bluuebunny/crossref_metadata_2025 huggingface dataset:
Urban Ecology of Arboviral Mosquito Vectors Along the Kenyan Coast
Authors: Karisa Jonathan , Muriu Simon , Omuoyo Donwilliams , Karia Boniface , Ngari Moses , Nyamwaya Doris , Rono Martin , Warimwe George , Mwangangi Joseph , Mbogo Charles M
Published: July 2020

The purpose of this study was to determine the ecology of the common arboviral mosquito vectors in Mombasa, Kilifi and Malindi urban areas of coastal Kenya. Mosquito larvae were collected using standard dippers and pipettes. Egg survivorship in dry soil was evaluated by collecting soil samples from dry potential larval developmental sites, re-hydrating them for hatching and rearing of the eventual larvae to adults. Adult mosquitoes were collected with CDC light traps and BG-Sentinel traps. All blood-fed females were tested for bloodmeal origin. Mosquitoes were screened for arboviruses using RT-qPCR. Overall, the predominant species were Culex quinquefasciatus (Say) 72.4% (n = 2,364) and Aedes aegypti (L.), 25.7%, (n = 838). A total of 415 larval developmental sites were identified indoors (n = 317) and outdoors (n = 98). The most productive larval developmental sites, both indoors and outdoors, were assorted small containers, water tanks, drainages, drums, and jerricans. Overall, 62% (n = 18) of the soil samples collected were positive for larvae which were used as a proxy to measure the presence of eggs. The mosquitoes fed on humans (29.8%) and chickens (3.7%). Of 259 mosquitoes tested for viral infection, 11.6% were positive for Flavivirus only. The most productive larval developmental sites for arboviral vectors indoors were small containers, water tanks, jerricans, and drums whereas small containers, water tanks, drainage channels, buckets, tires, and water troughs were the productive larval developmental sites outdoors.
Tailgut cyst: from differential diagnosis to surgical resection—case report and literature review
Authors: de Castro Gouveia Gustavo , Okada Letícia Yukari , Paes Beatriz Pires , Moura Thalita Millene , da Conceição Júnior Amarildo Henrique , Pinheiro Rodrigo Nascimento
Published: July 2020

Tailgut cyst is a rare tumor originating from the embryonic remnant located in the retrorectal space. The diagnosis is usually incidental duse to the absence of symptoms. When present, they are nonspecific, such as abdominal pain, dysuria and tenesmus. Imaging tests are a great help in the diagnosis and surgical planning. The standard treatment is resection, which the surgeon must perform to avoid future complications, such as malignancy. We present a case of tailgut cyst in a young patient with prior pilonidal cyst excision, subsequently submitted to surgical resection, to share our experience with a rare case, with few reports in the literature.
Hydrogen sulfide promotes hypocotyl elongation via increasing cellulose content and changing the arrangement of cellulose fibrils in alfalfa
Authors: Li Jisheng , Wang Xiaofeng , Wang Xiao , Ma Peiyun , Yin Weili , Wang Yanqing , Chen Ying , Chen Shaolin , Jia Honglei
Published: July 2020

Hydrogen sulfide (H2S) is known to have positive physiological functions in plant growth, but limited data are available on its influence on cell walls. Here, we demonstrate a novel mechanism by which H2S regulates the biosynthesis and deposition of cell wall cellulose in alfalfa (Medicago sativa). Treatment with NaHS was found to increase the length of epidermal cells in the hypocotyl, and transcriptome analysis indicated that it caused the differential expression of numerous of cell wall-related genes. These differentially expressed genes were directly associated with the biosynthesis of cellulose and hemicellulose, and with the degradation of pectin. Analysis of cell wall composition showed that NaHS treatment increased the contents of cellulose and hemicellulose, but decreased the pectin content. Atomic force microscopy revealed that treatment with NaHS decreased the diameter of cellulose fibrils, altered the arrangement of the fibrillar bundles, and increased the spacing between the bundles. The dynamics of cellulose synthase complexes (CSCs) were closely related to cellulose synthesis, and NaHS increased the rate of mobility of the particles. Overall, our results suggest that the H2S signal enhances the plasticity of the cell wall by regulating the deposition of cellulose fibrils and by decreasing the pectin content. The resulting increases in cellulose and hemicellulose contents lead to cell wall expansion and cell elongation.
Feeling the heat: developmental and molecular responses of wheat and barley to high ambient temperatures
Authors: Jacott Catherine N , Boden Scott A
Published: July 2020

The increasing demand for global food security in the face of a warming climate is leading researchers to investigate the physiological and molecular responses of cereals to rising ambient temperatures. Wheat and barley are temperate cereals whose yields are adversely affected by high ambient temperatures, with each 1 °C increase above optimum temperatures reducing productivity by 5–6%. Reproductive development is vulnerable to high-temperature stress, which reduces yields by decreasing grain number and/or size and weight. In recent years, analysis of early inflorescence development and genetic pathways that control the vegetative to floral transition have elucidated molecular processes that respond to rising temperatures, including those involved in the vernalization- and photoperiod-dependent control of flowering. In comparison, our understanding of genes that underpin thermal responses during later developmental stages remains poor, thus highlighting a key area for future research. This review outlines the responses of developmental genes to warmer conditions and summarizes our knowledge of the reproductive traits of wheat and barley influenced by high temperatures. We explore ways in which recent advances in wheat and barley research capabilities could help identify genes that underpin responses to rising temperatures, and how improved knowledge of the genetic regulation of reproduction and plant architecture could be used to develop thermally resilient cultivars.
Gas kinematics of key prebiotic molecules in GV Tau N revealed with an ALMA, PdBI, and Herschel synergy
Authors: Fuente A , Treviño-Morales S P , Le Gal R , Rivière-Marichalar P , Pilleri P , Rodríguez-Baras M , Navarro-Almaida D
Published: July 2020

A large effort has been made to detect warm gas in the planet formation zone of circumstellar discs using space and ground-based near-infrared facilities. GV Tau N, the most obscured component of the GV Tau system, is an outstanding source, being one of the first targets detected in HCN and the only one detected in CH4 so far. Although near-infrared observations have shed light on its chemical content, the physical structure and kinematics of the circumstellar matter remained unknown. We use interferometric images of the HCN 3→2 and 13CO 3→2 lines, and far-IR observations of 13CO, HCN, CN, and H2O transitions to discern the morphology, kinematics, and chemistry of the dense gas close to the star. These observations constitute the first detection of H2O towards GV Tau N. Moreover, ALMA high spatial resolution (∼ 7 au) images of the continuum at 1.1 mm and the HCN 3→2 line resolve different gas components towards GV Tau N, a gaseous disc with R∼25 au, an ionized jet, and one (or two) molecular outflows. The asymmetric morphology of the gaseous disc shows that it has been eroded by the jet. All observations can be explained if GV Tau N is binary, and the primary component has a highly inclined individual disc relative to the circumbinary disc. We discuss the origin of the water and the other molecules emission according to this scenario. In particular, we propose that the water emission would come from the disrupted gaseous disc and the molecular outflows.
An update to the MARVEL data set and ExoMol line list for 12C2
Authors: McKemmish Laura K , Syme Anna-Maree , Borsovszky Jasmin , Yurchenko Sergei N , Tennyson Jonathan , Furtenbacher Tibor , Császár Attila G
Published: July 2020

The spectrum of dicarbon (C2) is important in astrophysics and for spectroscopic studies of plasmas and flames. The C2 spectrum is characterized by many band systems with new ones still being actively identified; astronomical observations involve eight of these bands. Recently, Furtenbacher et al. presented a set of 5699 empirical energy levels for 12C2, distributed among 11 electronic states and 98 vibronic bands, derived from 42 experimental studies and obtained using the MARVEL (Measured Active Rotational-Vibrational Energy Levels) procedure.

Here, we add data from 13 new sources and update data from 5 sources. Many of these data sources characterize high-lying electronic states, including the newly detected 3 3Πg state. Older studies have been included following improvements in the MARVEL procedure that allow their uncertainties to be estimated. These older works in particular determine levels in the C 1Πg state, the upper state of the insufficiently characterized Deslandres–d’Azambuja (C 1Πg–A 1Πu) band.

The new compilation considers a total of 31 323 transitions and derives 7047 empirical (marvel) energy levels spanning 20 electronic and 142 vibronic states. These new empirical energy levels are used here to update the 8states C2 ExoMol line list. This updated line list is highly suitable for high-resolution cross-correlation studies in astronomical spectroscopy of, for example, exoplanets, as 99.4 per cent of the transitions with intensities over 10−18 cm molecule−1 at 1000 K have frequencies determined by empirical energy levels.
Comprehensive and Functional Analysis of Horizontal Gene Transfer Events in Diatoms
Authors: Vancaester Emmelien , Depuydt Thomas , Osuna-Cruz Cristina Maria , Vandepoele Klaas
Published: July 2020

Diatoms are a diverse group of mainly photosynthetic algae, responsible for 20% of worldwide oxygen production, which can rapidly respond to favorable conditions and often outcompete other phytoplankton. We investigated the contribution of horizontal gene transfer (HGT) to its ecological success. A large-scale phylogeny-based prokaryotic HGT detection procedure across nine sequenced diatoms showed that 3–5% of their proteome has a horizontal origin and a large influx occurred at the ancestor of diatoms. More than 90% of HGT genes are expressed, and species-specific HGT genes in Phaeodactylum tricornutum undergo strong purifying selection. Genes derived from HGT are implicated in several processes including environmental sensing and expand the metabolic toolbox. Cobalamin (vitamin B12) is an essential cofactor for roughly half of the diatoms and is only produced by bacteria. Five consecutive genes involved in the final synthesis of the cobalamin biosynthetic pathway, which could function as scavenging and repair genes, were detected as HGT. The full suite of these genes was detected in the cold-adapted diatom Fragilariopsis cylindrus. This might give diatoms originating from the Southern Ocean, a region typically depleted in cobalamin, a competitive advantage. Overall, we show that HGT is a prevalent mechanism that is actively used in diatoms to expand its adaptive capabilities.
Ureidothiophene inhibits interaction of bacterial RNA polymerase with –10 promotor element
Authors: Harbottle John , Zenkin Nikolay
Published: July 2020

Bacterial RNA polymerase is a potent target for antibiotics, which utilize a plethora of different modes of action, some of which are still not fully understood. Ureidothiophene (Urd) was found in a screen of a library of chemical compounds for ability to inhibit bacterial transcription. The mechanism of Urd action is not known. Here, we show that Urd inhibits transcription at the early stage of closed complex formation by blocking interaction of RNA polymerase with the promoter –10 element, while not affecting interactions with –35 element or steps of transcription after promoter closed complex formation. We show that mutation in the region 1.2 of initiation factor σ decreases sensitivity to Urd. The results suggest that Urd may directly target σ region 1.2, which allosterically controls the recognition of –10 element by σ region 2. Alternatively, Urd may block conformational changes of the holoenzyme required for engagement with –10 promoter element, although by a mechanism distinct from that of antibiotic fidaxomycin (lipiarmycin). The results suggest a new mode of transcription inhibition involving the regulatory domain of σ subunit, and potentially pinpoint a novel target for development of new antibacterials.
The Effect of T1-Slope in Spinal Parameters After Cervical Disc Arthroplasty
Authors: Kuo Yi-Hsuan , Kuo Chao-Hung , Chang Hsuan-Kan , Fay Li-Yu , Tu Tsung-Hsi , Chang Chih-Chang , Cheng Henrich , Wu Ching-Lan , Lirng Jiing-Feng , Wu Jau-Ching , Huang Wen-Cheng
Published: July 2020

BACKGROUND

Although patients with cervical kyphosis are not ideal candidates for cervical disc arthroplasty (CDA), there is a paucity of data on patients with a straight or slightly lordotic neck.

OBJECTIVE

To correlate cervical lordosis, T1-slope, and clinical outcomes of CDA.

METHODS

The study retrospectively analyzed 95 patients who underwent 1-level CDA and had 2-yr follow-up. They were divided into a high T1-slope (≥28°) group (HTSG, n = 45) and a low T1-slope (<28°) group (LTSG, n = 50). Cervical spinal alignment parameters, including T1-slope, cervical lordosis (C2-7 Cobb angle), and segmental mobility (range of motion [ROM]) at the indexed level, were compared. The clinical outcomes were also assessed.

RESULTS

The mean T1-slope was 28.1 ± 7.0°. After CDA, the pre- and postoperative segmental motility remained similar and cervical lordosis was preserved. All the clinical outcomes improved after CDA. The HTSG were similar to the LTSG in age, sex, segmental mobility, and clinical outcomes. However, the HTSG had higher cervical lordosis than the LTSG. Furthermore, the LTSG had increased cervical lordosis (ΔC2-7 Cobb angle), whereas the HTSG had decreased lordosis after CDA. Patients of the LTSG, who had more improvement in cervical lordosis, had a trend toward increasing segmental mobility at the index level (ΔROM) than the HTSG.

CONCLUSION

In this series, T1-slope correlated well with global cervical lordosis but did not affect the segmental mobility. After CDA, the changes in cervical lordosis correlated with changes in segmental mobility. Therefore, segmental lordosis should be cautiously preserved during CDA as it could determine the mobility of the disc.
Beyond the Superficial: Disseminated Trichophyton rubrum Infection in a Kidney Transplant Recipient
Authors: Trottier Caitlin A , Jhaveri Vimal V , Zimarowski Mary Jane , Blair Barbra M , Alonso Carolyn D
Published: July 2020

Superficial dermatophyte infections are common in the general population and are readily treated with topical antifungals. Deeper invasion is rare, and dissemination to visceral organs is extremely uncommon. We describe a 66-year-old renal transplant recipient who developed disseminated Trichophyton rubrum infection while undergoing treatment for acute humoral rejection. The infection presented as a facial rash with subsequent dissemination to the lungs and chest wall. All sites of infection improved with combination administration of oral posaconazole and terbinafine. In this work, we review the available literature regarding management of disseminated Trichophyton infection and discuss therapeutic interventions for disseminated dermatophytosis in immunosuppressed hosts.
The neural networks underlying reappraisal of empathy for pain
Authors: Naor Navot , Rohr Christiane , Schaare Lina H , Limbachia Chirag , Shamay-Tsoory Simone , Okon-Singer Hadas
Published: July 2020

Emotion regulation plays a central role in empathy. Only by successfully regulating our own emotions can we reliably use them in order to interpret the content and valence of others’ emotions correctly. In an functional magnetic resonance imaging (fMRI)-based experiment, we show that regulating one’s emotion via reappraisal modulated biased emotional intensity ratings following an empathy for pain manipulation. Task-based analysis revealed increased activity in the right inferior frontal gyrus (IFG) when painful emotions were regulated using reappraisal, whereas empathic feelings that were not regulated resulted in increased activity bilaterally in the precuneus, supramarginal gyrus and middle frontal gyrus (MFG), as well as the right parahippocampal gyrus. Functional connectivity analysis indicated that the right IFG plays a role in the regulation of empathy for pain, through its connections with regions in the empathy for pain network. Furthermore, these connections were further modulated as a function of the type of regulation used: in sum, our results suggest that accurate empathic judgment (i.e. empathy that is unbiased) relies on a complex interaction between neural regions involved in emotion regulation and regions associated with empathy for pain. Thus, demonstrating the importance of emotion regulation in the formulation of complex social systems and sheds light on the intricate network implicated in this complex process.
Rediscovering Dana: The Forgotten Black Coal Miners of Southern Wyoming
Authors: Blasi Brigida R
Published: July 2020

When coal was king in late nineteenth century Wyoming, the industry was dominated by the Union Pacific Coal Company (UPCC). Operating dozens of mines throughout the high deserts of southwestern and south-central Wyoming well into the twentieth century, the UPCC’s economic success was thanks in large part to its practice of creating wage competition among its carefully recruited pool of multinational and multiethnic laborers. Unsurprisingly, the company’s first recruited group of Black miners were brought in as strikebreakers. They came to a short-lived coal town called Dana about 150 miles west of Cheyenne. Instead of playing the company's intended role, the Black miners greatly influenced early labor reform efforts and the trend of Black western migration and settlement. This article contributes to the scholarship on Black laborers in the West by examining the story of Dana’s Black miners, their role in the passage of fair labor legislation, and their subsequent removal from the historical record. By both building on recent methodologies and utilizing tools of historical interpretation often dismissed or minimized outside the practice of public history, such as genealogy, this article also argues that restoring individual identity augments perception of overall migrant group experience and significance in the evolution of the social and industrial landscape of the U.S. West.
Challenges and Facilitators of Implementing a Physician-approved Naloxone Protocol: A Mixed-methods Study
Authors: Hincapie Ana L. , Hegener Michael , Heaton Pamela C. , Fish Gabrielle , Fetters Kathryn , Sneed Gregory T. , Koechlin Kathleen , DeFiore-Hyrmer Jolene , Holthusen Amy , MacKinnon Neil J.
Published: July 2020

Objectives:

In 2015, the State of Ohio passed legislation to allow pharmacists to dispense naloxone under a physician-approved protocol. The legislation allows all individuals authorized under a physician-approved protocol to personally furnish naloxone without requiring clients to be seen by a licensed prescriber, thus expanding the capacity of Ohio's community distribution programs. We aimed to evaluate the implementation of legislation allowing for a physician-approved protocol in pharmacies and other naloxone distribution sites in Ohio, and to compare barriers and facilitators of implementing the law changes among sites that implemented a physician-approved protocol versus sites that did not.

Methods:

The study used a convergent parallel mixed-method design. Random samples from all pharmacies registered with the State of Ohio Board of Pharmacy and community naloxone distribution sites were selected. Quantitative data were collected via survey (n = 168) and qualitative data were collected via semi-structured interviews (n = 17).

Results:

Most survey respondents agreed that the policy has expanded access to naloxone at their site for individuals who want or need the medication. Both pharmacies and other naloxone distribution sites identified that leadership and organizational support facilitated protocol implementation and cost, stigma, and lack of naloxone demand challenged protocol implementation.

Conclusions:

The study identified barriers and facilitators to the implementation of a physician-approved protocol within Ohio. The majority of respondents stated they could implement a protocol. However, barriers of cost, lack of public awareness of naloxone availability, and stigma remain for pharmacies and other naloxone distribution sites.
Systematic Review and Synthesis of Mechanism-based Classification Systems for Pain Experienced in the Musculoskeletal System
Authors: Shraim Muath A. , Massé-Alarie Hugo , Hall Leanne M. , Hodges Paul W.
Published: July 2020

Objectives:

Improvements in pain management might be achieved by matching treatment to underlying mechanisms for pain persistence. Many authors argue for a mechanism-based classification of pain, but the field is challenged by the wide variation in the proposed terminology, definitions, and typical characteristics. This study aimed to (1) systematically review mechanism-based classifications of pain experienced in the musculoskeletal system; (2) synthesize and thematically analyze classifications, using the International Association for the Study of Pain categories of nociceptive, neuropathic, and nociplastic as an initial foundation; and (3) identify convergence and divergence between categories, terminology, and descriptions of each mechanism-based pain classification.

Materials and Methods:

Databases were searched for papers that discussed a mechanism-based classification of pain experienced in the musculoskeletal system. Terminology, definitions, underlying neurobiology/pathophysiology, aggravating/easing factors/response to treatment, and pain characteristics were extracted and synthesized on the basis of thematic analysis.

Results:

From 224 papers, 174 terms referred to pain mechanisms categories. Data synthesis agreed with the broad classification on the basis of ongoing nociceptive input, neuropathic mechanisms, and nociplastic mechanisms (eg, central sensitization). “Mixed,” “other,” and the disputed categories of “sympathetic” and “psychogenic” pain were also identified. Thematic analysis revealed convergence and divergence of opinion on the definitions, underlying neurobiology, and characteristics.

Discussion:

Some pain categories were defined consistently, and despite the extensive efforts to develop global consensus on pain definitions, disagreement still exists on how each could be defined, subdivided, and their characteristic features that could aid differentiation. These data form a foundation for reaching consensus on classification.
Safety Profile, Surgical Technique, and Early Clinical Results for Simultaneous Lateral Lumbar Interbody Fusion and Anterior Lumbar Interbody Fusion in a Lateral Position
Authors: Virk Sohrab , Iyer Sravisht , Ellozy Sharif , Qureshi Sheeraz
Published: July 2020

Study Design:

Description of surgical technique and retrospective review.

Objective:

To describe a novel surgical technique for multilevel lumbar fusion and describe early clinical results.

Summary of Background Data:

Patients with multilevel lumbar spinal stenosis and adult degenerative scoliosis often require multilevel interbody placement to achieve indirect decompression and lordosis. We describe a case series of patients treated with simultaneous lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) at L5–S1.

Methods:

We retrospectively reviewed a consecutive series of patients treated for multilevel lumbar spinal stenosis with simultaneous ALIF and LLIF with at least 3-month follow-up. All patients received supplemental percutaneous bilateral pedicle screw placement as well. We measured on preoperative radiographs their lumbar lordosis, pelvic incidence, and L5–S1 lordosis. Intraoperative factors such as operative time, estimated blood loss, fluids provided, number of levels fused, and whether a trainee was present during the procedure were all recorded.

Results:

There were 15 patients included within our case series (69.5, 4 F). There were no reported intraoperative vascular or neurological complications in 15 cases. The operative time for the cases ranged from 2.7 to 8.4 hours (average=5.2±1.9 h). The average lordosis gained at L5–S1 was 8.6±3.0 degrees and the average lumbar lordosis gained was 14.7±6.4 degrees. The average PI-LL mismatch went from 22.4±13.3 degrees preoperative to 7.8±10.2 degrees postoperative. One patient had a postoperative complication of a sacral fracture requiring placement of a pelvic screw for a L2-pelvis fusion. There were 8 patients with 4+ levels of fusion. For this cohort of patients, the average lumbar lordosis gained was 16.0±7.5 degrees and the average PI-LL mismatch went from 24.7±16.3 degrees preoperative to 8.8±12.9 degrees postoperative. For the patients with 4+ levels of fusion, the average operative time was 5.9±1.8 hours.

Conclusions:

We have described our early positive results with simultaneous LLIF/ALIF surgery for treatment of lumbar degenerative conditions.
Thecal Transection and Canal Fusion With Structural Allograft for Refractory Charcot Spinal Arthropathy
Authors: Sedney Cara L. , Adams Samuel , Daffner Scott , France John C.
Published: July 2020

Charcot spinal arthropathy presents significant surgical challenges, with large bony defects and limitations in fixation and reconstruction which are exacerbated in often numerous revision surgeries. These challenges make the development of additional salvage techniques useful. We report on a technique of thecal transection and canal fusion with structural allograft as a salvage technique for refractory cases of Charcot spinal arthropathy. We illustrate the technique with 4 procedures done in 3 patients, over a period of 10 years.
Interpretation of Fetal Heart Rate Monitoring in the Clinical Context
Authors: HOLMGREN CALLA
Published: July 2020

Use of intrapartum fetal heart rate (FHR) monitoring has had limited success in preventing hypoxic injury to neonates. One of the most common limitations of FHR interpretation is the failure to consider chronic and acute clinical factors that may increase the risk of evolving acidemia. This manuscript reviews common clinical factors that may affect the FHR and should be considered when determining the need for early intervention based on changes in the FHR.
An Improved Technique of Subtotal Cochleoectomy for Removal of Intracochlear Schwannoma and Single-stage Cochlear Implantation
Authors: Plontke Stefan K.
Published: July 2020

Cochlear implantation in patients with intracochlear schwannomas has been reported anecdotally in case reports or small case series (1–5). The applied techniques have varied considerably ranging from extended cochleostomy (2–4), “push-through” and ”pull-through” techniques (3,4), partial and subtotal cochleoectomy (4) to cochlear implant insertion through the tumor (5). We here illustrate (see Video, Supplemental Digital Content 1, http://links.lww.com/MAO/A999) our improved surgical technique of subtotal cochleoectomy for tumor removal, cochlear implantation, and cochlear defect reconstruction with a “cartilage-in-perichondrium-bed” technique. The perimodiolar electrode array was closely placed around the preserved modiolus of the basal and second turn. It was stabilized and the electrodes were further approximated to the spiral ganglion cells in Rosenthal's canal with cartilage chips peripheral to the array. Despite substantial trauma to the cochlear capsule, surprisingly good results with respect to hearing rehabilitation were observed (word recognition score for monosyllables: 75% at 65 dB SPL, 18 mo after surgery). This good outcome is in accordance with recent case series on cochlear implantation after intracochlear tumor removal (6,7).
The Transmastoid Retrolabyrinthine Approach in Acoustic Neuroma Surgery: Our Experience in 189 Patients
Authors: Bento Ricardo Ferreira , Lopes Paula Tardim
Published: July 2020

Objective:

This study aimed to describe our experience with the retrolabyrinthine or infralabyrinthine approach in acoustic neuroma surgery, and to discuss its advantages, limitations, complications, and the outcomes of hearing and facial function preservation.

Study Design:

This study was a retrospective analysis of all acoustic neuroma cases, operated with a retrolabyrinthine approach in our hospital.

Setting:

This study was conducted at a tertiary university hospital.

Patients:

In total, 189 patients underwent hearing preservation and acoustic neuroma surgery, operated through the retrolabyrinthine approach, in our department. The average age was 43.6 years; there were 105 women and 84 men. All patients had unilateral tumors, 99 occurring in the right ear and 90 in the left ear.

Intervention:

A retrolabyrinthine approach was performed in all 189 patients to remove vestibular schwannoma.

Main Outcome Measures:

All tumors graded I and II using Koos tumor grading with serviceable hearing when the speech reception threshold (SRT) was better than 50 dB, and word recognition scores of 50% or higher.

Results:

Considering the 189 patients, good exposure of the internal auditory canal was possible in all patients, with total removal of the tumor in all patients, even though it was necessary to sacrifice the posterior canal in 12 of the cases, all classified as Koss II. Hearing was preserved in 49.73% of patients; 1% had permanent grade II House–Brackmann facial paralysis.

Conclusions:

The retrolabyrinthine approach showed security during facial nerve manipulation, small chance of morbidity, and good proportion of hearing preservation when tumor are up to Koss I and II classification.
Simultaneous Vestibular Schwannoma Resection and Cochlear Implantation Using Electrically Evoked Auditory Brainstem Response Audiometry for Decision-making
Authors: Dahm Valerie , Auinger Alice B. , Honeder Clemens , Riss Dominik , Landegger Lukas D. , Moser Gerhard , Matula Christian , Arnoldner Christoph
Published: July 2020

Objective:

The aim of the study was to evaluate the predictive value regarding postoperative hearing benefit of electrically evoked auditory brainstem response audiometry in sporadic vestibular schwannoma patients undergoing simultaneous tumor resection and cochlear implantation.

Design:

Patients were included in a prospective study conducted between October 2016 and January 2019.

Setting:

The study was conducted at a tertiary care center.

Participants:

Subjects with unilateral sporadic vestibular schwannoma were screened for study participation. Patients underwent translabyrinthine vestibular schwannoma resection and cochlear implantation simultaneously.

Intervention:

Electrically evoked brainstem response audiometry was performed during surgery before and after tumor removal using an intracochlear test electrode to objectively evaluate nerve conduction.

Main Outcome Measure:

Electrically evoked brainstem response audiometry results were correlated with postoperative sound field audiometry, word recognition tests, and speech reception thresholds. Quality of life was assessed before and 12 months after translabyrinthine tumor removal and cochlear implantation.

Results:

Five patients, three male and two female, were included in the study and followed for at least 1 year after implantation. Three of the five patients are daily cochlear implant users with open set speech recognition. Two individuals with negative intraoperative electrically evoked auditory brainstem response results showed no auditory perception with cochlear implant.

Conclusions:

Simultaneous translabyrinthine vestibular schwannoma resection and cochlear implantation with intraoperative electrically evoked auditory brainstem response measurements is a feasible and promising option for sporadic vestibular schwannoma patients. Preservation of electrically evoked auditory brainstem responses seems to predict good subsequent hearing outcomes.
Systematic Review of Surgical Outcomes Following Repair of Patulous Eustachian Tube
Authors: Ikeda Ryoukichi , Hidaka Hiroshi , Kikuchi Toshiaki , Ohta Nobuo , Kawase Tetsuaki , Katori Yukio , Kobayashi Toshimitsu
Published: July 2020

Objective:

To perform a systematic review and meta-analysis of surgical outcomes following repair of patulous Eustachian tube (PET).

Data Sources:

Analysis of cases collected from studies published between January 1990 and December 2018 and identified using PubMed, Google Scholar, and Cochrane databases.

Study Selection:

Articles addressing interventions to treat PET were selected.

Data Extraction:

The database was searched using the keywords “patulous Eustachian tube treatment” and yielded 1,370 studies. Twenty studies were eligible for inclusion.

Data Synthesis:

A total of 914 cases were evaluated for surgical approach, patient outcomes, and complications. The reported techniques were categorized by the procedure type, including ventilation tube insertion, mass loading of the tympanic membrane, ET injection, plug surgery, shim surgery, tuboplasty, and ET closure. Overall PET symptom improvement were reported for ventilation tube insertion (79 cases, mean: 58%, 95% CI: 47–69%), mass loading of the tympanic membrane (43 cases, mean: 50%, 95% CI: 32–69%), ET injection (139 cases, mean: 47%, 95% CI: 38–56%), plug surgery (386 cases, mean: 81%, 95% CI: 77–85%), shim surgery (122 cases, mean: 62%, 95% CI: 53–70%), tuboplasty (105 cases, mean: 41%, 95% CI: 31–51%), and ET closure (40 cases, mean: 66%, 95% CI: 49–80%). A low incidence of minor complications was reported.

Conclusions:

This systematic review describes clinical outcome data following surgical management of PET. Plug surgery and shim surgery show relatively high effectiveness and safety. Further prospective studies that compare surgical approaches for PET are needed.
Natural History of Growing Sporadic Vestibular Schwannomas: An Argument for Continued Observation Despite Documented Growth in Select Cases
Authors: Marinelli John P. , Lees Katherine A. , Lohse Christine M. , Driscoll Colin L.W. , Neff Brian A. , Link Michael J. , Van Gompel Jamie J. , Carlson Matthew L.
Published: July 2020

Objective:

Definitive treatment of sporadic vestibular schwannoma (VS) following documented growth is common practice at most centers in the United States. However, as a natural extension of this paradigm, very little evidence exists surrounding the natural history of growing tumors. The primary objective of the current work was to describe the natural history of sporadic VS following documentation of initial tumor growth.

Study Design:

Retrospective cohort study.

Setting:

Tertiary referral center.

Patients:

Patients diagnosed with sporadic VS between January 1, 2001 and December 31, 2015 who elected continued observation despite having volumetric growth ≥20% of original tumor volume on interval magnetic resonance imaging (MRI).

Main Outcome Measure:

Survival free of subsequent volumetric growth.

Results:

Of 361 patients undergoing observation with serial imaging during the study period, 85 patients met inclusion criteria at a median age of 66 years (interquartile ranges [IQR] 55–71). Within this cohort, 40 patients demonstrated subsequent volumetric growth at a median of 1.7 years (IQR 1.0–2.6) from the date of initial MRI that documented growth. The median volumetric growth was 43% (IQR 28–57), and the median growth rate was 0.026 cm3 per year (IQR 0.009–0.107). Survival free of subsequent volumetric growth rates (95% CI; number still at risk) at 1, 2, 3, 4, and 5 years were 93% (87–99; 75), 67% (58–79; 45), 54% (43–67; 29), 44% (33–59; 19), and 41% (30–56; 12), respectively.

Conclusions:

In a cohort exclusively comprised of sporadic VS with documented growth, over 40% of tumors demonstrated no subsequent volumetric growth after 5 years of continued MRI surveillance. These data challenge the supposition that once growth occurs, all tumors will exhibit sustained growth. Continued observation after documented growth of sporadic VS is a reasonable consideration in appropriately selected cases.
Fluctuations in Subjective Tinnitus Ratings Over Time: Implications for Clinical Research
Authors: Chen Jenny X. , Whitton Jonathon P. , Parthasarathy Aravindakshan , Hancock Kenneth E. , Polley Daniel B.
Published: July 2020

Objective:

Patients with chronic, subjective tinnitus are often administered a battery of audiometric tests to characterize their tinnitus percept. Even a comprehensive battery, if applied just once, cannot capture fluctuations in tinnitus strength or quality over time. Moreover, subjects experience a learning curve when reporting the detailed characteristics of their tinnitus percept, such that a single assessment will reflect a lack of familiarity with test requirements. We addressed these challenges by programming an automated software platform for at-home tinnitus characterization over a 2-week period.

Study Design:

Prospective case series.

Setting:

Tertiary referral center, patients’ homes.

Interventions:

Following an initial clinic visit, 25 subjects with chronic subjective tinnitus returned home with a tablet computer and calibrated headphones to complete questionnaires, hearing tests, and tinnitus psychoacoustic testing. We repeatedly characterized loudness discomfort levels and tinnitus matching over a 2-week period.

Main Outcome Measures:

Primary outcomes included intrasubject variability in loudness discomfort levels, tinnitus intensity, and tinnitus acoustic matching over the course of testing.

Results:

Within-subject variability for all outcome measures could be reduced by approximately 25 to 50% by excluding initial measurements and by focusing only on tinnitus matching attempts where subjects report high confidence in the accuracy of their ratings.

Conclusions:

Tinnitus self-report is inherently variable but can converge on reliable values with extended testing. Repeated, self-directed tinnitus assessments may have implications for identifying malingerers. Further, these findings suggest that extending the baseline phase of tinnitus characterizations will increase the statistical power for future studies focused on tinnitus interventions.
Inner Ear Enhancement With Delayed 3D-FLAIR MRI Imaging in Vestibular Schwannoma
Authors: Bowen Andrew J. , Carlson Matthew L. , Lane John I.
Published: July 2020

Objectives:

To evaluate blood–labyrinth barrier permeability using delayed gadolinium enhanced three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) in patients with untreated sporadic vestibular schwannoma (VS) to interrogate the etiopathogenesis of progressive sensorineural hearing loss.

Design:

Prospective case series.

Setting:

Single institution tertiary care center.

Participants:

Patients with previously untreated small to medium-sized unilateral VS undergoing 3D-FLAIR imaging 10 minutes (immediate) and 5 to 8 hours (delayed) after administration of intravenous gadolinium.

Main Outcome Measures:

Comparison of cochlear and vestibular signal intensity ratios (SIRs) across immediate and delayed images and across the tumor and nontumor ear.

Results:

Six of eight (75%) patients demonstrated asymmetric enhancement of inner ear structures on delayed contrast-enhanced imaging. Delayed mean cochlea and vestibule SIRs were significantly greater than immediate SIRs (cochlea: 1.91 versus 1.21 [p = 0.02]; vestibule 1.74 versus 1.15 [p = 0.02]). A higher vestibule SIR was statistically significantly associated with poorer pure-tone average and word recognition scores (p = 0.001).

Conclusion:

Ears with VS exhibited increased enhancement on delayed 3D FLAIR imaging. These findings suggest that alterations in blood–labyrinth barrier permeability may explain progressive sensorineural hearing loss in a subset of patients with untreated VS.
Uniform Registration Agreements on Cholesteatoma Care: A Nationwide Consensus Procedure
Authors: ten Tije Fleur A. , Pauw Robert J. , Braspenning Jozé C. , Hemler Raphael J. B. , ter Schiphorst Annette J. , Hensen Erik F. , van der Putten Lisa , Kramer Sophia E. , Merkus Paul
Published: July 2020

Background:

To coordinate and align the content for registration of cholesteatoma care.

Methods:

Systematic Delphi consensus procedure, consisting three rounds: two written sessions followed by a face-to-face meeting. Before this procedure, input on important patient outcomes was obtained. Consensus was defined as at least 80% agreement by participants. Hundred-thirty-six adult patients who had undergone cholesteatoma surgery and all ENT surgeons of the Dutch ENT Society were invited. The consensus rounds were attended by ENT surgeons with cholesteatoma surgery experience. Feasibility and acceptability of outcome measures and reporting agreements were assessed in round 1 by 150 ENT surgeons. In round 2 definitions were narrowed and context information to interpret outcome measure were questioned. In round 3, the results, amendments, and the open-ended points were discussed to reach agreement.

Results:

Most important outcome measures are: 1) the presence or absence of a cholesteatoma in the first 5 years after surgical removal of cholesteatoma, 2) hearing level after surgical removal of cholesteatoma, and 3) the documented assessment of patient's complaints with a validated patient reported outcome measures questionnaire (PROM). Furthermore, consensus was reached on the registration of cholesteatoma type (residual/recurrent), localization of cholesteatoma, and reporting of the presence of cholesteatoma in the follow-up.

Conclusion:

Consensus was reached on the content and method of registration of cholesteatoma care based on patient's and ENT surgeons input. Three outcome measures were defined. National agreements on the method and content of registration will facilitate monitoring and feedback to the ENT surgeon about the cholesteatoma care.
Cochlear Implant Infections and Outcomes: Experience From a Single Large Center
Authors: Vijendren Ananth , Ajith Amritha , Borsetto Daniele , Tysome James R. , Axon Patrick R. , Donnelly Neil P. , Bance Manohar L.
Published: July 2020

Objective:

To review our experience with cochlear implant infections over the past 5 years, the management strategy and to identify predictive factors that led to explantation.

Study Design:

Retrospective record-base case series of cochlear implant infections.

Setting:

Tertiary otology and implant center.

Patients:

All patients who had cochlear implantation over a period of 5 years.

Intervention(s):

None.

Main Outcome Measure(s):

To identify risk factors, rates and outcomes of cochlear implant infections, and to formulate strategies to develop clearer management protocols to prevent cochlear implant explantation.

Results:

Of 704 implanted patients, 22 suffered a postoperative soft tissue infection (3%). Fifty-nine percent of these infected patients resulted in explantation, giving an explantation rate of 1.8% over the whole study population. One hundred percent of the infected implants identified as having either Staph. Aureus or Pseudomonas spp. as the single causative organism resulted in explantation.

Conclusions:

There is a high rate of explantation when infection is detected. Currently there is no clear consensus on medical management, such as choice of antibiotics or length of antibiotic course. A registry of cochlear implants would facilitate standard reporting methods for severity and type of infection, to be able to pool data across centers and form a more robust management protocol for cochlear implant infections.
Maternal Microchimerism in Cord Blood and Risk of Celiac Disease in Childhood
Authors: Tapia German , Mortimer Georgina , Ye Jody , Mårild Karl , Chipper‐Keating Saranna , Gillard Benjamin T. , Viken Marte K. , Lie Benedicte A. , Stene Lars C. , Gillespie Kathleen M. , Størdal Ketil
Published: July 2020

Objectives:

During pregnancy, small quantities of maternal cells are naturally transmitted to the fetus. This transmission, termed maternal microchimerism (MMc), has been implicated in autoimmune diseases but its potential role is unclear. We aimed to investigate if MMc at birth predicted childhood celiac disease (CD) risk, a common immune‐mediated enteropathy often presenting in childhood.

Methods:

We designed a case‐control study, nested in the Norwegian Mother, Father and Child Cohort. Participants were HLA class II typed to determine noninherited, nonshared maternal alleles (NIMA). Droplet digital (dd) PCR assays specific for common HLA class II NIMAs (HLA‐DQB1*03:01, *04:02 and *06:02/03) were used to estimate the quantity of maternal DNA, as a marker of maternal cells, in cord blood DNA from 124 children who later developed clinically diagnosed CD (median age at end of study 7.4 years, range 3.6–12.9) and 124 random controls. We tested whether presence of MMc was associated with CD using logistic regression, and compared ranks between cases and controls.

Results:

MMc, for example, maternal HLA antigens not inherited by the child, was found in 42% of cases and 43% of controls, and not associated with CD (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.58–1.60). The ranks of MMc quantities in cases and controls were also similar (Mann‐Whitney U‐test, P = 0.71). The subgroup with HLA‐DQB1:03*01 as their NIMA had a potential association with MMc, where levels greater than median was associated with CD (OR 3.78, 95% CI 1.28–11.18).

Conclusion:

MMc measured in cord blood was not associated with later risk of CD.
Using Eosinophil Biomarkers From Rectal Epithelial Samples to Diagnose Food Protein‐induced Proctocolitis
Authors: de Boer Justin , Deb Chirajyoti , Bornstein Jeffrey , Horvath Karoly , Mehta Devendra , Smadi Yamen
Published: July 2020

Objectives:

The gold standard diagnostic procedure for food protein‐induced proctocolitis (FPIP) requires flexible sigmoidoscopy (FS). To date there is no validated, noninvasive test to confirm FPIP diagnosis. Eosinophil‐derived neurotoxin (EDN), a product of eosinophil (EOS) degranulation, has been shown to correlate with eosinophil infiltration in other tissues. Our objective was to compare EDN concentrations in rectal epithelial samples from infants with FPIP with those from a control population.

Methods:

Children who underwent routine FS at Arnold Palmer Hospital for Children were enrolled in an IRB‐approved, prospective, open‐label pilot study between July 2017 and May 2019. We obtained rectal epithelial samples via: rectal swab, cytology brushing through FS, and rectal biopsy through FS. We then measured EDN levels in the samples and compared levels found in infants with FPIP against levels found in the control group. FPIP was defined as more than 60 EOS per 10 high‐power fields (HPF) in rectal epithelial tissue obtained via rectosigmoid biopsy.

Results:

Twenty‐four patients were enrolled. The control group (n = 13) included patients with normal histopathology (84% boys, mean age 19 months, SD 6 months) and the FPIP group (n = 11) included patients with FPIP confirmed via biopsy (45% boys, mean age 6.9 months, SD 9 months). EDN concentration was significantly higher in the FPIP group than in the control group, for 2 sampling methods: rectal biopsy (183.6 ± 114.6 vs 76.6 ± 71.0 μg/mL; P = 0.010) and rectal swab (66.2 ± 64.8 vs 20.4 ± 22.2 μg/mL; P = 0.025).

Conclusions:

EDN concentrations measured from rectal swab and rectal biopsy samples is elevated and may be a useful tool to screen for FPIP in children.