bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic Normal-Pressure Hydrocephalus: Diagnostic Accuracy of Automated Sulcal Morphometry in Patients With Ventriculomegaly
Authors: Kuchcinski Grégory , Jacquiez Caroline , Baroncini Marc , Machuron François , Béhal Hélène , Dumont Julien , Lopes Renaud , Delmaire Christine , Lebouvier Thibaud , Bottlaender Michel , Bordet Regis , Defebvre Luc , Pruvo Jean-Pierre , Leclerc Xavier , Hodel Jérôme
Published: March 2019

BACKGROUND

Idiopathic normal-pressure hydrocephalus (iNPH) is a treatable cause of gait and cognitive impairment. iNPH should be differentiated from ventriculomegaly secondary to brain atrophy to choose the best therapeutic option (ventriculoperitoneal shunt vs medical management).

OBJECTIVE

To determine the diagnostic accuracy of automated sulcal morphometry to differentiate patients with iNPH from patients with ventriculomegaly of neurodegenerative origin.

METHODS

Thirty-eight consecutive patients with iNPH (shunt responsive n = 31, nonresponsive n = 7), 35 with vascular cognitive disorder, and 25 age- and sex-matched healthy controls were prospectively included and underwent cognitive evaluation and 3T brain magnetic resonance imaging. Sulcal opening of 10 sulci of interest was retrospectively measured using an automated surface-based approach from the 3-dimensional T1-weighted images. Receiver-operating characteristic curve analyses determined the best parameter to identify iNPH patients.

RESULTS

The best parameter to discriminate shunt-responsive iNPH from patients with vascular cognitive disorder and healthy controls was the ratio between calcarine sulcus and cingulate sulcus opening with an area under the curve of 0.94 (95% CI: 0.89, 0.99). A cut-off value of 0.95 provided the highest sensitivity (96.8%) and specificity (83.3%).

CONCLUSION

This preliminary study showed that automated sulcal morphometry may help the neurosurgeon to identify iNPH patients and to exclude other causes of ventriculomegaly.
The Involvement of Jasmonic Acid, Ethylene, and Salicylic Acid in the Signaling Pathway of Clonostachys rosea-Induced Resistance to Gray Mold Disease in Tomato
Authors: Wang Qiuying , Chen Xiuling , Chai Xinfeng , Xue Dongqi , Zheng Wei , Shi Yuying , Wang Aoxue
Published: March 2019

Tomato gray mold disease caused by Botrytis cinerea is a serious disease that threatens tomato production around the world. Clonostachys rosea has been used successfully as a biocontrol agent against divergent plant pathogens, including B. cinerea. To understand the signal transduction pathway of C. rosea-induced resistance to tomato gray mold disease, the effects of C. rosea on gray mold tomato leaves along with changes in the activities of three defense enzymes (phenylalanine ammonialyase [PAL], polyphenol oxidase [PPO], and catalase [CAT]), second messengers (nitric oxide [NO], hydrogen peroxide [H2O2], and superoxide anion radical [O2−]), and stress-related genes (mitogen-activated protein kinase [MAPK], WRKY, Lexyl2, and atpA) in four different hormone-deficient (jasmonic acid [JA], ethylene [ET], salicylic acid [SA], and gibberellin) tomato mutants were investigated. The results revealed that C. rosea significantly inhibited the growth of mycelia and spore germination of B. cinerea. Furthermore, it reduced the incidence of gray mold disease, induced higher levels of PAL and PPO, and induced lower levels of CAT activities in tomato leaves. Moreover, it also increased NO, H2O2, and O2− levels and the gene expression levels of WRKY, MAPK, atpA, and Lexyl2. The incidence of gray mold disease in four hormone-deficient mutants was higher than that in the corresponding wild-type tomato plants. Among all of these hormone-deficient tomato mutants, JA had the most significant effect in regulating the different signal molecules. Additional study suggested that JA upregulated the expression of Lexyl2, MAPK, and WRKY but downregulated atpA. Furthermore, JA also enhanced the activity of PAL, PPO, and CAT and the production of NO and H2O2. SA downregulated CAT and PAL, whereas ET upregulated PAL but downregulated CAT. This study is of significance in understanding the regulatory pathways and biocontrol mechanism of C. rosea against B. cinerea.
Prediction of Spread and Regional Development of Hop Powdery Mildew: A Network Analysis
Authors: Gent David H. , Bhattacharyya Sharmodeep , Ruiz Trevor
Published: March 2019

Dispersal is a fundamental aspect of epidemic development at multiple spatial scales, including those that extend beyond the borders of individual fields and to the landscape level. In this research, we used the powdery mildew of the hop pathosystem (caused by Podosphaera macularis) to formulate a model of pathogen dispersal during spring (May to June) and early summer (June to July) at the intermediate scale between synoptic weather systems and microclimate (mesoscale) based on a census of commercial hop yards during 2014 to 2017 in a production region in western Oregon. This pathosystem is characterized by a low level of overwintering of the pathogen as a result of absence of the ascigerious stage of the fungus and consequent annual cycles of localized survival via bud perennation and pathogen spread by windborne dispersal. An individual hop yard was considered a node in the model, whose disease status in a given month was expressed as a nonlinear function of disease incidence in the preceding month, susceptibility to two races of the fungus, and disease spread from other nodes as influenced by their disease incidence, area, distance away, and wind run and direction in the preceding month. Parameters were estimated by maximum likelihood over all 4 years but were allowed to vary for time transition periods from May to June and from June to July. The model accounted for 34 to 90% of the observed variation in disease incidence at the field level, depending on the year and season. Network graphs and analyses suggest that dispersal was dominated by relatively localized dispersal events (<2 km) among the network of fields, being mostly restricted to the same or adjacent farms. When formed, predicted disease attributable to dispersal from other hop yards (edges) associated with longer distance dispersal was more frequent in the June to July time transition. Edges with a high probability of disease transmission were formed in instances where yards were in close proximity or where disease incidence was relatively high in large hop yards, as moderated by wind run. The modeling approach provides a flexible and generalizable framework for understanding and predicting pathogen dispersal at the regional level as well as the implications of network connectivity on epidemic development.
Imaging of Venous Diseases in the Abdomen and Pelvis
Authors: Tjong Willy , Oppenheimer Daniel C.
Published: March 2019

The abdomen and pelvis contain a complex network of systemic and portomesenteric veins. Disease processes (including occlusion or narrowing of these vessels) may create pathologic changes that may be compensated by collateral venous formation or alterations in physiology. This article reviews the imaging features of a variety of venous conditions within the abdomen and pelvis.
Screening, Brief Intervention, and Referral to Treatment in a Retail Pharmacy Setting: The Pharmacist's Role in Identifying and Addressing Risk of Substance Use Disorder
Authors: Shonesy Brian C. , Williams Donald , Simmons Damian , Dorval Erin , Gitlow Stuart , Gustin Richard M.
Published: March 2019

Objective:

This study determined the feasibility of interviewing and screening patients presenting to a retail pharmacy using Screening, Brief Intervention, and Referral to Treatment (SBIRT) interview protocols, and to compare SBIRT results to a risk score calculated from Prescription Drug Monitoring Program (PDMP) data.

Methods:

Using the NIDA Quick Screen and NIDA Modified-ASSIST (NM-ASSIST) and the Alcohol Use Disorder Identification Test (AUDIT), retail pharmacy customers were screened for substance and alcohol use disorder and tobacco use. PDMP reports were collected on subjects and a PDMP-risk score was calculated based on the numbers of Schedule II-V prescriptions and prescribers over the previous 12 months.

Results:

A total of 24 patients were included in this study (67% response rate). SBIRT screening revealed that 20.8% were at-risk for substance use disorder (SUD), 16.7% for alcohol use disorder, and 37.5% used tobacco. Overall, 33.3% of subjects were at-risk for SUD or alcohol use disorder. Fifty percent of subjects required education and/or brief intervention based on their responses, 37.5% of all subjects were deemed at-risk based on their PDMP-risk score, and 60% of patients who were risk-positive by SBIRT screening were also PDMP-risk positive.

Conclusions:

This study demonstrates the feasibility of performing SBIRT-based screenings in a retail pharmacy setting and combining these with PDMP-risk analysis to screen patients for prescription and illicit drug misuse. Findings from this study will inform the design of larger multisite studies, which should validate these findings and include follow-up analysis to assess the efficacy of intervention on this patient population.
A Pilot Crossover Trial of Sleep Medications for Sleep-disturbed Methadone Maintenance Patients
Authors: Stein Michael D. , Kurth Megan E. , Anderson Bradley J. , Blevins Claire E.
Published: March 2019

Objectives:

Problems with sleep are a common and detrimental occurrence among individuals who receive methadone maintenance for opioid use disorder (OUD).

Methods:

We enrolled ten methadone-maintained persons with insomnia (60% female, mean age 40) in a double-blind trial using actigraphy to confirm daily sleep reports. After a no-medication week to establish baseline sleep patterns, each participant received 1 week each of mirtazapine (30 mg), zolpidem (sustained-release 12.5 mg), mirtazapine (30 mg IR) plus zolpidem (10 mg), and placebo, with a washout week between each medication week. Study medication order was randomized so that the order of each 1-week medication treatment was different for each participant, but all participants received all 4 regimens.

Results:

We found that mirtazapine alone improved total sleep (mean 23 minutes), sleep latency (mean 23 minutes), and sleep efficiency (mean 3%), surpassing the other regiments.

Conclusions:

This pilot work suggests that mirtazapine is worthy of further testing as a sleep aid for persons with OUD receiving methadone maintenance.
Gradually Increasing Tidal Volume May Mitigate Experimental Lung Injury in Rats
Authors: Felix Nathane S. , Samary Cynthia S. , Cruz Fernanda F. , Rocha Nazareth N. , Fernandes Marcos V. S. , Machado Joana A. , Bose-Madureira Rebecca L. , Capelozzi Vera L. , Pelosi Paolo , Silva Pedro L. , Marini John J. , Rocco Patricia R. M.
Published: March 2019

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Background

This study hypothesized that, in experimental mild acute respiratory distress syndrome, lung damage caused by high tidal volume (VT) could be attenuated if VT increased slowly enough to progressively reduce mechanical heterogeneity and to allow the epithelial and endothelial cells, as well as the extracellular matrix of the lung to adapt. For this purpose, different strategies of approaching maximal VT were tested.

Methods

Sixty-four Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomly assigned to receive mechanical ventilation with VT = 6 ml/kg for 2 h (control); VT = 6 ml/kg during hour 1 followed by an abrupt increase to VT = 22 ml/kg during hour 2 (no adaptation time); VT = 6 ml/kg during the first 30 min followed by a gradual VT increase up to 22 ml/kg for 30 min, then constant VT = 22 ml/kg during hour 2 (shorter adaptation time); and a more gradual VT increase, from 6 to 22 ml/kg during hour 1 followed by VT = 22 ml/kg during hour 2 (longer adaptation time). All animals were ventilated with positive end-expiratory pressure of 3 cm H2O. Nonventilated animals were used for molecular biology analysis.

Results

At 2 h, diffuse alveolar damage score and heterogeneity index were greater in the longer adaptation time group than in the control and shorter adaptation time animals. Gene expression of interleukin-6 favored the shorter (median [interquartile range], 12.4 [9.1–17.8]) adaptation time compared with longer (76.7 [20.8 to 95.4]; P = 0.02) and no adaptation (65.5 [18.1 to 129.4]) time (P = 0.02) strategies. Amphiregulin, metalloproteinase-9, club cell secretory protein-16, and syndecan showed similar behavior.

Conclusions

In experimental mild acute respiratory distress syndrome, lung damage in the shorter adaptation time group compared with the no adaptation time group was attenuated in a time-dependent fashion by preemptive adaptation of the alveolar epithelial cells and extracellular matrix. Extending the adaptation period increased cumulative power and did not prevent lung damage, because it may have exposed animals to injurious strain earlier and for a longer time, thereby negating any adaptive benefit.
Relationship between Perioperative Hypotension and Perioperative Cardiovascular Events in Patients with Coronary Artery Disease Undergoing Major Noncardiac Surgery
Authors: Roshanov Pavel S. , Sheth Tej , Duceppe Emmanuelle , Tandon Vikas , Bessissow Amal , Chan Matthew T. V. , Butler Craig , Chow Benjamin J. W. , Khan James S. , Devereaux P. J.
Published: March 2019

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Background

Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery. It is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension.

Methods

In this retrospective exploratory analysis of a substudy of an international prospective blinded cohort study, 955 patients 45 yr of age or older with history or risk factors for coronary artery disease underwent coronary computed tomographic angiography before elective inpatient noncardiac surgery. The authors evaluated the potential interaction between angiographic findings and perioperative hypotension (defined as systolic blood pressure less than 90 mmHg for a total of 10 min or more during surgery or for any duration after surgery and for which intervention was initiated) on the composite outcome of time to myocardial infarction or cardiovascular death up to 30 days after surgery. Angiography assessors were blinded to study outcomes; patients, treating clinicians, and outcome assessors were blinded to angiography findings.

Results

Cardiovascular events (myocardial infarction or cardiovascular death within 30 days after surgery) occurred in 7.7% of patients (74/955), including in 2.7% (8/293) without obstructive coronary disease or hypotension compared to 6.7% (21/314) with obstructive coronary disease but no hypotension (hazard ratio, 2.51; 95% CI, 1.11 to 5.66; P = 0.027), 8.8% (14/159) in patients with hypotension but without obstructive coronary disease (hazard ratio, 3.85; 95% CI, 1.62 to 9.19; P = 0.002), and 16.4% (31/189) with obstructive coronary disease and hypotension (hazard ratio, 7.34; 95% CI, 3.37 to 15.96; P < 0.001). Hypotension was independently associated with cardiovascular events (hazard ratio, 3.17; 95% CI, 1.99 to 5.06; P < 0.001). This association remained in patients without obstructive disease and did not differ significantly across degrees of coronary disease (P value for interaction, 0.599).

Conclusions

In patients having noncardiac surgery, perioperative hypotension was associated with cardiovascular events regardless of the degree of coronary artery disease on preoperative coronary computed tomographic angiography.
Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures
Authors: Kohzuka Yuuya , Isono Shiroh , Ohara Sayaka , Kawabata Kazune , Kitamura Anri , Suzuki Takashi , Almeida Fernanda R. , Sato Yasunori , Iijima Takehiko
Published: March 2019

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Background

Intravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypothesized that abnormal breathing events occur frequently and are underdetected by pulse oximetry during sedation for dental procedures (primary hypothesis) and that insertion of a small-diameter nasopharyngeal tube reduces the frequency of the abnormal breathing events (secondary hypothesis).

Methods

In this nonblinded randomized control study, frequency of abnormal breathing episodes per hour (abnormal breathing index) of the patients under sedation for dental procedures was determined and used as a primary outcome to test the hypotheses. Abnormal breathing indexes were measured by a portable sleep monitor. Of the 46 participants, 43 were randomly allocated to the control group (n = 23, no nasopharyngeal tube) and the nasopharyngeal tube group (n = 20).

Results

In the control group, nondesaturated abnormal breathing index was higher than the desaturated abnormal breathing index (35.2 [20.6, 48.0] vs. 7.2 [4.1, 18.5] h−1, difference: 25.1 [95% CI, 13.8 to 36.4], P < 0.001). The obstructive abnormal breathing index was greater than central abnormal breathing index (P < 0.001), and half of abnormal breathing indexes were followed by irregular breathing. Despite the obstructive nature of abnormal breathing, the nasopharyngeal tube did not significantly reduce the abnormal breathing index (48.0 [33.8, 64.4] h−1
vs. 50.5 [36.4, 63.9] h−1, difference: −2.0 [95% CI, −15.2 to 11.2], P = 0.846), not supporting the secondary hypothesis.

Conclusions

Patients under sedation for dental procedure frequently encounter obstructive apnea/hypopnea events. The majority of the obstructive apnea/hypopnea events were not detectable by pulse oximetry. The effectiveness of a small-diameter nasopharyngeal tube to mitigate the events is limited.
Opioid Sensitivity in Children with and without Obstructive Sleep Apnea
Authors: Montana Michael C. , Juriga Lindsay , Sharma Anshuman , Kharasch Evan D.
Published: March 2019

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Background

Opioids are a mainstay of perioperative analgesia. Opioid use in children with obstructive sleep apnea is challenging because of assumptions for increased opioid sensitivity and assumed risk for opioid-induced respiratory depression compared to children without obstructive sleep apnea. These assumptions have not been rigorously tested. This investigation tested the hypothesis that children with obstructive sleep apnea have an increased pharmacodynamic sensitivity to the miotic and respiratory depressant effects of the prototypic μ-opioid agonist remifentanil.

Methods

Children (8 to 14 yr) with or without obstructive sleep apnea were administered a 15-min, fixed-rate remifentanil infusion (0.05, 0.1, or 0.15 μg · kg-1 · min-1). Each dose group had five patients with and five without obstructive sleep apnea. Plasma remifentanil concentrations were measured by tandem liquid chromatography mass spectrometry. Remifentanil effects were measured via miosis, respiratory rate, and end-expired carbon dioxide. Remifentanil pharmacodynamics (miosis vs. plasma concentration) were compared in children with or without obstructive sleep apnea.

Results

Remifentanil administration resulted in miosis in both non-obstructive sleep apnea and obstructive sleep apnea patients. No differences in the relationship between remifentanil concentration and miosis were seen between the two groups at any of the doses administered. The administered dose of remifentanil did not affect respiratory rate or end-expired carbon dioxide in either group.

Conclusions

No differences in the remifentanil concentration–miosis relation were seen in children with or without obstructive sleep apnea. The dose and duration of remifentanil administered did not alter ventilatory parameters in either group.
Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery
Authors: Klinger Rebecca Y. , Cooter Mary , Bisanar Tiffany , Terrando Niccolò , Berger Miles , Podgoreanu Mihai V. , Stafford-Smith Mark , Newman Mark F. , Mathew Joseph P. ,   for the Neurologic Outcomes Research Group of the Duke Heart Center
Published: March 2019

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Background

Cognitive decline after cardiac surgery occurs frequently and persists in a significant proportion of patients. Preclinical studies and human trials suggest that intravenous lidocaine may confer protection in the setting of neurologic injury. It was hypothesized that lidocaine administration would reduce cognitive decline after cardiac surgery compared to placebo.

Methods

After institutional review board approval, 478 patients undergoing cardiac surgery were enrolled into this multicenter, prospective, randomized, double-blinded, placebo-controlled, parallel group trial. Subjects were randomized to lidocaine 1 mg/kg bolus after the induction of anesthesia followed by a continuous infusion (48 μg · kg−1 · min−1 for the first hour, 24 μg · kg−1 · min−1 for the second hour, and 10 μg · kg−1 · min−1 for the next 46 h) or saline with identical volume and rate changes to preserve blinding. Cognitive function was assessed preoperatively and at 6 weeks and 1 yr postoperatively using a standard neurocognitive test battery. The primary outcome was change in cognitive function between baseline and 6 weeks postoperatively, adjusting for age, years of education, baseline cognition, race, and procedure type.

Results

Among the 420 allocated subjects who returned for 6-week follow-up (lidocaine: N = 211; placebo: N = 209), there was no difference in the continuous cognitive score change (adjusted mean difference [95% CI], 0.02 (−0.05, 0.08); P = 0.626). Cognitive deficit (greater than 1 SD decline in at least one cognitive domain) at 6 weeks occurred in 41% (87 of 211) in the lidocaine group versus 40% (83 of 209) in the placebo group (adjusted odds ratio [95% CI], 0.94 [0.63, 1.41]; P = 0.766). There were no differences in any quality of life outcomes between treatment groups. At the 1-yr follow-up, there continued to be no difference in cognitive score change, cognitive deficit, or quality of life.

Conclusions

Intravenous lidocaine administered during and after cardiac surgery did not reduce postoperative cognitive decline at 6 weeks.
Auditory Localization and Spatial Release From Masking in Children With Suspected Auditory Processing Disorder
Authors: Boothalingam Sriram , Purcell David W. , Allan Chris , Allen Prudence , Macpherson Ewan
Published: March 2019

Objectives:

We sought to investigate whether children referred to our audiology clinic with a complaint of listening difficulty, that is, suspected of auditory processing disorder (APD), have difficulties localizing sounds in noise and whether they have reduced benefit from spatial release from masking.

Design:

Forty-seven typically hearing children in the age range of 7 to 17 years took part in the study. Twenty-one typically developing (TD) children served as controls, and the other 26 children, referred to our audiology clinic with listening problems, were the study group: suspected APD (sAPD). The ability to localize a speech target (the word “baseball”) was measured in quiet, broadband noise, and speech-babble in a hemi-anechoic chamber. Participants stood at the center of a loudspeaker array that delivered the target in a diffused noise-field created by presenting independent noise from four loudspeakers spaced 90° apart starting at 45°. In the noise conditions, the signal-to-noise ratio was varied between −12 and 0 dB in 6-dB steps by keeping the noise level constant at 66 dB SPL and varying the target level. Localization ability was indexed by two metrics, one assessing variability in lateral plane [lateral scatter (Lscat)] and the other accuracy in the front/back dimension [front/back percent correct (FBpc)]. Spatial release from masking (SRM) was measured using a modified version of the Hearing in Noise Test (HINT). In this HINT paradigm, speech targets were always presented from the loudspeaker at 0°, and a single noise source was presented either at 0°, 90°, or 270° at 65 dB A. The SRM was calculated as the difference between the 50% correct HINT speech reception threshold obtained when both speech and noise were collocated at 0° and when the noise was presented at either 90° or 270°.

Results:

As expected, in both groups, localization in noise improved as a function of signal-to-noise ratio. Broadband noise caused significantly larger disruption in FBpc than in Lscat when compared with speech babble. There were, however, no group effects or group interactions, suggesting that the children in the sAPD group did not differ significantly from TD children in either localization metric (Lscat and FBpc). While a significant SRM was observed in both groups, there were no group effects or group interactions. Collectively, the data suggest that children in the sAPD group did not differ significantly from the TD group for either binaural measure investigated in the study.

Conclusions:

As is evident from a few poor performers, some children with listening difficulties may have difficulty in localizing sounds and may not benefit from spatial separation of speech and noise. However, the heterogeneity in APD and the variability in our data do not support the notion that localization is a global APD problem. Future studies that employ a case study design might provide more insights.
Spectral-temporally modulated ripple test Lite for computeRless Measurement (SLRM): A Nonlinguistic Test for Audiology Clinics
Authors: Landsberger David M. , Stupak Natalia , Aronoff Justin M.
Published: March 2019

Objectives:

Many clinics are faced with the difficulty of evaluating performance in patients who speak a language for which there are no validated tests. It would be desirable to have a nonlinguistic method of evaluating these patients. Spectral ripple tests are nonlinguistic and highly correlated with speech identification performance. However, they are generally not amenable to clinical environments as they typically require the use of computers which are often not found in clinic sound booths. In this study, we evaluate the Spectral-temporally Modulated Ripple Test (SMRT) Lite for computeRless Measurement (SLRM), which is a new variant of the adaptive SMRT that can be implemented via a CD player.

Design:

SMRT and SLRM were measured for 10 normal hearing and 10 cochlear implant participants.

Results:

Performance on the two tests was highly correlated (r = 0.97).

Conclusions:

The results suggest that SLRM can be used interchangeably with SMRT but can be implemented without a computer.
Associations Between Telomere Length and Hearing Status in Mid-Childhood and Midlife: Population-Based Cross-Sectional study
Authors: Wang Jing , Nguyen Minh Thien , Sung Valerie , Grobler Anneke , Burgner David , Saffery Richard , Wake Melissa
Published: March 2019

Objectives:

The purpose of this study is to determine if telomere length (a biomarker of aging) is associated with hearing acuity in mid-childhood and midlife.

Design:

The study was based on the population-based cross-sectional study within the Longitudinal Study of Australian Children with telomere length and audiometry data. We calculated high Fletcher Index (hFI, mean threshold of 1, 2, and 4 kHz), defining hearing loss as threshold >15 dB HL (better ear). Linear and logistic regression analyses quantified associations of telomere length with continuous hearing threshold and binary hearing loss outcomes, respectively.

Results:

One thousand one hundred ninety-five children (mean age 11.4 years, SD 0.5) and 1334 parents (mean age 43.9 years, SD 5.1) were included in analyses. Mean (SD) telomere length (T/S ratio) was 1.09 (0.55) for children and 0.81 (0.38) for adults; hFI (dB HL) was 8.0 (5.6) for children and 13.1 (7.0) for adults, with 8.4% and 25.9%, respectively, showing hearing loss.Telomere length was not associated with hearing threshold or hearing loss in children (hFI: OR, 0.99; 95% confidence interval, 0.55 to 1.78) or adults (hFI: OR, 1.35; 95% confidence interval, 0.81 to 2.25).

Conclusions:

Telomere length was not associated with hearing acuity in children or their midlife parents.
Mechanisms of Localization and Speech Perception with Colocated and Spatially Separated Noise and Speech Maskers Under Single-Sided Deafness with a Cochlear Implant
Authors: Dirks Coral , Nelson Peggy B. , Sladen Douglas P. , Oxenham Andrew J.
Published: March 2019

Objectives:

This study tested listeners with a cochlear implant (CI) in one ear and acoustic hearing in the other ear, to assess their ability to localize sound and to understand speech in collocated or spatially separated noise or speech maskers.

Design:

Eight CI listeners with contralateral acoustic hearing ranging from normal hearing to moderate sensorineural hearing loss were tested. Localization accuracy was measured in five of the listeners using stimuli that emphasized the separate contributions of interaural level differences (ILDs) and interaural time differences (ITD) in the temporal envelope and/or fine structure. Sentence recognition was tested in all eight CI listeners, using collocated and spatially separated speech-shaped Gaussian noise and two-talker babble. Performance was compared with that of age-matched normal-hearing listeners via loudspeakers or via headphones with vocoder simulations of CI processing.

Results:

Localization improved with the CI but only when high-frequency ILDs were available. Listeners experienced no additional benefit via ITDs in the stimulus envelope or fine structure using real or vocoder-simulated CIs. Speech recognition in two-talker babble improved with a CI in seven of the eight listeners when the target was located at the front and the babble was presented on the side of the acoustic-hearing ear, but otherwise showed little or no benefit of a CI.

Conclusion:

Sound localization can be improved with a CI in cases of significant residual hearing in the contralateral ear, but only for sounds with high-frequency content, and only based on ILDs. In speech understanding, the CI contributed most when it was in the ear with the better signal to noise ratio with a speech masker.
Spiritual Care at the Bedside
Authors: Taylor Elizabeth Johnston , Gober-Park Carla , Schoonover-Shoffner Kathy , Mamier Iris , Somaiya Chintan K. , Bahjri Khaled
Published: March 2019

Little is known about how nurses' personal spirituality and religious (S/R) beliefs impact their spiritual care of patients. An online survey was used to collect data from 445 nurses, assessing facets of religiosity, their opinions about introducing S/R during patient care, demographic, and work-related variables. Findings indicated that even in a sample of Christian nurses who scored high on religiousness measures, spiritual care is infrequent. Nurses' opinions about whether it was appropriate to initiate S/R conversation, self-disclosure, and prayer were associated with aspects of nurse religiosity. Nurses working in a faith-based organization were more likely to believe they could initiate S/R conversation and offer prayer.
Histological Analysis of the Effect of ATX-101 (Deoxycholic Acid Injection) on Subcutaneous Fat: Results From a Phase 1 Open-Label Study
Authors: Walker Patricia S. , Lee Daniel R. , Toth Bryant A. , Bowen Beta
Published: March 2019

BACKGROUND

ATX-101 is approved for submental fat reduction.

OBJECTIVE

To characterize the histological effect of ATX-101 injection into subcutaneous fat.

METHODS

This Phase 1 open-label study enrolled 14 adults to receive injections of ATX-101 into abdominal fat at varying concentrations (0.5%, 1.0%, 2.0%, or 4.0%), volumes (0.2 or 0.4 mL), spacing (0.7, 1.0, or 1.5 cm), and time points before scheduled abdominoplasty (1, 3, 7, or 28 days). During abdominoplasty, tissue was excised and preserved for histology.

RESULTS

All injection paradigms resulted in histological changes confined to the subcutaneous layer, which were more prominent at higher concentrations and independent of volume and spacing. Key features at Day 1 after injection were adipocytolysis, blood vessel injury, neutrophilic inflammation, and lysis of locally present neutrophils. At Day 3, inflammation was reduced versus Day 1, and hemorrhage and lipid lake formation (at higher concentrations) were observed. Day 7 samples exhibited prominent adipocytolysis, mild inflammation, lipid-laden macrophages in the septae, and repair of vascular injury. At Day 28, inflammation was largely resolved and prominent features were septal thickening, neovascularization, and atrophy of fat lobules.

CONCLUSION

Subcutaneous injection of ATX-101 induces adipocytolysis and local inflammation with septal thickening and resolution of inflammation by 28 days after injection.
Virtual Reality to Improve the Experience of the Mohs Patient—A Prospective Interventional Study
Authors: Higgins Shauna , Feinstein Shera , Hawkins Makenzie , Cockburn Myles , Wysong Ashley
Published: March 2019

BACKGROUND

Nonmelanoma skin cancer is the most common cancer in the United States with significant quality of life impact.

OBJECTIVE

To assess the utility of a highly immersive virtual reality (VR) experience in the context of outpatient skin cancer surgery as a means to minimize patient-reported feelings of anxiety or pain. The authors also sought to assess the effects on patient-reported overall satisfaction.

MATERIALS AND METHODS

Patients completed a pre-VR experience survey after completion of their first Mohs surgery layer, followed by a 10-minute VR experience, and a post-VR experience survey. Differences in the pre-VR survey and post-VR survey were compared using the chi-square test. The anxiety scores were compared using a t-test.

RESULTS

In all but 2 questions, there was a trend toward improvement of the anxiety-related sensations after completion of the VR experience. There were statistically significant differences for 4 questions: “Are you currently feeling unable to relax” (p = .0013), “are you currently feeling fear of the worst happening” (p < .0001), “are you currently feeling terrified or afraid” (p = .0046), and “are you currently feeling nervous” (p < .0001).

CONCLUSION

Virtual reality experiences during the Mohs surgical day significantly improved measures of anxiety and patient satisfaction.
Practical Guidelines for Hyaluronic Acid Soft-Tissue Filler Use in Facial Rejuvenation
Authors: Lee Won , Hwang Seung-Gook , Oh Wook , Kim Chang-Yeol , Lee Jin-Liang , Yang Eun-Jung
Published: March 2019

BACKGROUND

Hyaluronic acid (HA) fillers are the most commonly used fillers for soft-tissue augmentation. The face is a dynamic structure. Facial rejuvenation by filler products depends on mechanical forces on the region of the face. The successful use of injectable HA fillers requires an understanding of the options available.

OBJECTIVE

The purpose of this study is to measure the rheological properties of HA fillers and to clarify how to select these fillers considering their rheological properties.

MATERIALS AND METHODS

Rheological characterization was performed on 41 fillers. Physical parameters directly linked to product performance were measured.

RESULTS

The properties of the HA fillers varied. These findings provide a basis for selection guideline regarding rheological properties in facial rejuvenation.

CONCLUSION

The authors' report is the largest study to determine the rheological properties of HA fillers to date. Understanding the fillers' properties can help physicians select the appropriate fillers for more predictable and sustainable results.
Botulinum Toxin Injections for Masseter Reduction in East Asians
Authors: Cheng Judy , Hsu Sarah H. , McGee Jean S.
Published: March 2019

BACKGROUND

Cultural ideals for a slimmer face have led to an upsurge in interest in facial contouring among East Asians. Although surgical resection has traditionally been the main treatment option, botulinum toxin injection is becoming a popular, noninvasive alternative.

OBJECTIVE

To describe the use of botulinum toxin injection for masseter reduction in East Asians.

METHODS

An electronic search of the PubMed database was performed for studies published from 2000 to 2017 that meet the word combination of botulinum toxin, masseter, hypertrophy, and/or lower face contouring. Only the studies conducted in East Asian countries were analyzed in this review, exception of one study from Thailand.

RESULTS

A total of 12 publications were identified. Each study was reviewed to extract relevant information on patient selection, injection techniques, efficacy, dosage, frequency, and main side effects of treating masseters with botulinum toxin.

CONCLUSION

Botulinum toxin injection for masseter reduction in East Asians is efficacious and generally considered safe with no significant side effects. Future areas for investigation include defining the criteria for benign masseteric hypertrophy, minimum effective dosage of botulinum toxin, and the potential long-term effects of the injection.
Impact of Preservation Solutions on the Trichogenicity of Hair Micrografts Ascertained by Dermal Papilla Gene Expression
Authors: Castro Ana Rita , Portinha Carlos , Logarinho Elsa
Published: March 2019

BACKGROUND

Appropriate storage of human hair follicle (HF) grafts during follicular unit excision (FUE) is crucial toward successful hair shaft implantation. Several commercial storage solutions are currently used to ensure ex vivo maintenance of follicular grafts viability and trichogenicity. However, quantitative experimental evidence demonstrating molecular changes in HF cells associated with the usage of different storage solutions is largely missing.

OBJECTIVE

To identify gene expression changes in HF cells caused by ex vivo storage of hair grafts in different preservation conditions.

METHODS

The authors performed gene expression analysis in dermal papilla (DP) isolated from HF stored under different temperatures and solutions. The expression signature of key genes controlling hair growth and cycling, apoptosis, inflammation, and senescence was assessed for (1) chilled versus room temperature (RT) and (2) DP cell medium, saline, Hypothermosol, platelet-rich plasma, and ATPv-supplemented saline.

RESULTS

The authors found chilled versus RT to prevent inflammatory cytokine signaling. Under chilled conditions, ATPv-supplemented saline was the best condition to preserve the expression of the trichogenic genes HEY1 and LEF1.

CONCLUSION

Data disclose DP gene expression analysis as a useful methodology to ascertain the efficacy of preserving solutions and elucidate about the best currently available option for FUE clinical practice.
The ‘Yin’ and the ‘Yang’ of the kynurenine pathway: excitotoxicity and neuroprotection imbalance in stress-induced disorders
Authors: Barone Pascal
Published: March 2019

The amino-acid tryptophan (TRY) is converted into kynurenine (KYN) and subsequent metabolites by the tryptophan/catabolites (TRY/CAT) pathway (kynurenine pathway). ‘Excito-toxic’ and ‘neuro-protective’ metabolites are produced, which modulate the glutamatergic neurotransmission. The TRY/CAT pathway is activated by hypothalamic–pituitary–adrenal endocrine induction during stress by corticoids hormones, and the excitotoxic branch of the TRY/CAT pathway is activated by proinflammatory cytokines. During stress and major depressive disorders, it is generally accepted that inflammation induces an imbalance toward the excitotoxic branch of the TRY/CAT pathway, causing changes in brain connectivity in corticolimbic structures and therefore psychocognitive abnormalities. In neurodegenerative diseases, the activation of the oxidative branch of the TRY/CAT pathway has been frequently reported. We propose a comprehensive survey of the TRY/CAT pathway (kynurenine pathway) abnormalities in stress and inflammation-induced MDD and neurodegenerative diseases. As TRY/CAT pathway is a common feature of stress, inflammation, affective disorders, and neurodegenerative diseases, we discuss the status of the TRY/CAT pathway as a possible link among chronic stress, inflammation, depressive disorders and neurodegenerative diseases. This review does not claim to be exhaustive, but in a pharmacological perspective, it will be proposed that modulation of the excitotoxicity/neuroprotection balance is a valuable strategy for new and more effective treatments of mood disorders.
Stress and the gut microbiota-brain axis
Authors: Molina-Torres Guadalupe , Rodriguez-Arrastia Miguel , Roman Pablo , Sanchez-Labraca Nuria , Cardona Diana
Published: March 2019

Stress is a nonspecific response of the body to any demand imposed upon it, disrupting the body homoeostasis and manifested with symptoms such as anxiety, depression or even headache. These responses are quite frequent in the present competitive world. The aim of this review is to explore the effect of stress on gut microbiota. First, we summarize evidence of where the microbiota composition has changed as a response to a stressful situation, and thereby the effect of the stress response. Likewise, we review different interventions that can modulate microbiota and could modulate the stress according to the underlying mechanisms whereby the gut–brain axis influences stress. Finally, we review both preclinical and clinical studies that provide evidence of the effect of gut modulation on stress. In conclusion, the influence of stress on gut microbiota and gut microbiota on stress modulation is clear for different stressors, but although the preclinical evidence is so extensive, the clinical evidence is more limited. A better understanding of the mechanism underlying stress modulation through the microbiota may open new avenues for the design of therapeutics that could boost the pursued clinical benefits. These new designs should not only focus on stress but also on stress-related disorders such as anxiety and depression, in both healthy individuals and different populations.
Quercetin mitigates anxiety-like behavior and normalizes hypothalamus–pituitary–adrenal axis function in a mouse model of mild traumatic brain injury
Authors: Kosari-Nasab Morteza , Shokouhi Ghaffar , Ghorbanihaghjo Amir , Mesgari-Abbasi Mehran , Salari Ali-Akbar
Published: March 2019

Mild traumatic brain injury (mTBI) is a major public health risk for developing anxiety-related disorders and hypothalamus–pituitary–adrenal (HPA) axis dysregulation in humans. Extensive research has shown that dietary intake or supplementation of the natural flavonoid quercetin might be useful for treating anxiety-related symptoms. The objectives of this study were to determine whether quercetin treatment can attenuate anxiogenic-like behaviors and normalize HPA axis function in mice with mTBI. Animals subjected to mTBI were treated daily with quercetin (50 mg/kg) or diazepam (positive control, 3 mg/kg) for 14 days. Four behavioral tests (open field, plus maze, light-dark box, and zero maze) were used to assess anxiety-related behaviors in mice. To evaluate HPA axis function, adrenocorticotropic hormone and corticosterone were measured in the serum of mice after the anxiety tests. Quercetin treatment was found to significantly reduce anxiety-like behaviors in mTBI-induced mice. A strength of this study is the consistency of results among anxiety tests. The dysregulation of the HPA axis in mTBI-induced mice treated with quercetin was also attenuated, with decreased levels of adrenocorticotropic hormone and corticosterone. The effects of quercetin were comparable with those of diazepam treatment. Taken together, these results suggest that quercetin might be useful for treating anxiety-related symptoms and HPA axis hyperreactivity in patients with mTBI.
Implementing Precision Medicine and Artificial Intelligence in Plastic Surgery: Concepts and Future Prospects
Authors: Kim You J. , Kelley Brian P. , Nasser Jacob S. , Chung Kevin C.
Published: March 2019

Precision medicine, or the individualization of evidence-based medicine, is forthcoming. As surgeons, we must be prepared for the integration of patient and system factors. Plastic surgeons regard themselves as innovators and early adopters. As such, we need our adaptability now more than ever to implement digital advancements and precision medicine into our practices. The integration of artificial intelligence (AI) technology and the capture of big data techniques should foster the next great leaps in medicine and surgery, allowing us to capture the detailed minutiae of precision medicine. The algorithmic process of artificial neural networks will guide large-scale analysis of data, including features such as pattern recognition and rapid quantification, to organize and distribute data to surgeons seamlessly. This vast digital collection of information, commonly termed “big data,” is only one potential application of AI. By incorporating big data, the cognitive abilities of a surgeon can be complemented by the computer to improve patient-centered care. Furthermore, the use of AI will provide individual patients with increased access to the broadening world of precision medicine. Therefore, plastic surgeons must learn how to use AI within the contexts of our practices to keep up with an evolving field in medicine. Although rudimentary in its practice, we present a glimpse of the potential applications of AI in plastic surgery to incorporate the practice of precision medicine into the care that we deliver.
Evaluation of Long-term Outcomes of Facial Sensation following Cranial Vault Reconstruction for Craniosynostosis
Authors: Dengler Jana , Ho Emily S. , Klar Erin L. , Phillips John H. , Forrest Christopher R.
Published: March 2019

Background:

Cranial vault reshaping to correct craniosynostosis in infants may injure terminal branches of the trigeminal nerve, namely the supraorbital, supratrochlear, zygomaticofacial, and zygomaticotemporal nerves, especially if a fronto-orbital advancement is performed. Despite numerous studies demonstrating successful esthetic outcome after FOA, there are no long-term studies assessing facial sensation after possible damage to these nerves as the result of surgery.

Methods:

A cross-sectional case-control research design was used to evaluate facial sensory threshold in the trigeminal branches after cranial vault reconstruction in children with isolated, nonsyndromic metopic, and unicoronal craniosynostosis, compared with those with sagittal craniosynostosis and age-matched nonaffected controls. Study participants were recruited from the Hospital for Sick Children between the ages of 6 and 18 years. Sensory outcome was determined using the Weinstein Enhanced Sensory Test, the Ten Test, and self-reported facial sensibility function questionnaire.

Results:

The sensory outcomes of 28 patients and 16 controls were examined at an average age of 9.6 years and 10.3 years, respectively. No subjective or objective sensory deficit was noted in supraorbital, supratrochlear, zygomaticofacial, or zygomaticotemporal nerve distributions between groups. Qualitative reports of facial sensibility function indicated no difference in subjective sensation, protective sensation, or motor behavior between groups.

Conclusions:

These results suggest that while sensory nerve injury during routine FOA may occur, it does not result in a quantifiable nor clinically significant long-term sensory deficit threshold. Patients do not develop long-term neuropathic pain following surgical intervention.