Publications by authors named "Daniel J Lee"

315 Publications

Neuroimaging Correlates of Syndromal Anxiety Following Traumatic Brain Injury: A Systematic Review of the Literature.

J Acad Consult Liaison Psychiatry 2021 Sep 14. Epub 2021 Sep 14.

Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences. Electronic address:

Background: Traumatic brain injury (TBI) can precipitate new-onset psychiatric symptoms or worsen existing psychiatric conditions. To elucidate specific mechanisms for this interaction, neuroimaging is often used to study both psychiatric conditions and TBI. This systematic review aims to synthesize the existing literature of neuroimaging findings among patients with anxiety after TBI.

Methods: We conducted a PRISMA-compliant literature search via PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May, 2019. We included studies that clearly defined TBI, measured syndromic anxiety as a primary outcome, and statistically analyzed the relationship between neuroimaging findings and anxiety symptoms.

Results: A total of 5982 articles were retrieved from the systematic search, of which 65 studied anxiety and 13 met eligibility criteria. These studies were published between 2004 and 2017, collectively analyzing 764 participants comprised of 470 TBI patients and 294 non-TBI controls. Imaging modalities used included magnetic resonance imaging (MRI), functional MRI, diffusion tensor imaging, electroencephalogram, magnetic resonance spectrometry, and magnetoencephalography. Eight of 13 studies presented at least one significant finding and together reflect a complex set of changes that lead to anxiety in the setting of TBI. The left cingulate gyrus in particular was found to be significant in two studies using different imaging modalities. Two studies also revealed perturbances in functional connectivity within the default mode network.

Conclusions: This is the first systemic review of neuroimaging changes associated with anxiety after TBI, which implicated multiple brain structures and circuits, such as the default mode network. Future research with consistent, rigorous measurements of TBI and syndromic anxiety, as well as attention to control groups, previous TBIs, and time interval between TBI and neuroimaging, are warranted. By understanding neuroimaging correlates of psychiatric symptoms, this work could inform future post-TBI screening and surveillance, preventative efforts, and early interventions to improve neuropsychiatric outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaclp.2021.09.001DOI Listing
September 2021

Impact of the COVID-19 Pandemic on Urological Care Delivery in the United States.

J Urol 2021 Sep 2:101097JU0000000000002145. Epub 2021 Sep 2.

Departments of Urology, and Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.

Plain language summary:Outpatient visits and surgical procedures declined and recovered, and the magnitude of both varied by many factors, such as race, insurance type, location, urgency of diagnosis and procedure. The impact of delayed treatment and the differences in decline and recovery should inform approaches for the ongoing treatment of patients both during and post pandemic.

Purpose: We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features.

Materials And Methods: We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urological practices and 3,165 providers across 48 U.S. states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021.

Results: We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Nonurgent outpatient visits decreased more across various nonurgent procedures (49%-59%) than for procedures performed for potentially urgent diagnoses (38%-52%); surgical procedures for nonurgent conditions also decreased more (43%-79%) than those for potentially urgent conditions (43%-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of recovery to baseline (73% and 69%, respectively).

Conclusions: This study provides real-world evidence on the decline in urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urological health services by demographics and procedure type.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JU.0000000000002145DOI Listing
September 2021

Psychometric properties of the Posttraumatic Avoidance Behaviour Questionnaire among a treatment-seeking adult sample.

Psychol Trauma 2021 Aug 16. Epub 2021 Aug 16.

National Center for PTSD.

Objective: Avoidance of trauma-related stimuli is thought to be central in the development and maintenance of posttraumatic stress disorder (PTSD). However, knowledge of trauma-related avoidance has been limited by conceptualization of this construct as unifactorial and consisting of only two components. The Posttraumatic Avoidance Behaviour Questionnaire (PABQ; van Minnen & Hagenaars, 2010) was developed to assess distinct domains of avoidance.

Method: The current study expanded upon one prior psychometric study of the PABQ by examining the internal consistency and construct validity of the PABQ among a sample of 177 treatment-seeking adults diagnosed with PTSD.

Results: Results indicated that the psychometric properties vary by PABQ subscale. Although all subscales demonstrated adequate internal consistency, items that appear to be negatively impacting internal consistency were identified for several subscales. Although correlations between PABQ subscales indicate subscales index distinct dimensions of trauma-related avoidance, observed similar associations with external correlates suggest these subscales may not functionally differ in their association with PTSD symptoms and co-occurring psychopathology. Accordingly, results suggest further construct validity evidence is needed to determine whether, despite potentially representing distinct domains of avoidance, avoidance of different forms of trauma-related stimuli predicts functionally distinct outcomes.

Conclusions: Collectively, our results indicate that the PABQ is a potentially promising measure for assessing trauma-related avoidance behavior, although additional research is needed to better understand the degree to which these hypothesized distinct domains of avoidance behaviors represent meaningfully distinct constructs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/tra0001060DOI Listing
August 2021

International Survey of Operative Practices for Otologists and Neurotologists During the COVID-19 Crisis.

Otol Neurotol 2021 09;42(8):1275-1284

Department of Otorhinolaryngology - Head and Neck Surgery, University of Tuebingen, Tuebingen, Germany.

Objective: To investigate the influence of the COVID-19 pandemic on operative practices of otology and neurotology providers internationally.

Study Design: Cross-sectional survey.

Methods: A 78-question survey was distributed to otologists and neurotologists between May 12, 2020 and June 8, 2020 to assess the impact of the pandemic on surgical practices. Sections within the survey delineated time periods: prior to the crisis, onset of the crisis, during the crisis, postcrisis transition.

Results: Of 396 survey respondents, 284 participants from 38 countries met inclusion criteria.Respondents were 16.9% female and 82.4% male, with a most common age range of 40 to 49 years (36.3%). 69.8% of participants had been in practice for over 10 years and most respondents worked in an academic medical center (79.2%). The average operative weekly caseload was 5.3 (SD 3.9) per surgeon prior to the crisis, 0.7 (SD 1.2) during the COVID-19 crisis, and 3.5 (SD 3.3) for those who had begun a postcrisis transition at the time of survey administration (p < 0.001). 71.5% of providers did not perform an elective otologic or neurotologic operative procedure during the initial crisis period. 49.8% reported modifying their surgical technique due to the COVID-19 pandemic. Use of powered air-purifying respirators and filtering facepiece 2 or 3 (FFP2/FFP3) respirators were in minimal supply for 66.9% and 62.3% of respondents, respectively.

Conclusion: The COVID-19 pandemic impacted the otology and neurotology community globally, resulting in significant changes in operative volume and case selection. Modification of surgical technique and shortages of personal protective equipment were frequently reported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000003219DOI Listing
September 2021

International Survey of Operative Practices for Otologists and Neurotologists During the COVID-19 Crisis.

Otol Neurotol 2021 09;42(8):1275-1284

Department of Otorhinolaryngology - Head and Neck Surgery, University of Tuebingen, Tuebingen, Germany.

Objective: To investigate the influence of the COVID-19 pandemic on operative practices of otology and neurotology providers internationally.

Study Design: Cross-sectional survey.

Methods: A 78-question survey was distributed to otologists and neurotologists between May 12, 2020 and June 8, 2020 to assess the impact of the pandemic on surgical practices. Sections within the survey delineated time periods: prior to the crisis, onset of the crisis, during the crisis, postcrisis transition.

Results: Of 396 survey respondents, 284 participants from 38 countries met inclusion criteria.Respondents were 16.9% female and 82.4% male, with a most common age range of 40 to 49 years (36.3%). 69.8% of participants had been in practice for over 10 years and most respondents worked in an academic medical center (79.2%). The average operative weekly caseload was 5.3 (SD 3.9) per surgeon prior to the crisis, 0.7 (SD 1.2) during the COVID-19 crisis, and 3.5 (SD 3.3) for those who had begun a postcrisis transition at the time of survey administration (p < 0.001). 71.5% of providers did not perform an elective otologic or neurotologic operative procedure during the initial crisis period. 49.8% reported modifying their surgical technique due to the COVID-19 pandemic. Use of powered air-purifying respirators and filtering facepiece 2 or 3 (FFP2/FFP3) respirators were in minimal supply for 66.9% and 62.3% of respondents, respectively.

Conclusion: The COVID-19 pandemic impacted the otology and neurotology community globally, resulting in significant changes in operative volume and case selection. Modification of surgical technique and shortages of personal protective equipment were frequently reported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000003219DOI Listing
September 2021

Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance.

JAMA Netw Open 2021 Aug 2;4(8):e2119764. Epub 2021 Aug 2.

Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia.

Importance: With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance.

Objective: To examine differences in spending and utilization for patients with private insurance undergoing common cancer surgery at National Cancer Institute (NCI) centers vs community hospitals.

Design, Setting, And Participants: This retrospective cross-sectional study included adult patients with an incident diagnosis of breast, colon, or lung cancer who underwent cancer-directed surgery from 2011 to 2014. Mean risk-adjusted spending and utilization outcomes were examined for each hospital type using multilevel generalized linear mixed-effects models, adjusting for patient, hospital, and region characteristics. Data were collected from the Health Care Cost Institute's national multipayer commercial claims data set, which encompasses claims paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and UnitedHealthcare). Data analyses were conducted from February 2018 to February 2019.

Exposures: Hospital type at which cancer surgery was performed: NCI, non-NCI academic, or community.

Main Outcomes And Measures: Spending outcomes were surgery-specific insurer prices paid and 90-day postdischarge payments. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days of discharge.

Results: The study included 66 878 patients (51 569 [77.1%] women; 31 585 [47.2%] aged ≥65 years) with incident breast (35 788 [53.5%]), colon (21 378 [32.0%]), or lung (9712 [14.5%]) cancer undergoing cancer surgery at 2995 hospitals (5522 [8.3%] at NCI centers; 10 917 [16.3%] at non-NCI academic hospitals; 50 439 [75.4%] at community hospitals). Treatment at NCI centers was associated with higher surgery-specific insurer prices paid compared with community hospitals ($18 526 [95% CI, $16 650-$20 403] vs $14 772 [95% CI, $14 339-$15 204]; difference, $3755 [95% CI, $1661-$5849]; P < .001) and 90-day postdischarge payments ($47 035 [95% CI, $43 289-$50 781] vs $41 291 [95% CI, $40 350-$42 231]; difference, $5744 [95% CI, $1659-9829]; P = .006). There were no significant differences in LOS, ED use, or hospital readmission within 90 days of discharge.

Conclusions And Relevance: In this cross-sectional study, surgery at NCI centers vs community hospitals was associated with higher insurer spending for a surgical episode without differences in care utilization among patients with private insurance undergoing cancer surgery. A better understanding of the factors associated with prices and spending at NCI cancer centers is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2021.19764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335573PMC
August 2021

Adult Auditory Brainstem Implant Outcomes and Three-Dimensional Electrode Array Position on Computed Tomography.

Ear Hear 2021 Jul 16. Epub 2021 Jul 16.

Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA Department of Audiology, Massachusetts Eye and Ear, Boston, Massachusetts, USA Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.

Objectives: Factors contributing to auditory brainstem implant (ABI) outcomes are poorly understood. The aims of this study are to (1) characterize ABI electrode array position on postoperative imaging and (2) determine if variability in position is related to perceptual outcomes.

Design: Retrospective cohort study. Subjects were selected from the adult ABI recipient population at Massachusetts Eye and Ear. Postoperative three-dimensional (3D) computed tomography (CT) reconstruction of the head was used to measure ABI array position in 20 adult ABI recipients (17 with Neurofibromatosis Type 2 (NF2) and three non-NF2 recipients). Three-dimensional electrode array position was determined based on angles from the horizontal using posterior and lateral views and on distances between the proximal array tip superiorly from the basion (D1), laterally (D2P) and posteriorly (D2L) from the midline. Array position was correlated with perceptual data (in 15 of the 20 recipients who used their ABI). Perceptual data included the number of electrodes that provided auditory sensation, location and type of side effects, level of speech perception (from no sound to open-set word recognition of monosyllables) and the amount of charge required for auditory perception.

Results: Although the 3D orientation of the ABI array exhibited a variety of angles, all arrays were posteriorly tilted from the lateral view and most were medially tilted from the posterior view. ABI position relative to the basion from posterior showed mean distances of 1.71 ± 0.42 and 1.1 ± 0.29 cm for D1 and D2, respectively, and a mean D2 of 1.30 ± 0.45 cm from the lateral view. A strong linear negative correlation was found between the number of active electrodes and the distance of the proximal array tip laterally from the basion (D2P; rs = -0.73, p = 0.006) when measured in the posterior view. Although side effects were experienced in all recipients and varied in type and location across the array, electrodes in the middle part of the array tended to elicit auditory sensations while the proximal and distal tips of the array tended to elicit nonauditory side effects. Arrays with and without low charge thresholds appeared to generally overlap in position. However, the two recipients with the best (open-set) speech perception had low charge thresholds and had arrays that were tilted superiorly in the posterior view.

Conclusion: ABI recipients with better speech perception appear to share a profile of arrays that are tilted superiorly as compared to recipients with lower speech perception levels. These ABI recipients have a high number of active electrodes (10 or more) and require less electrical charge on individual electrodes to achieve optimal stimulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AUD.0000000000001064DOI Listing
July 2021

The temporal sequence of change in PTSD symptoms and hypothesized mediators in Cognitive Processing Therapy and Written Exposure Therapy for PTSD.

Behav Res Ther 2021 Sep 24;144:103918. Epub 2021 Jun 24.

National Center for PTSD, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.

We examined whether extinction or changes negative trauma-related beliefs occur either prior to or concurrently with changes in posttraumatic stress symptoms among individuals who received either Cognitive Processing Therapy (CPT) or Written Exposure Therapy (WET) using statistical methods that permit proper discernment of temporal sequence. Community participants with PTSD (N = 126) were evenly randomized to 12 sessions of CPT or 5 sessions of WET. We assessed within- and between-session changes in arousal and valence and changes in trauma-related beliefs 6-, 12-, 24-, 36- and 60-weeks following the first treatment session. Between-session change in post-session emotional valence temporally preceded PTSD symptom reduction among participants who received WET but did not predict subsequent symptom reduction. Although negative trauma-related beliefs changed in parallel with and correlated with PTSD symptom reduction in both conditions, this change did not temporally precede symptom reduction. Our results are inconsistent with those from prior studies and suggest these constructs may more appropriately be characterized as correlates, rather than mediators, of symptom reduction. These results highlight the value of discernment of the temporal sequence of change between hypothesized mediators and symptoms and underscore that we still have much to learn about how evidence-based treatments reduce PTSD symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.brat.2021.103918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325637PMC
September 2021

Measuring Quality of Life Following Robot-Assisted Radical Prostatectomy.

Patient Prefer Adherence 2021 23;15:1373-1382. Epub 2021 Jun 23.

Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA.

Background: Prostate cancer (PCa) represents the most common solid organ malignancy in men. Fortunately, at the time of diagnosis, the majority of cases are staged as localized or regional disease, conferring excellent 5- and 10-year cure rates. There are several first line treatment options including surgical approaches such as robot-assisted radical prostatectomy (RARP) and radiation therapy (RT) available to patients with localized disease that offer similar PCa oncologic outcomes but are associated with potentially significant side effects which may impact health-related quality of life (HRQOL) domains. Recently, clinicians and investigators have sought to better understand these changes in HRQOL metrics with the utilization of patient-reported outcomes (PRO). Given that RARP represents the most common surgical treatment for PCa in the United States, there has been a particular interest in assessing these outcomes derived by patient perspectives to more fully appreciate treatment-related impact on quality of life following RARP.

Objective: This narrative review sought to explore the instruments available to measure quality of life after RARP, a review of the PRO data after RARP, and future directions for assessing and improving quality of life outcomes following this surgery.

Clinical Use: There are several treatment options for men diagnosed with local and regional prostate cancer with similar oncologic outcomes but differing patterns of side effects affecting post-treatment quality of life. Understanding data reported directly by patients following RARP about their side effects and quality of life gives providers additional information for appropriate preoperative counseling for patients choosing between treatment options for their prostate cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/PPA.S271447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236265PMC
June 2021

Outcomes of mohs microgrpahic resection for cutaneous malignancy involving the scrotum.

Urol Oncol 2021 08 27;39(8):501.e11-501.e16. Epub 2021 Jun 27.

Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.

Introduction: Squamous cell carcinoma (SCC) and extramammary Paget's Disease (EMPD) of the scrotum are exceedingly rare. Given their propensity for local invasion and treatment with wide local excision, they can be highly morbid conditions. Outcomes of Mohs Micrographic Surgery (MMS) for scrotal cutaneous malignancy is not well described in current literature. We hypothesized that MMS for scrotal cutaneous malignancy would provide equivalent or improved oncologic outcomes while limiting the morbidity associated with wide excision.

Materials/methods: This is a retrospective review and analysis of a prospectively maintained database spanning entries from 2005 to 2019. Collected data included general patient characteristics and surgical characteristics reported on a per lesion basis. MMS was performed by our institution's department of dermatology using their standard technique.

Results: Overall, a total of 26 consecutive patients with 28 lesions (SCC or EMPD) were analyzed. Out of our cohort of 15 patients with 16 scrotal SCC lesions, 10 (66%) patients were current or former smokers, 4 (26%) were immunosuppressed, and 2 (13%) had HPV infections. The median preoperative and postoperative size of SCC lesions were 5.7cm [2] and 20.2cm [2] respectively. There was one (6%) oncologic recurrence of SCC of the scrotum and one (6%) local wound complication. Our cohort also included 11 patients with 12 scrotal EMPD lesions. One patient (9%) had an underlying associated malignancy (prostate cancer). The preoperative and postoperative area of lesions were 50.6cm [2] and 96.4cm [2] respectively. One (9%) EMPD lesion had a positive final margin at resection requiring reoperation. After achieving negative surgical margins, no patients in this cohort had an oncologic recurrence. 3 (26%) scrotal EMPD cases had local wound postoperative complications, only one required reoperation.

Conclusion: To our knowledge, this is the first case series focused on MMS for both SCC and EMPD with scrotal involvement. Our data suggests that MMS for scrotal cutaneous malignancy may improve oncologic outcomes and may decreases local post-operative reconstructive issues when compared to reported outcomes of treatment with wide local excision. When able, scrotal cutaneous malignancy patients should be referred to urologists at centers with MMS capabilities as it likely will improve their outcomes. The urologist should maintain active involvement with these patients to coordinate this complex and advanced pattern of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urolonc.2021.05.019DOI Listing
August 2021

Pembrolizumab Induced Acute Persistent Airway Disease in a Patient with Recurrent Respiratory Papillomatosis (RRP).

Ann Otol Rhinol Laryngol 2021 May 30:34894211021276. Epub 2021 May 30.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

Objective: To present an uncommon but serious, recently identified complication of checkpoint inhibitor therapy in a patient treated with pembrolizumab infusion for disseminated recurrent respiratory papillomatosis (RRP).

Methods: Case report.

Results: A 43-year-old woman with underlying asthma developed acute hypoxic respiratory failure within 24 hours of her third infusion of pembrolizumab for treatment of intractable, disseminated recurrent respiratory papillomatosis. Pulmonary function testing revealed a severe intra-thoracic obstructive ventilatory defect. Discontinuation of pembrolizumab, ventilatory support, and treatment with systemic and inhaled corticosteroids resulted in resolution of respiratory failure; however, her underlying asthma remains poorly controlled.

Conclusion: To our knowledge, this case is the first report of pembrolizumab-induced obstructive respiratory failure in a patient being treated for RRP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/00034894211021276DOI Listing
May 2021

Pediatric Single-Sided Deafness: A Review of Prevalence, Radiologic Findings, and Cochlear Implant Candidacy.

Ann Otol Rhinol Laryngol 2021 May 26:34894211019519. Epub 2021 May 26.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear/Massachusetts General Hospital, Boston, MA, USA.

Objective: To characterize the prevalence, imaging characteristics, and cochlear implant candidacy of pediatric patients with single-sided deafness (SSD).

Methods: An audiometric database of patients evaluated at a large tertiary academic medical center was retrospectively queried to identify pediatric patients (<18 years old) with SSD, defined as severe to profound sensorineural hearing loss in one ear and normal hearing in the other. Medical records of identified patients were reviewed to characterize the prevalence, etiology, and cochlear implant candidacy of pediatric patients with SSD.

Results: We reviewed audiometric data obtained from 1993 to 2018 for 52,878 children at our institution. 191 (0.36%) had the diagnosis of SSD. Cochlear nerve deficiency (either hypoplasia or aplasia) diagnosed on MRI and/or CT was the most common etiology of SSD and was present in 22 of 88 (25%) pediatric SSD patients with available imaging data. 70 of 106 (66%) pediatric SSD patients with available imaging had anatomy amenable to cochlear implantation.

Conclusions: Pediatric SSD is a rare condition and the most common etiology based on radiology is cochlear nerve deficiency. High resolution imaging of the temporal bone is essential to determine cochlear nerve morphology prior to consideration of cochlear implantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/00034894211019519DOI Listing
May 2021

Transcanal Computed Tomography Views for Transcanal Endoscopic Lateral Skull Base Surgery: Pilot Cadaveric Study.

J Neurol Surg B Skull Base 2021 Jun 7;82(3):338-344. Epub 2019 Nov 7.

Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.

 Transcanal endoscopic operative approaches provide for a minimally invasive surgical portal to the lateral skull base. Traditional preoperative imaging evaluation involves computed tomography (CT) acquisition in the axial and coronal planes that are not optimized for the transcanal surgical corridor. Herein, we describe a novel CT-based "transcanal view" for preoperative surgical planning and intraoperative navigation.  Present study is a cadaveric imaging study.  Cadaveric temporal bones (  = 6) from three specimens underwent high-resolution CT (0.625 mm slice thickness). Using three-dimensional (3D) Slicer 4.8, reformatted "transcanal" views in the plane of the external auditory canal (EAC) were created. Axial and coronal reformats were used to compare and measure distances between anatomic structures in the plane of the EAC.  The degree of oblique tilt for transcanal CT reformats was 6.67 ± 1.78 degrees to align the EAC in axial and coronal planes. Anticipated critical landmarks were identified easily using the transcanal view. Mean values were 8.68 ± 0.38 mm for annulus diameter, 9.5 ± 0.93 mm for isthmus diameter, 10.27 ± 0.73 mm for distance between annulus and isthmus, 2.95 ± 0.13 mm for distance between annulus and stapes capitulum, 5.12 ± 0.35 mm for distance between annulus and mastoid facial nerve, and 19.54 ± 1.22 mm for EAC length.  This study is the first to illustrate a novel "transcanal" CT sequence intended for endoscopic lateral skull base surgery. Future studies may address how incorporation of a transcanal CT reformat may influence surgical decision making.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-3400219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133816PMC
June 2021

Systematic Comparison of Trial Exclusion Criteria for Pupillometry Data Analysis in Individuals With Single-Sided Deafness and Normal Hearing.

Trends Hear 2021 Jan-Dec;25:23312165211013256

Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States.

The measurement of pupil dilation has become a common way to assess listening effort. Pupillometry data are subject to artifacts, requiring highly contaminated data to be discarded from analysis. It is unknown how trial exclusion criteria impact experimental results. The present study examined the effect of a common exclusion criterion, percentage of blinks, on speech intelligibility and pupil dilation measures in 9 participants with single-sided deafness (SSD) and 20 participants with normal hearing. Participants listened to and repeated sentences in quiet or with speech maskers. Pupillometry trials were processed using three levels of blink exclusion criteria: 15%, 30%, and 45%. These percentages reflect a threshold for missing data points in a trial, where trials that exceed the threshold are excluded from analysis. Results indicated that pupil dilation was significantly greater and intelligibility was significantly lower in the masker compared with the quiet condition for both groups. Across-group comparisons revealed that speech intelligibility in the SSD group decreased significantly more than the normal hearing group from quiet to masker conditions, but the change in pupil dilation was similar for both groups. There was no effect of blink criteria on speech intelligibility or pupil dilation results for either group. However, the total percentage of blinks in the masker condition was significantly greater than in the quiet condition for the SSD group, which is consistent with previous studies that have found a relationship between blinking and task difficulty. This association should be carefully considered in future experiments using pupillometry to gauge listening effort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23312165211013256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150669PMC
May 2021

Systematic Comparison of Trial Exclusion Criteria for Pupillometry Data Analysis in Individuals With Single-Sided Deafness and Normal Hearing.

Trends Hear 2021 Jan-Dec;25:23312165211013256

Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States.

The measurement of pupil dilation has become a common way to assess listening effort. Pupillometry data are subject to artifacts, requiring highly contaminated data to be discarded from analysis. It is unknown how trial exclusion criteria impact experimental results. The present study examined the effect of a common exclusion criterion, percentage of blinks, on speech intelligibility and pupil dilation measures in 9 participants with single-sided deafness (SSD) and 20 participants with normal hearing. Participants listened to and repeated sentences in quiet or with speech maskers. Pupillometry trials were processed using three levels of blink exclusion criteria: 15%, 30%, and 45%. These percentages reflect a threshold for missing data points in a trial, where trials that exceed the threshold are excluded from analysis. Results indicated that pupil dilation was significantly greater and intelligibility was significantly lower in the masker compared with the quiet condition for both groups. Across-group comparisons revealed that speech intelligibility in the SSD group decreased significantly more than the normal hearing group from quiet to masker conditions, but the change in pupil dilation was similar for both groups. There was no effect of blink criteria on speech intelligibility or pupil dilation results for either group. However, the total percentage of blinks in the masker condition was significantly greater than in the quiet condition for the SSD group, which is consistent with previous studies that have found a relationship between blinking and task difficulty. This association should be carefully considered in future experiments using pupillometry to gauge listening effort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23312165211013256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150669PMC
May 2021

The displacement technique: a simple method for clearing maxillary sinus stubborn mucus.

Eur Arch Otorhinolaryngol 2021 Aug 20;278(8):3125-3127. Epub 2021 May 20.

Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.

Background: Clearing thick secretions from the hidden crevices of the maxillary sinus can be challenging and can increase operative time during endoscopic sinus surgery.

Methods: We demonstrate the Displacement Technique as a user-friendly technique to address thick secretions within the maxillary sinus barring no orbital floor dehiscence. First, a wide maxillary antrostomy is performed. Then, a surgical pledget is placed in the maxillary sinus to displace the inspissated content into the nasal cavity using a curved suction. This process is repeated as necessary.

Conclusion: The displacement technique is a simple and inexpensive method for addressing stubborn secretions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-021-06874-7DOI Listing
August 2021

Associations of Medicaid Expansion With Insurance Coverage, Stage at Diagnosis, and Treatment Among Patients With Genitourinary Malignant Neoplasms.

JAMA Netw Open 2021 May 3;4(5):e217051. Epub 2021 May 3.

Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.

Importance: Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer.

Objective: To assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer.

Design, Setting, And Participants: This case-control study included adults aged 18 to 64 years with a new primary diagnosis of kidney, bladder, or prostate cancer, selected from the National Cancer Database from January 1, 2011, to December 31, 2016. Patients in states that expanded Medicaid were the case group, and patients in nonexpansion states were the control group. Data were analyzed from January 2020 to March 2021.

Exposures: State Medicaid expansion status.

Main Outcomes And Measures: Insurance status, stage at diagnosis, and receipt of cancer and stage-specific treatments. Cases and controls were compared with difference-in-difference analyses.

Results: Among a total of 340 552 patients with newly diagnosed genitourinary cancers, 94 033 (27.6%) had kidney cancer, 25 770 (7.6%) had bladder cancer, and 220 749 (64.8%) had prostate cancer. Medicaid expansion was associated with a net decrease in uninsured rate of 1.1 (95% CI, -1.4 to -0.8) percentage points across all incomes and a net decrease in the low-income population of 4.4 (95% CI, -5.7 to -3.0) percentage points compared with nonexpansion states. Expansion was also associated with a significant shift toward early-stage diagnosis in kidney cancer across all income levels (difference-in-difference, 1.4 [95% CI, 0.1 to 2.6] percentage points) and among individuals with low income (difference-in-difference, 4.6 [95% CI, 0.3 to 9.0] percentage points) and in prostate cancer among individuals with low income (difference-in-difference, 3.0 [95% CI, 0.3 to 5.7] percentage points). Additionally, there was a net increase associated with expansion compared with nonexpansion in receipt of active surveillance for low-risk prostate cancer of 4.1 (95% CI, 2.9 to 5.3) percentage points across incomes and 4.5 (95% CI, 0 to 9.0) percentage points among patients in low-income areas.

Conclusions And Relevance: These findings suggest that Medicaid expansion was associated with decreases in uninsured status, increases in the proportion of kidney and prostate cancer diagnosed in an early stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population. Associations were concentrated in population residing in low-income areas and reinforce the importance of improving access to care to all patients with cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2021.7051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134994PMC
May 2021

Clinical and scientific innovations in auditory brainstem implants.

World J Otorhinolaryngol Head Neck Surg 2021 Apr 6;7(2):109-115. Epub 2021 Apr 6.

Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.

The auditory brainstem implant (ABI) was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2 (NF2). Recent studies of the ABI have investigated outcomes in non-NF2 cohorts, such as patients with cochlear nerve aplasia or cochlear ossification and more recently, intractable tinnitus. New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects. Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future, enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry. These advances will improve surgical planning and ultimately improve patients' audiological capabilities. ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve. Herein, we aim to characterize ongoing clinical, basic science, and bioengineering advances in ABIs and discuss future directions of this technology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wjorl.2021.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103538PMC
April 2021

Current trends and applications in endoscopy for otology and neurotology.

World J Otorhinolaryngol Head Neck Surg 2021 Apr 6;7(2):101-108. Epub 2021 Feb 6.

Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.

There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade. In this review paper, we discuss the current trends and applications of the endoscope in the field of otology and neurotology. Advantages of the endoscope include excellent ergonomics, compatibility with pediatric anatomy, and improved access to the middle ear through the external auditory canal. Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma, tympanic membrane perforations, and otosclerosis as compared to microscopic approaches, while utilizing less invasive surgical corridors and reducing the need for postauricular incisions. When a postauricular approach is required, the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma. The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors, meningiomas, and vestibular schwannomas. Outside of the operating room, the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities. For these reasons, the endoscope is currently poised to transform the field of otology and neurotology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wjorl.2020.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103526PMC
April 2021

Urinary Diversion: Core Curriculum 2021.

Am J Kidney Dis 2021 08 8;78(2):293-304. Epub 2021 May 8.

Division of Nephrology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Urinary diversion after cystectomy has been a historical standard for the treatment of numerous benign and malignant diseases of the bladder. Since the first published description in the early 1900s, improvements in surgical technique and a better understanding of the metabolic sequelae postoperatively have greatly enhanced patient outcomes. Both continent and incontinent diversions are available to patients after cystectomy. In appropriately selected patients, orthotopic neobladder reconstruction can offer preservation of body image and continence, and continent cutaneous diversions represent a reasonable alternative. Conduit diversion, which remains the most commonly performed diversion technique, is ideal for patients who would benefit from a less morbid surgical procedure that negates the need for self-catheterization. This installment of the Core Curriculum in Nephrology outlines numerous aspects of urinary diversion, in which a multidisciplinary approach to postoperative management at the intersection of nephrology and urology is required to effectively optimize patient outcomes. This article includes a discussion of the various reconstructive options after cystectomy as well as a comprehensive review of frequently encountered short-term and long-term metabolic abnormalities associated with altered electrolyte and acid-base homeostasis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.ajkd.2020.12.023DOI Listing
August 2021

The Use of a Brief Family Intervention to Reduce Dropout Among Veterans in Individual Trauma-Focused Treatment: A Randomized Controlled Trial.

J Trauma Stress 2021 08 23;34(4):829-839. Epub 2021 Apr 23.

National Center for PTSD at VA Boston Healthcare System, Behavioral Science Division, Boston, Massachusetts, United States.

Dropout from trauma-focused treatment for posttraumatic stress disorder (PTSD) represents a daunting challenge for the field, particularly among military and veteran samples. Family involvement may help to increase the effectiveness of PTSD treatment while also improving retention. We tested a two-session brief family intervention (BFI) protocol delivered as an adjunct to individual trauma-focused treatment among a sample of 20 veteran-family member dyads (N = 40). Willingness to participate in the family-inclusive protocol was high, with over 85% of veterans and family members who were screened agreeing to take part. All enrolled veterans were beginning a course of either cognitive processing therapy (CPT) or prolonged exposure (PE), delivered in outpatient Veterans Affairs clinics. Family members were randomized to either receive or not receive the BFI from study clinicians. In the BFI condition, 20.0% of veterans dropped out of CPT/PE before the 16-week study end; the remainder were either still attending on-protocol sessions or had completed the full protocol. In the control condition, 40.0% of veterans dropped out of CPT/PE before the end of the study. Observed significant, large-magnitude decreases in PTSD symptoms over time did not differ by condition, ESsg range = -1.12 to -2.04. Accommodation did not significantly decrease over time in either condition, ESsg range = 0.18 to -0.98. The BFI represents a promising option for veterans, family members, and clinicians who are seeking a brief, feasible, narrowly focused method for incorporating families into veterans' individual trauma-focused therapy and potentially reducing the rate of dropout.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jts.22680DOI Listing
August 2021

Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome.

Front Neurol 2021 6;12:638574. Epub 2021 Apr 6.

Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States.

Patients with superior canal dehiscence syndrome (SCDS) can present with a range of auditory and/or vestibular signs and symptoms that are associated with a bony defect of the superior semicircular canal (SSC). Over the past two decades, advances in diagnostic techniques have raised the awareness of SCDS and treatment approaches have been refined to improve patient outcomes. However, a number of challenges remain. First, there is currently no standardized clinical testing algorithm for quantifying the effects of superior canal dehiscence (SCD). SCDS mimics a number of common otologic disorders and established metrics such as supranormal bone conduction thresholds and vestibular evoked myogenic potential (VEMP) measurements; although useful in certain cases, have diagnostic limitations. Second, while high-resolution computed tomography (CT) is the gold standard for the detection of SCD, a bony defect does not always result in signs and symptoms. Third, even when SCD repair is indicated, there is a lack of consensus about nomenclature to describe the SCD, ideal surgical approach, specific repair techniques, and type of materials used. Finally, there is no established algorithm in evaluation of SCDS patients who fail primary repair and may be candidates for revision surgery. Herein, we will discuss both contemporary and emerging diagnostic approaches for patients with SCDS and highlight challenges and controversies in the management of this unique patient cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.638574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055857PMC
April 2021

Urologic emergencies before and after COVID-19: a retrospective chart review.

Can J Urol 2021 04;28(2):10614-10619

Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic, decreased presentations for various emergent conditions have been observed. Our objective was to compare the volume of patients with urologic emergencies presenting to emergency departments (EDs) within a single health system before and after the onset of the COVID-19 pandemic.

Materials And Methods: A retrospective chart review was performed for 3 EDs within a single health system in the United States to identify all ED consults to urology from January 1, 2019 to May 31, 2020. For emergent consults, covariates were extracted, including demographic information, insurance status, Charlson Comorbidity Index (CCI) score, travel distance from home to the ED, and whether the patient had seen a provider in the hospital system before. Data were compared between COVID-19 months (March-May 2020) and corresponding months in 2019.

Results: The study period encompassed 1,179 consults and 373 urologic emergencies. We observed not only a 22% decrease in urologic presentations to the ED compared to corresponding months in 2019, but also a 54% decrease in the proportion of urologic presentations that were truly emergent. For patients with emergent diagnoses, April 2020 saw an increase in Medicare/Medicaid coverage and a decrease in private insurance, May 2020 saw a decreased travel distance from home to the ED, and March and May 2020 saw an increase in patients who had previously seen a health system provider outside of the ED. No changes were seen in demographic characteristics or CCI.

Conclusions: During the early COVID-19 pandemic, urologic emergencies within a single health system decreased by 54% compared to the corresponding months pre-pandemic. Those who do present for care may be influenced by both locality and provider familiarity.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2021

Pulmonary Carcinoid and the Importance of Correct Radiotracer Selection.

Ochsner J 2021 ;21(1):6-9

Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31486/toj.20.0155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993423PMC
January 2021

Comparative Study of Chemosensory Dysfunction in COVID-19 in 2 Geographically Distinct Regions.

Ear Nose Throat J 2021 Mar 17:1455613211000170. Epub 2021 Mar 17.

Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, 7938University of Toronto, Toronto, Ontario, Canada.

Objective: To directly compare the prevalence of chemosensory dysfunction (smell and taste) in geographically distinct regions with the same questionnaires.

Methods: A cross-sectional study was performed to evaluate the self-reported symptoms among adults (older than 18 years) who underwent COVID-19 testing at an ambulatory assessment center in Canada and at a hospital in Israel between March 16, 2020, and August 19, 2020. The primary outcome was the prevalence of self-reported chemosensory dysfunction (anosmia/hypomsia and dysgeusia/ageusia). Subgroup analysis was performed to evaluate the prevalence of chemosensory deficits among the outpatients.

Results: We identified a total of 350 COVID-19-positive patients (138 Canadians and 212 Israelis). The overall prevalence of chemosensory dysfunction was 47.1%. There was a higher proportion of chemosensory deficits among Canadians compared to Israelis (66.7% vs 34.4%, P < .01). A subgroup analysis for outpatients (never hospitalized) still identified a higher prevalence of chemosensory dysfunction among Canadians compared to Israelis (68.2% vs 36.1%, P < 0.01). A majority of patients recovered their sense of smell after 4 weeks of symptom onset.

Conclusion: Although the prevalence of chemosensory deficit in COVID-19 was found to be similar to previously published reports, the prevalence can vary significantly across different geographical regions. Therefore, it is important to obtain regionally specific data so that the symptom of anosmia/dysgeusia can be used as a guide for screening for the clinical diagnosis of COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/01455613211000170DOI Listing
March 2021

Longitudinal assessment of PTSD and illicit drug use among male and female OEF-OIF veterans.

Addict Behav 2021 07 8;118:106870. Epub 2021 Feb 8.

U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States.

Objectives: Posttraumatic stress disorder (PTSD) and substance use share both directional ("self-medication") and mutually-reinforcing associations over time. Research on gender differences regarding the co-occurrence of PTSD and substance use over time remains limited and largely focused on alcohol use; less is known regarding the co-occurrence of PTSD and illicit drug use, especially among veteran men vs. women. As the proportion of women in the military expands, we believe a greater focus on gender differences is warranted.

Method: We conducted a cross-lagged panel analysis of PTSD symptoms and drug use problems using two waves of data from a large, nationwide longitudinal registry of post-9/11 veterans. Participants included 608 men and 635 women (N = 1243; M = 42.3; 75.2% White) who completed self-report PTSD and drug use problem questionnaires at T1 and again at T2 15-37 months later.

Results: Veteran men reported more severe drug use and related problems overall, yet the cross-sectional correlation between PTSD and drug use problems was strongest among drug using veteran women. In our cross-lagged models, we found that PTSD symptoms predicted future drug use problems among veteran men, whereas drug use problems predicted future PTSD symptom severity among women.

Conclusions: These results support the self-medication pathway among veteran men but not women, for whom drug use problems might prolong or exacerbate PTSD symptom severity over time. These results are consistent with some emerging evidence but also provide novel insight into functional associations governing the longitudinal course of PTSD and drug use problems for men vs. women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.addbeh.2021.106870DOI Listing
July 2021

Contemporary National Trends and Variations of Pelvic Lymph Node Dissection in Patients Undergoing Robot-Assisted Radical Prostatectomy.

Clin Genitourin Cancer 2021 08 28;19(4):309-315. Epub 2021 Jan 28.

Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Introduction: Previous studies showed suboptimal adherence to clinical practice guidelines for pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Robot-assisted RP (RARP) has become the predominant surgical management for localized prostate cancer in the United States but contemporary national data on PLND adherence during RARP are still lacking.

Methods: RARPs for clinically localized (cT1-2N0M0) intermediate-risk and high-risk prostate cancer diagnosed between 2010 and 2016 in National Cancer Database were identified. Outcome of interest was PLND and multivariable logistic regressions were used to identify whether patient demographics and facility characteristics were associated with the outcome.

Results: We included 115,355 patients in the final cohort (intermediate-risk = 86,314, high-risk = 29,041). From 2010 to 2016, there was an increasing trend of PLND in the overall, intermediate-risk, and high-risk cohorts. In 2016, PLND was performed in 79.7% of the intermediate-risk and 93.5% of the high-risk patients. Multivariable logistic regressions showed Hispanic race/ethnicity (vs. white) (odds ratio [OR] = 0.90, P = .010), lowest socioeconomic status (vs. highest) (OR = 0.85, P < .001), rural area (vs. metro area) (OR=0.61, P < .001), and community facility (vs. academic) (OR = 0.56, P < .001) were some of the factors associated with lower PLND rate. Variations of PLND rate among reporting facility's locations were also identified.

Conclusion: Contemporary national data showed significantly increased PLND rate in patients who underwent RARP for intermediate-risk and high-risk prostate cancer in recent years. However, there were still some variations in PLND rate among different patient populations and facilities. Continued efforts need to be made to further increase PLND rate and narrow or eliminate disparities we identified.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clgc.2021.01.005DOI Listing
August 2021

Improved Speech Intelligibility in Subjects With Stable Sensorineural Hearing Loss Following Intratympanic Dosing of FX-322 in a Phase 1b Study.

Otol Neurotol 2021 08;42(7):e849-e857

Frequency Therapeutics, Woburn, MA & Farmington, CT.

Objectives: There are no approved pharmacologic therapies for chronic sensorineural hearing loss (SNHL). The combination of CHIR99021+valproic acid (CV, FX-322) has been shown to regenerate mammalian cochlear hair cells ex vivo. The objectives were to characterize the cochlear pharmacokinetic profile of CV in guinea pigs, then measure FX-322 in human perilymph samples, and finally assess safety and audiometric effects of FX-322 in humans with chronic SNHL.

Study Designs: Middle ear residence, cochlear distribution, and elimination profiles of FX-322 were assessed in guinea pigs. Human perilymph sampling following intratympanic FX-322 dosing was performed in an open-label study in cochlear implant subjects. Unilateral intratympanic FX-322 was assessed in a Phase 1b prospective, randomized, double-blinded, placebo-controlled clinical trial.

Setting: Three private otolaryngology practices in the US.

Patients: Individuals diagnosed with mild to moderately severe chronic SNHL (≤70 dB standard pure-tone average) in one or both ears that was stable for ≥6 months, medical histories consistent with noise-induced or idiopathic sudden SNHL, and no significant vestibular symptoms.

Interventions: Intratympanic FX-322.

Main Outcome Measures: Pharmacokinetics of FX-322 in perilymph and safety and audiometric effects.

Results: After intratympanic delivery in guinea pigs and humans, FX-322 levels in the cochlear extended high-frequency region were observed and projected to be pharmacologically active in humans. A single dose of FX-322 in SNHL subjects was well tolerated with mild, transient treatment-related adverse events (n = 15 FX-322 vs 8 placebo). Of the six patients treated with FX-322 who had baseline word recognition in quiet scores below 90%, four showed clinically meaningful improvements (absolute word recognition improved 18-42%, exceeding the 95% confidence interval determined by previously published criteria). No significant changes in placebo-injected ears were observed. At the group level, FX-322 subjects outperformed placebo group in word recognition in quiet when averaged across all time points, with a mean improvement from baseline of 18.9% (p = 0.029). For words in noise, the treated group showed a mean 1.3 dB signal-to-noise ratio improvement (p = 0.012) relative to their baseline scores while placebo-treated subjects did not (-0.21 dB, p = 0.71).

Conclusions: Delivery of FX-322 to the extended high-frequency region of the cochlea is well tolerated and enhances speech recognition performance in multiple subjects with stable chronic hearing loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000003120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279894PMC
August 2021

Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics.

J Otolaryngol Head Neck Surg 2021 Feb 12;50(1):10. Epub 2021 Feb 12.

Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.

Background: Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy.

Methods: A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications.

Results: There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952).

Conclusion: Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40463-020-00484-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881444PMC
February 2021

Three-dimensional (3D) Printed Vestibular Schwannoma for Facial Nerve Tractography Validation.

Otol Neurotol 2021 06;42(5):e598-e604

Eaton-Peabody Laboratories, Massachusetts Eye and Ear.

Objectives: Predicting the course of cranial nerve (CN) VII in the cerebellopontine angle (CPA) on preoperative imaging for vestibular schwannoma (VS) may help guide surgical resection and reduce complications. Diffusion MRI based tractography has been used to identify cranial nerve trajectory, but intraoperative validation of this novel approach is challenging. Currently, validation is based on operative report descriptions of the course of cranial nerves, but yields a simplified picture of the three-dimensional (3D) course of CN VII. In this study, we investigate the accuracy of tractography with detailed patient-specific 3D-printed VS tumors.

Design: Retrospective case review.

Setting: Tertiary referral center.

Participants: Twenty adult VS surgical candidates.

Main Outcome Measures: We compared tractography with intraoperative 3D course of CN VII. The surgeons were blinded to tractography and drew the intraoperative course of the CN VII on a patient specific 3D-printed tumor model for detailed comparison with tractography.

Results: Of 20 patients, one was excluded due to subtotal removal and inability to assess CN VII course. In the remaining 19 patients, 84% (16/19) tractography was successful. In 94% of tumors with tractography (15/16), the intraoperative description of CN VII course matched the tractography finding. The maximum distance, however, between tractography and intraoperative course of CN VII was 3.7 mm ± 4.2 mm.

Conclusion: This study presents a novel approach to CN VII tractography validation in VS. Although descriptions of CN VII intraoperatively match tractography, caution is warranted as quantitative measures suggest a clinically significant distance between tractography and CN VII course.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000003058DOI Listing
June 2021
-->