bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial
Authors: Ghafouri Hamed Basir , Abazarian Niloofar , Yasinzadeh Mohammadreza , Modirian Ehsan
Published: June 2020

Objective

To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic.

Design

Randomized clinical trial.

Setting

This study was conducted in the emergency unit of a university hospital.

Subjects

Patients referred to the emergency room with renal colic.

Primary Outcome

Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol.

Methods

In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15 mg/kg) and intranasal desmopressin spray (40 μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60 minutes. Adverse effects and need for rescue analgesic (0.05 mg/kg max 3 mg morphine sulphate) were also recorded at the end of the study.

Results

Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15 minutes was more reduced and was clinically significant (>3) in the desmopressin group (P < 0.0001). There was no significant difference between mean pain scores in the two groups after 30 minutes (P = 0.350) or 60 minutes (P = 0.269), but the efficacy of the two drugs was significant in terms of pain reduction (>6).

Conclusions

Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin.
Rethinking Production under Uncertainty
Authors: Cochrane John H
Published: June 2020

Conventional models of production under uncertainty specify that output is produced in fixed proportions across states of nature. I investigate a representation of technology that allows firms to transform output from one state to another. I allow the firm to choose the distribution of its random productivity from a convex set of such distributions described by a limit on a moment of productivity scaled by a natural productivity shock. The model produces a simple discount factor that is linked to productivity and that can be used to price a wide variety of assets, without regard to preferences.

Received November 26, 2019; editorial decision May 23, 2020 by Editor Jeffrey Pontiff. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
TOWARD NATIONAL CT DIAGNOSTIC REFERENCE LEVELS IN THE UNITED ARAB EMIRATES: A MULTICENTER REVIEW OF CT DOSE INDEX AND DOSE LENGTH PRODUCT
Authors: Abuzaid Mohamed M , Elshami Wiam , El Serafi A , Hussien T , McConnell J R , Tekin H O
Published: June 2020

This multicenter study evaluated computed tomography dose index volume (CTDIvol) and dose length product (DLP) to contribute to establishing computed tomography (CT) national diagnostic reference levels (NDRLs) in the United Arab Emirates (UAE). Data from 240 patients, who underwent CT head, chest, abdomen–pelvis and urography examinations, were analyzed, including patient age, sex and weight, CTDIvol (mGy) and DLP (mGy cm). The proposed DRLs for each examination were calculated as the third quartile. DRLs are proposed using CTDIvol (mGy) and DLP (mGy cm) for CT head (67 and 1189, respectively), chest (8 and 302, respectively), abdomen–pelvis (28 and 1122, respectively) and urography (20 and 714, respectively). These values are comparable with the initial NDRLs and published international DRLs. Baseline values for International Radiology Center (IRC) CT DRLs were calculated on frequently performed CT examinations. Implementation of DRL values improves dose optimization based on procedures, scanner type and patient characteristics while maintaining acceptable image quality and diagnostic confidence.
The Impact of Anticholinergic Burden on Functional Capacity in Persons With Schizophrenia Across the Adult Life Span
Authors: Khan Waqas Ullah , Ghazala Zaid , Brooks Heather Jane , Subramaniam Ponnusamy , Mulsant Benoit H , Kumar Sanjeev , Voineskos Aristotle N , Blumberger Daniel M , Kern Robert S , Rajji Tarek K
Published: June 2020

Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19–79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.
Structural Change, Capital Deepening, and TFP Growth in Japan: 1885–1970
Authors: FUKAO Kyoji , MAKINO Tatsuji , SETTSU Tokihiko
Published: June 2020

After the Meiji Restoration of 1868, Japan modernized its institutions and economic growth gradually picked up. Growth accelerated especially during the so-called high-speed growth era from 1955 to 1970, when Japan rapidly caught up with Western economies. The long-term sustained high-speed growth recorded during this period was unprecedented, not only in Japan, but worldwide. Using newly constructed Hitotsubashi estimates of Japan’s historical gross domestic product (GDP) statistics and a growth accounting framework, we analyze the sources of Japan’s economic growth through a historical perspective covering the longer period than other studies and explore why Japan was not able to accomplish such high-speed growth from 1885 to 1955. Since the mid-1960s the primary sector accounted for a large share of economic activity, we use a two-sector model in which the economy overall is divided into the primary sector and the non-primary sector. Our results suggest that TFP growth and capital accumulation in the non-primary sector played a major role in achieving high-speed economic growth. From this perspective, the fact that the capital stock per worker did not grow substantially before World War II is one of the key reasons why Japan did not experience high-speed growth during this period.
Incomplete Kawasaki Disease as Presentation of COVID-19 Infection in an Infant: A Case Report
Authors: Raut Sumantra , Roychowdhoury Satyabrata , Bhakta Subhajit , Sarkar Mihir , Nandi Mousumi
Published: June 2020

Background

Recently a severe form of COVID-19 infection has been described in a cluster of children presenting as multisystem inflammatory condition. One of the important spectrum of this condition is incomplete Kawasaki disease (KD).

Case report

A 5-month-old male child presented with high-spiking fever for 5 days with skin rash, bilateral non-purulent conjunctivitis and irritability. His C-reactive protein was markedly elevated (215.4 mg/l). Echocardiography revealed dilated left main coronary artery (3.0 mm, Z score +4.30) and left anterior descending artery (2.37 mm, Z score +3.76). Concomitantly Reverse Transcription- Polymerase Chain Reaction for COVID-19 was positive on fifth day sample. He was diagnosed as incomplete KD with COVID-19 infection and treated with intravenous immunoglobulin (IVIG) (2 g/kg), oral aspirin and azithromycin. Patient improved after 48 h and was discharged on oral aspirin.

Conclusion

Incomplete KD may co-exist with COVID-19 infection in infant. Early institution of IVIG may lead to better outcome.
A first cladistic analysis of Antarctoperlinae (Plecoptera: Gripopterygidae) and a new micropterous species from Patagonia
Authors: Pessacq Pablo , Duarte Tácio , Epele Luis B
Published: June 2020

Gripopterygidae is a diverse family of stoneflies, Plecoptera, distributed in the Southern Hemisphere. It has been traditionally divided into five subfamilies, but the monophyly of most of these is not supported by molecular the more comprehensive molecular analysis of the order. To test the monophyly of Antarctoperlinae, and to establish the phylogenetic position of a new Gripopterygidae species, we performed a morphological cladistic analysis including 38 morphological characters and 27 terminal taxa, with representatives of the four subfamilies present in South America and three Austroperlidae. Based on published information, we rooted the tree with Penturoperla barbata, Austroperlidae. As a result, Antarctoperlinae was recovered as polyphyletic, with Vesicaperla kuscheli and Plegoperla punctata, two members of the subfamily, placed outside the clade that includes the nine remaining genera of Antarctoperlinae. Vesicaperla also falls outside the family in previous molecular analysis. Based on this evidence, it should not be placed in Antarctoperlinae. Plegoperla punctata, known only from the type series, possesses many missing entries in our data matrix. Based on this, it seems convenient to maintain its subfamilial placement. In the tree obtained, the potential new species nests together with Pehuenioperla llaima. We thus accept it as a member of Pehuenioperla and describe it as P. microptera sp. nov.
PA job availability in primary care during 2014 and 2016
Authors: Rana Rachel , Blazar Melinda , Jones Quincy , Butterfield Rita , Everett Christine M. , Morgan Perri
Published: June 2020

Objectives:

The objective of this project was to evaluate demand for PAs by examination of job postings. We compared proportions of PAs in primary care with proportions of job postings in primary care in 2014 and 2016 and described job postings for PAs by specialty in 2014 and 2016.

Methods:

Internet job postings for PAs supplied by Burning Glass Technologies were evaluated for practice specialty. Job postings were compared with existing filled positions by specialty as reported by the National Commission for the Certification of Physician Assistants.

Results:

In both years, more than 25% of PAs in practice were in primary care and fewer than 20% of job openings were in primary care. More than half of postings were in medical and surgical subspecialties.

Conclusions:

Our findings provide insights into which specialties have emerging high demand for PAs. The demand for PAs appears to remain much stronger for specialty jobs than for primary care jobs.
Nurse Educators’ Guide to Clinical Judgment: A Review of Conceptualization, Measurement, and Development
Authors: Klenke-Borgmann Laura , Cantrell Mary Ann , Mariani Bette
Published: June 2020

AIM

The purpose of this article is to define clinical judgment, examine valid and reliable instruments to measure the construct, review established strategies by which to develop it, and propose key future nursing education research priorities in clinical judgment.

BACKGROUND

A pressing interest in prelicensure nursing students’ clinical judgment development has emerged in response to the National Council of State Boards of Nursing project Next Generation NCLEX.

METHOD

Sequential literature reviews uncovered six instruments that measure clinical judgment and 24 studies that demonstrate the effects of high-fidelity simulation on clinical judgment in prelicensure learners.

RESULTS

Six themes emerged: number of simulation-based experience exposures, specific nursing specialty simulations, debriefing and its effect on clinical judgment, assessment, clinical decision-making, and reflection.

CONCLUSION

Based on these results, key future research priorities investigating the effects of interprofessional simulation and simulation in the classroom were identified.
Understanding the most commonly billed diagnoses in primary care
Authors: Rogers Julia , Baker Manisa
Published: June 2020

Atherosclerotic cardiovascular disease (ASCVD), the buildup of plaque within the arterial walls, contributes to acute coronary syndrome, angina, stroke, transient ischemic attack, and peripheral arterial disease. This second article in a series about the most commonly billed diagnoses in primary care describes the pathophysiologic processes of ASCVD as well as how the clinical manifestations and treatments are linked to the pathogenesis of the disease.
Disaster response resources and research goals for NPs
Authors: Wood Laura , Zak Concetta , Adelman Deborah S. , Fant Catherine
Published: June 2020

This final installment presents an overview of the series and calls for NPs to become more educated in disaster response planning, more involved in disaster response research, and better trained to lead in disaster response.
Valgus slipped capital femoral epiphysis: a systematic review
Authors: Assi Chahine , Mansour Jad , Kouyoumdjian Pascal , Yammine Kaissar
Published: June 2020

Valgus slipped capital femoral epiphysis (SCFE) is a rare entity which leads to a proximolateral displacement of the hip epiphysis. The literature on valgus SCFE consists of case reports or case series. Since no evidence synthesis has been conducted, a systematic review on all published cases of valgus SCFE was conducted. The search strategy located 27 studies comprising 74 subjects with 96 hips. Demographic results were as follows: female/male ratio was of 1.65, and the mean age at presentation was 13.0 ± 2.54 years. Bilateral cases were recorded in 31.1%. Hip pain was the most frequent symptom followed by limping. The most frequent clinical sign was the limitation of medial internal rotation. Comorbidities were present in 65.6% of patients, mostly as endocrine or metabolic disorders. The mean neck-shaft angle was 149.2 ± 9.2°, the mean physis-shaft angle was 83.3 ± 9.7°, the neck-physis angle was 36.1 ± 21.5°, and the posterior physeal tilt angle was 23 ± 6.07°. The physeal tilt was lateral in 90% of cases. Treatment was based on screws in 70.8% of cases, a femoral osteotomy in 18.75%, and the remaining had a combination of surgical procedures. Two out of the three screw migrations occurred following fixation with more than one screw. All major complications (8.3%) had the potential of developing osteoarthritis in the future. Valgus SCFE entity demonstrates distinctive demographic, clinical and radiological results. This rare entity should be always included in the differential diagnosis of hip pain or limping in children.
ACL Growth With Age in Pediatric Patients: An MRI Study
Authors: Putur Danielle E. , Slaven Sean E. , Niu Emily L.
Published: June 2020

Background:

There is limited knowledge of morphologic changes of the anterior cruciate ligament (ACL) during childhood. The purpose of the study is to describe normal ACL growth in pediatric patients.

Methods:

We performed retrospective review of patients under 19 years of age with at least 2 serial magnetic resonance imaging (MRI) examinations of the same knee without ACL tear. The parameters measured included length of the ACL, width of the ACL in sagittal and coronal planes, physeal status, ACL-tibial inclination angle, Notch Width Index, ACL tibial attachment width and midpoint, and anterior to posterior length and height of the tibial epiphysis. Pearson correlation coefficients were calculated to determine the strength of correlation of each parameter relative to age. Growth curves were calculated for individual parameters, producing a predictive model for growth of the ACL over time.

Results:

One hundred forty-seven patients (365 MRIs) were included. The average age at initial MRI was 12.2 years (range: 1.2 to 18.4 y). The Pearson correlation coefficient for each parameter was statistically significant relative to age. Younger patients had more oblique, anteriorly attached ACLs. Three distinct phases of growth were observed: patients age 1.5 to 5.75 years average 2.25 mm of growth per year; patients aged 6 to 11.5 average 1.46 mm of growth per year; growth slows at age 11.75, stopping by 18.5 years. The growth model for ACL sagittal width increased 0.45 mm/y from age 1.5 to 14.5 after which it plateaus, whereas coronal width increased 0.22 mm/y from age 1.5 to 18.75.

Conclusions:

In the pediatric patient, the ACL grows in length and width in a predictable manner until age 18. This model aids clinicians in predicting normal ACL parameters for anatomic reconstruction procedures in the skeletally immature patient.

Level of Evidence:

Level IV.
Long-term Follow-up of Eosinophilic Granulomas of the Axial and Appendicular Skeleton Managed With Biopsy Alone
Authors: Erol Bulent , Sofulu Omer , Caliskan Emrah
Published: June 2020

Background:

This study aimed to evaluate the long-term clinical and radiologic follow-up results of eosinophilic granulomas (EGs) of the axial and appendicular skeleton managed with biopsy alone.

Methods:

Fifty-five patients with unifocal osseous EGs of the axial and appendicular skeleton were followed after biopsy. Patients were divided into 2 groups on the basis of localization of the lesions. In group 1, there were 32 (58.2%) children with extremity long bone involvement: femur, tibia, humerus, ulna, and radius. Group 2 included 23 (41.8%) patients with lesions located in other appendicular and axial skeleton bones: pelvis, scapula, clavicle, lumbar, and thoracic vertebrae. After confirming the diagnosis by a closed biopsy, no further surgical intervention was performed. Clinical recovery included regression of the localized symptoms, mainly pain resolution. Functional improvement was assessed by Musculoskeletal Tumor Society (MSTS) scoring. Radiologic healing was defined as ossification of the entire lesion with cortical thickening in long and flat bones, and restoration of vertebral body height in the spine. Complications, including local recurrence, were determined.

Results:

The patients comprised 28 boys and 27 girls with an average age of 9.2 years (range, 3 to 16 y). The average follow-up was 76 months (range, 28 to 132 mo). The median time from biopsy to clinical recovery was 17 days [95% confidence interval (CI), 13.3-20.6] and 36 days (95% Cl, 32.8-39.1) in group 1 and group 2, respectively. MSTS scores increased progressively till the end of 12 months in both groups. The median time from biopsy to radiologic healing was 16 months (95% CI, 11.5-20.4) and 42 months (95% Cl, 39.3-44.6) in group 1 and group 2, respectively. Both clinical recovery (P=0.021) and radiologic healing (P=0.009) were significantly faster in group 1 compared with group 2. No major complication was seen after biopsy. All lesions regressed without a local recurrence.

Conclusions:

Unifocal osseous EGs have spontaneous healing potential and confirming the diagnosis by biopsy is enough to obtain good clinical and radiologic results without any additional surgical intervention.

Type of Study:

This was a therapeutic study.

Level of Evidence:

Level IV.
Successful Ponseti-treated Clubfeet at Age 2 Years: What Is the Rate of Surgical Intervention After This?
Authors: Siebert Matthew J. , Karacz Chelsea M. , Richards B. Stephens
Published: June 2020

Background:

In recent decades, nonoperative Ponseti casting has become the standard of care in the treatment of idiopathic clubfoot. However, the rate of recurrence, even after successful Ponseti treatment is not insignificant. The purpose of this study was to determine the future rate, timing, and type of surgery needed in patients whose idiopathic clubfeet treated by Ponseti casting were considered successful at the age of 2 years.

Methods:

Inclusion criteria for this retrospective study were patients under 3 months with idiopathic clubfoot treated exclusively by Ponseti casting, who had successful outcomes at 2 years of age without surgery, and who had at least 5 years of follow-up. The total number of surgical interventions in the age range 2 to 5 and above 5 years, the number and type of procedures performed, and the timing of surgery were reviewed.

Results:

Three hundred thirty-six patients with a total of 504 clubfeet fulfilled the inclusion criteria. One hundred twenty-two of these 336 patients (36.3%) eventually underwent surgical intervention. Between 2 and 5 years of age, 79 patients (23.5%) with 104 feet (20.6%) underwent surgery. The most common procedures performed between 2 and 5 years were limited (a la carte) in scope: tibialis anterior tendon transfer, posterior release, plantar fascia release, and repeat tendo-Achilles lengthening. At age above 5 years, 53 patients (20.1%) with 65 feet (16.9%) underwent surgery. Ten of these 53 patients had already undergone surgery between 2 and 5 years of age. The procedures most commonly performed were similar.

Conclusions:

In patients with idiopathic clubfoot who reached 2 years of age with successful outcomes from Ponseti cast treatment, ∼35% eventually underwent surgical intervention, mostly limited (a la carte), to regain or maintain a plantigrade foot. The most commonly performed procedures include tibialis anterior tendon transfer, posterior capsular release, plantar fascia release and repeat tendo-Achilles lengthening, either in isolation or in combination. However, before considering surgery, the need for these procedures can, and should, be minimized by recasting recurrent deformities using Ponseti method.

Level of Evidence:

Level III.
Assessment of circulating tumor DNA in cerebrospinal fluid by whole exome sequencing to detect genomic alterations of glioblastoma
Authors: Duan Hao , Hu Ji-Long , Chen Zheng-He , Li Jue-Hui , He Zhen-Qiang , Wang Zhen-Ning , Zhang Guan-Hua , Guo Xiao-Yu , Liang Lun , Mou Yong-Gao
Published: June 2020

Background

Cerebrospinal fluid (CSF) has been demonstrated as a better source of circulating tumor DNA (ctDNA) than plasma for brain tumors. However, it is unclear whether whole exome sequencing (WES) is qualified for detection of ctDNA in CSF. The aim of this study was to determine if assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma.

Methods

CSFs of ten glioblastoma patients were collected pre-operatively at the Department of Neurosurgery, Sun Yat-sen University Cancer Center. ctDNA in CSF and genome DNA in the resected tumor were extracted and subjected to WES. The identified glioblastoma-associated mutations from ctDNA in CSF and genome DNA in the resected tumor were compared.

Results

Due to the ctDNA in CSF was unqualified for exome sequencing for one patient, nine patients were included into the final analysis. More glioblastoma-associated mutations tended to be detected in CSF compared with the corresponding tumor tissue samples (3.56 ± 0.75 vs. 2.22 ± 0.32, P = 0.097), while the statistical significance was limited by the small sample size. The average mutation frequencies were similar in CSF and tumor tissue samples (74.1% ± 6.0% vs. 73.8% ± 6.0%, P = 0.924). The R132H mutation of isocitrate dehydrogenase 1 and the G34V mutation of H3 histone, family 3A (H3F3A) which had been reported in the pathological diagnoses were also detected from ctDNA in CSF by WES. Patients who received temozolomide chemotherapy previously or those whose tumor involved subventricular zone tended to harbor more mutations in their CSF.

Conclusion

Assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma, which may provide useful information for the decision of treatment strategy.
Age-dependent changes of total and differential white blood cell counts in children
Authors: Li Kun , Peng Ya-Guang , Yan Ruo-Hua , Song Wen-Qi , Peng Xiao-Xia , Ni Xin
Published: June 2020

Background

Total and differential white blood cell counts are important for the diagnostic evaluation of suspected diseases. To facilitate the interpretation of total and differential white blood cell counts in pediatric patients, the present study investigated age-dependent changes in total and differential white blood cell counts in healthy reference children.

Methods

Data were obtained from the Pediatric Reference Intervals in China study (PRINCE), which aims to establish and verify pediatric reference intervals for Chinese children based on a nationwide multicenter cross-sectional study from January 2017 to December 2018. Quantile curves were calculated using the generalized additive models for location, shape, and scale method. The 2.5th, 50th, and 97.5th quantile curves were calculated for both total and differential white blood counts. Percents of stacked area charts were used to demonstrate the proportions of differential white blood cells. All statistical analyses were performed using R software.

Results

Both 50th and 97.5th quantiles of total white blood cell count and monocyte count were highest at birth, then rapidly decreased in the first 6 months of life; relatively slow reduction continued until 2 years of age. The lymphocyte count was low during infancy and increased to its highest level at 6 months of age; it then exhibited moderate and continuous reduction until approximately 9 years of age. The pattern of neutrophil count changed with age in a manner opposite to that of lymphocyte count. Besides, there were two inter-sections of lymphocyte count and neutrophil count during infancy and at approximately 5 years of age, based on locally weighted regression (LOESS) analysis. There were no apparent age-related changes in eosinophil or basophil counts.

Conclusion

These data regarding age-related changes in total and differential white blood cell counts can be used to assess the health of pediatric patients and guide clinical decisions.
Global Alliance against Chronic Respiratory Diseases symposium on air pollution: overview and highlights
Authors: Schraufnagel Dean E.
Published: June 2020

A 1-day symposium before the annual meeting of the Global Alliance against Chronic Respiratory Diseases, gathered authorities and researchers from around the world to discuss the impact of air pollution on human and planetary health. Air quality is a high priority for Global Alliance against Chronic Respiratory Diseases and China, the host country. This article presents a summary, commentary, and amplification of the 17 presentations. Air pollution is closely linked with global warming and harms most body systems even at levels below international standards. Information about the genetic, cellular, and metabolic effects of exposure to air pollution is important for better understanding of individual responses and even potential therapeutic mediation. Reducing air pollution at its source leads to prompt and important benefits and should be the first priority for political and public action.
Quantifying the Size of the Pterygium Head by Evaluating the Fibrous Area or the Vascularized Area
Authors: Lee Olivia L. , Shi Yue , Brown Tyler , Maram Jyotsna
Published: June 2020

Purpose:

Pterygium is characterized by the development of wing-shaped fibrovascular tissue from the bulbar conjunctiva across the limbus onto the cornea. The purpose of this study was to quantify the discrepancy of the pterygium size between the fibrous area and the vascularized area.

Methods:

Color photographs of 146 eyes with pterygia obtained with a single-lens reflex camera system were analyzed by 2 independent graders for width (vertical dimension), length (horizontal dimension), and surface area of the pterygium head using 2 methods: the fibrous method, which measures any fibrovascular tissue crossing the corneal limbus, and the vascular method, which measures only tissue with discernible active blood flow, without any avascular tissue or opacity. Statistics of intraclass correlation coefficients for intergrader and intragrader reproducibility were calculated, and the paired t test between methods was used.

Results:

Both intergrader and intragrader intraclass correlation coefficients for both methods were above 0.85. The vascular measurement was significantly larger in width (vertical dimension, fibrous 3.97 ± 1.02 mm vs. vascular 4.49 ± 1.33 mm, P = 0.01), whereas the fibrous measurement was significantly larger in length (horizontal dimension, fibrous 2.41 ± 1.16 mm vs. vascular 2.23 ± 1.05 mm, P = 0.04). No significant difference was found in the surface area (fibrous 7.27 ± 4.65 mm2 vs. vascular 7.40 ± 5.13 mm2, P = 0.67).

Conclusions:

With both methods, reproducibility of the size of the pterygium head was high. Significant differences were shown between the two methods in quantification of the width and length but not in the surface area. Such methods can be used to standardize the evaluation of pterygia in clinical research and clinical trials.
Assessment of Factors Associated With Postoperative Pain After Photorefractive Keratectomy
Authors: Palochak Cherilyn Mae A. , Santamaria Joseph , Justin Grant A. , Apsey Douglas A. , Caldwell Matthew C. , Steigleman Walter A. , Evangelista Charisma , Legault Gary L. , Gillis John
Published: June 2020

Purpose:

To define the factors that affect patient's self-assessed postoperative pain after photorefractive keratectomy (PRK).

Methods:

Patients who underwent PRK in 2016 were evaluated. Anonymized data collected included patient gender, age, and season at the time of surgery, ablation depth, surgeon status (attending vs. resident), topical tetracaine use, and subjective pain scores at postoperative days (PODs) 1 and 7. Average pain scores and amount of pain medication taken were analyzed for each of the previously mentioned variables.

Results:

Overall, 231 patients who underwent PRK were analyzed. The mean pain score and SD were 0.78 ± 1.87 on POD 1 and 0.03 ± 0.37 by POD 7. Patients who used topical tetracaine reported significantly higher pain on POD 1 and 7 compared with patients who did not use tetracaine (P < 0.001 and P = 0.038, respectively). No significant differences in pain scores were seen based on surgeon status, ablation depth, gender, and season. Patients who used topical tetracaine took a higher amount of oral pain medication (9.44 ± 6.01) compared with those who did not (7.02 ± 4.71) (P = 0.022).

Conclusions:

Postoperative pain was significantly elevated in patients who used tetracaine on POD 1 and POD 7. These patients were also more likely to take oral pain medication than those who did not use topical tetracaine. Surgeon status, season, gender, and ablation depth showed no significant differences in subjective pain scores. Oral pain medication should be evaluated to assess efficacy and safety in inhibiting ocular pain after PRK.
The transition from acute to persistent pain: the identification of distinct trajectories among women presenting to an emergency department
Authors: Burns John W. , Janssen Imke , Lillis Teresa , Mulcahy Morgan , Purim-Shem-Tov Yanina A. , Bruehl Stephen , Burgess Helen J. , Fischer Alexandra , Rim Katie , Aranda Frances , Pinkerton Linzy , Hobfoll Stevan
Published: June 2020

Posttraumatic stress disorder (PTSD) symptoms and other negative psychosocial factors have been implicated in the transition from acute to persistent pain. Women (N = 375) who presented to an inner-city emergency department (ED) with complaints of acute pain were followed up for 3 months. They completed a comprehensive battery of questionnaires at an initial visit and provided ratings of pain intensity at the site of pain presented in the ED during 3 monthly phone calls. Latent class growth analyses were used to detect possible trajectories of change in pain intensity from the initial visit to 3 months later. A 3-trajectory solution was found, which identified 3 groups of participants. One group (early recovery; n = 93) had recovered to virtually no pain by the initial visit, whereas a second group (delayed recovery; n = 120) recovered to no pain only after 1 month. A third group (no recovery; n = 162) still reported elevated pain at 3 months after the ED visit. The no recovery group reported significantly greater PTSD symptoms, anger, sleep disturbance, and lower social support at the initial visit than both the early recovery and delayed recovery groups. Results suggest that women with high levels of PTSD symptoms, anger, sleep disturbance, and low social support who experience an acute pain episode serious enough to prompt an ED visit may maintain elevated pain at this pain site for at least 3 months. Such an array of factors may place women at an increased risk of developing persistent pain following acute pain.
Intraoperative Cochlear Implant Reinsertion Effects Evaluated by Electrode Impedance
Authors: Toner Fearghal M. , Sanli Halit , Hall Andrew C. , Birman Catherine S.
Published: June 2020

Objectives:

To assess the effect on impedance levels of intraoperative reinsertion of a cochlear implant (CI) array compared with matched controls.

Study Design:

Retrospective patient review.

Setting:

Cochlear implant center.

Patients:

CI recipients in the Sydney Cochlear Implant Centre (SCIC) database who required intraoperative array reinsertion and matched controls. Exclusion criteria; known preceding meningitis or labyrinthitis ossificans; electrode array buckling; incomplete “final” insertion.

Intervention:

Cochlear implantation.

Main Outcome Measures:

Impedance values measured intraoperatively, at switch on, 3 months, 6 months, and 12 months postoperatively were analyzed. The Generalized Estimating Equation (GEE) Model was used to compare cases with controls for each device, at each time point, and for each channel.

Results:

Thirty-one reinsertion cases identified; six CI 422 arrays; 14 CI 24RE (ST) arrays, and 11 CI 512 arrays. No increase in impedance levels was found in the reinsertion cases when compared with their matched controls. The only statistical difference in impedance was seen in the CI 422 cohort at switch on with the reinsertion cases having lower impedances (p = 0.03).

Conclusion:

This is the first study to examine impedance values in patients who underwent intraoperative CI array reinsertion and to compare them with the impedances of matched controls. No significant increase found in impedances between our reinsertion cases and matched controls, suggesting the reinsertion did not result in any additional trauma or inflammation. This has implications for surgery both in routine cases such as a faulty electrode and also for future design of mechanisms for delivery of intracochlear therapies.
Evaluation of Self-reported Symptoms in 1,457 Dizzy Patients and Associations With Caloric Testing and Posturography
Authors: Berge Jan Erik , Nordahl Stein Helge Glad , Aarstad Hans Jørgen , Gilhus Nils Erik , Goplen Frederik Kragerud
Published: June 2020

Objective:

To determine if symptoms regarding timing and triggers of dizziness are useful for categorizing patients with dizziness, and to evaluate how patient-reported symptoms predict vestibular asymmetry, postural sway, and vestibular diagnoses.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Patients referred for suspected vestibular disease.

Interventions:

Patients completed a symptom questionnaire before laboratory testing with static posturography and bithermal caloric tests.

Main Outcome Measure:

Evaluate whether responses from a symptom questionnaire predict caloric asymmetry, postural balance, and diagnoses.

Results:

One thousand four hundred fifty seven patients, 60.1% women, mean age 49.9 (±16.6) years were included. Vomiting was the strongest predictor for caloric asymmetry in adjusted analysis, odds ratio (OR): 1.60 (95% confidence interval [CI]: 1.24–2.06), followed by chronic hearing loss OR: 1.59 (1.19–2.13). Patients who reported constant dizziness had impaired postural balance, quantified as 15% increase in postural sway in adjusted analyses (7.25–24.6%). We found no association between caloric asymmetry and postural instability with eyes closed.

Conclusion:

Most patients were able to describe the timing of their symptoms and a categorization based on timing seems feasible. There seemed to be an over-reporting of triggers and confirmatory testing of triggers is therefore advocated. Vomiting, but not nausea, was a strong indicator of vestibular disease in this primarily outpatient population. Caloric asymmetry and postural balance were not associated, and assessment of fall risk may be warranted in patients who reports constant dizziness, visual disturbances or dizziness triggered by light, darkness or sounds.
Opioid Prescribing Patterns and Usage Following Cochlear Implantation
Authors: Mahairas Anthony D. , Neff Ryan , Craker Nikki , McNulty Beth N. , Shinn Jennifer B. , Bush Matthew L.
Published: June 2020

Objective:

To evaluate opioid prescribing patterns following cochlear implantation (CI) and assess factors associated with recurrent opioid use.

Study Design:

Retrospective cohort study.

Setting:

National pharmaceutical database recording opioid fulfillment (Truven Health Marketscan Commercial Claims and Encounters and Medicare Claims and Encounters database)

Participants:

CI recipients who filled opioid prescriptions between January 2011 and December 2016. All patients had no previous opioid prescriptions filled 60 days before implantation and filled at least one opioid prescription within 1 week after surgery. Cohort 1 filled only one prescription and cohort 2 filled more than one prescription in the 12 months following CI. Univariate/multivariate analysis was performed to assess for associations with recurrent opioid use.

Main Outcome Measure(s):

Opioid prescription details and recurrent opioid use.

Results:

The study included 98 patients (cohort 1 = 57, cohort 2 (recurrent opioid use) = 41). Hydrocodone 5 mg was most frequently used. The average duration opioids were prescribed was 5.49 days with an average quantity of tablets of 36.1. Recurrent opioid use in cohort 2 was associated with both total morphine milligram equivalents (MME) prescribed/day in the first postoperative week (OR = 1.03, p = 0.01) and use of stronger MME opioids (OR = 7.20, p = 0.05).

Conclusion:

Prescribing patterns following CI can influence recurrent opioid use in patients. Each additional tablet of hydrocodone 5 mg beyond 8 tablets/d or oxycodone 5 mg beyond 5.33 tablets/d, increases the likelihood of recurrent opioid use by 15 or 22.5%, respectively. Limiting opioids prescribed per day to no more than 40 MME could lower the likelihood of patients becoming recurrent opioid users postoperatively.
Explaining Speech Recognition and Quality of Life Outcomes in Adult Cochlear Implant Users: Complementary Contributions of Demographic, Sensory, and Cognitive Factors
Authors: Skidmore Jeffrey A. , Vasil Kara J. , He Shuman , Moberly Aaron C.
Published: June 2020

Hypotheses:

Adult cochlear implant (CI) outcomes depend on demographic, sensory, and cognitive factors. However, these factors have not been examined together comprehensively for relations to different outcome types, such as speech recognition versus quality of life (QOL). Three hypotheses were tested: 1) speech recognition will be explained most strongly by sensory factors, whereas QOL will be explained more strongly by cognitive factors. 2) Different speech recognition outcome domains (sentences versus words) and different QOL domains (physical versus social versus psychological functioning) will be explained differentially by demographic, sensory, and cognitive factors. 3) Including cognitive factors as predictors will provide more power to explain outcomes than demographic and sensory predictors alone.

Background:

A better understanding of the contributors to CI outcomes is needed to prognosticate outcomes before surgery, explain outcomes after surgery, and tailor rehabilitation efforts.

Methods:

Forty-one adult postlingual experienced CI users were assessed for sentence and word recognition, as well as hearing-related QOL, along with a broad collection of predictors. Partial least squares regression was used to identify factors that were most predictive of outcome measures.

Results:

Supporting our hypotheses, speech recognition abilities were most strongly dependent on sensory skills, while QOL outcomes required a combination of cognitive, sensory, and demographic predictors. The inclusion of cognitive measures increased the ability to explain outcomes, mainly for QOL.

Conclusions:

Explaining variability in adult CI outcomes requires a broad assessment approach. Identifying the most important predictors depends on the particular outcome domain and even the particular measure of interest.
Autophagy Is Deficient and May be Negatively Regulated by SERPINB3 in Middle Ear Cholesteatoma
Authors: Ho Kuen-Yao , Huang Chih-Jen , Hung Chih-Chang , Wu Yu-Rong , Chiu Chien-Chih , Chien Chen-Yu , Wang Hsun-Mo , Chang Ning-Chia , Lin I-Ling , Chen Jeff Yi-Fu
Published: June 2020

Hypothesis:

Whereas autophagy has been linked to various human diseases, whether it also plays a role in cholesteatoma is virtually unknown. This study aimed to investigate the activity and regulation of autophagy in cholesteatoma.

Background:

The treatment of middle ear cholesteatoma has been challenging due to an insufficient understanding of the underlying disease mechanism.

Methods:

Expression of microtubule-associated protein 1A/1B-light chain 3 (LC3), the autophagy protein marker, and phosphorylated Akt (p-Akt), and mammalian target of rapamycin (p-mTOR), the known autophagy regulators, in fresh retroauricular skin and cholesteatoma tissue samples was analyzed by immunoblotting. The results were further confirmed by immunohistochemistry and statistical analyses. Cell proliferation of primary retroauricular skin- and cholesteatoma-derived fibroblasts was evaluated by methyl thiazol tetrazolium (MTT) assay. Ectopic expression of serine proteinase inhibitor, clade B, member 3 (SERPINB3) in the fibroblasts was achieved by electroporation and the expression was detected by immunoblotting.

Results:

LC3 expression was significantly decreased in cholesteatoma in most of the 15 paired retroauricular skin/cholesteatoma tissue samples. However, p-Akt and p-mTOR expression in the cholesteatoma samples was not significantly different from that in the control subjects. Immunohistochemical studies further demonstrated an inverse correlation between LC3 expression and cholesteatoma. The cholesteatoma fibroblasts proliferated faster than the retroauricular skin fibroblasts, and had higher SERPINB3 but lower LC3 expression. Furthermore, overexpression of SERPINB3 in the retroauricular skin fibroblasts enhanced cell proliferation and downregulated LC3 expression.

Conclusion:

Autophagy is significantly suppressed in cholesteatoma tissues, which may not involve the Akt/mTOR signaling pathway. More importantly, SERPINB3 may promote cell proliferation and negatively regulate autophagy in cholesteatoma fibroblasts. Together, these findings warrant further investigation into the pathogenic mechanism of cholesteatoma.
Gentamicin Vestibulotoxicity: Further Insights From a Large Clinical Series
Authors: Fu Terence S. , Carr Simon D. , Douglas-Jones Paul , Dillon Wanda , Ilan Ophir , Syed Iqbal Mohammed , Leis Jerome , Gold Wayne , Pothier David D. , Rutka John A.
Published: June 2020

Objective:

To review insights gained from a 21-year experience with gentamicin-induced vestibulotoxicity including differences in vestibulotoxicity between single daily dosing (SDD) and multiple daily dosing (MDD) regimens.

Study Design:

Retrospective case series.

Setting:

Tertiary care center.

Patients:

Patients with gentamicin vestibulotoxicity referred to the Hertz Multidisciplinary Neurotology Clinic between January 1993 and September 2014.

Intervention:

None.

Main Outcome Measures:

Spectrum of vestibular dysfunction measured using videonystagmography, vestibular evoked myogenic potentials, video head impulse testing, and magnetic scleral search coil testing.

Results:

Of 53 patients with gentamicin-induced vestibulotoxicity, 24 received SDD and 29 received MDD treatment. The most common indications for treatment were sepsis, endocarditis, and osteomyelitis. Angular acceleration receptor function (semicircular canals) was more commonly affected than linear acceleration receptor function (otolithic organ of the saccule; 100% vs. 62%). A significant proportion of patients (53%) developed vestibulotoxicity in the absence of nephrotoxicity and 40% experienced vestibulotoxicity in a delayed fashion up to 10 days posttreatment cessation (mean 3.9 ± 0.7). Therapeutic monitoring did not necessarily prevent delayed vestibulotoxicity. Nephrotoxicity was less common for SDD compared with MDD (60% vs. 35%, p = 0.01). However, the SDD group experienced vestibulotoxicity at a lower cumulative dose (6.3 vs. 7.0 g, p = 0.04) and shorter duration of therapy (20.7 vs 29.4 d, p = 0.02).

Conclusions:

Our study further highlights important insights regarding gentamicin-induced vestibulotoxicity. While SDD is associated with decreased risk for nephrotoxicity compared with MDD, it confers a higher risk for vestibulotoxicity.
Nitinol in Passive Ossicular Reconstruction—First Results From Temporal Bone Experiments
Authors: Bevis Nicholas , Schwarz David , Pazen David , Effertz Thomas , Beutner Dirk
Published: June 2020

Hypothesis:

Nitinol is a suitable material for passive middle ear prosthesis.

Background:

In modern ear microsurgery, the restitution of hearing is tremendously important. In passive ossicular reconstruction, rigid alloplastic materials are widespread in use. However, rigid prostheses fail to adapt to atmospheric pressure changes. We describe the use of the super-elastic material nitinol in passive ossicular reconstruction to overcome this limitation.

Methods:

Together with an industrial partner, we developed a nitinol clip prosthesis equipped with a flexible prosthesis headplate. The new prosthesis was evaluated for flexibility and its sound transmission properties were compared with standard clip prostheses. For this purpose, the sound-induced acceleration of the stapes footplate was measured by laser-doppler vibrometry in temporal bones. Furthermore, the flexibility of the prosthesis plate was tested in a load-cell experiment.

Results:

On average, the pure tone transmission characteristics of the nitinol prosthesis is statistically not distinguishable from standard titanium clip prostheses. The tests in the load cell confirmed the flexibility of the prosthesis. Any measured prosthesis returns to its original state after deformation.

Conclusion:

The newly developed nitinol clip prosthesis shows similar sound transmission properties in comparison to established prostheses with high flexibility indicating a step forward to a physiological ossicular chain reconstruction.