bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Prevalence and Trends in Otology and Neurotology Publications
Authors: Schauwecker Natalie , Kaplan Alyson , Hunter Jacob B.
Published: February 2021

Objective:

To assess otology and neurotology authorship by gender, subject, and country of origin from 2000 to 2019.

Study Design:

Retrospective review of otology and neurotology publications in 2000, 2005, 2010, 2015, and 2019 from 10 prominent journals within otolaryngology.

Main Outcome Measures:

Demographics for first through third and final authors, including gender, degree, coauthorship, as well as number of authors, subject matter, and region of origin for each publication.

Results:

A total of 4,411 neurotology articles published in 2000, 2005, 2010, 2015, and 2019 were analyzed. During the study period, the proportion of female authors increased from 22.3% in 2000 to 33.9% in 2019 (p < 0.0001). However, authorship position analysis demonstrated no increase in final female authorship (22.5% in 2019, from 19.4% in 2000, p = 0.112). Geographic region analysis demonstrated a similar overall global trend toward an increase in female authors. When considering author gender by position, North America, the Middle East, and Africa failed to demonstrate significant increasing trends for female final authors. Female final authors were also significantly less likely to have medical degrees than final male authors, (37.4% versus 78.6%, respectfully, p =  < 0.0001). Finally, women published more often within the subjects of pediatrics and audiology (46.5% and 37.3% of final authors, p < 0.0001).

Conclusions:

Female authorship in otology and neurotology has increased globally. With the predominant number of articles originating from North America, and articles originating from North America failing to demonstrate an increase in female final authorship, overall, final female authorship did not change during the study period.

Professional Practice Gap and Educational Need:

There is no comprehensive study exploring gender distribution within only the specialty of otology and neurotology. While it is known that more women are becoming otolaryngologists, it is unknown if this increase is reflected in otology and neurotology publications, domestically and internationally.

Learning Objective:

To understand if gender biases and/or differences exist within otology and neurotology publications.

Desired Result:

Identify trends in otology and neurotology publications to address particular barriers to female publication within the field.
Further Evidence for the Expansion of Adult Cochlear Implant Candidacy Criteria
Authors: Perkins Elizabeth , Dietrich Mary S. , Manzoor Nauman , O’Malley Matthew , Bennett Marc , Rivas Alejandro , Haynes David , Labadie Robert , Gifford René
Published: February 2021

Objective:

1) To complete a follow-up investigation of postoperative outcomes for adult cochlear implant (CI) recipients scoring ≥30% Consonant-Nucleus-Consonant (CNC) preoperatively, and 2) to describe the postoperative performance trajectory for this group of higher performing patients.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

One hundred four (105 ears) postlingually deafened adults who scored ≥30% CNC word recognition in the ear to be implanted preoperatively.

Interventions:

One hundred four subjects underwent cochlear implantation.

Main Outcome Measures:

Pre- and postoperative CNC word scores and AzBio sentences in quiet and noise in the ear to be implanted as well as the bilateral-aided condition pre-CI and at 1, 3, 6, and 12 months post-CI.

Results:

Statistically significant improvement was demonstrated for CNC and AzBio sentences in quiet and noise for the CI alone and bilateral listening conditions. Most improvement was demonstrated by 6-months postoperatively (p < 0.001) with the exception of AzBio sentences in noise demonstrating improvement within 3 months (p < 0.001). For patients with preop CNC scores up to 40% (n = 57), all recipients demonstrated either equivocal (n = 17) or statistically significant improvement (n = 40) for CNC word recognition in the CI-alone condition and none demonstrated a significant decrement in the bilateral condition. For patients with preop CNC scores >40% (n = 47, 48 ears), 89.3% (42 patients) demonstrated either equivocal (n = 24, 50%) or statistically significant improvement (n = 19, 39.6%) for CNC word recognition in the CI-only condition and none demonstrated a significant decrement in the bilateral condition.

Conclusions:

CI candidates with preoperative CNC word scores higher than conventional CI recipients derive statistically significant benefit from cochlear implantation for both the CI ear and best-aided condition. These data provide further support for the expansion of adult CI candidacy up to at least 40% CNC word recognition preoperatively with consideration given to further expansion possibly up to 60%.
Dilatation of the Endolymphatic Space in the Ampulla of the Posterior Semicircular Canal: A New Clinical Finding Detected on Magnetic Resonance Imaging
Authors: Morioka Masaru , Sugimoto Satofumi , Yoshida Tadao , Teranishi Masaaki , Kobayashi Masumi , Nishio Naoki , Katayama Naomi , Naganawa Shinji , Sone Michihiko
Published: February 2021

Objectives:

To investigate the clinical features of ears with dilatation of the endolymphatic space in the ampulla of the posterior semicircular canal on magnetic resonance imaging.

Study Design:

Retrospective study.

Setting:

A university hospital.

Methods:

This study included 1,842 ears from 934 patients who underwent 3-T magnetic resonance imaging with gadolinium to investigate the presence of endolymphatic hydrops. Age, sex distribution, hearing thresholds on pure-tone audiometry, and vestibular symptoms were compared between cases of unilateral and bilateral dilatation of the endolymphatic space in the ampulla of the posterior semicircular canal.

Results:

Forty-eight ears (17 men and 14 women; mean age 49.9 yrs) showed dilatation of the endolymphatic space in the ampulla of the posterior semicircular canal. Age and the rate of chronic sensorineural hearing loss were significantly higher in the unilateral group (14 ears) than in the bilateral group (34 ears). The average hearing thresholds and rates of vestibular symptoms reported did not differ between unilateral and bilateral cases, but some patients showed positional nystagmus.

Conclusions:

Dilatation of the endolymphatic space in the ampulla was observed selectively in the posterior semicircular canal, though its pathogenesis was not clear. Such dilatation is not usually accompanied by vestibular endolymphatic hydrops, and it may be a cause of vertigo and dizziness.
Imbalance Associated With Cisplatin Chemotherapy in Adult Cancer Survivors: A Clinical Study
Authors: Prayuenyong Pattarawadee , Kasbekar Anand V. , Hall Deborah A. , Hennig Ivo , Anand Anjana , Baguley David M.
Published: February 2021

Objective:

This study investigated balance problems and vestibular function in adult cancer survivors who had completed cisplatin chemotherapy treatment.

Study Design:

Observational cross-sectional study.

Setting:

Tertiary care center.

Patients:

Adult survivors of cancer who had completed cisplatin treatment.

Main Outcome Measures:

Patient-reported balance symptoms were evaluated by a semistructured clinical interview. Patients underwent bedside clinical tests including Dynamic Visual Acuity test, Modified Clinical Testing of Sensory Interaction and Balance (CTSIB-m), and vibration sense testing to detect peripheral neuropathy. The video Head Impulse Test (vHIT) of all semicircular canals was performed.

Results:

Eleven of 65 patients (17%) reported some balance symptoms after cisplatin therapy, including vertigo, dizziness, unsteadiness, and falls. Vertigo was the most common balance symptom, reported by six patients (9.2%), and the clinical histories of these patients were consistent with benign paroxysmal positional vertigo. Three patients (5%) had abnormal results of the CTSIB-m test, and they were the same patients who reported falls. There was a significant association of peripheral neuropathy detected by vibration test and balance symptoms. All patients had normal vHIT results in all semicircular canals.

Conclusions:

Balance symptoms after cisplatin treatment occurred in 17% of adult cancer survivors. Patients with peripheral neuropathy were more likely to have balance symptoms. The CTSIB-m test is a useful bedside physical examination to identify patients with a high risk of fall. Though there was no vestibular dysfunction detected by the vHIT in cancer survivors after cisplatin therapy, benign paroxysmal positional vertigo was relatively prevalent in this group of patients.
Towards Providing an Automated Approach to Differentiating the Nystagmus of Ménière's Disease, Vestibular Migraine, and Benign Paroxysmal Positional Vertigo
Authors: Phillips John S. , Newman Jacob , Cox Stephen
Published: February 2021

Objective:

The diagnosis of vertigo is challenging, particularly as patients usually present while asymptomatic. We have developed an ambulatory medical device that allows vestibular telemetry to record eye movements over a 30-day period to aid the diagnosis of vertigo. We have undertaken proof-of-concept work to identify unique properties of nystagmus that could be used to differentiate between three of the most common causes of vertigo: Ménière's disease, vestibular migraine, and Benign Paroxysmal Positional Vertigo.

Patients:

We analyze the nystagmus from patients with a diagnosis of Ménière's disease, vestibular migraine, and Benign Paroxysmal Positional Vertigo.

Intervention(s):

Our vestibular telemetry system includes a wearable, ambulatory monitor which continuously records horizontal and vertical eye-movements, as well as three-axis movements of the head.

Main Outcome Measure(s):

Horizontal and vertical eye-movement data, and three-axis head positioning data.

Results:

Sixteen participants were enrolled onto the study and three reported experiencing rotatory vertigo during their 30-day trial, confirmed by the presence of nystagmus in their eye-movement traces. Vestibular telemetry revealed distinct differences between the nystagmus produced during an acute Ménière's attack, and attacks of vestibular migraine and Benign Paroxysmal Positional Vertigo. Attack frequency, nystagmus duration, whether the nystagmus onset was motion provoked, nystagmus direction, slow phase velocity, and slow phase duration were found to be discriminatory features that could be exploited to allow an automated diagnosis to be made.

Conclusions:

The data provided by vestibular telemetry can be used to differentiate between different inner-ear causes of dizziness.
Intraoperative Auditory Brainstem Response Results Predict Delayed Sensorineural Hearing Loss After Middle Cranial Fossa Resection of Vestibular Schwannoma
Authors: Welch Christopher M. , Mannarelli Gregory , Koehler Lindsey , Telian Steven A.
Published: February 2021

Objective:

To identify intraoperative neurophysiologic measures predictive of delayed progressive sensorineural hearing loss in the operative ear after a middle fossa approach (MCF) for resection of vestibular schwannoma (VS).

Study Design:

Retrospective review.

Setting:

Academic, tertiary referral center.

Patients:

Subjects with vestibular schwannoma who underwent a MCF microsurgical resection of VS were analyzed for individuals whose hearing was initially preserved but subsequently developed progressive sensorineural hearing loss in the operative ear. Thirty-seven patients were identified for whom audiologic and neurophysiologic data was available.

Intervention:

Intraoperative neurophysiologic changes will correlate with delayed sensorineural hearing loss in the operative ear.

Main Outcome Measures:

Audiometric evaluations, intraoperative electrocochleography (ECoG), and auditory brainstem response (ABR) measures.

Results:

Twenty-five subjects experienced stable hearing or hearing loss in the operative ear comparable to the contralateral ear. Twelve subjects suffered a significant increase in the hearing asymmetry between ears. Deterioration in the amplitude of wave V of the ABR persisting at the close of tumor resection correlated with delayed sensorineural hearing loss in the operative ear (p 0.02, 5% mean improvement in the stable hearing group, versus a 14% decline with progressive asymmetry), but changes in ECoG or other auditory brainstem response parameters (p > 0.05) were not predictive.

Conclusions:

Persisting amplitude reduction of wave V of the intraoperative ABR best correlates with delayed progressive sensorineural hearing loss in the operative ear. Neither persistent changes in ECoG, other ABR parameters, nor transient changes, correlated with delayed progressive sensorineural hearing loss in the operative ear.
High-frequency Cochlear Nerve Deficit Region: Relationship With Deaf Duration and Cochlear Implantation Performance in Postlingual Deaf Adults
Authors: Kim Yehree , Lee Jee Yeon , Kwak Min Young , Park Jin Taek , Kang Woo Seok , Ahn Joong Ho , Chung Jong Woo , Park Hong Ju
Published: February 2021

Objective:

To analyze the changes of cochlear nerve diameter and the presence of a cochlear nerve deficit at a high-frequency region and investigate their effects on cochlear implant (CI) performance in postlingual deaf adults.

Study Design:

Retrospective.

Setting:

Tertiary care academic center.

Patients:

Eighty-three postlingual deaf adults with no labyrinthine anomalies or cognitive deficits who received a CI with perimodiolar electrodes from a single manufacturer.

Main Outcomes and Measures:

We evaluated the changes of cochlear nerve diameter and the presence of a “tail sign,” defined as identifiable nerve fibers originating from the far basal turn of the cochlea, which represents the presence of cochlear nerve at a high-frequency region in magnetic resonance imaging, on monosyllabic word recognition scores.

Results:

The cochlear nerve diameter showed a positive correlation with word recognition scores (maximum diameter, R2 = 0.26, p < 0.01; minimum diameter, R2 = 0.26, p < 0.01), but a negative correlation with deaf duration. Recipients with a positive tail sign performed better (73 ± 19%) than those without (45 ± 24%, p < 0.01). A positive tail sign was more commonly found in good performers (52 of 62, 84%) than in poor performers (5 of 21, 24%, p < 0.01).

Conclusions:

Favorable outcomes could be anticipated in postlingual deaf adults with a large cochlear nerve diameter and positive tail sign. A presence of cochlear nerve at a high-frequency region may be an imaging marker for predicting good CI performance.
Prevalence of Otological Disease in Turner Syndrome: A Systematic Review
Authors: Geerardyn Alexander , Willaert Annelore , Decallonne Brigitte , Desloovere Christian , Verhaert Nicolas
Published: February 2021

Introduction:

Girls and women with Turner syndrome (TS) present with multiple ear and hearing problems, ranging from external morphologic abnormalities to sensorineural or conductive hearing loss. The exact pathophysiology behind these otological diseases is not yet completely understood. The aim of this study is to provide a systematic review on the prevalence of otological disease in TS.

Methods:

We conducted a systematic review according to the PRISMA guidelines. A database search was performed in PubMed, Embase, Web of Science, and Cochrane library.

Results:

The prevalence of otological disease as external ear deformities (20–62%), recurrent otitis media (24–48%), and hearing loss (36–84%) is high in TS. The auditory phenotype in TS is complex and seems to be dynamic with CHL due to middle ear disease at young age and sensorineural hearing loss later in life.

Conclusion:

This systematic review of the literature confirms that otological disease is definitely part of the widely variable phenotype in Turner patients. Strong evidence is lacking on the exact prevalence numbers, emphasizing the need for more prospective data gathering. Growing insights in its pathophysiology will help in the understanding and management of hearing problems in TS across lifespan.
Veno-Venous Extracorporeal Membrane Oxygenation for Children With Cancer or Hematopoietic Cell Transplant: A Ten Center Cohort
Authors: Bridges Brian C. , Kilbaugh Todd J. , Barbaro Ryan P. , Bembea Melania M. , Chima Ranjit S. , Potera Renee M. , Rosner Elizabeth A. , Sandhu Hitesh S. , Slaven James E. , Tarquinio Keiko M. , Cheifetz Ira M. , Rowan Courtney M. , Friedman Matthew L.
Published: February 2021

We performed a multicenter retrospective cohort study of children with 14 days to 18 years of age in the United States from 2011 to 2016 with cancer or hematopoietic cell transplant (HCT) who were supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared the outcomes of children with oncological diagnoses or HCT supported with V-V ECMO to other children who have received V-V ECMO support. In this cohort of 204 patients supported with V-V ECMO, 30 (15%) had a diagnosis of cancer or a history of HCT. There were 21 patients who had oncological diagnoses without HCT and 9 children were post-HCT. The oncology/HCT group had a higher overall ICU mortality (67% vs. 28%, P < 0.001), mortality on ECMO (43% vs. 21%, P < 0.01), and ICU mortality among ECMO survivors (35% vs. 8%, P < 0.01). The oncology/HCT group had a higher rate of conversion to veno-arterial (V-A) ECMO (23% vs. 9%, P = 0.02) (RR, 2.5; 95% CI, 1.1–5.6). Children with cancer or HCT were older (6.6 vs. 2.9 years, P = 0.02) and had higher creatinine levels (0.65 vs. 0.4 mg/dL, P = 0.04) but were similar to the rest of the cohort for other pre-ECMO variables. For post-HCT patients, survival was significantly worse for those whose indication for HCT was cancer or immunodeficiency (0/6) as compared to other nonmalignant indications (3/3) (P = 0.01).
Homozygous missense STRADA mutation in a patient with polyhydramnios, megalencephaly and symptomatic epilepsy syndrome
Authors: Aerden Mio , Vallaeys Lore , Holvoet Maureen , De Waele Liesbeth , Van Den Bogaert Kris , Devriendt Koen
Published: February 2021

Homozygous or compound heterozygous mutations in STRADA cause polyhydramnios, megalencephaly and symptomatic epilepsy syndrome (PMSE), with additional features of distinctive facial traits and severe developmental delay or intellectual disability. This syndrome was first defined in 16 Old Order Mennonite patients, carrying a homozygous STRADA deletion of exon 9–13. Five additional PMSE patients have been reported since, each of them with loss-of-function variants. We report a female patient with the typical clinical features of PMSE, homozygous for a novel STRADA missense mutation c.792T>A (p.Ser264Arg) in exon 10. This finding contributes to the further delineation of the phenotype of PMSE.
Effect of Statin Use on Cancer-related Mortality in Nonalcoholic Fatty Liver Disease
Authors: Hajifathalian Kaveh , Tafesh Zaid , Rosenblatt Russell , Kumar Sonal , Homan Edwin A. , Sharaiha Reem Z. , Cohen David E. , Brown Robert S. , Fortune Brett E.
Published: February 2021

Background:

Indications for use of statins are common among patients with nonalcoholic fatty liver disease (NAFLD). Epidemiologic studies have suggested a possible association between statins and decreased risk of malignancies. We hypothesized that statin use has a protective effect on cancer mortality in patients with NAFLD.

Methods:

Participants with NAFLD in 8 rounds of National Health and Nutrition Examination Survey (NHANES) were included in this study. Mortality data were obtained by linking the NHANES data to National Death Index. NAFLD was defined using the previously validated Hepatic Steatosis Index model.

Results:

A total of 10,821 participants with NAFLD were included and 23% were statin users (n=2523). Statin use was associated with a 43% lower risk of cancer mortality [hazard ratio (HR)=0.57, 95% confidence interval (CI): 0.43-0.75, P<0.001] in multivariable analysis. Statin use under 1 year did not show a significant effect on cancer mortality (HR=0.72, 95% CI: 0.46-1.12), while statin use for 1 to 5 years decreased cancer mortality by 35% (HR=0.65, 95% CI: 0.42-0.99, P=0.46), and statin use >5 years decreased cancer mortality by 56% (HR=0.44, 95% CI: 0.29-0.66, P<0.001). Statin use was associated with a significant decrease in the risk of cancer mortality in NAFLD patients with both low and high risk of liver fibrosis (HR=0.55, 95% CI: 0.38-0.81; and HR=0.53, 95% CI: 0.31-0.89, respectively).

Conclusion:

Using a large US prospective cohort, we showed statin use is associated with a considerable decrease in cancer-related mortality among patients with NAFLD. These results are important for clinical decision making, as statin indications are prevalent among NAFLD patients, but many do not receive benefit in the event that the statin is discontinued due to liver test abnormalities.
The impact of feeding experiences during infancy on later child eating behaviours
Authors: Pang Wei Wei , McCrickerd Keri
Published: February 2021

Purpose of review

Individual differences in appetite and eating behaviours appear early in infancy. This review synthesizes recent research investigating the impact of feeding experiences during infancy on later appetite and energy intake regulation, and appraises the consistency and longevity of any effects.

Recent findings

Three themes of early feeding experiences were identified; breastfeeding, infants’ first foods and caregivers’ feeding practices. Recent findings suggest that breastfeeding alone is unlikely to promote better regulation of food intake later in childhood. It remains unclear whether the method of first food introduction (e.g., baby-led weaning vs traditional spoon feeding), or types of food introduced (e.g. ultra-processed foods), affect later child eating self-regulation. Randomised controlled trials (RCTs) on receiving guidance for responsive feeding showed some benefits; lower child body mass index z-scores in toddlerhood, parents reported less likelihood to pressure their child to eat or use food as a reward and lower emotional eating in the child.

There is little consistent new evidence for the lasting impact of any one specific infant feeding experience on later eating self-regulation. More RCTs using observed and measured behaviours, with longer follow-ups of children's eating behaviours, and those conducted across different populations are warranted.
Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8
Authors: Jiménez Sònia , Miró Òscar , Llorens Pere , Martín-Sánchez Francisco J. , Burillo-Putze Guillermo , Piñera Pascual , Martín Alfonso , Alquézar Aitor , García-Lamberechts Eric J. , Jacob Javier , Grima María L.L. , Millán Javier , Molina Francisca , Albero Patricia B. , Cardozo Carlos , Mòdol Josep M. , Aguirre Alfons , Gaya Ruth , Adroher María , Llauger Lluís , Díaz Juan J. L. , González Nayra C. , Aragües Paula L. , Gómez Ana P. , del Castillo Juan G.
Published: February 2021

Background and importance

A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.

Objective

We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.

Methods

We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.

Results

We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23–1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45–1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03–2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77–2.45).

Conclusions

DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.
Association of frailty on treatment outcomes among patients with suspected infection treated at emergency departments
Authors: Ishikawa Shigeto , Miyagawa Ippei , Kusanaga Masashi , Abe Toshikazu , Shiraishi Atsushi , Fujishima Seitaro , Ogura Hiroshi , Saitoh Daizoh , Kushimoto Shigeki , Shiino Yasukazu , Hifumi Toru , Otomo Yasuhiro , Okamoto Kohji , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiraishi Shin-ichiro , Takuma Kiyotsugu , Hagiwara Akiyoshi , Yamakawa Kazuma , Takeyama Naoshi , Gando Satoshi , Mayumi Toshihiko
Published: February 2021

Background

The clinical frailty scale (CFS) score has been validated as a predictor of adverse outcomes in community-dwelling older people. Older people are at a higher risk of sepsis and have a higher mortality rate. However, the association of frailty on outcomes in patients with sepsis has not been completely examined.

Objective

This study evaluated the association between CFS and outcomes in patients with sepsis.

Design

This was a multicenter prospective cohort substudy.

Settings and participants

The study included 37 emergency departments from across Japan. The patients (age ≥16 years) were included in this study if they had suspected infection at an emergency department during December 2017–February 2018.

Outcome measure and analysis

The primary outcome was 28-day mortality, stratified by the CFS score categories. The secondary outcomes were the duration of hospital stay, number of ICU-free days (ICUFDs) and number of ventilator-free days (VFDs).

Main results

A total of 917 patients were included. The median age was 79 years. The CFS score was associated with an increased risk of 28-day mortality and with a higher likelihood of long-term hospital stay and short-term VFDs and ICUFDs. Multivariate logistic regression analysis indicated that the CFS score was a predictor of 28-day mortality [odds ratio (OR), 1.26; 95% confidence interval (CI), 1.11–1.42].

Conclusions

This study reported that in patients with suspected sepsis in the emergency department, frailty may be associated with poor prognosis and length of hospital stay.
Evaluation of HEAR score to rule-out major adverse cardiac events without troponin test in patients presenting to the emergency department with chest pain
Authors: Moumneh Thomas , Penaloza Andrea , Cismas Anda , Charpentier Sandrine , Schotté Thibault , Pernet Sabrina , Malatest Stéphanie , Prunier Fabrice , Warnant Alexandra , Mezdad Tin-Hinan , Gangloff Cédric , Soulat Louis , Douillet Delphine , Riou Jérémie , Roy Pierre-Marie
Published: February 2021

Background and importance

Current guidelines for patients presenting to the emergency department with chest pain without ST-segment elevation myocardial infarction (non-STEMI) on electrocardiogram are based on troponin measurement. The HEART score is reportedly a reliable work-up strategy that combines clinical evaluation with troponin value. A clinical rule that could select very low-risk patients without the need for a blood test (HEAR score, being the HEART score without the troponin item) would be of great interest.

Objectives

To prospectively assess the safety of a HEAR score <2 to rule-out non-STEMI without troponin measurement. Secondary objective was to assess the safety of a sequential strategy that combines HEAR score and HEART (defined as two-step HEART strategy).

Design, settings and participants

Prospective observational study in six emergency departments. Patients with nontraumatic chest pain and no alternative diagnosis were included and followed up for 45 day. Patients were considered at low-risk if the HEAR score was <2 or, for the two-step HEART strategy, if the HEART score was <4.

Outcomes measure and analysis

The primary endpoint was the 45-day rate of major adverse cardiac events (MACE) in patients with a HEAR score <2. A HEAR score based strategy was consider safe if the rate of the primary endpoint was below 1%, with an upper margin of the 95% confidence interval (CI) below 3%.

Results

Among 1452 patients included, 1402 were analyzed and 97 (7%) had a MACE during the follow-up period. The HEAR score was <2 in 279 (20%) patients and one presented a MACE [0.4% (95% CI: 0.01–1.98)]. The two-step HEART strategy classified low-risk an additional 476 patients (34%) and one of these 476 patients had a MACE [0.3% (95% CI: 0.03–0.95)]. The two-step HEART strategy would have theoretically avoided 360 troponin measurements (19%).

Conclusions

In our prospective multicenter study, a HEAR based work-up strategy was safe, with a very low risk of MACE at 45 day. We also report that a two-step HEART-based strategy may safely allow significant reduction of troponin measurements in patients presenting to the emergency department with chest pain.
Is 18F-FDG PET/CT capable of differential diagnosis from tuberculous pleurisy from malignant mesothelioma?
Authors: Özmen Özlem , Tatci Ebru , Demiröz Ş. Mustafa , Tazeler Zuhal , Demirağ Funda
Published: February 2021

Aim

18F-Fluorodeoxyglucose (FDG) PET/computerized tomography (CT) is a valuable method in the diagnosis of malignant pleural mesothelioma (MPM). But, some infections, particularly tuberculosis, are known to mimic cancer. We aimed to compare the FDG PET/CT findings of tuberculosis pleurisy (TP) and malignant mesothelioma and evaluate its role of differential diagnosis.

Material and method

We retrospectively reviewed the data from 85 patients (45 patients with MPM and 40 patients with TP) who underwent FDG PET/CT. All images were reevaluated and pleural thickening, maximum standardized uptake values (SUVmax), lymphatic uptake and accompanying parenchymal findings were noted.

Results

There was no significant difference in age and sex between the two groups. Pleural thickening was more prominent in the MPM group. Mean pleural thickness was 21.4 ± 18.6 mm in the MPM group and 6.8 ± 3.5 mm in the TP group (P = 0.0). Besides pleural pathology, lymph nodes involvement in the thoracic (P = 0.0) and extrathoracic area (P = 0.34) and parenchymal findings were prominent in the TP group (P = 0.0). However, there was no significant difference in pleural SUVmax values between the two groups (P = 0.61).

Conclusion

Intense pleural FDG uptake can be observed in TP like malignant mesothelioma. For the evaluation of the pleural pathologies in the tuberculosis endemic countries, it should be considered that FDG PET/CT may have false-positive results. Evaluation of increased pleural FDG uptake together with the detected parenchymal findings and lymphatic involvement may help us to make more accurate interpretation of the diagnosis.
Diagnostic utility of Ga-68 DOTA-SSTR and F-18 FDG PET/CT in the detection of culprit tumours causing osteomalacia: a systematic review and meta-analysis
Authors: Agrawal Kanhaiyalal , Padhy Biswa Mohan , Meher Bikash Ranjan , Mohanty Rashmi Ranjan
Published: February 2021

Background

Tumour-induced osteomalacia (TIO) or oncogenic osteomalacia is a rare variant of paraneoplastic syndrome secondary to a small benign phosphaturic mesenchymal tumour that secretes phosphaturic substances. Complete tumour excision is often curative. However, the localization of these offending tumours has always remained a challenge because of their small size, slow-growing nature, and presence in atypical locations. We performed a systemic review and meta-analysis on the sensitivity and specificity of F-18 FDG PET/CT and Ga-68 DOTA-SSTR PET/CT to detect tumours causing osteomalacia.

Methods

Pub Med, SCOPUS, the Cochrane Library and Web of Science were searched for articles on F-18 FDG and Ga-68 DOTA-SSTR PET/CT in the detection of culprit tumours in TIO till September 2020. Both retrospective and prospective studies having three or more patients were included. The methodological quality of included studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. A random-effect model was used for the statistical pooling of sensitivity and specificity. Pooled data were presented with 95% confidence intervals (95% CI) and displayed using Forest plots. Heterogeneity was expressed using the I
2 statistic.

Results

The pooled sensitivity of Ga-68 DOTA-SSTR PET/CT in detecting the culprit tumour derived from all included studies is 86% (95% CI: 79–91%). There is moderate statistical heterogeneity among the included studies (I
2 = 72.7%). The pooled sensitivity of F-18 FDG PET/CT in detecting the offending tumour derived from all included studies is 73% (95% CI: 61–84%) with moderate statistical heterogeneity among the included studies (I
2 = 45.4%).

Conclusion

In the detection of offending tumours in TIO, Ga-68 DOTA-SSTR PET/CT has better sensitivity than F-18 FDG PET/CT and should be used as first-line imaging modality due to very high sensitivity.
Role of post-therapy 99mTc-MIBI single-photon emission computed tomography/computed tomography scan in predicting survival in patients with high-grade glioma
Authors: Roshdy Esraa , ElNaggar Maha , Atta Haisam , Kandeel Ahmed , Abdel-Wanis Mostafa , Abd Elbadee Osama Mostafa , Abdelhafez Yasser G. , Mohamed Yasser
Published: February 2021

Objective

High-grade gliomas (HGGs) carry dismal prognosis with survival typically reported as less than a year. We explored the predictive value of qualitative and quantitative evaluations of post-treatment 99m-technetium-labelled methoxyisobutylisonitrile (99mmTc-MIBI) brain single-photon emission computed tomography-computed tomography (SPECT/CT) tumor uptake in relation to overall survival (OS) in patients with HGG.

Methods

Thirty patients with pathologically or radiologically documented high-grade glioma (HGG) were prospectively recruited for this study (24 male, 6 female; mean age 43 ± 14 years). All patients had a clinical or radiological suspicion of residual/recurrent tumor after initial therapy. 99mTc-MIBI brain SPECT/CT scanning was performed, and the scans were evaluated qualitatively on a five-point probability score (1–5, scores ≥3 considered positive for residual/recurrent tumor); and quantitively via drawing volumes of interest (VOI) on the suspected lesions and normal contralateral brain tissue. All patients were followed up for 1 year or till death.

Results

Positive visual MIBI results were associated with poor survival. Among 10 patients with negative MIBI scores, only two patients died (OS = 75%), while 11/20 patients reported positive on MIBI died, with a median survival of 9 months (OS = 14.5%; P = 0.03). All patients with active isocontour volume ≤1.96 cm3 were alive at the end of the study, compared to a median survival of 9 months and OS of 12% for patients with an isocontour volume of >1.97% (P = 0.003).

Conclusion

In patients with HGG, post-therapy brain SPECT/CT with 99mTc-MIBI can provide useful prognostic information.
Systemic manifestations – do not forget the small bowel
Authors: Chetcuti Zammit Stefania , Sidhu Reena
Published: February 2021

Purpose of review

Systemic diseases can afflict the small bowel (SB) but be challenging to diagnose. In this review, we aim to provide a broad overview of these conditions and to summarise their management.

Recent findings

Small bowel capsule endoscopy (SBCE) is an important modality to investigate pathology in the SB. SB imaging can be complementary to SBCE for mural and extramural involvement and detection of multiorgan involvement or lymphadenopathy. Device assisted enteroscopy provides a therapeutic arm, to SBCE enabling histology and therapeutics to be carried out.

SB endoscopy is essential in the diagnosis, management and monitoring of these multi-system conditions. Collaboration across SB centres to combine experience will help to improve the management of some of these rarer SB conditions.
Insulin Resistance as a Diagnostic Criterion for Metabolically Healthy Obesity in Children
Authors: Nso‐Roca Ana Pilar , Cortés Castell Ernesto , Carratalá Marco Francisco , Sánchez Ferrer Francisco
Published: February 2021

Objectives:

In recent years, a subgroup of individuals with obesity has been described as having a lower risk of metabolic and cardiovascular complications. These individuals have what is referred to as metabolically healthy obesity (MHO), which has a favorable metabolic profile and a lower probability of long‐term complications. The definition of this subtype in children is not clear. The aim of the present study was to determine whether Homeostasis Model Assessment (HOMA) above a set threshold could be the marker of metabolically unhealthy obesity (MUO) in children, or a parameter that can be used in the overall assessment. It is intended to compare the International Diabetes Federation (IDF) criteria against HOMA in the diagnosis of MUO.

Methods:

This observational, retrospective, cohort study included children with obesity and analyzed their metabolic state by means of blood testing and dual‐energy X‐ray absorptiometry.

Results:

A total of 96 patients were included, 44.8% boys and 55.2% girls, ages 6–17 years. The patients with MHO according to the HOMA criterion were younger (P = 0.001), had a lower body mass index (BMI) z score (P = 0.006), waist–height index (P = 0.009), hip–height index (P = 0.010), blood glucose (P = 0.003), insulin (P < 0.001), and lower percentages of total fat (P = 0.002), trunk fat (P = 0.001), and android fat (P = 0.009) than those with MUO. The logistic regression analysis according to IDF criteria detected an area under the receiver operating characteristic (ROC) curve of 0.659 (95% CI 0.546–0.771; P = 0.009) versus the area under the ROC curve of 0.854 (95% CI 0.777–0.931; P < 0.001) for the HOMA definition. Therefore, the determination of the metabolic state according to HOMA has greater sensitivity and specificity than the IDF criteria. The multivariate analysis in children classified according to HOMA revealed that the percentage of total fat and gynoid fat distributions and triglyceride level could be markers of a healthy or unhealthy metabolic state in children with obesity (P < 0.001).

Conclusions:

The use of HOMA as a single criterion was demonstrated to be an effective and simple detector of adiposity, which predicts the metabolically healthy obesity in children.
Clinical Practice Survey of Repeat Endoscopy in Pediatric Inflammatory Bowel Disease in North America
Authors: Moses Jonathan , Sandberg Kelly , Winberry Gabriel , Riera Diana , DeLozier Sarah , Gupta Sandeep K. , Reilly Norelle , Park KT , Picoraro Joseph
Published: February 2021

Objectives:

Endoscopic remission has become a standard treatment target in inflammatory bowel disease (IBD). It is unclear how widely this practice has been adopted amongst pediatric gastroenterology providers. This study determines the frequency of repeat endoscopy in pediatric IBD and evaluates for predictive baseline characteristics of providers.

Methods:

We developed a cross‐sectional survey, which was distributed via 3 national email listservs to pediatric gastroenterology providers. We obtained baseline characteristics of respondents and assessed motivations and barriers for the practice of repeat endoscopy compared with none.

Results:

Two hundred and thirty‐eight unique respondents completed the online survey. Response rate was 11% (238 of 2300 possible participants). The majority practice in an academic setting (77%) and reported participation in ImproveCareNow (63%). Overall, 65% of respondents perform repeat endoscopy to assess for endoscopic remission in pediatric IBD as part of routine clinical practice. Fifty‐six percent reported repeat endoscopy as individuals in the absence of a departmental protocol. “Symptoms are not sufficient to follow IBD patients” was reported by 82% of those who repeat endoscopy; conversely, “I perform endoscopy based on clinical, biomarker, and/or imaging trends” was reported by 81% of those who do not repeat endoscopy. The establishment of a pediatric‐specific guideline was most commonly reported to change current practice, based on rank‐order scoring.

Conclusions:

A majority of representative providers repeat endoscopy to assess for endoscopic remission in pediatric IBD. Fewer years in practice favored repeating endoscopy. The need for North American pediatric guidelines with pediatric‐specific evidence to support the long‐term benefits of endoscopic remission are highlighted in this study.
Therapy-related Myeloid Neoplasms in Children: A Single-institute Study
Authors: Li Geling , Holly Taylor , Kelly David R. , Reddy Vishnu , Mikhail Fady M. , Carroll Andrew J. , Kutny Matthew A.
Published: February 2021

Therapy-related myeloid neoplasm (t-MN) in the pediatric population is not well characterized. We studied 12 pediatric patients diagnosed with t-MN in our institution since 2006. The median age at the t-MN diagnoses was 14.8 years (range, 9 to 20 y). The primary malignancies included 9 solid tumors and 3 hematopoietic malignancies. Rhabdomyosarcoma (n=4) was the most common primary malignancy. Five of the 9 patients with solid tumors and all 3 patients with hematopoietic malignancies had primary neoplasms involving bone marrow. The median latency period was 5.2 years (range, 1.8 to 13.8 y). Thrombocytopenia was present in all patients at the t-MN diagnoses. Complete or partial monosomy of chromosome 5 or 7 were the 2 most common cytogenetic abnormalities. A quarter of patients demonstrated a genetic predisposition to t-MN: 1 with Li-Fraumeni syndrome with a germline TP53 R248Q mutation, 1 with Noonan syndrome with a somatic mutation (PTPN11 S502T), and 1 with a constitutive chromosomal translocation [t(X;9)(p22;q34)] and a germline TP53 L130V mutation. Outcomes remain poor. Two patients survived 3 and 5.1 years after hematopoietic stem cell transplantation.
Association of Anemia and Blood Pressure With Novel Markers of Diastolic Function in Pediatric Sickle Cell Disease
Authors: Jhaveri Simone , Choueiter Nadine , Manwani Deepa , Ranabothu Saritha , Morrone Kerry , Hafeman Michael , Reidy Kimberly , Kaskel Frederick , Mahgerefteh Joseph
Published: February 2021

Diastolic dysfunction is a known cause of mortality in adults with sickle cell disease (SCD). Left atrial function (LAf) and strain (LAS) are novel echocardiographic parameters to assess early diastolic dysfunction, which have not been assessed in pediatric SCD. Through a retrospective single-center study, we describe echocardiographic parameters of diastology in children with SCD and evaluate their relationship with clinical variables including anemia and blood pressure. Baseline clinical data, 24-hour ambulatory blood pressure monitoring data and echocardiography results were collected. LAf and LAS were measured using volumetric data and speckle-tracking echocardiography, respectively. Sixty-seven children with SCD (13.5±7 y, 47% male, 7% hypertensive) with a mean hemoglobin of 8.8±1.3 g/dL, LAf of 61±8% (n=53) and LAS of 46.3±7.4% (n=28) were included. LAS was significantly associated with hemoglobin (ρ=0.43, P=0.022) but not with maximal left atrial (LA) volume (ρ=−0.05, P=0.79) or any blood pressure parameters. On multivariate analysis, LAS decreased by 3.2% (1.3, 5.1) and LA volume increased by 1.6 mL/m2 (3.1, 0.08) for every 1 g/dL decrease in hemoglobin. Thus, severity of baseline anemia in pediatric SCD correlates with diastolic function as measured by LAS, independent of LA dilation.
Increased Expression of IL-17A and IL-17F Is Correlated With RUNX1 and RORγT in Pediatric Patients With Primary Immune Thrombocytopenia
Authors: Elnaenaey Wafaa A. , Omar Omneya M. , Aboelwafa Reham A.
Published: February 2021

Immune thrombocytopenia (ITP) is characterized by dysregulated cellular immunity. Interleukin 17 (IL-17) and its secreting cells (Th17) are involved in the pathogenesis of ITP. Retinoic acid receptor–related orphan receptor γt (RORγt) is the chief regulator of Th17 development. The interaction among Runt-related transcription factor 1 (RUNX1) and IL-17-related genes in ITP remains questionable. The study aimed to evaluate the expression of RUNX1 and RORγt together with
IL-17A
and IL-17F genes in childhood ITP to investigate their contribution to disease pathogenesis and clinical presentation. Ninety children were included, 30 primary active ITP patients, 30 ITP patients in remission after treatment, and 30 healthy controls. The expression levels of RUNX1, RORγt, IL-17A, and IL-17F genes were measured. Significant overexpression of RUNX1, RORγt, IL-17A, and IL-17F genes was observed in active ITP patients, which was restored to normal levels in both ITP patients in remission and controls (P<0.001 for the 4 genes). Positive correlations between RUNX1, RORγt, IL-17A, and IL-17F expression levels were observed in active ITP patients (P=0.001 for RUNX1 with RORγt, P<0.001 for RUNX1 with both IL-17A and IL-17F, regarding RORγt
P<0.001 with IL-17A and P=0.002 with IL-17F, P=0.001 for IL-17A with IL-17F). In conclusion, RUNX1 is possibly involved in the molecular pathogenesis of ITP upregulating the expression of Th17-secreted cytokines, IL-17A and IL-17F, through RORγt at the transcriptional level. Thus, targeting RUNX1 or RORγt may be new alternative therapeutic strategies.
Malignant Giant Cell Tumor of Bone With a KRAS G12V Mutation
Authors: Donigian Sara , Whiteway Susan L. , Hipp Sean J. , Lybeck Dustin , Clark Rebecca O.
Published: February 2021

Malignant giant cell tumor of bone (GCTB) is a rare, aggressive, sarcoma occurring in adolescent and young adults. It is characterized by the presence of multinucleated giant cells and an aggressive clinical course. Because of the rarity of this tumor, no standard therapies have been identified. Current treatment regimens often include osteosarcoma chemotherapy protocols. We present a case of a malignant GCTB with a KRAS G12V mutation. This mutation is a known oncogenic driver that has not previously been reported on patients with malignant GCTB.
Erythropoietin Concentration in Boys With p.His63Asp Polymorphism of the HFE Gene
Authors: Kaczorowska-Hac Barbara , Luszczyk Marcin , Wasilewska Eliza , Antosiewicz Jedrzej , Kaczor Jan J.
Published: February 2021

The molecular mechanism that regulates iron homeostasis is based on a network of signals, which reflect on the iron requirements of the body. HFE-related hemochromatosis is characterized by excessive intestinal absorption of dietary iron, in particular cases resulting in pathologically high iron storage in tissues and organs. During childhood, HFE gene homozygosity or heterozygosity manifests exclusively in the form of biochemical abnormalities. Because of their mutual link, bioavailable iron and endogenous erythropoietin (EPO) are indispensable for effective erythropoiesis. We analyzed the impact of p.(His63Asp) polymorphism of the HFE gene on erythropoiesis taking into consideration endogenous EPO production in the developmental age. In the study we performed, we observed a significant, strong and negative correlation between the concentration of EPO, hemoglobin, and red blood cell count. A negative trend was also noted on the impact of iron concentration and transferrin saturation on EPO production. In conclusion, this preliminary study demonstrates an impaired impact of endogenous EPO on erythropoiesis in the presence of increased iron content in carriers of p.(His63Asp) (heterozygotes) variant of the HFE gene in developmental age.