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Trott S, Lei F, Jay Christian W, Mao X, Lehmkuhl B, Kejner A. Geographic variation of HPV-associated cancer incidence in Kentucky using spatial scan statistics. Cancer Causes Control 2024; 35:817-824. [PMID: 38212533 DOI: 10.1007/s10552-023-01835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Populations with high cancer risk that are targeted for screening, education, and vaccination have been shown to increase rates of screening, which ultimately may improve timing of diagnosis and overall outcome for certain cancers. Spatial scan analysis provides a visual representation of areas with higher rates of disease. Limited research has used this methodology to assess HPV-associated cancers. Using, spatial scan statistics, our goal was to identify regions within Kentucky having significantly higher rates of HPV-associated tumors. These regions can be targeted for public health efforts in the form of education, vaccination, screening, and physician recruitment. METHODS The Kentucky Cancer Registry data from 1995 to 2016 and spatial scan statistics were used to identify county-level clusters with high-incidence of HPV-associated cancers after adjustment for age and sex. Anatomic sites included in this analysis were oropharynx, cervix, anus, penis, and vulva. RESULTS There was one high-rate cluster of oropharyngeal cancer, which was observed in the Louisville metropolitan region (Relative Risk [RR] = 1.24, p < 0.001). One high-rate cluster of anal and penile cancer incidence in men was identified that partially overlapped with the oropharyngeal cluster. There were five clusters of higher cervical, vulvar, and anal cancer incidence in females, one of which overlapped with the oropharyngeal cluster. CONCLUSION Overlapping clusters of HPV-associated cancers were identified at the county-level and included both urban and rural counties of Kentucky. Findings can assist in the design of public health interventions to increase screenings, promote vaccination, and recruit physicians in these regions to improve prevention, diagnosis, and early treatment of HPV-associated cancers.
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Affiliation(s)
- Skylar Trott
- Department of Otolaryngology, University of Kentucky, Lexington, KY, USA
| | - Feitong Lei
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - W Jay Christian
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Xihua Mao
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Ben Lehmkuhl
- Department of Otolaryngology, University of Kentucky, Lexington, KY, USA
| | - Alexandra Kejner
- Department of Otolaryngology, Medical University of South Carolina, Charleston, SC, USA.
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Trott S, Burruss CP, Weltzer M, Iverson K, Azbell C, Bush ML. Perioperative factors influencing hospitalization duration for pediatric neck abscesses. Am J Otolaryngol 2023; 44:103967. [PMID: 37454430 DOI: 10.1016/j.amjoto.2023.103967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Pediatric neck abscesses are a common pathology seen in an ambulatory setting. Although some pediatric neck abscesses are managed medically with antibiotics, surgical intervention is often required. Given the often non-emergent presentation of many abscesses, a variety of logistical and perioperative factors may delay time to care and subsequently prolong hospital stay. The objective of this study was to examine factors that influence the overall time to surgery (TTS) and hospital length of stay (LOS) in a pediatric population with neck abscesses who ultimately require surgical drainage. MATERIALS AND METHODS 161 pediatric patients who underwent incision and drainage of a neck abscess over a ten-year period at a tertiary referral children's center were reviewed. Demographic information, radiographic studies, and surgical information were extracted from patient charts. Descriptive statistics, Mann-Whitney U tests, and multivariate analyses were performed. RESULTS The most common subcategory location was deep neck abscesses (33.1 %). Computed tomography (CT) was the most common pre-operative imaging modality (54.1 %) followed by ultrasound (US) (49.1 %) and magnetic resonance imaging (2.6 %). US and a combination of multiple preoperative imaging modalities were associated with increased LOS and TTS. Repeat surgery was associated with increased LOS. Pre-admission antibiotic use was associated with increased LOS and TTS. Younger patients were more likely to have a longer LOS. CONCLUSIONS A variety of factors can influence TTS, LOS, and time from surgery to discharge including patient age, abscess location, a non-optimized utilization of imaging modalities, the utilization of pre-admission antibiotics, and the need for repeat operations.
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Affiliation(s)
- Skylar Trott
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | | | | | - Kenneth Iverson
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Chris Azbell
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Matthew L Bush
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA.
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Gumus M, Sukalinskaya A, Andric Z, Cheshuk V, Ciuleanu TE, Sezgin Goksu S, Cil T, Cicin I, Bulat I, Ostapenko Y, Penkov K, Hart C, Lai M, Chaao B, Jimenez J, Sepahi A, Shi G, Trott S, Hooper E. 181P SELECT: A phase II randomized trial evaluating 2 doses of vopratelimab (V) + pimivalimab (P) vs P in TISvopra selected patients (pts). Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Trott S, Young R, Hayden C, Yessin O, Bush M, Gupta N. Risk Factors for Operating Room No-Show in an Academic Otolaryngology Practice. Laryngoscope 2022; 132:1738-1742. [PMID: 35122445 PMCID: PMC9352814 DOI: 10.1002/lary.30018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS A no-show to the operating room date negatively impacts a hospital and can lead to increased costs for an institution in terms of time, materials, and manpower. Our objectives are to identify the factors associated with operating room no-shows in order to increase clinical efficiency, reduce hospital costs, and increase patient access to care. STUDY DESIGN Single institution retrospective chart review. METHODS A retrospective review was performed of all surgeries within the Otolaryngology department performed at a single tertiary academic center between 2006 and 2019. Demographic and surgical data were collected from the charts. Descriptive, univariate, and multivariate statistics were performed on the data. RESULTS There were a total of 1,752 no-shows and 46,440 patients who did show with an overall no-show rate of 3.63%. A multivariate logistic regression analysis was performed to compare patients who did not show for surgery to those who did. Analysis found multiple risk factors for not showing to surgery that were statistically significant (P < .05) and included decreasing age, planned outpatient case, head and neck oncology subspecialty, increasing distance from the facility, higher number of clinic no-shows, and not having private insurance. African-American race was more likely to show for surgery as scheduled. CONCLUSIONS Numerous factors may play a role on whether or not a patient attends a scheduled surgical date. Some of these factors may be preventable or modifiable to mitigate increased hospital costs associated with no-show to surgery and increase access to care. LEVEL OF EVIDENCE 3 Laryngoscope, 132:1738-1742, 2022.
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Affiliation(s)
- Skylar Trott
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Rory Young
- University of Kentucky School of Medicine, Lexington, KY, USA
| | - Chris Hayden
- University of Kentucky School of Medicine, Lexington, KY, USA
| | - Olivia Yessin
- University of Kentucky School of Medicine, Lexington, KY, USA
| | - Matthew Bush
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Nikita Gupta
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
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Abstract
BACKGROUND Human interaction begins with visual evaluation of others, and this often centers on the face. Objective measurement of this evaluation gives clues to social perception. OBJECTIVES The objective of this study was to use eye-tracking technology to evaluate if there are scanpath differences when observers view faces of cisgender men, cisgender women, and transgender women before and after facial feminization surgery (FFS) including when assigning tasks assessing femininity, attractiveness, and likability. METHODS Undergraduate psychology students were prospectively recruited as observers at a single institution. Their eye movements were recorded by eye-tracking technology when they were presented with frontal photographs of prototypical male, prototypical female, and pre- and post-FFS faces in a random order and then with prompting to assess femininity, attractiveness, and likability. RESULTS Twenty-seven observers performed the tasks. Participants focused their attention more on the central triangle of post-FFS and prototypical female images and on the forehead of pre-FFS and prototypical male images. Higher femininity ratings were associated with longer proportional fixations to the central triangle and lower proportional fixations to the forehead. CONCLUSIONS This preliminary study implies the scanpath for viewing a post-FFS face is closer to that for viewing a prototypical female than a prototypical male based on differences viewing the forehead and brow vs the central triangle.
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Affiliation(s)
- Nikita Gupta
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky , Lexington, KY , USA
| | - Hannah White
- Department of Psychological Sciences, University of Missouri-St. Louis , St. Louis, MO , USA
| | - Skylar Trott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky , Lexington, KY , USA
| | - Jeffrey H Spiegel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine , Boston, MA , USA
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Beydoun AS, Koss K, Nielsen T, Holcomb AJ, Pichardo P, Purdy N, Zebolsky AL, Heaton CM, McMullen CP, Yesensky JA, Moore MG, Goyal N, Kohan J, Sajisevi M, Tan K, Petrisor D, Wax MK, Kejner AE, Hassan Z, Trott S, Larson A, Richmon JD, Graboyes EM, Wood CB, Jackson RS, Pipkorn P, Bruening J, Massey B, Puram SV, Zenga J. Perioperative Topical Antisepsis and Surgical Site Infection in Patients Undergoing Upper Aerodigestive Tract Reconstruction. JAMA Otolaryngol Head Neck Surg 2022; 148:547-554. [PMID: 35476816 PMCID: PMC9047735 DOI: 10.1001/jamaoto.2022.0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain. Objective To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. Design, Setting, and Participants This cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. Main Outcomes and Measures The primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model. Results A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). Conclusions and Relevance Findings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction.
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Affiliation(s)
- Ahmed Sam Beydoun
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Kevin Koss
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Tyson Nielsen
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, Nebraska
| | - Andrew James Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, Nebraska
| | - Priscilla Pichardo
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Nicholas Purdy
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Aaron L Zebolsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Caitlin P McMullen
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jessica A Yesensky
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Michael G Moore
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joshua Kohan
- Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington
| | - Mirabelle Sajisevi
- Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington
| | - Kenneth Tan
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Daniel Petrisor
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Zain Hassan
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Skylar Trott
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Andrew Larson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - C Burton Wood
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer Bruening
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Becky Massey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
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Trott S, Dornhöfer N, Höckel M, Aktas B, Wolf B. Lebensqualität nach operativer Behandlung des Vulvakarzinoms mittels Vulvafeldresektion und anatomischer Rekonstruktion. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- S Trott
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - N Dornhöfer
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - M Höckel
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - B Aktas
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - B Wolf
- Gynäkologie Universitätsfrauenklinik Leipzig
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Trott S, Vsevolozhskaya O, Pennypacker K, Alhajeri A, Fraser JF. Immune System Activation in Perioperative Thrombectomy Patients: Preliminary Retrospective Study. World Neurosurg 2019; 128:e966-e969. [PMID: 31100531 DOI: 10.1016/j.wneu.2019.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ischemic stroke is a devastating condition resulting in significant morbidity. Mechanical thrombectomy is now standard for large vessel occlusive stroke. Neuroinflammation is known to play important roles in ischemic stroke. Our aims were to examine our thrombectomy procedures and preliminarily examine systemic immune response in relation to thrombectomy changes. METHODS A retrospective review was conducted on mechanical thrombectomy cases from July 2011 through December 2015. Primary outcomes were time to recanalization, final Thrombolysis in Cerebral Infarction score, procedural complications, National Institutes of Health Stroke Scale improvement, and changes in white blood cell (WBC) count. RESULTS One-hundred and twenty-nine procedures were performed. We found a significant difference between WBC count on admission and WBC count post thrombectomy day 1 for patients with >90 minutes to recanalization (P = 0.006107). There was a positive association between WBC change and absolute National Institutes of Health Stroke Scale change among females (P = 0.0273) but not among males. CONCLUSIONS Overall, we found that systemic immune response has close relationships with speed of recanalization and preliminarily may shift differently on the basis of sex.
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Affiliation(s)
- Skylar Trott
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Olga Vsevolozhskaya
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Keith Pennypacker
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA; Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Abdulnasser Alhajeri
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA; Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Justin F Fraser
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA; Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA; Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Department of Radiology, University of Kentucky, Lexington, Kentucky, USA.
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Abstract
BACKGROUND Estrogen has been identified as playing a key role in many organ systems. Recently, estrogen has been found to be produced in the human brain and is believed contribute to central auditory processing. After menopause, a low estrogen state, many women report hearing loss but demonstrate no deficits in peripheral hearing sensitivity, which support the notion that estrogen plays an effect on central auditory processing. Although animal research on estrogen and hearing loss is extensive, there is little in the literature on the human model. PURPOSE The aim of this study was to evaluate relationships between hormonal changes and hearing as it relates to higher auditory function in pre- and postmenopausal (Post-M) females. RESEARCH DESIGN A prospective, group comparison study. STUDY SAMPLE Twenty eight women between the ages of 18 and 70 at the University of Kentucky were recruited. DATA COLLECTION AND ANALYSIS Participants were separated into premenopausal and peri-/Post-M groups. Participants had normal peripheral hearing sensitivity and underwent a behavioral auditory processing battery and electrophysiological evaluation. An analysis of variance was performed to address the aims of the study. RESULTS Results from the study demonstrated statistically significant difference between groups, where Post-M females had difficulties in spatial hearing abilities as reflected on the Listening in Spatialized Noise Test-Sentences test. In addition, measures on the auditory brainstem response and the middle latency response reflected statistically significant differences between groups with Post-M females having longer latencies. CONCLUSIONS Results from the present study demonstrated significant differences between groups, particularly listening in noise. Females who present with auditory complaints in spite of normal hearing thresholds should have a more extensive audiological evaluation to further evaluate possible central deficits.
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Affiliation(s)
- Skylar Trott
- University of Kentucky College of Medicine, Lexington, KY
| | - Trey Cline
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY
| | - Jeffrey Weihing
- Department of Audiology, University of Louisville, Louisville, KY
| | - Deidra Beshear
- Divisions of Women's Health, Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Matthew Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY
| | - Jennifer Shinn
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY
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Trott S, Bauer R, Knackmuss HJ, Stolz A. Genetic and biochemical characterization of an enantioselective amidase from Agrobacterium tumefaciens strain d3. Microbiology (Reading) 2001; 147:1815-24. [PMID: 11429459 DOI: 10.1099/00221287-147-7-1815] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An enantioselective amidase was purified to homogeneity from Agrobacterium tumefaciens d3. The enzyme has a molecular mass of about 490000 Da and is composed of identical subunits with a molecular mass of about 63000 Da. The purified enzyme converted racemic 2-phenylpropionamide to the corresponding S-acid with an enantiomeric excess (ee) value >95% at almost 50% conversion of the racemic amide. The purified enzyme was digested with trypsin and the amino acid sequences of the N terminus and different tryptic peptides determined. These amino acid sequences were used to clone the encoding gene. Finally, a 9330 bp DNA fragment was sequenced and the amidase gene identified. The deduced amino acid sequence showed homology to other enantioselective amidases from different bacterial genera. No indications of a structural coupling of the amidase gene with the genes for a nitrile hydratase could be found on the cloned DNA fragment. The amidase gene was encoded by an approximately 500 kb circular plasmid in A. tumefaciens d3. The amidase was heterologously expressed in Escherichia coli and, as well as 2-phenylpropionamide, was shown to hydrolyse alpha-chloro- and alpha-methoxyphenylacetamide and 2-methyl-3-phenylpropionamide highly enantioselectively. Some amino acids within a highly conserved region common amongst all known enantioselective amidases ('amidase signature') were changed by site-specific mutagenesis and significant changes in the relative activities with different amides observed.
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Affiliation(s)
- S Trott
- Institut für Mikrobiologie, Universität Stuttgart, 70569 Stuttgart, Germany
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Sütterlin M, Bussen S, Trott S, Caffier H. Predictive value of CEA and CA 15-3 in the follow up of invasive breast cancer. Anticancer Res 1999; 19:2567-70. [PMID: 10470196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND The clinical usefulness of tumor markers in the follow-up care of invasive breast cancer is controversial. METHODS In 1228 serum samples of 664 women with history of breast cancer, the diagnostic accuracy and predictive power of CEA and CA 15-3 for the detection of disease relapse was determined prospectively by analyzing the clinical course for at least 6 months after the measurement of the tumor markers in 1994. RESULTS A total of 76 patients relapsed during the period of study. The diagnostic accuracy was 83% for CEA and 88% for CA 15-3. CEA and CA 15-3 had a positive predictive value of 27% and 47% as well as a negative prediction of 91% and 93%, respectively. CONCLUSIONS The low positive predictive value and sensitivity of these tumor markers clearly limit their clinical utility. Therefore, the effectiveness of routine determinations during the follow-up seems questionable.
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Affiliation(s)
- M Sütterlin
- Department of Gynecology and Obstetrics, University of Würzburg, Germany
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Abstract
STUDY DESIGN A consecutive study of patients who underwent lumbar spinal arthrodesis with an unconstrained pedicle screw system. OBJECTIVES To determine the rate of arthrodesis and of clinical success and to examine and characterize the cases of hardware failure with the AO/Dynamic Compression Plate system (Synthes, Paoli, PA). SUMMARY OF BACKGROUND DATA Although the advantages and disadvantages of nonconstrained versus constrained systems have been studied extensively, instrumentation failure has not. Additionally, the association between pseudarthrosis and hardware failure per se is unclear. METHODS Seventy-four consecutive cases of lumbar spinal fusion are reviewed. Standard outcome scores based on pain relief and medication usage were tabulated, along with pertinent demographic data. The patients were observed at five intervals after surgery for at least 2 years (range, 24 to 35 months; mean, 27 months). Standard statistical analyses were used to analyze data. Status of the arthrodesis was determined by standard radiographic criteria. RESULTS The overall fusion rate was 61%. At final follow-up, 60% of patients believed that their back pain had improved, whereas 70% believed that their limb pain had improved. The presence of a solid fusion (r = 3.3, P = 0.010) was correlated positively with a successful clinical outcome; the presence of pseudarthrosis and preoperative narcotic use were negatively correlated with a successful clinical outcome. Twenty-two percent of patients (16) experienced hardware failure. Twelve of the 16 had pseudarthrosis; in the majority of these patients, hardware failure occurred at the level of the pseudarthrosis. CONCLUSIONS The results of this study demonstrate an extremely high rate of hardware failure and pseudarthrosis using an unconstrained pedicle screw system. Interestingly, the initial rate of pain relief was higher and declined over time and was quite possibly associated with loosening of the hardware. Based on these data, it is difficult to recommend the use of an unconstrained fixation system in the lumbar spine.
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Affiliation(s)
- F T Wetzel
- Section of Orthopaedic Surgery and Rehabilitation and Anesthesia and Critical Care, University of Chicago Spine Center, Illinois, USA
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Affiliation(s)
- K R Blakeley
- Department of Anesthesiology, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA
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Trott S, Paasch G, Gobsch G, Trott M. Magnetic-field-dependent self-consistent electronic structure of an inversion layer in the two-subband state. Phys Rev B Condens Matter 1989; 39:10232-10235. [PMID: 9947802 DOI: 10.1103/physrevb.39.10232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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