Citations

AbstractObjectiveThe objective of this study is to determine if a history of traumatic brain injury (TBI) degrades postoperative the audiological performance of patients with cochlear implantation (CI).Study DesignRetrospective review.SettingDepartment of Defense‐wide database.MethodsInternational Classification of Diseases, Ninth Revision (ICD‐9) and ICD‐10 codes were used to identify patients that were diagnosed with TBI prior to CI between 2005 and 2023. They were matched 2:1 with controls without TBI based on age and sex. Preoperative and postoperative pure tone average (PTA) thresholds and AzBio scores were compared.ResultsNineteen TBI patients representing 20 implanted ears were identified and matched with 39 patients without TBI representing 40 implanted ears. Thirteen ears carried a diagnosis of mild TBI, and seven were diagnosed with moderate to severe TBI. The average follow‐up period was 44 months. The TBI group attained mean postoperative PTA and AzBio scores of 37 dB (SD 24) and 67% (SD 28). The non‐TBI group attained scores of 31 dB (SD 12) and 69% (SD 26). P‐values for the PTA and AzBio intergroup comparisons were .93 and .88, respectively. All TBI ears attained at least sound awareness after implantation, with 79% achieving open‐set speech perception compared to 82% of non‐TBI ears.ConclusionCI after TBI of any severity provides hearing rehabilitation comparable to patients without a prior diagnosis of TBI.

AbstractObjectiveTo assess relations between Ménière's disease and suicidality, measured by suicidal ideation, suicidal behaviors, and death by suicide.Data SourcesCINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS databases were searched from inception through July 2, 2024.Review MethodsObservational studies related to suicidality in patients with Ménière's disease were included. Non‐English language papers, editorials, and studies on vestibular disorders not specified as Ménière's disease were excluded. The Risk Of Bias In Nonrandomized Studies‐of Exposure tool was used for cohort and qualitative studies, and the Joanna Briggs Institute critical appraisal checklist was used for case‐control studies.ResultsFour studies (n = 168,566) were included in our review. Two cohort studies found significantly increased adjusted hazard ratios of 2.1 (95% CI: 2.0‐2.2) for death by suicide and 7.6 (95% CI: 4.4‐13.3) for suicidal behaviors, respectively, in patients with Ménière's disease compared to the control population after their diagnosis. However, a case‐control study found no significant difference in the prevalence of suicidal ideation or behaviors prior to the date of diagnosis in patients with Ménière's disease compared to the control population (0.9% vs 0.8%; P = .44). In addition, one patient with Ménière's disease expressed suicidal ideation in the qualitative study.ConclusionPatients may experience variable responses to Ménière's disease. Thus, otolaryngologists should be mindful of the potential for suicidality in patients with Ménière's disease.

Abstract Biliary strictures are a complicated entity that requires careful thought and dedicated workup to define, understand, and plan the proper management pathway. From a surgical standpoint, it can be a mixed bag at the time of presentation. Even then, the information may not be fully diagnostic and often requires multiple interventions to assess the pathology and extent of the disease. In most cases, there is concern for malignancy with no effective screening tools and small surgical windows for cure. Therefore, a dedicated multidisciplinary team of surgeons, interventional radiologists, advanced endoscopists, hepatologists, and oncologists is always necessary to work together efficiently to gather information, diagnose, prevent secondary complications, and create an effective treatment plan with aligned goals of care.

ABSTRACTThe goal of the present study was to investigate the effect of positioning a soft flexible tube‐based actuator parallel or orthogonal to the principle muscle fibre direction, on measurements of the stiffness of upper trapezius (UT) muscle obtained using magnetic resonance elastography (MRE). The effects of using three different vibration frequencies (60 Hz, 80 Hz and 100 Hz) and studying left and right sides of the body were also investigated. The relevant MRE datasets were acquired on a 1.5 T MRI system using a 2D gradient‐echo (GRE) MRE sequence, and corresponding wave images produced using multimodel direct inversion (MMDI) were analysed by two observers using the manual caliper technique. Except for two of the 108 individual datasets, when the agreement was moderate, there was substantial to perfect agreement between wave quality scores obtained by the two observers, with an identical mean value. Similarly, and again with only two exceptions, there was good to excellent agreement between the measurements of UT stiffness obtained by the two observers. UT stiffness values obtained when the acoustic waves were propagating along the principle muscle fibre direction were significantly higher than when the waves were propagating orthogonal to the principle muscle fibre direction at all vibration frequencies (p < 0.005), and only for the former was a significant dispersion effect observed whereby stiffness increased as frequency increased (p < 0.05). No significant asymmetry was observed in measurements of UT stiffness obtained for the left and right sides of the body (p = 0.29). In conclusion, the new soft and flexible tube‐based actuator is comfortable and produced very good wave propagation in UT when positioned in either orientation. However, it is recommended for wave propagation to be induced in the principle fibre direction and there was found to be no advantage in using a vibration frequency above 60 Hz.

Bipolar disorder (BD) is characterized by disrupted circadian rhythms and neuronal loss. Lithium amplifies circadian rhythms and is neuroprotective, indicating mechanistic overlap across cellular systems. We examined the role of neuroprotection in determining lithium response and how circadian clock genes regulate apoptosis. In stem‐cell‐derived neuronal progenitor cells (NPCs) from BD patients, and in immortalized mouse hippocampal neurons, lithium was neuroprotective against staurosporine (STS)‐induced apoptosis. However, neuroprotection did not distinguish lithium‐responders (Li‐Rs) from nonresponders (Li‐NRs). Disruption of selected clock genes—period circadian regulator 1 ( PER1 ), basic helix–loop–helix ARNT like 1 ( ARNTL , also known as BMAL1 ), and nuclear receptor subfamily 1 group D member 1 ( NR1D1 ; also known as REV‐ERBα )—with small interfering RNA (siRNA) had distinct effects on apoptosis in mouse neurons and human NPCs. In BD patient NPCs, reduced expression of PER1 and BMAL1 increased apoptosis more in Li‐NR NPCs vs. Li‐R NPCs. Reduced expression of REV‐ERBα caused more extensive apoptosis in BD vs. control NPCs, but did not distinguish Li‐Rs vs. Li‐NRs. The REV‐ERB agonist GSK4112 was neuroprotective in mouse neurons and control NPCs, but did not reduce apoptosis in BD NPCs. Simultaneous treatment of NPCs with STS and GSK4112 revealed BD‐ and Li‐R‐associated differences in apoptosis‐related gene expression. In summary, the pharmacological effects of lithium in promoting neuroprotection are not sufficient to distinguish between Li‐Rs and Li‐NRs. However, genetic and pharmacological manipulations of the circadian clock reveal distinct roles in apoptosis in BD patient NPCs, some of which do distinguish Li‐Rs and Li‐NRs. We conclude that genetic disruption of cellular circadian clocks may predispose neurons to apoptosis preferentially in BD and/or Li‐NR. These findings imply that differences in BD between Li‐Rs/Li‐NRs primarily arise from defining biological characteristics of patient subgroups, not from distinct pharmacodynamic factors following lithium treatment.

ABSTRACTIntroductionVaccination is crucial to the thoracic solid organ transplant (SOT) population to reduce vaccine‐preventable infection. However, data on posttransplant hepatitis B virus (HBV) vaccination compliance and vaccine‐induced seroprotection are lacking.MethodsWe conducted a retrospective study of adult thoracic organ (heart and lung) transplant recipients at Mayo Clinic sites in Minnesota, Arizona, and Florida between January 2018 and August 2023. Recombivax HB was used before 2020, and Heplisav‐B was preferred after 2020. Recipients with posttransplant hepatitis B surface antibody (HBsAb) < 10 IU/L were eligible for the HBV vaccine. HBV seroprotection was defined as an HBsAb ≥ 10 IU/L.ResultsA total of 1116 recipients were evaluated, all of whom underwent posttransplant HBsAb testing. Of these, 751 (67%) had an HBsAb level < 10 IU/L and were eligible for posttransplant HBV vaccination. Of the eligible recipients, 117 (16%) completed the HBV vaccine series during the study period. Among these 117 recipients, 40 (34%) had their HBsAb levels rechecked after completing the vaccine series, with a seroprotection rate of 37.5% (15/40). There was no statistically significant difference in the seroprotection rates between Heplisav‐B and Recombivax HB vaccines (39% [13/33] vs. 29% [2/7]; p = 0.691). In addition, HBsAb levels were lowest at week 2 but rebounded at week 4 posttransplant and pretransplant HBsAb levels of ≥100 IU/L ensured 5‐year seroprotection.ConclusionSuboptimal compliance with HBV vaccination and poor vaccine‐induced seroprotection occur in thoracic organ transplant recipients, regardless of the vaccine used. These findings underscore the necessity of enhancing vaccination strategies for SOT recipients. image

AbstractBackgroundTraditionally, there has been a reluctance to use weight training with female gymnasts due to concerns that it could cause detrimental increases in muscle mass and impede flexibility. Recent literature has demonstrated that strength training has no significant effect on flexibility and can improve athletic performance.ObjectiveTo assess in a pilot study the perceptions of collegiate gymnasts and coaches toward strength training after starting inaugural strength and conditioning training.DesignSurvey‐based study.SettingNational Collegiate Athletics Association Division I women's gymnastics program at a public university in California.ParticipantsOf the 23 gymnasts surveyed, 17 (74%) responded to the survey. Of the two coaches surveyed, both (100%) responded to the survey.InterventionsNot applicable.Main Outcome MeasuresDescriptive statistics characterizing demographics, characteristics of gymnasts' strength and conditioning program, and perceptions regarding the safety of strength training and its impact on performance, body shape, flexibility, and injury rates.ResultsMost gymnasts agreed (35%) or strongly agreed (59%) that weight training may improve performance. All gymnasts disagreed (59%) or strongly disagreed (41%) that weight training is not safe; 41% disagreed, 29% strongly disagreed, and 17% agreed that weight training may negatively affect body shape. Most gymnasts disagreed (59%) or strongly disagreed (18%) that weight training decreases flexibility; four (24%) felt neutral. Eighty three percent (59% strongly agree, 24% agree) felt that weight training had a positive impact on performance. More than half of the gymnasts either agreed (24%) or strongly agreed (29%) they had fewer injuries the season after implementing weight training, compared to prior seasons. Both coaches similarly endorsed the safety of strength training and its potential to improve performance.ConclusionsIn this pilot study, collegiate gymnasts and coaches expressed generally positive perceptions toward the safety of strength training and its effect on performance. A small number of gymnasts expressed concerns regarding the effects of weight training on body shape and flexibility.

ABSTRACT Introduction Atrial fibrillation (AF) is the most common arrhythmia, and atrioventricular (AV) node ablation with pacemaker implantation is a therapeutic option for refractory cases. However, AV node ablation in patients with bioprosthetic tricuspid valves poses technical challenges. Methods An 84‐year‐old male with an EVOQUE transcatheter tricuspid valve replacement underwent AV node ablation (AVNA) under intracardiac echocardiography (ICE) guidance. Results Successful AV block was achieved with precise catheter positioning, improving the patient's symptoms and ventricular rate control. Conclusion This case demonstrates the feasibility of AVNA in patients with tricuspid bioprostheses, demonstrating feasibility with ICE guidance.