Tag: pubmed

Eur Arch Otorhinolaryngol. 2022 Oct 9. doi: 10.1007/s00405-022-07676-1. Online ahead of print.

ABSTRACT

PURPOSE: A narrow bony internal auditory canal (IAC) may be associated with a hypoplastic cochlear nerve and poorer hearing performances after cochlear implantation. However, definitions for a narrow IAC vary widely and commonly, qualitative grading or two-dimensional measures are used to characterize a narrow IAC. We aimed to refine the definition of a narrow IAC by determining IAC volume in both control patients and patients with inner ear malformations (IEMs).

METHODS: In this multicentric study, we included high-resolution CT (HRCT) scans of 128 temporal bones (85 with IEMs: cochlear aplasia, n = 11; common cavity, n = 2; cochlear hypoplasia type, n = 19; incomplete partition type I/III, n = 8/8; Mondini malformation, n = 16; enlarged vestibular aqueduct syndrome, n = 19; 45 controls). The IAC diameter was measured in the axial plane and the IAC volume was measured by semi-automatic segmentation and three-dimensional reconstruction.

RESULTS: In controls, the mean IAC diameter was 5.5 mm (SD 1.1 mm) and the mean IAC volume was 175.3 mm³ (SD 52.6 mm³). Statistically significant differences in IAC volumes were found in cochlear aplasia (68.3 mm³, p < 0.0001), IPI (107.4 mm³, p = 0.04), and IPIII (277.5 mm³, p = 0.0004 mm³). Inter-rater reliability was higher in IAC volume than in IAC diameter (intraclass correlation coefficient 0.92 vs. 0.77).

CONCLUSIONS: Volumetric measurement of IAC in cases of IEMs reduces measurement variability and may add to classifying IEMs. Since a hypoplastic IAC can be associated with a hypoplastic cochlear nerve and sensorineural hearing loss, radiologic assessment of the IAC is crucial in patients with severe sensorineural hearing loss undergoing cochlear implantation.

PMID:36210370 | DOI:10.1007/s00405-022-07676-1

Eur Ann Otorhinolaryngol Head Neck Dis. 2022 Oct 6:S1879-7296(22)00093-X. doi: 10.1016/j.anorl.2022.07.007. Online ahead of print.

ABSTRACT

OBJECTIVE: Hearing loss is a highly prevalent condition in the pediatric population. Pediatric maxillary expansion is a widespread treatment to address transverse maxillary deficiency. First reports describing an association between improvements for patients with HL and PME initiated in the 1960s. In this systematic review and meta-analysis we aim to review the role of maxillary expansion in reducing conductive hearing loss in pediatric population.

REVIEW METHODS: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked. Main outcome was expressed as the difference between air-bone gap, compliance, ear volume and conductive hearing thresholds before and after treatment and the 95% confidence interval.

RESULTS: A total of 10 studies (218 patients) met inclusion criteria. The pooled data in the meta-analysis under a random effects model shows a statistically significant difference of 10.57dB mean reduction after palatal expansion. The air-bone gap was significantly reduced by 5.39dB (CI 95% 3.68, 7.10). Compliance and volume were assessed in three studies, with a non-significant positive difference in the compliance (0.14) and a statistically significant difference for volume (0.80) after palatal expansion.

CONCLUSION: This systematic review and meta-analysis found a positive effect of pediatric maxillary expansion in conductive hearing loss in well-select children. However, results cannot be extrapolated for children with conductive hearing loss without an accompanying orthodontic indication (maxillary constriction). It showed that the existing prospective studies exhibited qualitative pitfalls, limiting the ability to obtain conclusive evidence about the role of pediatric maxillary expansion on conductive hearing loss in children.

PMID:36210326 | DOI:10.1016/j.anorl.2022.07.007

Psych J. 2022 Oct 9. doi: 10.1002/pchj.599. Online ahead of print.

ABSTRACT

The COVID-19 pandemic threatens health-care workers’ (HCW) mental health and well-being. Although traumatic life events may result in psychiatric disorders, occasionally they give rise to positive changes, such as post-traumatic growth. Accordingly, the present study evaluated the traumatic stress, anxiety, and depression levels of HCWs and their post-traumatic growth levels during the pandemic. In addition, the study aimed to assess the changes in psychological outcomes during the pandemic. For this aim, the data were collected in two different periods. The first data-collection period was between May and July 2020, and the second period started in November 2020 and ended in January 2021. The sociodemographic data form, Impact of Events Scale-Revised (IES-R), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Post-traumatic Growth Inventory (PTGI) were used to collect data. Sixty-six HCWs participated in the study. No significant differences appeared between the baseline scores and 6-month follow-up in the depression, anxiety, and traumatic stress levels of HCWs. Furthermore, the PTGI scores decreased significantly over time. Although the change in the psychological distress scores was not statistically significant, the depression and post-traumatic stress scores increased over time. Previous research specified an inverse-parabolic relationship between traumatic stress and PTGI. Our results support previous research; as the exposure to the stressors continues, individual traumatic stress levels increase, psychiatric disorders become frequent, and affirmative changes (like post-traumatic growth) decline.

PMID:36210343 | DOI:10.1002/pchj.599

J Cyst Fibros. 2022 Oct 6:S1569-1993(22)00690-7. doi: 10.1016/j.jcf.2022.09.013. Online ahead of print.

ABSTRACT

BACKGROUND: As survival and health improve in people with cystic fibrosis (CF), more women with CF (wwCF) are considering their sexual and reproductive health (SRH). This study compared SRH experiences, behaviors, and care utilization of wwCF to the general population and defined CF-impacted considerations and care preferences.

METHODS: We surveyed wwCF aged ≥25 years regarding SRH and compared results to the US National Survey of Family Growth (NSFG;n = 4357) and friend controls(n = 123). We used descriptive statistics and chi-squared/Fisher’s exact testing and linear regression for comparisons.

RESULTS: A total of 460 wwCF (mean age 36.1 years) completed the survey. WwCF were less likely to report current contraceptive use (43%vs76% NSFG, p<0.001;60% friends, p = 0.005). Nearly 25% of wwCF reported worsened CF symptoms during their menstrual cycles, 50% experienced urinary incontinence, and 80% vulvovaginal candidiasis. WwCF were significantly less likely to be parents (46%vs62% friends, p = 0.015) and to have experienced pregnancy (37%vs78% NSFG, p<0.001;58% friends, p = 0.002). More wwCF required medical assistance to conceive (29%vs12% NSFG, p<0.001 and 5% friends, p<0.001). Eighty-four percent of wwCF view their CF doctor as their main physician and 41% report no primary care provider (vs19% friends; p<0.001). WwCF report suboptimal rates of contraceptive and preconception counseling/care and are less likely to have received HPV vaccination (42%vs55%friends, p = 0.02). Despite desiring SRH conversations with their CF team, <50% report discussing SRH topics.

CONCLUSION: WwCF have significantly different SRH experiences than non-CF peers. They report suboptimal SRH care compared to their preferences highlighting an urgent need to encourage SRH counseling/care in the CF model.

PMID:36210323 | DOI:10.1016/j.jcf.2022.09.013

Hepatobiliary Pancreat Dis Int. 2022 Sep 30:S1499-3872(22)00236-3. doi: 10.1016/j.hbpd.2022.09.013. Online ahead of print.

ABSTRACT

BACKGROUND: The hepatic artery is the only blood source nourishing the biliary duct and associated with biliary complication after liver transplantation (LT). Gastroduodenal artery (GDA) disconnection increased proper hepatic artery flow. Whether this procedure attenuates biliary non-anastomotic stricture (NAS) is not clear.

METHODS: A total of 241 patients with LT were retrospectively analyzed. The patients were divided into the GDA disconnection (GDA-) and GDA preservation (GDA+) groups. Propensity score matching (PSM) was administrated to reduce bias. Logistic regression was conducted to analyze risk factors for biliary NAS before and after PSM. Postoperative complications were compared. Kaplan-Meier survival analysis and log-rank tests were performed to compare overall survival.

RESULTS: In all, 99 patients (41.1%) underwent GDA disconnection, and 49 (20.3%) developed NAS. Multivariable logistic regression revealed that GDA preservation (OR = 2.24, 95% CI: 1.11-4.53; P = 0.025) and model for end-stage liver disease (MELD) score > 15 (OR = 2.14, 95% CI: 1.12-4.11; P = 0.022) were risk factors for biliary NAS. PSM provided 66 pairs using 1:2 matching method, including 66 GDA disconnection and 99 GDA preservation patients. Multivariable logistic regression after PSM also showed that GDA preservation (OR = 3.15, 95% CI: 1.26-7.89; P = 0.014) and MELD score > 15 (OR = 2.41, 95% CI: 1.08-5.36; P = 0.031) were risk factors for NAS. When comparing complications between the two groups, GDA preservation was associated with a higher incidence of biliary NAS before and after PSM (P = 0.031 and 0.017, respectively). In contrast, other complications including early allograft dysfunction (P = 0.620), small-for-size graft syndrome (P = 0.441), abdominal hemorrhage (P = 1.000), major complications (Clavien-Dindo grade ≥ 3, P = 0.318), and overall survival (P = 0.088) were not significantly different between the two groups.

CONCLUSIONS: GDA disconnection during LT ameliorates biliary NAS incidence and may be recommended for application in clinical practice.

PMID:36210313 | DOI:10.1016/j.hbpd.2022.09.013

Clin Breast Cancer. 2022 Sep 17:S1526-8209(22)00217-8. doi: 10.1016/j.clbc.2022.09.004. Online ahead of print.

ABSTRACT

BACKGROUND: Health-related quality of life (HRQoL) is one of the core outcomes for breast reconstruction. The aim of this study was to evaluate whether the method of delayed breast reconstruction affects long-term HRQoL.

METHODS: Participants were divided into 2 arms depending on previous radiotherapy, and subsequently randomized between 2 methods of breast reconstruction: a latissimus dorsi flap or a deep inferior epigastric artery perforator flap in the radiated arm and a thoracodorsal flap and implant or an expander in the non-radiated arm. Validated HRQoL instruments were used: BREAST-Q to evaluate breast specific HRQoL and satisfaction, RAND-36 and EQ-5D to evaluate generic HRQoL, and BDI-21 to measure symptoms of depression and anxiety.

RESULTS: During the recruitment period (2009-2015), 233 patients were randomized. After opt-outs and exclusions, the remaining 107 participants comprise the study sample. Postoperative HrQoL was measured on average 7to 8years post-operatively. Response rates varied between 60 and 82 per cent. The BREAST-Q scores were higher after the reconstruction than before for the great majority of domains in both arms; albeit statistically significant only between the 2 methods for physical well-being chest in the radiated arm. Most participants in both arms had minimal or mild depression both before and after the operation.

CONCLUSION: No distinct differences in long-term HrQoL could be seen for different methods There was a clear improvement in HrQoL compared to pre-reconstruction in all groups, but the effect of specific reconstructive methods on scores could not be reliably demonstrated.

PMID:36210311 | DOI:10.1016/j.clbc.2022.09.004

Eur Urol Focus. 2022 Oct 6:S2405-4569(22)00216-4. doi: 10.1016/j.euf.2022.09.009. Online ahead of print.

ABSTRACT

BACKGROUND: Social media use in medicine has exploded, with uptake by most physicians and patients. There is a risk of dissemination of inaccurate information about urological conditions on social media. Physicians, as key opinion leaders, must play a role in sharing evidence-based information through social media.

OBJECTIVE: To identify and describe the top 100 urology influencers on the Twitter social media platform and to correlate Twitter influence with academic impact in urology.

DESIGN, SETTING, AND PARTICIPANTS: Twitter influence scores for the search topic “urology” were collected in April 2022 using published methodology. The top 100 personal accounts with the highest computed scores were linked to individuals’ names, all-time h index, geographic location, specialty, attributed sex, and board certification status in this cross-sectional study.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We examined the correlation between influence rank and h index.

RESULTS AND LIMITATIONS: Of the top 100 Twitter influencers on the topic of urology, the majority are from the USA (64%), male (85%), and practicing urologists (91%). Some 93% of US urology influencers are board-certified. Only 22 of the 50 US states are represented. The second most frequent country is the UK, with ten urology influencers. The median all-time h index is 42 (interquartile range 28.25-58). There is a weak positive correlation between influence rank and h index (r = 0.23; p = 0.02). Limitations of the study include the inability to validate the accuracy of the proprietary ranking algorithm and investigation of just one social media platform.

CONCLUSIONS: The top Twitter influencers in urology are mostly board-certified US urologists. Collectively, influencers have a relatively greater academic impact in comparison to the average urologist, although there is a weak positive correlation between Twitter influence and h index among top Twitter influencers.

PATIENT SUMMARY: Given the explosion of medical information on Twitter, we report the personal accounts with the greatest impact for the topic of “urology”. We found that most urology influencers on Twitter are US board-certified urologists with a strong research history.

PMID:36210295 | DOI:10.1016/j.euf.2022.09.009

J Optom. 2022 Oct 7:S1888-4296(22)00060-7. doi: 10.1016/j.optom.2022.09.002. Online ahead of print.

ABSTRACT

PURPOSE: To discriminate suspect glaucomatous from control eyes using corneal densitometry based on the statistical modeling of the pixel intensity distribution of Scheimpflug images.

METHODS: Twenty-four participants (10 suspect glaucomatous and 14 control eyes) were included in this retrospective study. Corneal biomechanics was assessed with the commercial Scheimpflug camera Corvis ST (Oculus). Sets of 140 images acquired per measurement were exported for further analysis. After corneal segmentation, pixel intensities corresponding to different corneal depths were statistically modeled for each image, from which corneal densitometry in the form of parameters α (brightness) and β (homogeneity) was derived. After data pre-processing, parameters α and β were input to six supervised machine learning algorithms that were trained, tested, and compared.

RESULTS: There exists a statistically significant difference in α and β parameters between suspect glaucomatous and control eyes (both, P < 0.05/N, Bonferroni). From the implemented supervised machine learning algorithms, the K-nearest neighbors (K-NN) algorithm reached 83.93% accuracy to discriminate between groups only using corneal densitometry parameters (α and β).

CONCLUSION: Densitometry of the anterior cornea including epithelium on its own has the potential to serve as a clinical tool for early glaucoma risk assessment.

PMID:36210294 | DOI:10.1016/j.optom.2022.09.002

J Plast Reconstr Aesthet Surg. 2022 Aug 24:S1748-6815(22)00487-9. doi: 10.1016/j.bjps.2022.08.042. Online ahead of print.

ABSTRACT

BACKGROUND: Peripheral vascular malformations (VMs) may lead to disfigurement of the body and face, potentially impairing aesthetic appearance. Yet, data on appearance in this population is limited. This study aimed to examine appearance-related concerns and their impact on health-related quality of life (HR-QoL) in patients with VMs.

METHODS: In this cross-sectional study, 384 adults and 194 children with VMs were invited to complete the Outcome Measures for VAscular MAlformations (OVAMA) questionnaire to evaluate potential appearance-related concerns on a five-point verbal-rating scale, with higher scores indicating more appearance-related concerns (e.g., colour-difference, facial-distortion, reduced self-esteem, and dissatisfaction with appearance). HR-QoL was evaluated using Patient-Reported Outcome Measurement Information System (PROMIS). Subgroups of patients reporting more appearance-related concerns were identified using univariate analysis. Associations between appearance-related concerns and various HR-QoL domains (e.g., anxiety and social participation) were assessed.

RESULTS: A total of 184 patients (32%) completed the questionnaires; 121 patients (66%) reported that one or more appearance outcome was severely affected (i.e., 4-5 out of 5). The following factors statistically significant associated with more appearance-related concerns: capillary/combined origin, facial localization, subcutaneous tissue involvement, larger size, overgrowth, and diagnosis of a syndrome. In adults, dissatisfaction with appearance and reduced self-esteem due to the appearance of the VM correlated with more anxiety and depression symptoms. Reduced self-esteem correlated with less social participation. In children, bodily distortion and being stared at were correlated with less peer relationships.

CONCLUSION: Severe appearance-related concerns were present in two-thirds of patients with VMs, impairing their mental HR-QoL. Clinicians should acknowledge appearance-related aspects, monitor psychological well-being, and offer intervention aimed at improving satisfaction with appearance.

PMID:36210292 | DOI:10.1016/j.bjps.2022.08.042

Aust Crit Care. 2022 Oct 6:S1036-7314(22)00098-4. doi: 10.1016/j.aucc.2022.07.007. Online ahead of print.

ABSTRACT

INTRODUCTION: While paediatric critical illness mortality rates in Australia are declining, the growing cohort of paediatric intensive care unit (PICU) survivors means an increasing number of children facing substantial health challenges after their discharge from intensive care. General practitioners (GPs) play a key role in provision of comprehensive health care to children and families and are ideally positioned to provide developmental surveillance and support the care of both the child and family following critical illness.

METHODS: An anonymous, cross-sectional survey of 60 GPs, reached via private invitation (19% response) or via social media weblink, was conducted where the GPs were asked about their current confidence and knowledge in managing children post PICU. This included awareness of short- and long-term problems, of paediatric intensive care syndrome in paediatrics (PICS-p), and of educational materials. Lastly, a parent-completed screening questionnaire and shared-care pathway were proposed to GPs for their feedback on perceived benefit and willingness to participate. Data were analysed using frequency distributions and chi-square statistics.

RESULTS: Ninety-three percent of GPs had some level of confidence in caring for a child post PICU admission and low confidence in their knowledge of potential short- and long-term complications. Eighty percent of GPs had not heard of PICS-p, and 93% were unaware of educational materials available on this topic. Ninety-five percent of GPs perceived that the proposed patient-screening tool and shared-care pathways would be beneficial, and 70% predicted that they would definitely use educational materials if accessible through GP central repositories.

CONCLUSION: To reduce ongoing health problems for children recovering from critical illness, the family GP plays a pivotal role in providing community-level developmental care, particularly in Australia. Increasing GP confidence and knowledge through education is essential, and using a parent-completed screening questionnaire and shared-care pathway to improve care may be beneficial. GPs must also be involved in the implementation stages of future shared-care models.

PMID:36210281 | DOI:10.1016/j.aucc.2022.07.007