of the CMS at the end of the 12th week with statistical significance (P < 0.01); the vasomotor, psychosocial, physical, and sexual domains significantly improvement after treatment (P < 0.01). Compared with the baseline hormone levels, YYSG markedly decreased the bFSH level with statistical significance (P < 0.01) and improved the AMH level (P < 0.01). Furthermore, YYSG greatly improved the participants’ AFC and ovarian PSV, compared with placebo (P < 0.01). There were no serious adverse events, and the safety indices of whole blood counts, renal function, and liver function were within the normal range, both before and after treatment.

Conclusions:

Treatment with YYSG was more effective than placebo for improving menopausal symptoms, basal hormone levels, and ovarian function in women with POI in Guangdong, China.
The influence of formal and informal policies and practices on health care innovation implementation: A mixed-methods analysis
Authors: DiMartino Lisa D. , Birken Sarah A. , Hanson Laura C. , Trogdon Justin G. , Clary Alecia S. , Weinberger Morris , Reeder-Hayes Katherine , Weiner Bryan J.
Published: March 2018

Background:

The implementation science literature has contributed important insights regarding the influence of formal policies and practices on health care innovation implementation, whereas informal implementation policies and practices have garnered little attention. The broader literature suggests that informal implementation policies and practices could also influence innovation use.

Purpose:

We used the Organizational Theory of Innovation Implementation to further understand the role of formal and informal implementation policies and practices as determinants of implementation effectiveness. We examined their role within the context of initiatives to increase palliative care consultation in inpatient oncology.

Methods:

We used a case study design in two organizational settings within one academic medical center: medical and gynecologic oncology. We completed semistructured interviews with medical (n = 12) and gynecologic (n = 10) oncology clinicians using questions based on organizational theory. Quantitative data assessed implementation effectiveness, defined as aggregated palliative care consult rates within oncology services from 2010 to 2016. Four palliative care clinicians were interviewed to gain additional implementation context insights.

Results:

Medical oncology employed multiple formal policies and practices including training and clinician prompting to support palliative care consultation and a top-down approach, yet most clinicians were unaware of the policies and practices, contributing to a weak implementation climate. In contrast, gynecologic oncology employed one formal policy (written guideline of criteria for initiating a consult) but also relied on informal policies and practices, such as spontaneous feedback and communication; they adopted a bottom-up approach, contributing to broader clinician awareness and strong implementation climate. Both services exhibited variable, increasing consult rates over time.

Practice Implications:

Informal policies and practices may compensate or substitute for formal policies and practices under certain conditions (e.g., smaller health care organizations). Further research is needed to investigate the role of formal and informal policies and practices in shaping a strong and sustainable implementation climate and subsequent effective innovation implementation.
Relationships between organizational and individual support, nurses’ ethical competence, ethical safety, and work satisfaction
Authors: Poikkeus Tarja , Suhonen Riitta , Katajisto Jouko , Leino-Kilpi Helena
Published: March 2018

Background:

Organizations and nurse leaders do not always effectively support nurses’ ethical competence. More information is needed about nurses’ perceptions of this support and relevant factors to improve it.

Purpose:

The aim of the study was to examine relationships between nurses’ perceived organizational and individual support, ethical competence, ethical safety, and work satisfaction.

Methodology:

A cross-sectional questionnaire survey was conducted. Questionnaires were distributed to nurses (n = 298) working in specialized, primary, or private health care in Finland. Descriptive statistics, multifactor analysis of variance, and linear regression analysis were used to test the relationships.

Results:

The nurses reported low organizational and individual support for their ethical competence, whereas perceptions of their ethical competence, ethical safety, and work satisfaction were moderate. There were statistically significant positive correlations between both perceived individual and organizational support, and ethical competence, nurses’ work satisfaction, and nurses’ ethical safety.

Conclusions:

Organizational and individual support for nurses’ ethical competence should be strengthened, at least in Finland, by providing more ethics education and addressing ethical problems in multiprofessional discussions. Findings confirm that organizational level support for ethical competence improves nurses’ work satisfaction. They also show that individual level support improves nurses’ sense of ethical safety, and both organizational and individual support strengthen nurses’ ethical competence.

Practice Implications:

These findings should assist nurse leaders to implement effective support practices to strengthen nurses’ ethical competence, ethical safety, and work satisfaction.
Team functioning as a predictor of patient outcomes in early medical home implementation
Authors: Wu Frances M. , Rubenstein Lisa V. , Yoon Jean
Published: March 2018

Background:

New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes.

Purpose:

The aim of the study was to assess the relationships between primary care team functioning, patients’ use of acute care, and mortality.

Methodology/Approach:

Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia).

Results:

In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup.

Conclusion:

These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes.

Practice Implications:

A focus on team functioning is important especially in the early implementation of team-based primary care models.
POSTERIOR FUNDUS HEMORRHAGES
Authors: Zhou Jin Qiong , Wang Ya Xing , Xu Liang , Zhao Liang , Wang Shuang , Xu Jie , You Qi Sheng , Yang Hua , Wei Wen Bin , Jonas Jost B.
Published: March 2018

Purpose:

To examine frequency and associations of retinal hemorrhages.

Methods:

The population-based Beijing Eye Study included 3,468 individuals. Monoscopic fundus photographs were examined for hemorrhages.

Results:

Retinal hemorrhages were detected in 515 eyes (429 individuals) (prevalence: 7.6%; 95% confidence interval [CI]: 7.0–8.0 per eye; 12.7%; 95% CI: 11.7–13.7 per person). Higher prevalence of retinal hemorrhages was correlated (multivariate analysis) with higher systolic blood pressure (P < 0.001; odds ratio: 1.02; 95% CI: 1.01–1.03), higher prevalence of diabetic retinopathy (P < 0.001; odds ratio: 121; 95% CI: 61–240), and higher prevalence of retinal vein occlusions (P < 0.001; odds ratio: 27; 95% CI: 17–42). Retinal hemorrhages were due to diabetic retinopathy (189 [36.7%] eyes), retinal vein occlusions (n = 65 [12.6%]), posterior vitreous detachment (n = 23 [4.5%]), glaucoma (n = 14 [2.7%]), exudative age-related macular degeneration (n = 8 [1.6%]), hypertensive retinopathy (n = 10 [1.9%]), and exudative myopic maculopathy (n = 1 [0.2%]). Retinal hemorrhages without evident ocular cause (“NOH”) were detected in 204 (3.0%) eyes (or 39.6% of all retinal hemorrhages). Higher prevalence of NOHs was correlated with higher systolic blood pressure (P < 0.001; odds ratio: 1.02; 95% CI: 1.01–1.03) after adjusting for blood glucose concentration and prevalence of cortical cataract.

Conclusion:

In a population-based recruited cohort of individuals aged 50+ years, prevalence of any fundus hemorrhage was about 8% per eye and 13% per individual. Approximately 60% of the hemorrhages were due to ocular reasons, mainly diabetic retinopathy, retinal vein occlusions, and posterior vitreous detachment, whereas 40% of the bleedings were not evidently associated with ophthalmologic causes but strongly with elevated systolic blood pressure.
RAPIDLY PROGRESSIVE NEOVASCULAR GLAUCOMA FROM CYTOMEGALOVIRUS RETINITIS IN A NON–HUMAN IMMUNODEFICIENCY VIRUS PATIENT
Authors: Cho Jane , Siegel Nicole , Subramanian Manju L. , Ying Howard , Ness Steven
Published: March 2018

Purpose:

To describe a case of neovascular glaucoma from cytomegalovirus (CMV) retinitis in a human immunodeficiency virus–negative patient with immunosuppression after stem-cell transplant for multiple myeloma.

Methods:

Retrospective case report.

Results:

A 71-year-old man on monthly infusion of daratumumab for multiple myeloma after stem-cell transplant presenting with a 2-week history of floaters, photophobia, and blurry vision was found to have polymerase chain reaction–confirmed CMV retinitis associated with diffuse occlusive vasculitis. The patient was human immunodeficiency virus negative with a CD4 count of 450/mm3. Despite immediate aggressive treatment, the patient developed neovascular glaucoma with poor visual outcome.

Conclusion:

Cytomegalovirus retinitis in human immunodeficiency virus–negative patients is becoming more prevalent with increasing use of systemic immunosuppression therapy for various reasons. Patients with non–human immunodeficiency virus related CMV retinitis can have severe ischemia atypical of the classic CMV retinitis and should be followed closely for neovascularization.
Thin Rigid Contact Lens Used in Vitreous-Retinal Surgery for Corneal Protection: A Randomized Controlled Trial
Authors: Hu Zizhong , Ding Yuzhi , Zheng Xinhua , Yuan Songtao , Li Jia , Xie Ping , Liu Qinghuai
Published: March 2018

Purpose:

To design a rigid contact lens (CL) to be used in combination with a wide-angle viewing system and analyze its protection for corneal epithelial during vitreous-retinal surgery.

Methods:

A thin and lightweight rigid CL was designed and constructed. The impact of the CL on the visualized fundus range was evaluated using a concrete eye model. Patients with severe proliferative diabetic retinopathy (PDR) were randomized to either the CL group, corneal protective agent (CPA) group, or balanced salt solution (BSS) group. All patients underwent phacoemulsification and a standard 23-gauge three-port vitrectomy. Surgery time and corneal fluorescein staining score (FSS) postoperatively were mainly measured.

Results:

In the eye model, a larger area of fundus was visualized with the use of our CL under 128 D or 60 D Resight lens. The mean surgery time was 51.36±8.06 min, 50.89±8.26 min, and 55.46±9.14 in CL, CPA, and BSS group, respectively (F=2.325, P=0.105). In eight eyes in the BSS group, corneal epithelial layer was peeled off because the dryness of the cornea could not maintain a clear fundus image. The FSS in BSS group was markedly higher than that of CL and BSS group 1 day (P<0.001), 3 days (P<0.001), and 7 days (P=0.002) postoperatively. There was no statistical significance of the FSS between CL and CPA group at each follow-up endpoint.

Conclusions:

The CL that we designed can slightly enlarge the visible fundus range and efficiently protect corneal epithelium during vitrectomy for patients with PDR.
Burden of orofacial pain in a socially deprived and culturally diverse area of the United Kingdom
Authors: Joury Easter , Bernabe Eduardo , Gallagher Jennifer E. , Marcenes Wagner
Published: March 2018

Little is known about the burden and impact of orofacial pain in deprived areas, and whether it mediates the relationship between socioeconomic position and impacts on daily life. We analysed data from a representative sample of 2168 adults, aged 16 to 65 years, from the East London Oral Health Inequality study. Participants completed a validated questionnaire on demographics, socioeconomic position (area deprivation), orofacial pain (by anatomical site) in the past month, and impacts related to oral conditions on daily life. Negative binomial regression models with robust variance estimator were fitted. The prevalence of orofacial pain was high (30.2%). The most common subset of orofacial pain was intraoral pain (27.5%). The prevalence of pain related to temporomandibular disorders was 6.8%. The most common subsets of intraoral pain were tooth (20.4%) and gingival (11.4%) pain. Orofacial pain, its subsets (intraoral and temporomandibular disorder–related pain), and intraoral pain subsets (tooth and gingival pain) consistently showed associations with all dimensions of impacts on daily life that were highly statistically significant: functional limitation, psychological discomfort, disabilities, and handicap. Socioeconomic inequalities were present in orofacial pain and some dimensions of impacts on daily life. Orofacial pain did not mediate the relationship between area deprivation and impacts on daily life. Our study demonstrated a substantial burden and impact of orofacial pain in a socially deprived and culturally diverse area of the United Kingdom. To address this burden, interventions that lie within the remit of health services are needed to improve access to dental care for adults with orofacial pain.
Sustained and repeated mouth opening leads to development of painful temporomandibular disorders involving macrophage/microglia activation in mice
Authors: Wang Guan Yun Frances , Shi Xiang Qun , Wu Wenjia , Gueorguieva Maria , Yang Mu , Zhang Ji
Published: March 2018

Temporomandibular disorder (TMD) is a set of heterogeneous musculoskeletal conditions involving the temporomandibular joint (TMJ) and/or the masticatory muscles. Up to 33% of the population has had at least 1 symptom of TMD with 5% to 10% of them requiring treatment. Common symptoms include limited jaw movement, joint sound, and pain in the orofacial area. Once TMD becomes chronic, it can be debilitating with comorbidities that greatly reduce one's overall quality of life. However, the underlying mechanism of TMD is unclear because of the multicausative nature of the disease. Here, we report a novel mouse model of TMD where a bite block was placed in between the upper and lower incisors such that the mouth was kept maximally open for 1.5 hours per day for 5 days. After sustained mouth opening, mice developed persistent orofacial mechanical allodynia and TMJ dysfunction. At the cellular level, we found masseter muscle dystrophy, and increased proteoglycan deposition and hypertrophic chondrocytes in the mandibular condyle. Increased F4/80+ macrophages were also observed in the masseter muscles and the TMJ posterior synovium. We also found ATF3+ neuronal injury and increased F4/80+ macrophages in the trigeminal ganglia. Microglia activation was observed in the trigeminal subnucleus caudalis. Inhibiting macrophage and microglia activation with a colony stimulating factor-1 receptor inhibitor prevented the development of orofacial mechanical allodynia, but not TMJ dysfunction. This study suggests that mouth opening for an extended period during dental treatments or oral intubations may risk the development of chronic TMD and inflammation associated with macrophage and microglia in the tissue and trigeminal system contributes to the development of TMD pain.
Radiosurgery of Glomus Tumors of Temporal Bone: a Meta-analysis
Authors: Sahyouni Ronald , Mahboubi Hossein , Moshtaghi Omid , Goshtasbi Khodayar , Sahyouni Sammy , Lin Harrison W. , Djalilian Hamid R.
Published: March 2018

Objective:

1) Perform a meta-analysis of the available data on the outcomes of stereotactic radiosurgery (SRS) for the treatment of temporal bone glomus tumors (GT), and 2) evaluate the collective outcomes of SRS treatment with respect to tumor control.

Data Sources:

A thorough literature search of the published English-language literature from 2011 to 2016 was performed in PubMed, Ovid, and Cochrane databases using the keywords (“Gamma Knife” or “CyberKnife” or “linear accelerator” or “radiosurgery”) and (“glomus jugulare” or “jugular paraganglioma” or “glomus tympanicum”).

Study Selection:

Studies reporting outcomes of SRS for temporal bone GT were included.

Data Extraction:

Of 45 articles found, 15 studies met our inclusion and exclusion criteria and were selected for qualitative and quantitative analyses totaling 511 patients.

Data Synthesis:

Average margin dose, modality, isodose line, volume decrease, follow-up duration, and tumor control rate data were extracted and analyzed.

Conclusion:

Gamma Knife was the most commonly implemented radiosurgery modality and was used in eight studies. The mean marginal dose varied between 13.2 and 20 Gy. The pooled tumor control rate was 95.4% (95% CI: 93.6–97.2%) over a median follow-up duration ranging between 27.4 and 148 months. Clinical data on outcomes of SRS for the treatment of GTs are sparse and primarily limited to single institutional analyses, with considerable variation in tumor volume and follow-up duration. This meta-analysis provides an in-depth analysis of the available data in the literature and reviews the reported outcomes. Future studies on SRS for GT should include data on tumor growth before radiation as well as follow-up periods sufficiently long to identify true tumor control.
Early Fitting in Cochlear Implantation: Benefits and Limits
Authors: Günther Stefanie , Baumann Uwe , Stöver Timo
Published: March 2018

Objective:

Evaluation of a shortened delay time between surgical placement of the cochlear implant (CI) device and processor activation to less than 8 days (early CI fitting). Assessment of benefits and limits of early fitting in terms of medical, technical, audiological, and subjective outcome.

Study Design:

Prospective.

Setting:

Tertiary referral center.

Patients:

Forty-one patients scheduled for cochlear implant surgery divided into early fit (EF, n = 21) and control group (CG, n = 19).

Main Outcome Measures:

Questionnaires were used to evaluate technical, medical, and subjective outcomes associated with early fitting. Additional, electrode impedance and speech recognition scores were measured. These data, collected preoperative, at first activation and after 3 months were compared with the CG with standard fitting.

Results:

The medical and audiological status of the EF subjects allowed early fitting in nearly all patients (20/21). Evidence of pain, delayed wound healing, or other compromises was equal in both study groups. Speech recognition scores show comparable development over time for EF and CG. Average electrode impedance was significantly higher in the CG at first activation.

Conclusions:

Early fitting of the sound processor is feasible and did not compromise wound healing or generates additional pain. During the first month following surgery, reduction of wound swelling can be expected. Hence, regular inspection of magnet strength is recommended at follow-ups. Over all, early activation of their CI device was highly appreciated by nearly all patients.
Speech Perception in Quiet and Noise With an Off the Ear CI Processor Enabling Adaptive Microphone Directionality
Authors: Wesarg Thomas , Voss Bettina , Hassepass Frederike , Beck Rainer , Aschendorff Antje , Laszig Roland , Arndt Susan
Published: March 2018

Objective:

To investigate the impact of the wearing position of an off-the-ear-processor (OTE) on speech perception in quiet and noise.

Patients:

The study group consisted of 16 adult subjects with bilateral severe-to-profound sensorineural hearing loss, 2 of them unilaterally, and 14 bilaterally provided with cochlear implants.

Main Outcome Measures:

Speech perception in quiet and noise was measured for frontal presentation with the recipients behind-the-ear processor CP810 or CP910 and the OTE processor Kanso (Cochlear Limited, Sydney, Australia). Additionally, speech performance in noise with the OTE for spatially separated signal and noise sources was assessed.

Results:

The recipients showed monosyllabic word recognition scores in quiet between 65 and 95% and speech reception thresholds in noise between 2.4 and −5.5 dB SNR with the OTE. For frontal presentation of speech and noise, application of the adaptive directional microphone (Beam) yielded a slight median decrement of 0.6 dB for the speech reception threshold compared with standard directionality. However, huge median improvements, ranging from −3.7 to −11.6 dB, for the three tested conditions with spatially separated sources (S0NIL, S0NCL, S0N180) were observed.

Conclusion:

The beamforming algorithm in the investigated OTE processor provides similar benefits as described in previous studies for behind-the-ear processors in conditions with spatially separated speech and noise sources. Adaptive microphone directionality can be successfully implemented in an OTE processor. The OTE processor's potential to increase usability, comfort, and cosmetics might not be compromised by a deterioration of speech performance.
Video Head Impulse Test (vHIT): The Role of Corrective Saccades in Identifying Patients With Vestibular Loss
Authors: Janky Kristen L. , Patterson Jessie , Shepard Neil , Thomas Megan , Barin Kamran , Creutz Tom , Schmid Kendra , Honaker Julie A.
Published: March 2018

Objective:

1) Characterize corrective saccades (CS) in normal controls, and 2) examine the sensitivity of the video head impulse test (vHIT) for identifying vestibular loss using both gain and CS.

Study Design:

Prospective combined with retrospective review.

Setting:

Tertiary referral center.

Patients:

Seventy subjects with normal vestibular function served as controls (mean age, 44.1 yr; range, 10–78) and data from 49 patients with unilateral and bilateral vestibular loss was retrospectively reviewed (mean age, 50; range, 7–81).

Intervention:

vHIT; individual horizontal head impulses were then analyzed in MATLAB.

Main Outcome Measures:

Horizontal vHIT gain, CS peak velocity, frequency, and latency.

Results:

There was not an age effect for CS velocity or latency, and only a weak relationship between CS frequency and age in the control group. Gain and CS latency were the only parameters affected by impulse side, demonstrating higher gain and longer latency on the right. The group with vestibular loss had significantly lower mean vHIT gain, higher mean CS frequency, higher mean CS velocity, earlier CS latency, and smaller mean CS standard deviations of the latency compared with the control group.

When all factors were analyzed separately by logistic regression, vHIT gain provided the best classification (83.8%), closely followed by CS frequency (83.1%). Using a two variable approach (both gain and CS frequency) yielded the best diagnostic accuracy (overall classification = 84.6%).

Conclusions:

Along with gain, incorporating CS frequency in interpreting vHIT improves diagnostic accuracy. A repeatable CS (>81.89%) and/or low gain (<0.78) indicate vestibular loss.
Picosecond Infrared Laser (PIRL) Application in Stapes Surgery—First Experience in Human Temporal Bones
Authors: Petersen Hannes , Gliese Alexandra , Stober Yannick , Maier Stephanie , Hansen Nils-Owe , Kruber Sebastian , Eggert Dennis , Tóth Miklós , Gosau Tobias , Schlüter Hartmut , Püschel Klaus , Schumacher Udo , Miller Robert John Dwayne , Münscher Adrian , Dalchow Carsten
Published: March 2018

Objective:

Using a contact-free laser technique for stapedotomy reduces the risk of mechanical damage of the stapes footplate. However, the risk of inner ear dysfunction due to thermal, acoustic, or direct damage has still not been solved. The objective of this study was to describe the first experiences in footplate perforation in cadaver tissue performed by the novel Picosecond-Infrared-Laser (PIRL), allowing a tissue preserving ablation.

Patients and Intervention:

Three human cadaver stapes were perforated using a fiber-coupled PIRL. The results were compared with footplate perforations performed with clinically applied Er:YAG laser. Therefore, two different laser energies for the Er:YAG laser (30 and 60 mJ) were used for footplate perforation of three human cadaver stapes each.

Main Outcome Measure:

Comparisons were made using histology and environmental scanning electron microscopy (ESEM) analysis.

Results:

The perforations performed by the PIRL (total energy: 640–1070 mJ) revealed a precise cutting edge with an intact trabecular bone structure and no considerable signs of coagulation. Using the Er:YAG-Laser with a pulse energy of 30 mJ (total energy: 450–600 mJ), a perforation only in the center of the ablation zone was possible, whereas with a pulse energy of 60 mJ (total energy: of 195–260 mJ) the whole ablation zone was perforated. For both energies, the cutting edge appeared irregular with trabecular structure of the bone only be conjecturable and signs of superficial carbonization.

Conclusion:

The microscopic results following stapes footplate perforation suggest a superiority of the PIRL in comparison to the Er:YAG laser regarding the precision and tissue preserving ablation.
Right Ear Advantage of Speech Audiometry in Single-sided Deafness
Authors: Wettstein Vincent G. , Probst Rudolf
Published: March 2018

Background:

Postlingual single-sided deafness (SSD) is defined as normal hearing in one ear and severely impaired hearing in the other ear. A right ear advantage and dominance of the left hemisphere are well established findings in individuals with normal hearing and speech processing. Therefore, it seems plausible that a right ear advantage would exist in patients with SSD.

Methods:

The audiometric database was searched to identify patients with SSD. Results from the German monosyllabic Freiburg word test and four-syllabic number test in quiet were evaluated. Results of right-sided SSD were compared with left-sided SSD. Statistical calculations were done with the Mann–Whitney U test.

Results:

Four hundred and six patients with SSD were identified, 182 with right-sided and 224 with left-sided SSD. The two groups had similar pure-tone thresholds without significant differences. All test parameters of speech audiometry had better values for right ears (SSD left) when compared with left ears (SSD right). Statistically significant results (p < 0.05) were found for a weighted score (social index, 98.2 ± 4% right and 97.5 ± 4.7% left, p < 0.026), for word understanding at 60 dB SPL (95.2 ± 8.7% right and 93.9 ± 9.1% left, p < 0.035), and for the level at which 100% understanding was reached (61.5 ± 10.1 dB SPL right and 63.8 ± 11.1 dB SPL left, p < 0.022) on a performance-level function.

Conclusion:

A right ear advantage of speech audiometry was found in patients with SSD in this retrospective study of audiometric test results.
Evolution of Otology and Neurotology Education in the United States
Authors: Gantz Bruce J.
Published: March 2018

A brief history of the evolution of Otology and Neurotology training in the United States is presented. The development of the Neurotology Fellowship accreditation process by the Accreditation Council on Graduate Education and the certification of neurotology fellows by the American Board of Otolaryngology is outlined.
Reflections on the Last 25 Years of the American Otological Society and Thoughts on its Future
Authors: Welling D. Bradley , Jackler Robert K.
Published: March 2018

Purpose:

To review contributions of the American Otological Society (AOS) over the most recent quarter century (1993–2018) and to comment on possible future evolution of the field during the quarter century to come.

Methods:

Retrospective review of selected topics from the AOS transactions, distinguished lectureships over the past 25 years, and selective reflection by the authors. Speculation on potential advances of the next quarter century derived from emerging topics in the current literature and foreseeable trends in science and technology are also proffered for consideration (and possible future ridicule).

Results:

Integration of multiple disciplines including bioengineering, medical imaging, genetics, molecular biology, physics, and evidence based medicine have substantially benefitted the practice of otology over the past quarter century. The impact of the contributions of members of the AOS in these developments cannot be over estimated.

Conclusions:

Further scientific advancement will certainly accelerate change in the practice of otologic surgery and medicine over the coming decade in ways that will be marvelous to behold.
Pharmacological cognitive enhancement in pediatrics
Authors: Colaneri Natalie , Sheldon Mark , Adesman Andrew
Published: March 2018

Purpose of review

Given the pervasiveness of psychotropic medication in the youth population and an increasingly competitive culture regarding educational performance, children, teenagers, and/or their parents may increasingly seek psychotropic substances in an effort to enhance a student's cognitive abilities and/or academic performance. Physicians must become aware of this very important and clinically relevant issue and work to ensure that medications remain in the hands of patients seeking wellness and not enhancement.

Recent findings

The current article highlights findings on the pervasiveness of stimulant misuse and diversion in youth, the motivations and effects of stimulant use, health and legal consequences associated with use, and physician perceptions and preventive practices. Ethical concerns regarding pharmacological cognitive enhancement in pediatrics are also outlined – including coercion for nonusers, inequities in access, and threats to an individual's sense of self with regard to authenticity and autonomy.

Pharmacological cognitive enhancement in pediatrics will become a larger, clinically relevant issue in the coming years. Physicians who care for children and adolescents must become more aware of this issue. Given the myriad health, legal, and ethical concerns, clinicians should discourage use of pharmaceuticals for enhancement purposes in the pediatric population.
Acute concussion: making the diagnosis and state of the art management
Authors: Eisenberg Matthew , Mannix Rebekah
Published: March 2018

Purpose of review

Concussion is an increasingly common injury in children. We aim to review the basic epidemiology and management of acute concussion and highlight recent studies that have contributed to our understanding of care for this injury.

Recent findings

While concussion is considered a ‘mild’ form of traumatic brain injury, recent evidence suggests that as many as 30% of children are still symptomatic 1 month after injury. Although there is increasing interest in finding objective measures of injury and recovery, emerging imaging and serum biomarkers are not ready for routine clinical use. Identification of children at risk for prolonged symptoms is vital. Prolonged rest after injury may worsen outcomes.

Concussion is a common injury in children. Objective measures of injury and recovery are needed, as are targeted therapies to mitigate the risk of prolonged recovery after injury.
The importance of specific rehabilitation for an obese patient with idiopathic intracranial hypertension: a case report
Authors: Raggi Alberto , Grazzi Licia , Bianchi Marzoli Stefania , Ciasca Paola , Chiapparini Luisa , Erbetta Alessandra , Faragò Giuseppe , Leonardi Matilde , D’Amico Domenico
Published: March 2018

Idiopathic intracranial hypertension (IIH) is associated with obesity, and weight loss is important to reduce intracranial pressure and improve visual function. A 38-year-old woman with IIH followed an extreme diet, which resulted in 30% weight loss (BMI moved from 34.9 to 24.6). Weight loss resulted in a significant reduction of papilloedema, normalization of intracranial pressure and improvement in headache pattern, but also induced a state of initial malnutrition, relevant depression and disability. She was discharged with the indication to start a controlled diet and improve physical activity: clinical situation get back to stability, with the patient loosing further weight (BMI=21.8) through a balanced diet and moderate physical exercise. Obese patients with IIH should be offered a comprehensive treatment approach consisting of diet and nutritional support, psychological counselling, indication to increase physical activity and, when appropriate, a specific rehabilitation programme.
Mothers and Fathers Experience Stress of Congenital Heart Disease Differently: Recommendations for Pediatric Critical Care*
Authors: Sood Erica , Karpyn Allison , Demianczyk Abigail C. , Ryan Jennie , Delaplane Emily A. , Neely Trent , Frazier Aisha H. , Kazak Anne E.
Published: March 2018

Objective:

To inform pediatric critical care practice by examining how mothers and fathers experience the stress of caring for a young child with congenital heart disease and use hospital and community supports.

Design:

Qualitative study of mothers and fathers of young children with congenital heart disease.

Setting:

Tertiary care pediatric hospital in the Mid-Atlantic region of the United States.

Subjects:

Thirty-four parents (20 mothers, 14 fathers) from diverse backgrounds whose child previously underwent cardiac surgery during infancy.

Interventions:

Subjects participated in semi-structured, individual interviews about their experiences and psychosocial needs at the time of congenital heart disease diagnosis, surgical admission, and discharge to home after surgery. Qualitative interview data were coded, and consistent themes related to emotional states, stressors, and supports were identified.

Measurements and Main Results:

Fathers experience and respond to the stressors and demands of congenital heart disease in unique ways. Fathers often described stress from not being able to protect their child from congenital heart disease and the associated surgeries/pain and from difficulties balancing employment with support for their partner and care of their congenital heart disease child in the hospital. Fathers were more likely than mothers to discuss support from the work environment (coworkers/managers, flexible scheduling, helpful distraction) and were less likely to describe the use of hospital-based resources or congenital heart disease peer-to-peer supports.

Conclusions:

This study highlights the importance of understanding the paternal experience and tailoring interventions to the unique needs of both mothers and fathers. Opportunities for critical care practice change to promote the mental health of mothers and fathers following a diagnosis of congenital heart disease are discussed.
Depressive Symptoms, Exercise Capacity, and Clinical Outcomes After Lung Transplantation
Authors: Smith Patrick J. , Byrd Rebecca , Lusby Megan , Clausen Emily , Snyder Laurie D.
Published: March 2018

Objective

Depressive symptoms are common among lung transplant recipients and have been associated with worse clinical outcomes. However, few studies have examined the association between depressive symptoms assessed at multiple time points or behavioral mechanisms by which posttransplant depressive symptoms may confer greater clinical risk. We therefore examined the associations between depressive symptoms, exercise capacity, chronic lung allograft dysfunction (CLAD), and mortality prospectively in a large sample of lung transplant recipients.

Methods

Between July 2009 and February 2016, 251 lung transplant recipients were assessed before transplantation and again approximately 3 weeks and 3 months after transplant. Depressive symptoms were assessed using the Centers for Epidemiologic Studies of Depression scale. Functional exercise capacity was assessed using the 6-minute walk test. Cox proportional hazards models were used to examine the associations between depressive symptoms, exercise capacity, CLAD, and mortality.

Results

During a median (range) follow-up of 4.5 (0.1 to 6.3) years, 53 participants (21%) died. Greater depressive symptoms (hazard ratio [HR] = 1.39 [95% CI = 1.05 to 1.84],p= .021) and poorer exercise capacity (HR = 0.58 [95% CI = 0.38 to 0.90],p= .021) assessed 3 months after transplant were both independently associated with mortality. Although greater depressive symptoms were associated with lower exercise capacity (β = −0.14,p= .039), exercise capacity did not mediate the association between depressive symptoms and mortality. In secondary analyses, depressive symptoms were independently predictive of CLAD (HR = 1.29 [95% CI = 1.01 to 1.65],p= .045) and the composite outcome of CLAD and mortality in a clustered event model (HR = 1.30 [1.09 to 1.56],p= .005).

Conclusions

Depressive symptoms are associated with mortality and CLAD after lung transplantation, independent of exercise capacity.
Brief Report: Changes in Plasma RANKL-Osteoprotegerin in a Prospective, Randomized Clinical Trial of Initial Antiviral Therapy: A5260s
Authors: Kelesidis Theodoros , Moser Carlee B. , Johnston Elizabeth , Stein James H. , Dube Michael P. , Yang Otto O. , McComsey Grace A. , Currier Judith S. , Brown Todd T.
Published: March 2018

Background:

The contributions of the receptor activator of nuclear factor kappa-B ligand (RANKL)/osteoprotegerin (OPG) axis to cardiovascular and bone disease in treated HIV-1 infection are not well defined.

Setting:

Prospective, observational, longitudinal study.

Methods:

In a subset analysis of a prospective randomized clinical trial, 234 HIV-1–infected antiretroviral therapy–naive participants received tenofovir–emtricitabine plus either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir and achieved plasma HIV-1 RNA <50 copies per milliliter by week 24 and thereafter. Associations between plasma RANKL, OPG, or RANKL/OPG ratio levels with total, hip, and spine bone mineral density (BMD) loss or progression of carotid artery intima-media thickness were assessed longitudinally over 96 weeks.

Results:

Over 96 weeks, all treatment groups had similar and sustained declines in plasma RANKL, increases in plasma OPG, and subsequently, decreases in the RANKL/OPG ratio. There were no associations between plasma RANKL or RANKL/OPG ratio levels with total, hip, and spine BMD loss or progression of carotid artery intima-media thickness; however, plasma OPG in successfully treated HIV-infected patients (week 48 and 96) was associated with spine BMD loss.

Conclusions:

In virologically suppressed HIV-infected patients, the evolution of bone disease could be linked to plasma OPG levels; however, the role of plasma levels of RANKL and RANKL/OPG ratio in the prediction of morbidity in treated HIV-1 infection may be limited.
Antipsychotic-Induced Pisa Syndrome: A 2-Year Follow-up Study
Authors: Lee Yen-Feng
Published: March 2018

Objectives

Pisa syndrome is characterized by lateral trunk flexion. It is an uncommon adverse drug reaction in patients on antipsychotic medication. Although Pisa syndrome has been reported in patients on antipsychotic treatment, previous studies have not discussed the prognosis of patients with Pisa syndrome. We studied psychiatric patients with Pisa syndrome following antipsychotic treatment for a 2-year period.

Methods

From January 2012 to December 2014, 13 inpatients with Pisa syndrome following antipsychotic treatment were identified at our institution, from a prospectively collected database. These patients were studied for a 2-year period.

Results

The prevalence rate of Pisa syndrome during neuroleptic treatment was 0.45% in men and 0.37% in women, with a collective prevalence rate of 0.42%. The mean age of patients with Pisa syndrome was 47 years. Eight (61.5%) of the cases had a position with a tilt toward the right side. In 5 (38.5%) of the cases, a tilt toward the left side was observed. The average Cobb angle of the trunk was 17.3 (SD, 4.0) degrees. On presentation with Pisa syndrome within 3 months of medication modification, the pattern of trunk dystonia had a significantly shorter duration (P = .024) compared with that seen in the tardive-onset group.

Conclusions

Pisa syndrome is an uncommon adverse event that can also be chronic or recurrent, especially in those with tardive onset. We should be aware of the risks in patients with the following predisposing factors: old age, chronic psychosis, long-term antipsychotic use, advanced drug-induced parkinsonism, and combined pharmacologic treatment.