Nursing Science

Secondary Traumatic Stress in Nursing: A Walker and Avant Concept Analysis Nurses on the front lines of health care are impacted psychologically by their work and may experience secondary traumatic stress. The literature contains several different terms to explore concepts that describe the impact of traumatic patient experiences on the nurse, making it difficult to differentiate the concepts. Using the Walker and Avant method of analysis, the author reviewed nursing-specific publications within the last 10 years and seminal works to develop a purer meaning of secondary traumatic stress and distinguish it from other related terms. A more precise definition of secondary traumatic stress will allow for the advancement of research related to awareness and prevention in nursing. Correspondence: Marni B. Kellogg, PhD, RN, CPN, CNE, University of Massachusetts Dartmouth, 285 Old Westport Rd, Dartmouth, MA, 02747 (mkellogg@umassd.edu). The author has no acknowledgments or disclosures. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Symptom Management Theory: Analysis, Evaluation, and Implications for Caring for Adults With Cancer A detailed analysis of Symptom Management Theory (SMT) along with its extent of use and implications for adults with cancer as demonstrated in 20 oncology research studies is reported. SMT provides useful guidance for adult oncology research and nursing practice. Theory dimension most researched in cancer was symptom experience. Although theory assertions were demonstrated in 80% of the studies, it was used to an adequate extent only in 35% of them. Comparisons between cancer-related clinical outcomes with and without use of SMT, certain theory modifications, and future SMT-based studies involving longitudinal designs in this population are warranted. Correspondence: Asha Mathew, MBA, MSN, RN, RM, Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, Room 1024, Chicago, IL 60612 (asolom8@uic.edu). This article was supported by the National Institute of Nursing Research of the National Institutes of Health under award no. K24NR015340. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare that they have no conflicts of interest. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Exploring Nurses' Perceptions of Safety: A Phenomenological Study The purpose of the study is to explore the lived experiences of nurses with regard to their personal safety and to identify the fundamental structures underlying nurse safety. A qualitative descriptive phenomenological design, using the data analysis method proposed by Colaizzi, was used. Eleven nurses participated in the study between March and July 2019. The research findings indicated the fundamental structure of nurse safety encompasses 3 categories: "nurses' personal protection systems," "safety support systems," and "risk factors." The fundamental structure identified in this study can contribute to better understanding and insight regarding the safety of nurses. Correspondence: Seung Wan Kang, PhD, MD, Associate Professor, College of Nursing, Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (drdemian@snu.ac.kr). Immeasurable appreciation for their support is extended to the nurses who participated and shared their stories and Dr Hack Sun Kim, who reviewed the results of the study. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.advancesinnursingscience.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

A Critical Analysis of the American Nurses Association Position Statement on Workplace Violence: Ethical Implications In 2015, the American Nurses Association issued a position statement on workplace violence. An authoritative, disciplinary position is critically important to inform policies and recommendations addressing this significant issue in nursing. Position statements and policies should reflect disciplinary values. A discourse analysis of this position statement was performed through the lens of nursing ethics. The position statement endorses a zero-tolerance response, which is moralist, punitive, and questionably effective. It problematically presents patient and coworker violence as equivalent. Promotion of this position has the potential to erode public trust and lead us down a path of criminalizing illness behaviors. Correspondence: Darcy Copeland, PhD, RN, University of Northern Colorado, Campus Box 125, Gunter Hall, Greeley, CO 80639 (Darcy.copeland@unco.edu). The author would like to thank Dr Lorna Hutchison for reviewing this article. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Integrity of Databases for Literature Searches in Nursing: Avoiding Predatory Journals The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information. Findings indicated that no predatory nursing journals were currently indexed in MEDLINE or CINAHL, and only one journal was in Scopus. Citations to articles published in predatory nursing journals are not likely found in a search using these curated databases but rather through Google or Google Scholar search engines. Correspondence: Marilyn H. Oermann, PhD, RN, ANEF, FAAN, Duke University School of Nursing, DUMC 3322, 307 Trent Dr, Durham, NC 27710 (marilyn.oermann@duke.edu). Peggy L. Chinn, PhD, RN, FAAN, Editor, Advances in Nursing Science, is a member of our research team and contributed to the study and preparation of the manuscript. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

End-of-Life Care Terminology: A Scoping Review The purpose of this scoping review is to present an overview of terms found in publications associated with end-of-life care management that can impact decision making by patients, health care providers, and researchers. Connotative terminology and syntax can influence the decision-making approach and process. We examined 49 publications for positive, negative, and neutral connotations. We consistently found negative terminology in the publications. To advance the development of nursing knowledge regarding end-of-life care, researchers should be aware of their biases of terminology and syntax use. We propose modifications to language used in end-of-life care planning models and literature can improve care congruency. Correspondence: Zahra Rahemi, PhD, RN, College of Behavioral, Social and Health Sciences, School of Nursing, Clemson University, 116 Edwards Hall, Clemson, SC 29634 (zrahemi@clemson.edu). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Black Female Sexuality: Intersectional Identities and Historical Contexts Black females experience significant sexual health disparities. Intersectionality theory offers nurses a framework to address health disparities. Intersectionality theory examines how categorical identities of difference confer power or oppression, affect social interactions, and influence individuals' engagement with institutional structures. This secondary analysis of qualitative data details the damaging effects that power, oppression, and disadvantaged identities have on the sexual health of Black women. Twenty participants explained how the intersection of race, gender, age, education, and sexuality influences sexual health risk. Our expanded model of intersectionality theory emphasizes historical context with implications for research, practice, and education to promote health equity. Correspondence: Natasha Crooks, PhD, RN, Department of Human Development Nursing Science, University of Illinois Chicago College of Nursing, 845 S. Damen Ave, Room 816, Chicago, IL 60612 (ncrooks@uic.edu). This study was funded by the National Institute of Nursing Research, Pre-doctoral Fellowship Ruth L. Kirschstein National Research Service Award (F31NR016624), principal investigator Natasha Crooks. We would like to acknowledge and thank the participants who shared their personal stories. We would also like to acknowledge the support from the University of Wisconsin-Madison, Public Health and Dane County, and the Allied Wellness Center. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

A Conceptual Framework of Self-advocacy in Women With Cancer Researchers define self-advocacy as the ability of an individual with cancer to overcome challenges in getting their preferences, needs, and values met. While imperative in all health care settings, self-advocacy is especially important in cancer care. The goal of this article is to present a conceptual framework for self-advocacy in cancer. We review foundational studies in self-advocacy, define the elements of the conceptual framework, discuss underlying assumptions of the framework, and suggest future directions in this research area. This framework provides an empirical and conceptual basis for studies designed to understand and improve self-advocacy among women with cancer. Correspondence: Teresa H. Thomas, PhD, RN, University of Pittsburgh School of Nursing, 3500 Victoria St, Ste 440, Pittsburgh, PA 15261 (t.thomas@pitt.edu). The authors want to dedicate this article to the late Susan M. Cohen, PhD, APRN, FAAN. She was a dedicated member of our research team and brought clarity of thought, enthusiasm, and reassurance to each of our studies described in this article. As a mentor, she endlessly supported this work and the development of all of her mentees. Without her guidance, along with that of our entire team of mentors and collaborators, this work would never have reached fruition. The following funding supported this article: American Cancer Society Mentored Research Scholar Grant MSRG-18-051-51 (Thomas), National Palliative Care Research Center Career Development Award (Thomas), American Cancer Society, Doctoral Degree Scholarship in Cancer Nursing DSCN-14-077-01-SCN (Thomas), National Institute of Nursing Research/National Institute of Health F31NR014066 (Thomas), National Institute of Nursing Research/National Institute of Health T32NR0111972 (Bender), National Institute of Nursing Research/National Institute of Health R01NR010735 (Donovan), Judith A. Erlen Nursing PhD Student Research Award (Thomas), Nightingale Awards of Pennsylvania, Doctoral Student Research Award (Thomas), Oncology Nursing Foundation, Doctoral Student Award (Thomas), Sigma Theta Tau International, Rosemary Berkel Crisp Research Award (Thomas), The Rockefeller University's Heilbrunn Family Center for Research Nursing, Heilbrunn Nurse Scholar (Thomas) Award, and Palliative Research Center (PaRC) at the University of Pittsburgh (Schenker). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Advancing Nursing Policy Advocacy Knowledge: A Theoretical Exploration Nursing policy advocacy continues to be recognized as a key part of a nurse's role by educators, professional associations, and regulators. Despite normative calls on nurses to engage in political action and advocacy, limited theories, models, and frameworks exist to support this practice within nursing. Using Walt and Gilson's Health Policy Triangle Framework, this article explores the theoretical underpinnings of policy advocacy to enhance nursing's contemporary role in advancing social justice. Specific consideration is placed on the type of nursing and policy knowledge and perspectives required to understand policy content, contexts, processes, and actors. Correspondence: Patrick Chiu, RN, MPH, Faculty of Nursing, 4-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada (pakcheon@ualberta.ca). The author acknowledges the valuable feedback provided by Professor Jill White, PhD, MEd, MHPol, RN, RM, FAAN, Professor Emerita, University of Sydney, Australia, and the University of Technology Sydney; and Joanne Olson, PhD, RN, FAAN, Professor, Faculty of Nursing, University of Alberta. The author has disclosed that he has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Properties of Situation-Specific Theories and Neo-pragmatism The purpose of this article is to discuss whether the properties of existing situation-specific theories are congruent with the philosophical stance of neo-pragmatism. A literature review was conducted using PubMed, CINAHL, and PsycInfo with keywords of "situation-specific theory" and "nursing." Fifteen situation-specific theories were included in the analysis. The properties of existing situation-specific theories included "high specificity and low level of abstraction," "context understanding," "direct linkages to research and practice," and "reflecting diversities and complexities with limited generalizability." Finally, the findings are discussed in terms of their linkages to the major tenets of neo-pragmatism. Correspondence: Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta GA 30322 (eun.ok.im@emory.edu). The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,

Noise and Health

Noise induced epigenetic effects: A systematic review Veruscka Leso, Luca Fontana, Ferdinando Finiello, Luigi De Cicco, Maria Luigia Ercolano, Ivo Iavicoli Noise and Health 2020 22(107):77-89 Background: Noise-induced hearing loss (NIHL) is one of the leading causes of acquired sensorineural hearing loss. However, molecular mechanisms responsible for its pathogenesis remain to be elucidated. Epigenetic changes, i.e. DNA methylation, histone and microRNA expression modifications may function as a link between noise exposure and hearing loss. Therefore, the aim of the present review was to assess whether epigenetic alterations may serve as biomarkers of noise exposure or early effect. Materials and Methods: A systematic review of studies available in Pubmed, Scopus, and ISI Web of Science databases was performed. Results: Noise exposure was able to induce alterations in DNA methylation levels in workers and animal models, resulting in expression changes of genes related to hearing loss and also to extra-auditory effects. Differently expressed microRNAs were determined in NIHL workers compared to noise-exposed subjects with normal hearing, supporting their possible role as biomarkers of effect. Acoustic trauma affected histon acethylation and methylation levels in animals, suggesting their influence in the pathogenesis of acute noise-induced damage and their role as targets for potential therapeutic treatments. Conclusions: Although preliminary data suggest a relationship between noise and epigenetic effects, the limited number of studies, their different methodologies and the lack of adequate characterization of acoustic insults prevent definite conclusions. In this context, further research aimed to define the epigenetic impact of workplace noise exposure and the role of such alterations in predicting hearing loss may be important for the adoption of correct risk assessment and management strategies in occupational settings.

Hearing loss among military personnel in relation to occupational and leisure noise exposure and usage of personal protective equipment Hans Orru, Assar Luha, Mihkel Pindus, Rainer Jõgeva, Maie Vahisalu, Urve Lekk, Ene Indermitte, Eda Merisalu Noise and Health 2020 22(107):90-98 Context: Hearing loss (HL) is a major health concern among military personnel due to noise from shooting, blasts, military vehicles, and noisy training environments. Nevertheless, one’s exposure can be partially reduced by using personal protective equipment (PPE). The aim of this study is to estimate the prevalence of HL among military personnel, to analyse associations between HL and self-reported occupational and leisure noise exposure, and use of PPEs. Materials and Methods: A cross-sectional study was conducted among 150 military personnel during their routine medical examinations. First, all participants filled in a questionnaire about their exposure to noise and later the respondents went through an audiometric test. The diagnostic criteria for slight, moderate, and severe HL was HL of 25–40, 41–60, and >60 dB at 4 and 6 kHz, respectively. The associations between noise exposure and HL were studied with multinomial logistic regression analysis. Results: The prevalence of slight to severe HL in high frequencies (4 and 6 kHz) among study participants was 62.7%. Nevertheless, the majority of it was slight, as the prevalence of severe HL was 9.3%. The prevalence of any kind of HL was highest in the Navy and the prevalence of severe HL was highest in the Central Command Units. The relative risk ratios (RRRs) for HL were higher among those who had been working for a long time in a noisy environment, working with noise-producing equipment, driving in a PASI or a Bandvagn or had been shooting with blanks at least once per week. It also appeared that military personnel who had HL, reported tinnitus more often. Respondents’ previous health problems, music-listening habits, and amount of exposure to loud noise in non-military environments were not independently associated with HL, but in several cases it increased the RRRs together with military exposure. We also found significantly more frequent HL among those never using PPEs. Conclusion: HL loss was more prevalent among personnel who are more often exposed to military noise, especially among those who never use PPEs. The effect was enhanced by leisure time noise, but it was not independently associated to HL.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,

Otology & Neurotology

Predictive Ability of Direct Electrical Stimulation on Facial Nerve Function Following Vestibular Schwannoma Surgery: A Systematic Review and Meta-analysis Objective: Facial nerve preservation is critical in vestibular schwannoma (VS) surgery. Direct electrical stimulation (DES) is a widely used method for intraoperative localization of the facial nerve and assessment of nerve integrity. We sought to assess the predictive ability of DES parameters on facial nerve function post-VS surgery. Databases reviewed: A systematic literature search of English-language studies published from 1946 to 2019 was undertaken using EMBASE, MedLine/PubMed, and the Cochrane Central Register of Controlled Trials. Methods: Included studies involved patients undergoing VS surgery and assessed predictive ability of any DES parameter on postoperative facial function. Two authors independently reviewed studies and extracted data. Meta-analysis of diagnostic accuracy of DES parameters was used to calculate pooled sensitivities and specificities of common cutoffs. For DES parameters reported by less than four studies, outcomes were reported descriptively. Results: A MST cutoff of 0.10 mA had sensitivity of 0.76 (95% CI 0.53–0.90) and specificity 0.68 (95% CI 0.42–0.87) for facial function in the long term, and MST 0.05 mA had sensitivity 0.73 (95% CI 0.58–0.84) and specificity 0.74 (95% CI 0.59–0.85). CMAP amplitude < 500 μV had sensitivity of 0.87 (95% CI 0.78–0.93) for poor short-term facial function. Conclusions: A CMAP amplitude response < 500 μV is sensitive for poor short-term facial function, whereas MST values of 0.05 mA and 0.10 mA are both sensitive and specific in the long term. Other DES parameters may be able to accurately predict both short- and long-term postoperative facial function, but have been less studied. Address correspondence and reprint requests to Dr. Joseph Chen, M.D., F.R.C.S.C., Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1 102, Toronto, ON M4S 3M5, Canada. E-mail: aquim047@uottawa.ca The authors disclose no conflicts of interest. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Pulsatile Tinnitus in Superior Semicircular Canal Dehiscence Cured by Endovascular Coil Occlusion of the Superior Petrosal Sinus No abstract available

When to Refer a Hearing-impaired Patient for a Cochlear Implant Evaluation Objectives: To explore the predictive value of utilizing routine audiometry to best determine cochlear implant (CI) candidacy using AzBio sentences. Methods: A retrospective chart review was performed between 2011 and 2018 for 206 adult patients who underwent CI evaluation assessed with AzBio sentences. Better hearing ear word recognition score (WRS) using Northwestern University-6 word lists presented at decibel hearing level from a standard audiogram was used to determine when best to refer a patient for CI evaluation. Predicted AzBio scores from multivariate regression models were calculated and compared with the actual CI candidacy to assess accuracy of the regression models. Results: Race, marital status, hearing aid type, better hearing ear WRS, and HL were all independently and significantly associated with AzBio testing in quiet on univariate analyses. Better hearing ear WRS and better hearing ear decibel hearing level predicted AzBio Quiet on multivariate regression analysis. For AzBio +10 dB signal-to-noise ratio (SNR), sex, and better hearing ear WRS each significantly predicted speech perception testing. Predicted CI candidacy was based on AzBio sentence testing of ≤60% for the ease of statistical analysis. Regression models for AzBio sentence testing in quiet and +10 dB SNR agreed with the actual testing most of the time (85.0 and 87.9%, respectively). A generalized linear model was built for both AzBio testing in quiet and +10 dB SNR. Conclusion: A WRS of <60% in the better hearing ear derived from a routine audiogram will identify 83.1% of CI candidates while appropriately excluding 63.8% of patients. Address correspondence and reprint requests to Jacob B. Hunter, M.D., Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, 2001 Inwood Road, Dallas, TX 75235; E-mail: jacob.hunter@utsouthwestern.edu Institutional Review Board Approval(s): STU 032018-085. Internal departmental funding was utilized without commercial sponsorship or support. The views expressed in this manuscript are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government. The authors disclose no conflicts of interest. Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

The Relationship Between Otitis Media With Effusion and Gastroesophageal Reflux Disease: A Meta-analysis Objective: Recent studies have investigated the mechanism by which refluxed gastric materials reach the middle ear, to establish otitis media with effusion (OME) causal relation between them in both children and adults. Therefore, the relationship between OME and gastro-esophageal reflux disease (GERD) should be further studied extensively. Methods: To identify eligible original articles, we searched a range of computerized databases, including Medline via PubMed, EMBASE, CNKI, and Web of Science with a systematic searching strategy. Subgroup analysis was performed to analyze heterogeneity and Egger and Begg funnel plot to assess the publication bias of the included articles. Results: The meta-analysis had an overall sample size of 1961. We identified a significant relationship between OME and GERD, with a pooled odds ratio (OR) of 4.52 (95% confidence interval [CI]: 2.42–8.44; p < 0.001). The pooled data were calculated with the random-effects model as a high significant heterogeneity was found among the studies and there was no significant publication bias observed. Conclusions: The meta-analysis suggested that there was a significant association between otitis media with effusion and gastroesophageal reflux disease. Address correspondence and reprint requests to Hai-Ying Sun, M.D., Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; E-mail: sunhaiying120@163.com Z.-H.W., Y.T., and X.N. are joint first author. These authors contributed equally to this study. H-Y.S. and X.C. are joint corresponding authors. Author Contributions: All authors contributed significantly to this work. W.Z.H. and T.Y. designed the research study; W.Z.H. and N.X performed the research study and extracted the data and analyzed the data; W.Z.H., N.X., S.H.Y. and C.X. wrote and revised the manuscript. In addition, all authors approved the final draft. Competing financial interests: No financial (no Funding, Employment and Personal financial interests) and Non-financial competing interests. This work is supported by grants from The National Natural Science Foundation of China (81600801). The authors disclose no conflicts of interest. Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Intracanalicular Vestibular Schwannoma: A Systematic Review and Meta-analysis of Therapeutics Outcomes Objective: To perform a systematic review and meta-analysis summarizing the current evidence on the management of intracanalicular vestibular schwannoma. Data Sources: Embase (1947–), Medline (1946–), Cochrane library (1947–), Scopus (2010–), and CINAHL (1961–) were searched from 1969 to October 5, 2019 (50 years). Study Selection: A search strategy was performed to identify patients with vestibular schwannoma confined to the internal auditory canal without extension to the cerebellopontine angle. Studies with patients aged less than 18, Neurofibromatosis type 2, revision cases, and non-English language were excluded. Data Extraction: A standardized collection sheet was used for the extracted data and a quality assessment was performed using the Newcastle-Ottawa Scale with the comparability criterion omitted. Data Synthesis: Seventy-one studies were included with 24 on observation, 14 on radiotherapy, and 34 on surgery. The primary outcome was serviceable hearing preservation. Secondary outcomes were preservation of facial nerve function, growth, involution, and dizziness. Sub-analysis on the type of surgery and type of radiotherapy were performed. Excel 2016 with MIX 2.0 Pro add-on package was used to analyze the data and create forest plots. Data were presented in proportion with a 95% confidence interval. Conclusions: Serviceable hearing was observed in 31% of patients after observation, 56% after radiotherapy, and 51% after surgical treatment with mean follow-up time of 4.04 years, 4.92 years, and 2.23 years, respectively. Facial nerve function was found to be best preserved in both observation and radiotherapy groups. Vestibular schwannoma growth occurred in 33% of patients under observation. Involution occurred in 2% of patients under observation and in 38% after radiotherapy. Address correspondence and reprint requests to Marina Neves Cavada, M.D., Sydney Adventist Hospital, 185 Fox Valley Rd, Wahroonga, Sydney, NSW 2076, Australia; E-mail: marinacavada@gmail.com Disclosure of funding: No funding or other supports were received. The author discloses no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Hearing Outcomes With a Novel Total Ossicular Replacement Prosthesis Introduction: A total ossicular replacement prosthesis (TORP) is used to reconstruct the ossicular chain in the absence of the stapes suprastructure. The Wildcat prosthesis is a novel TORP that eliminates the need for a separate footplate shoe prosthesis and aims to improve ease-of-use and stability. This study evaluates hearing outcomes using the Wildcat prosthesis. Study Design: Case series with chart review. Setting: Tertiary neurotology referral center. Methods: Retrospective chart review of 64 patients undergoing ossicular chain reconstruction using the Wildcat TORP. Hearing outcomes after surgery were assessed with air conduction pure-tone average, bone conduction pure-tone average, air-bone gap (ABG), speech recognition threshold , and word recognition score as primary outcome measures. The stability of hearing outcomes was evaluated on subsequent long-term follow-up. Results: At mean short-term follow-up of 4.4 ± 2.7 months, ABG improved from 31.0 ± 13.0 dB preoperatively to 22.5 ± 10.0 dB (p < 0.001) with 51.6% achieving ABG less than 20 dB. No significant difference in any primary outcome measures was found when analyzing outcomes by initial versus revision surgery, use of cartilage graft, or type of mastoidectomy. The only exception was a smaller reduction in ABG of 4.2 dB for patients with canal wall down mastoidectomy compared with a 13.7 dB ABG closure in patients with canal wall up mastoidectomy (p = 0.039). Conclusion: Total ossicular chain reconstruction using the Wildcat demonstrates versatility in challenging cases to provide hearing outcomes that are comparable to published data using TORPs. Address correspondence and reprint requests to Kenny F. Lin, M.D., Michigan Ear Institute, 30055 Northwestern Highway, #101, Farmington Hills, MI 48334; E-mail: kenny.f.lin@gmail.com All authors have approved the final manuscript and attest to the integrity of the original data and the analysis reported in the manuscript. The authors disclose no conflicts of interest. Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Which Inner Ear Disorders Lie Behind a Selective Posterior Semicircular Canal Hypofunction on Video Head Impulse Test? Objective: To assess all different patterns of associated abnormalities on audiometry, bithermal caloric test (BCT) and cervical/ocular vestibular-evoked myogenic potentials (VEMPs) to air/bone-conduction in patients with selective posterior semicircular canal (PSC) hypofunction and to correlate them with underlying disorders. Study Design: Retrospective review. Setting: Tertiary referral center. Patients: 51 patients (23 men, 28 women, mean age 57.5 yr) with isolated PSC deficit (one bilateral). Interventions: Correlation with instrumental data and underlying diagnoses. Main Outcome Measures: Video-oculographic findings, objective measurements on audiometry, BCT, VEMPs and video-head impulse test (vHIT). Results: Ongoing or previous acute vestibular loss (AVL) was diagnosed in 13 patients (25.5%, 3 inferior vestibular neuritis, 10 AVL with sudden sensorineural hearing loss [SSNHL]), Meniere's disease (MD) in 12 (23.5%), cerebellopontine angle (CPA) lesion in 9 (17.6%), various causes in 7 (13.7%), benign paroxysmal positional vertigo (BPPV) involving the non-ampullary arm of PSC in 5 cases (9.8%) whereas unknown pathology in 5 (9.8%). Involvement of at least one additional receptor besides PSC was seen in 89.8% of cases. Cochlear involvement was diagnosed in 74.5% with pure-tone average significantly greater in patients with AVL+SSNHL (p < 0.05). Overall involvement of labyrinthine receptors or afferents was highest in patients with AVL+SSNHL (p < 0.01), MD and CPA lesions (p < 0.05). Conclusions: Isolated loss of PSC function on vHIT is mostly accompanied by additional labyrinthine deficits that could only be identified through an accurate instrumental evaluation. Assessment of all receptors and afferents should be always pursued to identify the lesion site and better understand the underlying pathophysiological mechanisms. Address correspondence and reprint requests to Andrea Castellucci, M.D., ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, AUSL - IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; E-mail: andrea.castellucci@ausl.re.it Sources of support that require acknowledgment: none declared. Source of funding: none declared. Ethical statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of our Institution, approval number 273/2017/O/OssN) and with World Medical Association Declaration of Helsinki (2002). Informed consent was obtained from all individual participants included in the study. The authors disclose no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Comparative Performance of Lateral Wall and Perimodiolar Cochlear Implant Arrays Objective: The physical shape of cochlear implant (CI) arrays may impact hearing outcomes. The goal of this study was to compare post-operative speech and melody perception between patients with lateral wall (LW) and perimodiolar (PM) electrode arrays across a range of lengths and manufacturers. Study Design: Retrospective chart review. Setting: Tertiary Care Hospital. Patients: 119 adult patients with post-lingual hearing loss who underwent cochlear implantation. Main Outcome Measures: A total of seven different electrodes were evaluated including 5 different LW electrodes (CI422 [Cochlear American], 1J [Advanced Bionics], Medium [Med El], Standard [Med El], Flex28 [Med El]) and 2 PM electrodes (Contour [Cochlear American], MidScala [Advanced Bionics]). Speech perception outcomes (n = 119 patients) were measured by Consonant-Nucleus-Consonant (CNC) scores collected 3, 6, 12 and 24 months after implantation. Melody perception outcomes (n = 35 CI patients and n = 6 normal hearing patients) were measured by Melodic Contour Identification (MCI). Results: CNC scores increased over time after implantation across all array designs. PM designs exhibited higher CNC scores compared to LW electrodes, particularly 6-months after implantation. Pre-operative pure tone averages did not correlate with post-operative CNC scores. PM arrays outperformed LW electrodes in terms of MCI scores. Conclusions: The physical shape of cochlear implant electrode arrays may impact hearing performance. Compared to LW designs, PM arrays appear to offer superior speech perception during the first 6 months after implantation, with performance equalizing between groups by 24 months. Compared to LW designs, PM arrays also appear to afford superior melody perception. Correspondence: Ana H. Kim, M.D., Division of Otology, Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY; E-mail: ahk2166@cumc.columbia.edu Funding and Conflict of Interest: M.K. served on the advisory board for Med El. A.H.K. receives research funding from Advanced Bionics. No funding was received from either company or any other entity to support this project. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Is Menière's Disease a Contraindication to Stapedectomy? Objective: Review surgical outcomes of stapedectomy for otosclerosis in patients with Menierè's disease. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Patients with otosclerosis and Menière's disease undergoing stapedectomy between 2010 and 2017. Intervention: Stapedectomy. Main Outcome Measures: Pre- and postoperative hearing and complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone frequency, pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Results: Among 1,499 patients with otosclerosis, the incidence of concomitant Menière's disease was 1.7%. Fifteen patients with otosclerosis and Menière's disease underwent stapedectomy, 12 primary and three revisions. Mean AC PTA was 43 dB preoperatively, and 25 dB postoperatively (p = 0.0007), while the ABG improved on average from 20 to 5 dB (p = 0.0001). There was no significant difference in BC PTA or WRS postoperatively. Two patients experienced fluctuation of hearing in the postoperative period, one of which resolved with a course of steroids. The mean follow-up time was 41 months. Conclusions: In patients with otosclerosis and Menière's disease, stapedectomy provides excellent hearing outcomes in a majority of patients. As is characteristic of Menière's disease, some patients will continue to experience fluctuating hearing postoperatively, which may progress to severe sensorineural hearing loss. Menière's disease may not be an absolute contraindication to stapes surgery. Address correspondence and reprint requests to Pedrom C. Sioshansi, M.D., Michigan Ear Institute, 30055 Northwestern Highway, Suite 101, Farmington Hills, MI 48334; E-mail: psioshansi@gmail.com The authors disclose no conflicts of interest. Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

A Novel COCH Mutation Affects the vWFA2 Domain and Leads to a Relatively Mild DFNA9 Phenotype Objective: To study the genotype and phenotype of a Dutch family with autosomal dominantly inherited hearing loss. Study Design: Genotype–phenotype correlation study. Genetic analysis consisted of linkage analysis, variable number of tandem repeats analysis, and Sanger sequencing. Audiovestibular function was examined. Regression analysis was performed on pure tone audiometry and speech recognition scores and correlated with the age and/or level of hearing loss. Setting: Tertiary referral center. Patients: A large Dutch family presenting with sensorineural hearing loss. Main Outcome Measures: Identification of the underlying genetic defect of the hearing loss in this family. Results of pure tone and speech audiometry, onset age, progression of hearing loss and vestibular (dys)function. Results: A novel mutation in COCH, c.1312C > T p.(Arg438Cys), cosegregates with hearing loss and a variable degree of vestibular (dys)function in this family. The reported mean age of onset of hearing loss is 33 years (range, 18–49 yr). Hearing loss primarily affects higher frequencies and its progression is relatively mild (0.8 dB/yr). Speech perception is remarkably well preserved in affected family members when compared with other DFNA9 families with different COCH mutations. Conclusion: These findings expand the genotypic and phenotypic spectrum of DFNA9. The c.1312C > T mutation, which affects the vWFA2 domain, causes a relatively mild audiovestibular phenotype when compared with other COCH mutations. Address correspondence and reprint requests to Ronald J. E. Pennings, M.D., Ph.D., Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, Internal postal code 377, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands; E-mail: Ronald.Pennings@radboudumc.nl H.K. and E.V. have contributed equally to this article. This work was financially supported by a grant from the Heinsius Houbolt foundation [to H.K. and R.J.E.P.]. The authors disclose no conflicts of interest. Web resources: Deafness Variation Database (http://deafnessvariationdatabase.org/) (Accessed: 13-08-2020). ClinVar (https://www.ncbi.nlm.nih.gov/clinvar/ (Accessed: 13-08-2020). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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Fertility Science and Research

ART services and COVID −19– SARs 2– lessons to be learnt Kuldeep Jain Fertility Science and Research 2020 7(2):133-134

Luteal phase support in assisted reproductive technologies: a comprehensive review Kaberi Banerjee, Kavita Khoiwal, Bhavana Singla Fertility Science and Research 2020 7(2):135-140

To study the effect of autologous platelet-rich plasma instillation on suboptimal endometrium and pregnancy outcomes in infertile women undergoing frozen embryo transfer cycle Yashika Motwani, RK Sharma Fertility Science and Research 2020 7(2):141-146

A novel fertility score predictor: a cafeteria approach for fertility treatment option Snehal Chavan, Amruta Ahirrao, Bharati Dhorepatil, Yakub Sayyad Fertility Science and Research 2020 7(2):147-154

Ovarian response prediction index (ORPI): A novel biomarker for ovarian response prediction in IVF cycle: An implication for individualized controlled ovarian stimulation programme Ritika Gupta, Sanjay Makwana, Prateek Makwana, Sahil Singhal Fertility Science and Research 2020 7(2):155-161

To study the comparison of efficacy of letrozole versus clomiphene citrate for ovulation induction in infertile women with PCOS in Indian population Eshna Gupta, Kanad Nayar, Minal Singh, Shweta Gupta, Ratnaboli Bhattacharya Fertility Science and Research 2020 7(2):162-168

Effect of hyaluranon-rich medium for embryo transfer on IVF outcome in patients with recurrent implantation failure Nidhi Sharma, Kanad D Nayar, Minal Singh, Shweta Gupta, Ratnaboli Bhattacharya Fertility Science and Research 2020 7(2):169-174

Seminal plasma cadmium/zinc ratio among nonoccupationally exposed men investigated for infertility Mathias Abiodun Emokpae, Olasimbo Godswill Ikuejamoye Fertility Science and Research 2020 7(2):175-182

Comparison of pregnancy outcomes in women undergoing frozen thawed embryo transfer (FET) cycles following ultrasound for endometrial morphology with and without Doppler studies- a prospective cohort study Vasudha Gupta, Shweta M Gupta, Abha Majumdar, Neeti Tiwari, Ruma Satwik, Gaurav Majumdar Fertility Science and Research 2020 7(2):183-189

Effect of intrauterine administration of human chorionic gonadotropin (hCG) before embryo transfer on biochemical pregnancy rate, implantation rate, and clinical pregnancy rate in in vitro fertilization/intracytoplasmic sperm injection cycles: Prospective and interventional randomized comparative study Imlesh Meena, Rashmi Sharma, Abhishek Baldawat, Fizayur Rehman, Ankita Gupta, Divya Chauhan Fertility Science and Research 2020 7(2):190-198

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Trauma and Acute Care Surgery

Changes in Traumatic Mechanisms of Injury in Southern California Related to COVID-19: Penetrating Trauma as a Second Pandemic Background The COVID-19 pandemic resulted in a statewide stay-at-home (SAH) order in California beginning March 19, 2020, forcing large-scale behavioral changes and taking an emotional and economic toll. The effects of SAH orders on the trauma population remains unknown. We hypothesized an increase in rates of penetrating trauma, gunshot wounds, suicide attempts, and domestic violence in the Southern California trauma population after the SAH order. Methods A multicenter retrospective analysis of all trauma patients presenting to 11 American College of Surgeons (ACS) Level I and II trauma centers spanning seven counties in California was performed. Demographic data, injury characteristics, clinical data, and outcomes were collected. Patients were divided into three groups based on injury date: before SAH from 1/1/2020-3/18/2020 (PRE), after SAH from 3/19/2020-6/30/2020 (POST), and a historical control from 3/19/2019-6/30/2019 (CONTROL). POST was compared to both PRE and CONTROL in two separate analyses. Results Across all time periods, 20,448 trauma patients were identified (CONTROL: 7,707, PRE: 6,022, POST: 6,719). POST had a significantly increased rate of penetrating trauma (13.0% vs. 10.3%, p<0.001 and 13.0% vs. 9.9%, p<0.001) and gunshot wounds (4.5% vs. 2.4%, p=0.002 and 4.5% vs. 3.7%, p=0.025) compared to PRE and CONTROL, respectively. POST had a suicide attempt rate of 1.9% and a domestic violence rate of 0.7%, which were similar to PRE (p=0.478, p=0.514) and CONTROL (p=0.160, p=0.618). Conclusions This multicenter Southern California study demonstrated an increased rate of penetrating trauma and gunshot wounds after the COVID-19 SAH orders, but no difference in attempted suicide or domestic violence rates. These findings may provide useful information regarding resource utilization and a target for societal intervention during the current or future pandemic(s). Level of Evidence IV Corresponding Author: Jeffry Nahmias, 333 The City Blvd West, Suite 1600 | Orange, CA, USA 92868-3298 at jnahmias@hs.uci.edu or (714) 456-4553 or Fax: (714) 456-6048 Conflicts of Interest: The authors report that there are no conflicts of interest Meetings: None Disclosures: The authors report that there are no financial disclosures This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. © 2020 Lippincott Williams & Wilkins, Inc.

"Safer at Home": The effect of the Covid-19 Lockdown on Epidemiology, Resource Utilization and Outcomes at a Large Urban Trauma Center Background The COVID-19 pandemic has affected the entire global healthcare system. In California, due to a high burden of cases, a lockdown order was announced on March 19th, 2020. This study investigated the impact of the lockdown on the epidemiology and outcomes of trauma admissions at the largest trauma center in Los Angeles. Methods Retrospective study comparing epidemiological and clinical characteristics and outcomes of trauma admissions, during the lockdown period (03/20/2020 to 06/30/2020) to a similar period in the previous year (03/20/2019 to 06/30/2019). Data collection included demographics, mechanism of injury, prehospital transportation, substance use, injury severity, resource utilization, and outcomes. Findings There were 1,202 admissions during the lockdown period in 2020 and 1,143 during the same calendar period in 2019. Following the lockdown, there was a reduction in the automobile versus pedestrian admissions by 42.5%, motorcycle injuries by 38.7%, and bicycle accidents by 28.4%, but no significant effect on the number of motor vehicle accident admissions. There was an increase in ground level falls by 32.5%, especially in the elderly group. The absolute number of gunshot wounds increased by 6.2% and knife injuries by 39.3%. Suicides increased by 38.5%. Positive testing for substance use increased by 20.9%. During the lockdown patients suffered less severe trauma, with ISS<9 (p<0.001), as well as less severe head (p=0.001) and severe chest trauma (p<0.001). Trauma deaths were reduced by 27.9% and the crude overall mortality was significantly lower during the lockdown period (4.1% vs 5.9%, p= 0.046). ICU admission rates, mechanical ventilation, and ICU LOS were all reduced. Conclusions The COVID-19 lockdown in 2020 had a significant effect on the epidemiology, clinical characteristics and critical care resource utilization of trauma admissions in a large academic trauma center. These findings may help in planning and optimization of hospital resources during the pandemic. Level of Evidence Therapeutic, level III study type Retrospective observational Grant support: None Conflicts of interest: None Statement of human rights: The study was approved by the Institutional Review Board of the University of Southern California Address for Correspondance: Demetrios Demetriades MD, PhD, FACS, Professor of Surgery, Department of Surgery, University of Southern California, Los Angeles, demetria@usc.edu This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. © 2020 Lippincott Williams & Wilkins, Inc.

Advanced age heightens hepatic damage in a murine model of scald burn injury Background: Elderly burn patients exhibit a lower survival rate compared with younger counterparts. The liver is susceptible to damage after burn injury, which predisposes to poor outcomes. Lipid homeostasis and the antioxidant glutathione system play fundamental roles in preserving liver integrity. Herein, we explored changes in these major pathways associated with liver damage in the aging animals after burn injury. Methods: We compared liver enzymes, histology, lipid-peroxidation, and glutathione-metabolism profiles from young and aged female mice after a 15% total-body-surface-area burn. Mice were euthanized at 24hours after injury, and livers and serum were collected. Results: Aged burn animals exhibited elevated (p< 0.05) Aspartate-aminotransferase (AST), Alanine-aminotransferase (ALT) levels, and increased inflammatory cell infiltration, edema, and necrosis compared to their younger counterparts. The percentage of adipophilin-stained area in livers from young sham, young burn, aged sham, and aged burn groups was 10%, 44%, 16%, and 78% (p< 0.05), respectively. Liver malonaldehyde (DMA) levels were 1.4 ± 0.5, 2.06 ± 0.2, 1.81 ± 0.12, and 3.45 ± 0.2 nmol/mg (p< 0.05) in young sham, young burn, aged sham, and aged burn mice, respectively. Oxidized glutathione (GSSG) content increased 50% in the young burn, and 88% in aged burn animals compared with the young sham group (p< 0.05). The reduced glutathione GSH/GSSG ratio was significantly reduced by 54% in aged burn mice compared to young sham animals (p< 0.05). Furthermore, glutathione peroxidase (GPX) gene expression showed a 96% decrease in the aged burn group compared to young sham mice (p< 0.05). Conclusions: Aged burn animals exhibit severe liver damage from heightened lipid peroxidation and inadequate antioxidative response. The increased peroxidation is associated with abundant lipid deposits in hepatic tissue post-burn and a weak antioxidative response due to hepatic GPX downregulation. Further studies will focus on the functional significance of these findings concerning hepatic homeostasis. Level of evidence This is a basic science paper and, therefore, does not require a level of evidence. Study Type Basic Sciences Conflict of interest: None Disclosures of funding: (Supported by K08GM134185 (J.P.I.) and R01AG018859, R01GM115257, R35GM131831, 1 I01 BX004335 (E.J.K.).) Juan-Pablo Idrovo, M.D., Assistant Professor of Surgery and Critical Care., University of Colorado Denver / Anschutz Medical Campus, 12631 E. 17th Ave, Room 6001, Aurora, CO 80045. Office: 303-724-8366, Fax: 303-724-2733. Email: juan.idrovo@cuanschutz.edu © 2020 Lippincott Williams & Wilkins, Inc.

Letter to the editor, regarding "Timing and volume of crystalloid and blood products in pediatric trauma: An Eastern Association for the Surgery of Trauma multicenter prospective observational study" No abstract available

TRAUMA PATIENT TRANSPORT TIMES UNCHANGED DESPITE TRAUMA CENTER PROLIFERATION: A 10 YEAR REVIEW Introduction In certain regions of the U.S. there has been a dramatic proliferation of trauma centers. The goal of our study was to evaluate transport times during this period of trauma center proliferation. Methods Aggregated data summarizing level I trauma center admissions in Arizona between 2009 and 2018 were provided to our institution by the Arizona Department of Health Services. We evaluated patient demographics, transport times and injury severity for both rural and urban injuries. Results Data included statistics summarizing 266,605 level I trauma admissions in the state of Arizona. The number of state-designated trauma centers during this time increased from 14 to 47, with level I centers increasing from 8 to 13. Slight decreases in mean ISS (rural 9.4 vs. 8.4; urban 7.9 vs 7.0) were observed over this period. Median transport time for cases transported from the injury scene directly to a level I center remained stable in urban areas at 0.9 hours in both 2009 and 2018. In rural areas, transport times for these cases were approximately double, but also stable, with median times of 1.8 and 1.9 hours. Transport times for cases requiring inter-facility transfer prior to admission at a level I center increased by 0.3 hours for urban injuries (5.3 hours to 5.6) and 0.9 hours for rural injuries (5.6 to 6.5). Conclusion Despite the 3-fold increase in the number of state-designated trauma centers, transport time has not decreased in urban or rural areas. This finding highlights the need for regulatory oversight regarding the number and geographic placement of state-designated trauma centers. Level of Evidence III The authors declare no conflicts of interest. The study was presented as a Quickshot at the 79th Annual Meeting of AAST & Clinical Congress of Acute Care Surgery held online instead of Waikoloa, Hawaii, September 9-12, 2020. Corresponding Author: Jordan A. Weinberg, MD, Division Chief, Trauma/Acute General Surgery, Trauma Administration, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, AZ 85013. Tel: (602) 406-3157. Email: JordanWeinberg@Creighton.edu © 2020 Lippincott Williams & Wilkins, Inc.

Transfuse for Hemodynamics Not Hemodilution – Response to Letter to the Editor regarding timing and volume of crystalloid and blood products in pediatric trauma: An Eastern Association for the Surgery of Trauma multicenter prospective observational study No abstract available

Fast Track Pathway Provides Safe, Value Based Care on Busy Acute Care Surgery Service Abstract: Background Fast track(FT) pathways have been adopted across a multitude of elective surgeries but have been slow to be adopted into the acute care surgery(ACS) realm. We hypothesized that a FT pathway for acute cholecystitis patients would decrease patient length of stay and resource utilization. Methods All patients at two hospitals, one with a FT pathway and one with a traditional pathway, that underwent an urgent laparoscopic cholecystectomy for acute cholecystitis between May 1, 2019 and October 31, 2019 were queried using CPT codes. Exclusion criteria were conversion to open or partial cholecystectomy. Retrospective chart review was used to gather demographics, operative, hospital course, and outcomes. Time to OR, hospital length of stay, and resource utilization were the primary outcomes. Results There was a total of 479 urgent laparoscopic cholecystectomies performed, four hundred and thirty(89.8%) were performed under the FT pathway. The median[IQR] time to the OR was not different: 14.1 hours[8.3-29.0 hours] for FT and 18.5 hours[11.9-25.9 hours] for traditional(p=0.316). However, the median length of stay was shorter by 15.9 hours in the FT cohort(22.6 hours, [14.2-40.4] vs 38.5 hours,[28.3-56.3];p<0.001). Under the FT pathway, 33.0% of patients were admitted to the hospital and 75.6% were discharged from the PACU, compared to 91.8% and 12.2% on the traditional pathway(both p<0.001). 59.6% of FT patients received a phone call follow up, as opposed to 100% of the traditional patients having clinic follow up(p<0.001). ED bounce back rate, readmission rates, and complication rates were similar(p>0.2 for all). On multivariate analysis, having a fast track pathway was an independent predictor of discharge within 24 hours of surgical consultation(OR 7.65, 95% CI 2.90-20.15, p<0.001). Conclusions Use of a fast track program for patients with acute cholecystitis has a significant positive impact on resource utilization without compromise of clinical outcomes. Level of Evidence Level III, Therapeutic/Care Management Disclosures: All authors have no relevant financial conflicts or personal relationships that could inappropriately influence this work or its conclusions. Sources of funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors Presented at the 79th Annual Meeting of American Association for the Surgery of Trauma, September 8-18th, 2020 as a podium presentation. Address correspondence to: Kali Kuhlenschmidt, MD, University of Texas Southwestern Medical Center, Division of General and Acute Care Surgery, 5323 Harry Hines Blvd., Dallas, Texas 75390-9158. Kali.Kuhlenschmidt@UTSouthwestern.edu. (812) 483-1782 © 2020 Lippincott Williams & Wilkins, Inc.

Efficacy and feasibility of Amniotic membrane for the treatment of burn wounds: a meta-analysis No abstract available

Roadway Features Associated with Elderly Drivers in Motor Vehicle Crashes Background As the number of older US drivers has increased over the past decades, so has the number of injuries, hospitalizations, and deaths from motor vehicle crashes (MVCs) involving elderly drivers. We seek to identify personal, environmental, and roadway features associated with increased crashes involving elderly drivers. We hypothesize that elderly drivers are more likely to be involved in MVCs at intersections with more complex signage and traffic flow. Methods This is a retrospective observational study using 2015-2019 police traffic crash reports and a Department of Public Health database of built-environment variables from a single urban center. Demographics and environmental/road features were compared for vehicle-only MVCs involving elderly (≥ 65 years) and younger drivers. Chi-squared and nonparametric tests were used to analyze 36,168 drivers involved in MVCs. Results There were 2,575 (7.1%) elderly drivers involved in MVCs during the study period. Left turns and all-way stop signs were associated with increased crash risk among elderly drivers compared to younger drivers. Elderly-involved MVCs were less likely to occur at intersections with left-turn restrictions, traffic lights, only one-way streets, and bike lanes compared to MVCs with younger drivers. Elderly drivers were more likely to be involved in MVCs on weekdays, less often intoxicated at the time of the crash, and less frequently involved in fatal MVCs compared to younger drivers. However, elderly drivers were more frequently the at-fault party, especially after age 75. Conclusions Updates to roadway features have potential to decrease injury and death from MVCs involving elderly adults. Left turn restrictions or other innovative safety treatments at all-way stops or where left turns are permitted may mitigate road crashes involving older adults. Education may increase awareness of higher-risk driving tasks such as turning left, and driving alternatives including public transportation/paratransit may offer alternate means to maintain activities of daily living. Level of Evidence Level IV Conflict of Interest: The authors have no disclosures Presentation: Presented at the 79th Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 9-12, 2020 in Waikoloa, Hawaii (Virtual) Disclosures of Funding: None © 2020 Lippincott Williams & Wilkins, Inc.

The expression of repulsive guidance molecule a (RGMa) after traumatic brain injury: Time-course changes in gene expression in a murine model of controlled cortical impact INTRODUCTION Repulsive guidance molecule a (RGMa) is a key protein that negatively regulates neuronal regeneration as its inhibition enhances axonal growth and promotes functional recovery in animal models of spinal cord injury. However, the role of RGMa in traumatic brain injury (TBI) remains elusive. This study aimed to clarify TBI-responsive RGMa expression in a murine model. METHODS Adult male C57Bl/6J mice were subjected to controlled cortical impact. Brains were extracted 6 hours and 1, 3, 7, 14 and 21 days after injury (n=6 in each group). Changes in the mRNA expression of RGMa and its receptor, neogenin, were evaluated by quantitative polymerase chain reaction in the damaged area of the cortex and contralateral cortex, along with expression measurement of inflammation-related molecules. Neurological deficit was also assessed by the cylinder test. RESULTS Neurological score was consistently lower in the TBI group compared to the sham group throughout the experimental period. mRNA expressions of representative inflammatory cytokine TNF-alpha and chemokine CCR2 were remarkably increased in the injured cortex on day 1 and gradually decreased over time, although remaining at higher values at least until day 14. mRNA expressions of RGMa and neogenin were significantly suppressed in the damaged cortex until day 3. Interestingly, RGMa expression was suppressed most on day 1 and recovered over time. CONCLUSION In the acute phase of TBI, gene expression of inflammatory cytokines significantly increased, and gene expressions of RGMa and neogenin significantly decreased in the inflammatory milieu of the damaged area. Despite the subsequent remission of inflammation, RGMa gene expression recovered to the normal level one week after TBI. Intrinsic regenerative response to acute brain injury might be hampered by the following recovery of RGMa expression, hinting at the possibility of functional RGMa inhibition as a new, effective maneuver against TBI. Corresponding author: Goro Tajima, MD, PhD, Assistant Professor, Nagasaki University Hospital, Emergency and Critical Care Center, 1-7-1 Sakamoto, Nagasaki city 852-8501, Japan, Tel: +81(095) 819-7765, Fax: +81(095) 819-7978 E-mail: gtajima@nagasaki-u.ac.jp This study was presented at the 79th AAST annual meeting, Sept. 8-18, 2020, Virtual AAST Annual Meeting Conflicts of Interest and Source of Funding: All authors declare no conflicts of interest. This work was supported by the Japan Society for the Promotion of Science Grant-in-Aid Scientific Research (B) (No. 18H02903), and a research funding from Mitsubishi Tanabe Pharma Corporation. © 2020 Lippincott Williams & Wilkins, Inc.

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Current Oncology

Androgen receptor: A new player in triple negative breast cancer management Anurag Mehta, Atika Dogra Journal of Current Oncology 2020 3(2):51-54

Can a low-energy photon beam be suitable for the treatment of cervical malignancies? A dosimetric analysis Manindra Bhushan, Deepak Tripathi, Lalit Kumar, Rahul Lal Chowdhary, Anjali Kakria, Pawan Kumar, Swarupa Mitra, Munish Gairola Journal of Current Oncology 2020 3(2):55-61 Background: Radiotherapy to a patient with cervical cancer can be delivered by four-field “box technique” with a benefit of much less dose to intervening tissues along with a better and homogenous dose distribution at the target location. An important ingredient for a good radiotherapy planning is the choice of beam energy. The present study aims to investigate the feasibility of a 4 MV photon beam for the treatment of cervical cancers. Materials and Methods: A population of 20 patients, with carcinoma cervix, was included in the study. All the patients were planned for a prescribed dose of 45 Gy in 25 fractions. Results: Plans were evaluated for planning target volume and found better in terms of coverage and hot spots using 6 MV. The homogeneity index (HI) was 1.1 for both the energies. Similarly, conformity index (CI) was 2.0 depending on the method used for 4 MV and 6 MV photons. Although the HI and CI were comparable for both the plans, yet it seems significantly better for 6 MV. This indicates that spillage in 6 MV plans is lesser as compare to 4 MV. The present study reveals that there is a significant reduction in total monitor units in the plans with 6 MV photon beams, leading to fewer chances of secondary malignancies. Conclusion: A 6 MV photon beam has some proven mileage over 4 MV in terms of target coverage, dose homogeneity, and conformity and remains the best suitable photon energy for the treatment of cervical malignancies.

Indeterminate pulmonary nodules among patients with new diagnosis of colorectal cancer: Prevalence and significance assessment Nidal H Bokhary, Abdulrahman A Alghamdi, Faisal A Alfaidi, Khaled A Alfaidi, Naif H Aljohani, Fahad K Alshammari, Omar Iskandrani, Hanaa Tashkandi, Atlal Abusanad Journal of Current Oncology 2020 3(2):62-65 Background: In Saudi Arabia, colorectal cancer (CRC) accounts for 11.5% of cancer incidence, where nearly one-third is metastatic. Global guidelines recommend accurate pretreatment staging to determine resectability and stage-directed treatment. Computed tomography (CT) scan is among the widely used imaging for staging. However, at times, the characterization of abnormalities detected by CT scan is perplexing. Indeterminate pulmonary nodules (IPNs) are nodules that are neither benign nor malignant, which are incidentally detected on baseline staging chest CT. We aimed to estimate the prevalence of IPN that were identified among CRC patients. Materials and Methods: We conducted a retrospective record review of all newly diagnosed CRC patients between June 2013 and June 2018 from an academic hospital in Jeddah, Kingdom of Saudi Arabia (KSA). Demographics and certain prespecified variables were collected. The presence of IPN on staging chest CT as per consultant radiologist report was documented, and the ability of other modalities to identify the nature of IPN was compared. Data were analyzed using SPSS and a P value < 0.05 was considered significant. Results: Of 283 CRC patients, 208 (73.5%) underwent chest CT, and the mean age was 57.4 years (±SD 13.1). The prevalence of IPN among CRC patients is 17.7%. Thirty IPN patients had a follow-up chest CT for IPN, which identified IPN nature in 18(60%) of them. The likelihood of IPN to be CRC-related metastasis was significantly associated with the presence of synchronous liver metastasis (P = 0.0005), younger age (P = 0.022), and colon cancer (P = 0.011). Conclusion: The prevalence of IPN was 17.7%, which is different in comparison to other studies from different countries. There is a vital need for unified guidelines describing IPN to accurately stage CRC patients, decrease unnecessary follow-ups, and acquire the exact prevalence of IPN.

Biomarkers in colon cancer and its clinical implications Vijay Kumar Srinivasalu, Keechilat Pavithran Journal of Current Oncology 2020 3(2):66-71 Colorectal cancers have been a major burden in our society, with nearly 20,000 deaths in a year. Most of the patients are diagnosed with metastatic disease at presentation and have shorter survival despite the best effective treatment. The detection of novel targets and predictive biomarkers has changed the treatment paradigm, resulting in improved quality of life and prolonged survival in these patients. However, the identification of an ideal biomarker has been a major challenge and a quest for better biomarkers to detect premalignant lesions, early-stage cancers; to identify high-risk subsets who derive maximum benefit from adjuvant chemotherapy and minimize unnecessary chemo-toxicity; to identify newer targeted therapies in advanced stage to improve clinical responses; and to provide personalized treatments that would significantly help in improving survival outcomes. In this review article, we provide an overview of the biomarkers with clinical importance and an update on newer noninvasive, sensitive, and clinically reliable biomarkers in development.

Multiple myeloma: an update Lalit Kumar, Sukesh Nair, Surya Prakash Vadlamani, Priyanshu Chaudhary Journal of Current Oncology 2020 3(2):72-80 Survival of patients with multiple myeloma has increased significantly during the past two decades. This has been attributed to a better understanding of biology, the introduction of novel agents (immunomodulators, proteasome inhibitors), autologous stem cell transplantation, and maintenance therapy. Supportive care is an important component of overall care for these patients. Most patients have a high burden of symptoms at initial presentation in form of bone pains, fatigue, anemia, renal impairment, and infections, etc. Almost 10–20% of patients may have serious complications in the first 4–6 weeks. A high index of suspicion and timely intervention is important to reduce morbidity and mortality. Therapy-related complications, e.g., neuropathy, thromboembolism, cytopenias, GI symptoms (constipation/diarrhea), and relapse of disease, pose therapeutic challenges. Protocol-based approach, systematic assessment with respect to the quality of life and functioning and coordination with a palliative care team from the beginning may improve overall functioning and outcome.

A twisted tale of a family with multiple malignancies: Mystery solved Anurag Mehta, Shrinidhi Nathany Journal of Current Oncology 2020 3(2):81-83

Utilization of hydro-dissection: A novel technique during ongoing COVID pandemic Abhishek Bansal, Arvind K Chaturvedi, Rajiv Kapur, Sunil Pasricha, Ankush Jajodia Journal of Current Oncology 2020 3(2):84-85

Epithelioid hemangioma of clavicle: A case report and review of literature Thomas Sumi, Surendran Divya, Augustine Joy Journal of Current Oncology 2020 3(2):86-89 Epithelioid hemangioma (EH) of the bone is classified within benign vascular tumors. They are uncommon locally aggressive neoplasms. Tumors usually involve long tubular bones. We report a case of EH of clavicle in a 12-year-old girl treated with tumor resection and fibular grafting.

Breast cancer with orbital metastasis: An uncommon entity Sneha Bothra, Chaturbhuj Agrawal, Pankaj Goyal, Kahitij Domadia, Abhishek Bansal, Dinesh Chandra Doval Journal of Current Oncology 2020 3(2):90-92 Orbital metastasis is rare in breast cancer. We present a case of a 45-year-old premenopausal lady with hormone positive locally advanced breast cancer managed with surgery, chemotherapy, radiation therapy and adjuvant hormone therapy, had systemic failure after 6 years of completion of definitive therapy, in the form of orbital and vertebral metastases. Patient was investigated for other causes, however was found to have 2.6 x 2.0 x 2.9 cm mass encasing the optic nerve, causing early vision loss in one eye, with minimal proptosis. She was not under any adjuvant hormone therapy during the relapse. She was treated with external beam radiotherapy followed by tamoxifen, which showed good partial response radiologically and gradual improvement in her vision and regression of the tumor.

Renal cell carcinoma arising in an open pyelolithotomy scar: A perplexing scenario! Sandeep Bhoriwal, Kunal Dhall, Adarsh Barwad, Ashutosh Mishra Journal of Current Oncology 2020 3(2):93-96 Renal cell carcinoma (RCC) arising in a renal tissue away from the normal kidney is quite rare with only a few cases reported in the literature. The management of such cases is challenging and requires an individualized treatment approach. We report a case of a young male with a prior history of pyelolithotomy who presented with a right paravertebral mass. CECT chest and abdomen revealed a soft-tissue mass near the right kidney with obvious infiltration into posterior abdominal wall muscles and 12th rib erosion. Image-guided biopsy of the mass demonstrated features of metastatic RCC. The patient underwent surgery with en bloc removal of the tumor with 12th rib, infiltrated paraspinal muscles, a small part of the densely adhered right kidney, and overlying skin. Histopathology with recommended IHC panels showed papillary RCC. Because of the above, the multidisciplinary tumor board considered this as a malignancy arising from a pyelolithotomy scar. The patient was planned for follow-up only without any adjuvant treatment. This case highlights the importance of a multidisciplinary team approach and comprehensive planning in such rare and perplexing cases.

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