Self-help groups and opioid use disorder treatment: An investigation using a machine learning-assisted robust causal inference framework.

OBJECTIVES: This study investigates the impact of participation in self-help groups on treatment completion among individuals undergoing medication for opioid use disorder (MOUD) treatment. Given the suboptimal adherence and retention rates for MOUD, this research seeks to examine the association between treatment completion and patient-level factors. Specifically, we evaluated the causal relationship between self-help group participation and treatment completion for patients undergoing MOUD. METHODS: We used the Substance Abuse and Mental Health Services Administration's (SAMHSA) Treatment Episode Data Set: Discharges (TEDS-D) from 2015 to 2019. The data are filtered by the patient's opioid use history, demographics, treatment modality, and other relevant information. In this observational study, machine learning models (Lasso Regression, Decision Trees, Random Forest, and XGBoost) were developed to predict treatment completion. Outcome Adaptive Elastic Net (OAENet) was used to select confounders and outcome predictors, and the robust McNemars test was used to evaluate the causal relationship between self-help group participation and MOUD treatment completion. RESULTS: The machine-learning models showed a strong association between participation in self-help groups and treatment completion. Our causal analysis demonstrated an average treatment effect on treated (ATT) of 0.260 and a p-value < 0.0001 for the robust McNemars test. CONCLUSIONS: Our study demonstrates the importance of participation in self-help groups for MOUD treatment recipients. We found that participation in MOUD along with self-help groups caused higher chances of treatment completion than MOUD alone. This suggests that policymakers should consider further integrating self-help groups into the treatment for OUD to improve the adherence and completion rate.

A review on recent advances of cellulose acetate membranes for gas separation.

This review thoroughly investigates the wide-ranging applications of cellulose-based materials, with a particular focus on their utility in gas separation processes. By focusing on cellulose acetate (CA), the review underscores its cost-effectiveness, robust mechanical attributes, and noteworthy CO2 solubility, positioning it as a frontrunner among polymeric gas separation membranes. The synthesis techniques for CA membranes are meticulously examined, and the discourse extends to polymeric blend membranes, underscoring their distinct advantages in gas separation applications. The exploration of advancements in CA-based mixed matrix membranes, particularly the incorporation of nanomaterials, sheds light on the significant versatility and potential improvements offered by composite materials. Fabrication techniques demonstrate exceptional gas separation performance, with selectivity values reaching up to 70.9 for CO2/CH4 and 84.1 for CO2/N2. CA/PEG (polyethylene glycol) and CA/MOF (metal-organic frameworks) demonstrated exceptional selectivity in composite membranes with favorable permeability, surpassing other composite CA membranes. Their selectivity with good permeability lies well above all the synthesised cellulose. As challenges in experimental scale separation emerge, the review seamlessly transitions to molecular simulations, emphasizing their crucial role in understanding molecular interactions and overcoming scalability issues. The significance of the review lies in addressing environmental concerns, optimizing membrane compositions, understanding molecular interactions, and bridging knowledge gaps, offering guidance for the sustainable evolution of CA-based materials in gas separation technologies.

An explainable machine learning framework for predicting the risk of buprenorphine treatment discontinuation for opioid use disorder among commercially insured individuals.

OBJECTIVES: Buprenorphine is an effective evidence-based medication for opioid use disorder (OUD). Yet premature discontinuation undermines treatment effectiveness, increasing the risk of mortality and overdose. We developed and evaluated a machine learning (ML) framework for predicting buprenorphine care discontinuity within 12 months following treatment initiation. METHODS: This retrospective study used United States (US) 2018-2021 MarketScan commercial claims data of insured individuals aged 18-64 who initiated buprenorphine between July 2018 and December 2020 with no buprenorphine prescriptions in the previous six months. We measured buprenorphine prescription discontinuation gaps of ≥30 days within 12 months of initiating treatment. We developed predictive models employing logistic regression, decision tree classifier, random forest, extreme gradient boosting, Adaboost, and random forest-extreme gradient boosting ensemble. We applied recursive feature elimination with cross-validation to reduce dimensionality and identify the most predictive features while maintaining model robustness. For model validation, we used several statistics to evaluate performance, such as C-statistics and precision-recall curves. We focused on two distinct treatment stages: at the time of treatment initiation and one and three months after treatment initiation. We employed SHapley Additive exPlanations (SHAP) analysis that helped us explain the contributions of different features in predicting buprenorphine discontinuation. We stratified patients into risk subgroups based on their predicted likelihood of treatment discontinuation, dividing them into decile subgroups. Additionally, we used a calibration plot to analyze the reliability of the models. RESULTS: A total of 30,373 patients initiated buprenorphine and 14.98% (4551) discontinued treatment. C-statistic varied between 0.56 and 0.76 for the first-stage models including patient-level demographic and clinical variables. Inclusion of proportion of days covered (PDC) measured after one month and three months following treatment initiation significantly increased the models' discriminative power (C-statistics: 0.60 to 0.82). Random forest (C-statistics: 0.76, 0.79 and 0.82 with baseline predictors, one-month PDC and three-months PDC, respectively) outperformed other ML models in discriminative performance in all stages (C-statistics: 0.56 to 0.77). Most influential risk factors of discontinuation included early stage medication adherence, age, and initial days of supply. CONCLUSION: ML algorithms demonstrated a good discriminative power in identifying patients at higher risk of buprenorphine care discontinuity. The proposed framework may help healthcare providers optimize treatment strategies and deliver targeted interventions to improve buprenorphine care continuity.

Comparative Study of Treatment Outcome with Tenofovir Alafenamide and Entecavir in Patients with HBV Related Acute on Chronic Liver Failure.

Major causes of acute insult in Hepatitis B virus related acute on chronic liver failure in the Asian region are reactivation of Hepatitis B virus and super infection with hepatitis A and E virus (ACLF). Anti viral therapy should be started as soon as possible in the ACLF patients at presentation while waiting for confirmation by HBV DNA level. This randomized controlled trial was carried out at the Department of Hepatology, BSMMU, Bangladesh from September 2019 to august 2020 with Hepatitis B virus related ACLF patient. This trial was conducted among twenty seven HBV acute on chronic liver failure patient to compare Child Turcotte pugh (CTP) score, Model for end stage liver disease (MELD) score, Asia Pacific Association for study of Liver (APASL) ACLF Research consortium (AARC) score, survival of the patients and HBV DNA level at 3 months with antiviral therapy between tenofovir alafenamide (25mg) and entecavir (0.5mg) group. CTP score, MELD score and AARC score were significantly (p<0.05) decline from baseline to all subsequent follow-up at 1st (at 7 days), 2nd (at 14 days), 3rd (at 30 days) and 4th (at 90 days) in each group but non significant (p>0.05) difference occurred between two group. All twenty seven patients had detectable HBV DNA level at pre-treatment and all survived patients became undectable at 4th, 90 days follow-up. Total 10 patients (37.07%) were survived at 90 days follow-up, out of them seven patients (70.0%) were in tenofovir alafenamide group and three patients (30.0%) were in entecavir group which was statistically significant (p<0.05) in between two group. Hepatic encephalopathy and hepatorenal syndrome were most common causes of death in both groups. Both drugs tenofovir alafenamide and entecavir significantly improves liver functions but the former one is superior regarding survival.

Removal of Carbon Dioxide and Hydrogen Sulfide from Natural Gas Using a Hybrid Solvent of Monoethanolamine and N-Methyl 2-Pyrrolidone.

The main goal of traditional methods for sweetening natural gas (NG) is to remove hydrogen sulfide (H2S) and significantly lower carbon dioxide (CO2). However, when NG processes are integrated into the carbon capture and storage (CCS) framework, there is potential for synergy between these two technologies. A steady-state model utilizing a hybrid solvent consisting of N-methyl-2-pyrrolidone (NMP) and monoethanolamine (MEA) has been developed to successfully anticipate the CO2 and H2S capture process from NG. The model was tested against important variables affecting process performance. This article specifically explores the impact of operational parameters such as lean amine temperature, absorber pressure, and amine flow rate on the concentrations of CO2 and H2S in the sweet gas and reboiler duty. The result shows that hybrid solvents (MEA + NMP) perform better in removing acid gases and reducing reboiler duty than conventional chemical solvent MEA. The primary purpose is to meet product requirements while consuming the least energy possible, which is in line with any process plant's efficiency goals.

Staging and Management of Cervical Cancer at the Colposcopy Clinic of Bangabandhu Sheikh Sheikh Mujib Medical University (BSMMU), Bangladesh.

Anjuman SultanaCervical cancer (CC) ranks as the second most common cancer among women in Bangladesh. Unfortunately, due to late-stage diagnosis and inadequate treatment facilities, the mortality rate remains high. The stage at which CC is diagnosed plays a crucial role in predicting a woman's survival. This study aimed to determine the staging patterns of CC at presentation in the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) and the subsequent management provided to these women. This retrospective study was conducted at the BSMMU colposcopy clinic from January 2019 to June 2020. It included CC cases with known staging, spanning from January 2016 to June 2019. Data were collected from the colposcopy registry book, telephone interviews, and face-to-face discussions during follow-up appointments. The mean age of women diagnosed with CC was 48.59 years (±2 standard deviations). Among the 523 women studied, 107 (20.5%) were diagnosed at stage I, 124 (23.7%) at stage IIA, 240 (45.9%) at stage IIB, while the remaining 52 (9.90%) were diagnosed with Stage III and IV disease. Within the study population, 39 (7.5%) women underwent radical hysterectomy alone, 110 (21.00%) underwent radical hysterectomy followed by adjuvant therapy, and 184 (35.14%) received primary radiotherapy or concurrent chemoradiation. A significant portion of CC cases presented at an early stage, underscoring the importance of an effective screening program to prevent advanced-stage disease and enhance early detection rates. Establishing a patient navigation system immediately after diagnosis is crucial to prevent the loss of follow-up and ensure timely treatment. It is imperative to enhance the healthcare system's capacity to ensure timely treatment for cancer patients.

The Modulation of Euglycemic Endocrine and Exocrine Pancreatic Secretions in Iron Deficiency.

OBJECTIVES: The contribution of pancreatic secretions in iron metabolism has been elucidated, but the clinical outcomes of iron deficiency on pancreatic function are debatable. This study aimed to investigate the modulation of euglycemic endocrine and exocrine pancreatic excretions in response to variations in iron availability. SUBJECTS AND METHODS: Serum levels of insulin, glucagon, insulin-to-glucagon ratio (IGR), and amylase were determined in 170 adult subjects with variable levels of serum iron. RESULTS: Control (n = 46) and iron-deficient (n = 124) subjects had significant differences (p < 0.001) in their average levels of insulin (68.7 ± 0.5 vs. 100.0 ± 2.0 pmol/dL), glucagon (17.9 ± 0.6 vs. 10.8 ± 0.8 pmol/dL), IGR (4.0 ± 0.1 vs. 19.5 ± 2.1), and amylase (29.7 ± 0.9 vs. 17.5 ± 0.2). The upregulation of serum insulin levels increases proportionally and gradually to the extent of iron deficiency as compared to an abrupt downregulation of serum levels of glucagon and amylase. A significant association was observed between serum iron and IGR (r = -0.645, p < 0.001) and amylase levels (r = 0.653, p < 0.001). The receiver operating characteristic curve analysis defines an excellent predictivity of the reduced serum iron level to discriminate subjects with upregulated IGR and amylase levels with area under curves of 0.938 and 0.905, respectively. CONCLUSION: Iron deficiency is associated with an adaptive modulation of euglycemic endocrine and exocrine secretions that is consistent with a status of insulin resistance.

Assessment of heavy metals accumulation by vegetables irrigated with different stages of textile wastewater for evaluation of food and health risk.

Wastewater irrigation for vegetable cultivation is greatly concerned about the presence of toxic metals in irrigated soil and vegetables which causes possible threats to human health. This study aimed to ascertain the accumulation of heavy metals (HMs) in edible parts of vegetables irrigated with different stages of textile dyeing wastewater (TDW). Bio-concentration factor (BCF), Estimated daily intake (EDI), and target hazard quotient (THQ) were computed to estimate human health risks and speculate the hazard index (HI) of adults and children with the consumption of HMs contaminated vegetables at recommended doses. Five vegetables (red amaranth, Indian spinach, cauliflower, tomato, and radish) in a pot experiment were irrigated with groundwater (T1) and seven stages of TDW (T2∼T8) following a randomized complete block design (RCBD) with three replications. Among the TDW stages, T8, T7, T4, and T5 exhibited elevated BCF, EDI, THQ, and HI due to a rising trend in the accumulation of Pb, Cd, Cr, and Ni heavy metals in the edible portion of the red amaranth, followed by radish, Indian spinach, cauliflower, and tomato. The general patterns of heavy metal (HM) accumulation, regarded as vital nutrients for plants, were detected in the following sequence: Zn > Mn/Cu > Fe. Conversely, toxic metals were found to be Cd/Cr > Ni > Pb, regardless of the type of vegetables. Principal Component Analysis (PCA) identified T8, T7, and T4 of TDW as the primary contributors to the accumulation of heavy metals in the vegetables examined. Furthermore, the analysis of the heavy metals revealed that the BCF, THQ, and HI values for all studied metals were below 1, except for Pb. This suggests that the present consumption rates of different leafy and non-leafy vegetables, whether consumed individually or together, provide a low risk in terms of heavy metal exposure. Nevertheless, the consumption of T8, T7, and T4 irrigated vegetables, specifically Indian spinach alone or in combination with red amaranth and radish, by both adults and children, at the recommended rate, was found to pose potential health risks. On the other hand, T2, T3, and T6 irrigated vegetables were deemed safe for consumption. These findings indicated that the practice of irrigating the vegetables with T8, T7, and T4 stages of TDW has resulted in a significant buildup of heavy metals in the soils and edible parts of vegetables which are posing health risks to adults and children. Hence, it is imperative to discharge the T8, T7, and T4 stages of TDW after ETP to prevent the contamination of vegetables and mitigate potential health risks.

Colour, nutritional composition and antioxidant properties of dehydrated carrot (Daucus carota var. sativus) using solar drying techniques and pretreatments.

Carrot is a seasonal perishable tuberous root vegetable which presents a preservation challenge owing to its elevated moisture content. Recently, carrot processing has received more attention because of its many health-promoting qualities and the reduction of postharvest losses in a cost-effective safe way. This study was designed to sort out the effective solar drying technique including pre-treatment that would retain the color and quality characteristics of dehydrated carrot. Carrot slices were subjected to dry using open sun drying (D1), solar drying long chimney (D2), solar drying short chimney (D3) and box solar drying (D4) techniques with the pretreatments of ascorbic acid 1 % (C3), citric acid 5 % (C4), potassium metabisulfite 1 % (C5) and potassium sodium tartrate 0.3 % (C6) before drying. Drying characteristics, nutritional attributes, phytochemicals and antioxidant of the dehydrated carrot samples were compared with the fresh sample and untreated (control) sample. Results showed that D4 was a good drying method to preserve nutritional quality with good appearance. Among the pretreatments, C5 and C4 resulted improved nutritional quality retention, enhanced visual acceptability and enriched antioxidant activities. PCA (Principal Component Analysis) and correlation matrix revealed that D4 with C5 retained the maximum amount of vitamin, minerals, total phenolic content, antioxidant and admirable dehydrated carrot color by inactivating enzymatic reaction. Therefore, box solar drying with potassium metabisulfite pretreatment would be very promising for functional carrot drying retaining acceptable color and nutrition composition.

Hippocampal cognitive and relational map paradigms explored by multisensory encoding recording with wide-field calcium imaging.

Two major theories have been proposed to explain hippocampal function: cognitive map and the relational theories. They differ in their views on whether hippocampal neurons can process non-spatial information independently. However, the explanatory power of these theories remains unresolved. Additionally, more complex aspects of hippocampal neural population responses to non-spatial stimuli have not been investigated. Here, we used miniaturized fluorescence microscopy to investigate mouse CA1 responses to spatial, visual, auditory modalities, and combinations. We found that while neuronal populations primarily processed spatial information, they also showed strong sensitivity to non-spatial modalities independent of spatial inputs, exhibiting distinct neuronal dynamics and coding patterns. These results provide strong support for the relational theories.

Screening of Metal Oxides and Hydroxides for Arsenic Removal from Water Using Molecular Dynamics Simulations.

Arsenic in groundwater is a harmful and hazardous substance that must be removed to protect human health and safety. Adsorption, particularly using metal oxides, is a cost-effective way to treat contaminated water. These metal oxides must be selected systematically to identify the best material and optimal operating conditions for the removal of arsenic from water. Experimental research has been the primary emphasis of prior work, which is time-consuming and costly. The previous simulation studies have been limited to specific adsorbents such as iron oxides. It is necessary to study other metal oxides to determine which ones are the most effective at removing arsenic from water. In this work, a molecular simulation computational framework using molecular dynamics and Monte Carlo simulations was developed to investigate the adsorption of arsenic using various potential metal oxides. The molecular structures have been optimized and proceeded with sorption calculations to observe the adsorption capabilities of metal oxides. In this study, 15 selected metal oxides were screened at a pressure of 100 kPa and a temperature of 298 K for As(V) in the form of HAsO4 at pH 7. Based on adsorption capacity calculations for selected metal oxides/hydroxides, aluminum hydroxide (Al(OH)3), ferric hydroxide (FeOOH), lanthanum hydroxide La(OH)3, and stannic oxide (SnO2) were the most effective adsorbents with adsorption capacities of 197, 73.6, 151, and 42.7 mg/g, respectively, suggesting that metal hydroxides are more effective in treating arsenic-contaminated water than metal oxides. The computational results were comparable with previously published literature with a percentage error of 1%. Additionally, SnO2, which is rather unconventional to be used in this application, demonstrates potential for arsenic removal and could be further explored. The effects of pH from 1 to 13, temperature from 281.15 to 331.15 K, and pressure from 100 to 350 kPa were studied. Results revealed that adsorption capacity decreased for the high-temperature applications while experiencing an increase in pressure-promoted adsorption. Furthermore, response surface methodology (RSM) has been employed to develop a regression model to describe the effect of operating variables on the adsorption capacity of screened adsorbents for arsenic removal. The RSM models utilizing CCD (central composite design) were developed for Al(OH)3, La(OH)3, and FeOOH, having R2 values 0.92, 0.67, and 0.95, respectively, suggesting that the models developed were correct.

Investigation of Simulated Adherence in Long-Term Buprenorphine/Naloxone Treatment Patients.

BACKGROUND: Buprenorphine is a medication that is used to treat opioid use disorder by reducing withdrawal symptoms and cravings for opioids. Patients with poor adherence are at higher risk of relapse and overdose. Providers often test adherence through urine testing but are not aware of simulated adherence, where patients may directly add buprenorphine to the urine samples. As of now, there exists no literature on the simulated adherence practices for patients who stayed in the treatment for more than three months. METHODS: This study is a cross-sectional analysis of simulated adherence through urine toxicology results of 3950 patients undergoing buprenorphine/naloxone treatment. Simulated adherence was measured by the ratio of norbuprenorphine and buprenorphine <0.02 in the urine sample. Descriptive statistics as well as multivariate analysis was conducted to examine the relationship between patient information and outcomes. RESULTS: Out of 3950 patients, 411 (10.4%) had a history of one or more simulated adherence. On average, patients with multiple simulated adherences had 48.1% of their tests simulated, while on the contrary, patients with a single occurrence of simulated adherence had 17.6% of their tests simulated. Weekly testing and visit number of over 15 were associated with a higher likelihood of simulated adherence. CONCLUSION: The study demonstrates that simulated adherence is a recurring phenomenon among buprenorphine/naloxone treatment patients regardless of the duration in the treatment. Utilization of quantitative urine toxicology to identify simulated adherence will enable healthcare providers to formulate a more precise and effective treatment plan tailored to support individual patient needs.

Transporter-Mediated Cellular Distribution of Tyrosine Kinase Inhibitors as a Potential Resistance Mechanism in Chronic Myeloid Leukemia.

Chronic myeloid leukemia (CML) is a hematologic neoplasm characterized by the expression of the BCR::ABL1 oncoprotein, a constitutively active tyrosine kinase, resulting in uncontrolled growth and proliferation of cells in the myeloid lineage. Targeted therapy using tyrosine kinase inhibitors (TKIs) such as imatinib, nilotinib, dasatinib, bosutinib, ponatinib and asciminib has drastically improved the life expectancy of CML patients. However, treatment resistance occurs in 10-20% of CML patients, which is a multifactorial problem that is only partially clarified by the presence of TKI inactivating BCR::ABL1 mutations. It may also be a consequence of a reduction in cytosolic TKI concentrations in the target cells due to transporter-mediated cellular distribution. This review focuses on drug-transporting proteins in stem cells and progenitor cells involved in the distribution of TKIs approved for the treatment of CML. Special attention will be given to ATP-binding cassette transporters expressed in lysosomes, which may facilitate the extracytosolic sequestration of these compounds.

Work productivity in patients with axial spondyloarthritis initiating biological or targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review and meta-analysis.

BACKGROUND: Axial spondyloarthritis (axSpA) can limit work participation. Our objective was to characterise productivity in patients with axSpA, including changes after 12-16 weeks of treatment with biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). METHODS: A systematic literature review identified studies published from 1 January 2010 to 21 October 2021 reporting work productivity using the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA initiating b/tsDMARDs. Baseline and Week 12-16 overall work productivity, absenteeism, presenteeism and activity impairment scores were used in a random-effects meta-analysis to calculate absolute mean change from baseline for each WPAI-domain. RESULTS: Eleven studies in patients with axSpA who received either placebo (n=727) or treatment with adalimumab, bimekizumab, etanercept, ixekizumab, secukinumab or tofacitinib (n=994) were included. In working patients initiating a b/tsDMARD, mean baseline overall work productivity impairment, absenteeism and presenteeism scores were 52.1% (N=7 studies), 11.0% and 48.8% (N=6 studies), respectively. At Week 12-16, the pooled mean change from baseline in overall work impairment for b/tsDMARDs or placebo was -21.6% and -12.3%. When results were extrapolated to 1 year, the potential annual reductions in cost of paid and unpaid productivity loss per patient ranged from €11 962.88 to €14 293.54. CONCLUSIONS: Over 50% of employed patients with active axSpA experienced work impairment, primarily due to presenteeism. Overall work productivity improved at Weeks 12-16 to a greater extent for patients who received b/tsDMARDs than placebo. Work productivity loss was associated with a substantial cost burden, which was reduced with improvements in impairment.

Postoperative wound infection by nontuberculous mycobacteria; case series in Dhaka Medical College Hospital of Bangladesh.

The incidence of nontuberculous mycobacterial (NTM) infections after operations is increasing in Bangladesh but data regarding clinical presentation, diagnosis, treatment, and prognosis after treatment are lacking. In this case series, three patients having persistent serous discharge from incision wound after operation were studied. Discharge from wounds were collected, wet film microscopy was performed for pus cells and fungus, Gram stain, Ziehl-Neelsen (ZN) stain, culture in routine culture media and Lowenstein-Jensen (LJ) media, Xene-Xpert for mycobacterium tuberculosis (MTB), polymerase chain reaction (PCR) for NTM were done. NTM-positive patients were treated initially for 6 weeks with four drugs regimen (clarithromycin 500 mg 12 hourly, ciprofloxacin 500 mg 12 hourly, linezolid 400 mg 12 hourly, and amikacin 500 mg 12 hourly), followed by 5 months with three drugs regimen (clarithromycin 500 mg 12 hourly, ciprofloxacin 500 mg 12 hourly, and linezolid 400 mg 12 hourly) as a maintenance dose. Cessation of discharge occurred within 3-4 weeks after starting treatment, and the wounds were healed.

Corrigendum: Association of household fuel with acute respiratory infection (ARI) under-five years children in Bangladesh.

[This corrects the article DOI: 10.3389/fpubh.2022.985445.].

Canal wall up versus canal wall down mastoidectomy techniques in the pediatric population with cholesteatoma: A systematic review and meta-analysis of comparative studies.

IMPORTANCE: The optimal surgical management of cholesteatoma remains controversial. Within pediatric otolaryngology, one of the most vital points of contention is the selection of canal wall-up (CWU) versus canal wall-down (CWD) procedures. Pediatric cholesteatoma has high rates of recurrence (16%-54%). In adults, there is evidence that the selection of surgical techniques affects recurrence rates. This has not been shown in children. OBJECTIVES: 1. To systematically review the literature on recurrent and residual cholesteatoma after CWU and CWD in children and perform a meta-analysis of the data. 2. To assess the rates of recurrent and residual cholesteatoma between CWU and CWD techniques in pediatric patients. 3. To assess hearing outcomes by evaluating postoperative differences in the air-bone gap (ABG) between CWU and CWD techniques. DATA SOURCES: A systematic search of PubMed, Embase, Scopus, and Cochrane Collaboration was performed from inception to May 1st, 2020, to identify studies that compared CWU and CWD procedures for acquired cholesteatoma in children. STUDY SELECTION: Search records were screened in duplicate by four reviewers. Inclusion criteria consisted of comparative randomized clinical trials and observational studies assessing outcomes of CWU and CWD techniques in the pediatric population. Studies involving patients with congenital cholesteatoma were excluded. DATA EXTRACTION AND SYNTHESIS: Four reviewers working independently and in duplicate systematically reviewed and extracted study data. Dichotomous variables were analyzed as risk ratios (RR), while continuous variables were compared using weighted mean differences (MD). The risk of bias was assessed using the CLARITY Scale. PRIMARY OUTCOMES AND MEASURES: The outcomes were recurrence, residual disease, air-bone gap (ABG), and air conductive (AC) thresholds. RESULTS: After screening 1036 publications, 17 retrospective cohort studies were selected. 1333 children were included; the overall mean age was ten years (SD 7.9), and the overall mean follow-up time was 5.9 years (SD 6.6). CWU and CWD techniques were performed in 60% (796) and 40% (537) cases. We did not find differences in cholesteatoma recurrence (RR: 1.50, 95% CI 0.94; 2.40; n = 544; I2 0%; Tau [2]: 0.00), or rates of residual cholesteatoma (RR 1.51, 95% CI 0.96; 2.38, n = 506; I2: 0%; Tau [2]: 0.00) in patients who underwent CWU and CWD mastoidectomy. The mean air-bone gap was lower with CWU than CWD (mean difference: 7.60, 95% CI -10.65; -4.54; n = 242; I2: 71%; Tau [2]: 5.98). CONCLUSION: and relevance: We show similar rates of recurrence and residual disease after either CWU or CWD tympanoplasty. Our results challenge the fundamental principle of CWD surgery as a standard technique, as there is no difference in rates of recurrence and residual disease in CWU and CWD. Moreover, audiometric results support CWU with improved hearing outcomes. TRIAL REGISTRATION: PROSPERO identifier: CRD42020184029.

Evaluation of Asymmetries in Speech-in Noise Abilities in Audiologic Screening for Vestibular Schwannoma.

OBJECTIVES: Measures of speech-in-noise, such as the QuickSIN, are increasingly common tests of speech perception in audiologic practice. However, the effect of vestibular schwannoma (VS) on speech-in-noise abilities is unclear. Here, we compare the predictive ability of interaural QuickSIN asymmetry for detecting VS against other measures of audiologic asymmetry. METHODS: A retrospective review of patients in our institution who received QuickSIN testing in addition to a regular audiologic battery between September 2015 and February 2019 was conducted. Records for patients with radiographically confirmed, unilateral, pretreatment VSs were identified. The remaining records excluding conductive pathologies were used as controls. The predictive abilities of various measures of audiologic asymmetry to detect VS were statistically compared. RESULTS: Our search yielded 73 unique VS patients and 2423 controls. Receiver operating characteristic curve analysis showed that QuickSIN asymmetry was more sensitive and specific than pure-tone average asymmetry and word-recognition-in-quiet asymmetry for detecting VS. Multiple logistic regression analysis revealed that QuickSIN asymmetry was more predictive of VS (odds ratio [OR] = 1.23, 95% confidence interval [CI] [1.10, 1.38], p < 0.001) than pure-tone average asymmetry (OR = 1.04, 95% CI [1.00, 1.07], p = 0.025) and word-recognition-in-quiet asymmetry (OR = 1.03, 95% CI [0.99, 1.06], p = 0.064). CONCLUSION: Between-ear asymmetries in the QuickSIN appear to be more efficient than traditional measures of audiologic asymmetry for identifying patients with VS. These results suggest that speech-in noise testing could be integrated into clinical practice without hindering the ability to identify retrocochlear pathology.

Age-Related Changes in Neurologic Examination and Sensory Nerve Amplitude in the General Population: Aging of the Peripheral Nervous System.

BACKGROUND AND OBJECTIVES: Chronic axonal polyneuropathy is a common disease of the peripheral nervous system with increasing prevalence with age. Typical neurologic signs are present in patients with polyneuropathy but may also occur in individuals without disease. Owing to limited knowledge on normal aging of the peripheral nervous system, it can be difficult to distinguish peripheral nerve dysfunction due to disease from variations in normal aging. Therefore, we described the changes in neurologic examination and nerve conduction studies that accompany aging in the general population. METHODS: In this cross-sectional population-based study, we screened participants for chronic polyneuropathy in a controlled environment using standardized methods including a symptom questionnaire, neurologic examination, and nerve conduction studies (NCS). Inclusion criteria were 40 years or older and living in a suburb of Rotterdam, the Netherlands. Participants not diagnosed with chronic polyneuropathy, based on the discussion of findings in the screening by an expert team, were included to determine the effect of age (range 41-96 years) on features of neurologic examination and NCS using frequency calculations and quantile regression analysis. RESULTS: In total, 4,179 participants (mean age 64.5 ± 12.7 years, 54.9% female) were included of whom 3,780 (90.5%) did not fulfil the criteria for polyneuropathy. In the population without polyneuropathy, the frequency of normal features at neurologic examination declined with age, most pronounced for vibration sense at the hallux (from 6.6 [SD ± 1.5] in 40-49 years to 3.6 [SD ± 3.1] in 80 years or older) and Achilles tendon reflexes (absent in 9% in 40-49 years up to 33% in 80 years or older). Superficial pain sensation and patellar tendon reflexes remained stable over time. Sural sensory nerve action potential (SNAP) amplitude declined with age from 11.2 µV in 40-49 years to 3.3 µV in 80 years or older. Nonrecordable SNAP amplitudes were found in 25.1% of the participants older than 80 years, more often in men (30.3%) than in women (21.0%). DISCUSSION: This study showed the effect of age on features of neurologic examination and sural nerve amplitude in the general population. These findings are helpful to distinguish features suggesting polyneuropathy from variations of normal aging of the peripheral nervous system.