Closure Of Gap Research Articles

Pension Fund Restoration Policy in General Equilibrium

This paper quantifies the business cycle effects and distributional implications of pension fund restoration policy after the economy has been hit by a financial shock. We extend a canonical New-Keynesian dynamic general equilibrium model with a tractable demographic structure and a pension fund. Numerical simulations show that economies with pension funds that primarily write off accumulated pension wealth to restore financial adequacy behave similarly to an economy without a pension fund. Significant deviations from laissez-faire arise when the pension fund increases the pension fund contribution rate to close the funding gap or postpones the closure of the funding gap. At a cost of significantly distorting aggregate labour supply and output, the pension fund can shelter the group of retirees from unanticipated shocks by guaranteeing the value of their accumulated pension wealth. A defined benefit pension fund can be welfare improving to the group of agents that is already born in the period the financial shock hits. However, since pension funding gaps are typically closed over an extended period of time, a part of the welfare gains to currently alive agents comes at the expense of future, currently unborn, generations.

Strane direktne investicije kao izvor finansiranja ekonomskog razvoja zemalja Zapadnog Balkana

The paper considers economic growth of five Western Balkan countries on the one hand, and on the other the affluence of direct foreign investments as one of external sources of growth in the period 2000-2017. The starting point was the attitude that due to insufficient domestic savings and engagement of foreign investments, those countries have to treat external sources of investment as a condition of permanent change of economic growth rate to a higher level, because it is obvious that after the economic crisis in 2009, the economic growth rates do not provide closure of developmental gap with EU countries. Therefore, foreign direct investments are the supplement to domestic accumulation. However, without disclaiming their benefits, it should be borne in mind that they cannot be substitution for domestic saving.

Comparison of Various Graft Materials in the Reconstruction of Ossicular Chain in Patients with Chronic Otitis Media: A Prospective Hospital Based Study

Introduction
 Ossicular chain reconstruction is the surgical procedure used to correct the hearing problems in patients with chronic otitis media (COM). In this era, where a large variety of innovative artificial prosthetic materials are being used to replace and reconstruct the ossicular chain, autografts still play a significant role.
 Materials and Methods
 The present study included 40 patients. Study population was selected based on inclusion and exclusion criteria. The ossicular reconstructive procedure was done under anesthesia and according to the status of the ossicular chain. Temporalis fascia was used to close the perforation. Mainly two procedures were performed: one is intact canal wall and the other is canal wall down. 
 Results 
 Most of the study population was middle aged and males were more compared to females. Thirty five patients had air bone gap above 30dB. In 38 patients, the incus had undergone necrosis. Most of the patients underwent short columella reconstruction. A closure of air bone gap with in 20 dB was achieved in 72.2% in patients with malleus stapes assembly. In short columella 22.2% of patients had closure of air bone gap within 20 dB. Incus remnant grafts gave better hearing gain.
 Discussion
 The published literature on the result of use of sculptured ossicle and cartilage in tympanoplasty have been reviewed
 Conclusion 
 In the present study, cases with COM showed good hearing results patients implanted with autogenous cartilage and bone.

Radiological morphology variances of osteotomized vertebra-disc complex following pedicle subtraction osteotomy for ankylosing spondylitis with thoracolumbar kyphosis: the incidence, mechanisms, and prognosis

Background ContextInaccurate osteotomy cut along with incomplete or even subluxated bone-on-bone closure of osteotomy gap following pedicle subtraction osteotomy (PSO) may be disastrous, hampering the lordosing effect and increasing the likelihood of complications. The inelastic yet osteoporotic spine in ankylosing spondylitis (AS) is specially predisposed to such suboptimal osteotomy, while the relevant data concerning this issue are scarce. PurposeThis study aimed to analyze the incidence of radiological morphology variances (RMV) of osteotomized vertebra-disc complex (OVDC) following PSO in patients with kyphotic AS, conceptualize the mechanisms of the deviated morphology, and investigate the prognosis. Study DesignThis is a retrospective radiological data analysis. Patient SampleThe sample being screened comprises 71 patients with thoracolumbar kyphotic AS who underwent single-level PSO at our hospital between March 2006 and February 2014. They were stratified by the presence of bridging syndesmophytes (BS) locating within the OVDC. Outcome MeasuresAny irregular radiological configuration of OVDC other than the wedge morphology would be considered as RMV and were studied with care to fully describe and classify the spectrum of deviated morphologic features. Multiple spinopelvic sagittal parameters were measured to assess both the regional lordosing effect and the global realignment of sagittal spinal profile. MethodsFor each selected patient with confirmed RMV, the radiological morphology was assessed, defined, and categorized. The prognosis involving surgical corrections and maintenance of spinopelvic sagittal parameters, as well as the remodeling in disordered osteotomized vertebral shape over time, were also investigated. ResultsThe incidence of RMV was 21.9% in positive BS group (PG) and 30.8% in negative BS group (NG). Inappropriate angle and range of osteotomy accounted for the largest share (1 pts for PG and 10 pts for NG, 57.9%) of mechanisms responsible for RMV, followed by vertebral subluxation (VS) (5 pts for PG and 2 pts for NG, 36.8%) and failed osteotomy gap closure (1 pts for PG, 5.3%). For these patients, the mean bony lordosing effect per PSO segment was 36.0°±8.9° postoperatively, and decreased to 34.7°±8.7° by a mean follow-up of 3 years (p=.076). The magnitude of neighboring disc opening was significantly higher in NG (10.2°±6.5° vs. 2.4°±3.2°, p=.009). The global kyphosis and sagittal vertical axis were significantly corrected (77.0°±21.2° vs. 24.4°±18.8°; 160.6°±72.4° vs. 48.2°±38.6 mm, all p<.001) and remained stable by the ultimate follow-up (p>.05). No devastating neurologic deficits were noticed. Patients with VS and failed osteotomy gap closure exclusively showed solid bone healing and adaptive remodeling without rod breakage at final follow-up. ConclusionsRadiological morphology variances of OVDC were a high occurrence following PSO in AS, being mainly attributed to inaccurate osteotomy cut and VS. Neighboring disc opening and rotational or translational subluxation were major available remedial mechanisms strengthening the lordosing effect when that of vertebral wedging was impaired and insufficient. The bone fusion and remodeling concerning the subluxated or dislocated osteotomized vertebra was utterly favorable, maintaining the kyphosis correction and preventing instrumentation failure.

Short-term Subjective and Objective Outcomes of Patients Receiving Endoscopic Transcanal Myringoplasty for Repairing Tympanic Perforations.

Objective Endoscopic transcanal myringoplasty (ETM) has been an emerging technique for repairing tympanic perforations since the late 1990s. Objective outcomes (ie, graft success rates and hearing results) of patients who received ETM are well documented; however, subjective outcomes of these patients have rarely been reported. Hence, this study evaluated subjective and objective outcomes of patients who received ETM for repairing tympanic perforations. Study Design Prospective study. Setting Tertiary care university hospital. Patients and Methods Patients who underwent ETM for perforations of the tympanic membrane were included. We evaluated subjective variables of patients receiving ETM as the primary outcome and objective variables as the secondary outcome. Results In total, 91 ears that underwent ETM were included. The mean pain scale score was 0.1 (range, 0-2) on postoperative day 3. The mean duration of pain medication was 2.0 (range, 0-3) days. The mean number of days required to resume routine activities was 1.0 (range, 1-2) days. The overall graft success was determined postoperatively at 3 months in 80 of 91 ears (87.9%). Closure of the air-bone gap to within 20 dB was achieved in 79 (86.8%) ears. Conclusion In this study, patients who received ETM had mild postoperative pain and resumed routine activities early. These patients also exhibited favorable graft success rates and hearing results at 3 months postoperatively. On the basis of our results, we conclude that patients who receive ETM for the repair of tympanic perforations have favorable short-term subjective and objective outcomes.

Hearing Outcome With the Use of Glass Ionomer Cement as an Alternative to Crimping in Stapedotomy.

To evaluate early hearing outcomes using glass ionomer cement to fix the Teflon piston prosthesis onto the long process of incus to minimize residual conductive hearing loss after stapedotomy. Original report of prospective randomized control study. Tertiary referral center. A total of 80 consecutive patients with otosclerosis were randomized into two groups. Group A is a control group in which 40 patients underwent small fenestra stapedotomy using the classic technique. Group B included 40 patients who were subjected to small fenestra stapedotomy with fixation of the incus-prosthesis junction with glass ionomer bone cement. Stapedotomy with the classical technique in group A and the alternative technique in group B. The audiometric results before and after surgery. Analysis of the results was performed using the paired t test to compare between pre and postoperative results. χ test was used to compare the results of the two groups. A p value less than 0.05 was considered significant from the statistical standpoint. Significant postoperative improvement of both pure-tone air conduction thresholds and air-bone gaps were reported in the two studied groups. The postoperative average residual air-bone gap and hearing gain were statistically significant in group B (p < 0.05) compared with group A. The use of glass ionomer bone cement in primary otosclerosis surgery using the aforementioned prosthesis and the surgical technique is of significant value in producing maximal closure of the air-bone gap and better audiological outcomes.

Application of a Demineralized Cortical Bone Matrix and Bone Marrow–Derived Mesenchymal Stem Cells in a Model of Chronic Rotator Cuff Degeneration

Background: The success of rotator cuff repair is primarily dependent on tendon-bone healing. Failure is common because weak scar tissue replaces the native enthesis, rendering it prone to reruptures. A demineralized bone matrix (DBM) consists of a network of collagen fibers that provide a sustained release of growth factors such as bone morphogenetic proteins. Previous studies have demonstrated that it can regenerate a fibrocartilaginous enthesis. Hypothesis: The use of a DBM and mesenchymal stem cells (MSCs) at the healing enthesis will result in a higher bone mineral density at the tendon insertion and will enhance the regeneration of a morphologically superior enthesis when compared with an acellular human dermal matrix. Study Design: Controlled laboratory study. Methods: Eighteen female Wistar rats underwent unilateral detachment of the supraspinatus tendon. Three weeks later, tendon repair was carried out in animals randomized into 3 groups: group 1 received augmentation of the repair with a cortical allogenic DBM (n = 6); group 2 received augmentation with a nonmeshed, ultrathick, acellular human dermal matrix (n = 6); and group 3 underwent tendon-bone repair without a scaffold (n = 6). All animals received 1 × 106 MSCs delivered in fibrin glue to the repair site. Specimens were retrieved at 6 weeks postoperatively for histological analysis and the evaluation of bone mineral density. Results: All groups demonstrated closure of the tendon-bone gap with a fibrocartilaginous enthesis. Although there were no significant differences in the enthesis maturation and modified Movin scores, repair augmented with a dermal matrix + MSCs exhibited a disorganized enthesis, abnormal collagen fiber arrangement, and greater cellularity compared with other MSC groups. Only repairs augmented with a DBM + MSCs reached a bone mineral density not significantly lower than nonoperated controls. Conclusion: A DBM enhanced with MSCs can augment rotator cuff healing at 6 weeks and restore bone mineral density at the enthesis to its preinjury levels. Clinical Relevance: Biological augmentation of rotator cuff repair with a DBM and MSCs may reduce the incidence of retears, although further studies are required to determine its effectiveness.

Comparison of endoscopic underlay and microscopic underlay tympanoplasty: a prospective research at a tertiary care centre in Gujarat

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympanoplasty is an ever evolving surgery with myriad of approaches and tools. Use of endoscope is relatively new and there are few studies evaluating the use of endoscope via microscope because of a big learning curve in using one hand endoscopic technique despite it being minimally invasive.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study conducted from June 2016 to May 2017 with a sample size of 44 patients. The study included patients of Chronic Otitis Media (COM) of mucosal inactive type without any co-morbidities in which only Type-1 tympanoplasty was done. The patients were divided into endoscopic or microscopic group using simple random sampling and after taking written and informed consent. The patient’s details regarding audiometric, oto-endoscopic and nasal endoscopic evaluation were recorded. Intra operative findings, duration of surgery and post-operative pain scoring were recorded. The patients were followed up for 3 months and subjected to post-operative audiometry and patient satisfaction questionnaire. The groups were evaluated for graft take up and closure of air bone gap, post-operative complications and patient satisfaction. The results were analysed using descriptive statistics (mean and percentage) and CHISQ test.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Graft was taken up in 21 patients (95%) in microscopic as opposed to 20 in endoscopic group (90%). Mean VAS scoring for pain was 2.5 in microscopic group on first post-operative day and 1.5 for the endoscopic group. The mean improvement in air bone gap post-surgery was 23.68 dB (SD=4.94) for microscopic group and 16.13 dB (SD=6.49) for endoscopic group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic tympanoplasty as a technique has a long learning curve. The results indicate that endoscopic technique is as efficacious as and less invasive than microscope surgery for doing tympanoplasty. &lt;/p&gt;

Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis

ObjectiveWe compared the conventional ‘one-bag protocol’ of management of diabetic ketoacidosis (DKA) with the ‘two-bag protocol’ which utilizes two bags of fluids, one containing saline and supplemental electrolytes and the...

Quantum Hall effect in monolayer and bilayer black phosphorus

We numerically study the quantum Hall effect in both monolayer and bilayer black phosphorus (BP) under an external electric field in the presence of both disorder and a strong perpendicular magnetic field based on the tight-binding model. In the monolayer BP case, the quantized Hall conductivity is similar to that of a two-dimensional electron gas (2DEG), but the positions of all the Hall plateaus shift to the left due to the spectral asymmetry, in agreement with the experimental observations. The width of Hall plateau can be increased by applying a bias voltage to the top and bottom layers of the monolayer BP. The longitudinal conductivity exhibits a strong anisotropy that is large along the armchair direction. In the bilayer BP case, the Hall conductivity remains the same quantization rule as in the case of monolayer BP. Under a certain bias voltage, the plateau is markedly absent, and the LLs spectrum shows the appearance of doubly degenerate branches with a zero-energy level. Eventually, the system undergoes a phase transition from 2DEG to Dirac semimetal, which indicates a biased-induced closure of the bulk energy gap. The two central plateaus with are the most robust against disorder scattering. The longitudinal conductivity remains almost constant around zero energy in the presence of moderate disorder strength.

First-principles prediction of stabilities and instabilities of compounds and alloys in the ternary B-As-P system

We examine the thermodynamic stability of compounds and alloys in the ternary B-As-P system theoretically using first-principles calculations. We demonstrate that the icosahedral ${\mathrm{B}}_{12}{\mathrm{As}}_{2}$ is the only stable compound in the binary B-As system, while the zinc-blende BAs is thermodynamically unstable with respect to ${\mathrm{B}}_{12}{\mathrm{As}}_{2}$ and the pure arsenic phase at 0 K, and increasingly so at higher temperature, suggesting that BAs may merely exist as a metastable phase. On the contrary, in the binary B-P system, both zinc-blende BP and icosahedral ${\mathrm{B}}_{12}{\mathrm{P}}_{2}$ are predicted to be stable. As for the binary As-P system, ${\mathrm{As}}_{1\ensuremath{-}x}{\mathrm{P}}_{x}$ disordered alloys are predicted at elevated temperature---for example, a disordered solid solution of up to $\ensuremath{\sim}75$ at.% As in black phosphorus as well as a small solubility of $\ensuremath{\sim}1$ at.% P in gray arsenic at $T=750$ K, together with the presence of miscibility gaps. The calculated large solubility of As in black phosphorus explains the experimental syntheses of black-phosphorus-type ${\mathrm{As}}_{1\ensuremath{-}x}{\mathrm{P}}_{x}$ alloys with tunable compositions, recently reported in the literature. We investigate the phase stabilities in the ternary B-As-P system and demonstrate a high tendency for a formation of alloys in the icosahedral ${\mathrm{B}}_{12}$(${\mathrm{As}}_{1\ensuremath{-}x}{\mathrm{P}}_{x}$)${}_{2}$ structure by intermixing of As and P atoms at the diatomic chain sites. The phase diagram displays noticeable mutual solubility of the icosahedral subpnictides in each other even at room temperature as well as a closure of a pseudobinary miscibility gap around 900 K. As for pseudobinary ${\mathrm{BAs}}_{1\ensuremath{-}x}{\mathrm{P}}_{x}$ alloys, only a tiny amount of BAs is predicted to be able to dissolve in BP to form the ${\mathrm{BAs}}_{1\ensuremath{-}x}{\mathrm{P}}_{x}$ disordered alloys at elevated temperature. For example, less than 5% of BAs can dissolve in BP at $T=1000$ K. The small solubility limit of BAs in BP is attributed to the thermodynamic instability of BAs with respect to ${\mathrm{B}}_{12}{\mathrm{As}}_{2}$ and As.

Impact sensitivity of crystalline phenyl diazonium salts: A first-principles study of solid-state properties determining the phenomenon

Two crystalline salts, phenyl diazonium chloride (PDC) and tetrafluoroborate (PDT), were chosen as probes for theoretical study of solid-state properties responsible for impact sensitivity since these salts differ only in the nature of anion and, hence, in the properties of solid state. In the present report, we have studied the influence of electronic structure, vibrational spectra, mechanical properties, crystal growth morphology, and the stored energy content on impact sensitivity of PDC and PDT to find the most important solid state characteristics governing this phenomenon. The band structure calculations at various external pressures indicate very different response of the band gap. Extremely sensitive PDC crystals acquire the metallic nature at 29 GPa (metallization point), whilst in the PDT crystals the complete closure of band gap occurs only at 200 GPa. Moreover, the stored energy content in PDC is by 1000 kJ mol−1 higher than that of PDT. Only these two properties among the calculated in the present work differ significantly in the studied crystals. The rest solid-state characteristics such as crystal packing, vibratial spectra (phonon-valence vibration energy transfer probability), elastic properties (bulk moduli) demonstrate rather close values. The influence of metallization point (GPa) as well as crystal growth morphology on impact sensitivity is discussed for the first time.

Time-dependent jamming mechanism for Single-Shield TBM tunneling in squeezing rock

The entrapment risk of Tunnel Boring Machine (TBM) tunneling in squeezing rock associated with high overburden is a challenging and time-dependent consideration. However, there is limited advance knowledge of the shield jamming mechanism due to the difficulties in predicting the complex interactions among the ground, the TBM, its system components and the tunnel support. In this paper, time-dependent interactions between rock and shield, i.e., contact, squeezing and friction, for single-shield TBMs in squeezing ground are investigated. An extended Vlachopoulos-Diederichs approach, instead of the Hoek equation, is used to capture the longitudinal deformation profiles. The plastic behavior of squeezing rock is characterized by the Drucker-Prager criterion with the non-associated flow rule. Viscoelastic deformation is determined using the Burgers model. The contact behaviors are captured through the closure of the radial gap. Moreover, a linear relationship exists between the squeezing loads and the shield deformation. Ultimately, the required thrust force is determined by integrating the squeezing loads over a contact interval. Taking the Saint Martin La Porte access adit (Lyon-Turin Base Tunnel) as an example, the effects of standstill time, relaxation time and overcut on the size of the loaded area and the magnitude of squeezing loads after a standstill are investigated in detail. It is found from the obtained results that a longer standstill, smaller overcut or smaller relaxation time leads to a larger frictional contact area, as well as a larger squeezing load acting upon the TBM shield and a larger deformation of the shield. Moreover, the analytical results show that the TBM jamming is mainly caused by the increase of the squeezing loads and the loaded area.

Quantum Phase Transition and Entanglement in Topological Quantum Wires

We investigate the quantum phase transition of the Su-Schrieffer-Heeger (SSH) model by inspecting the two-site entanglements in the ground state. It is shown that the topological phase transition of the SSH model is signified by a nonanalyticity of local entanglement, which becomes discontinuous for finite even system sizes, and that this nonanalyticity has a topological origin. Such a peculiar singularity has a universal nature in one-dimensional topological phase transitions of noninteracting fermions. We make this clearer by pointing out that an analogous quantity in the Kitaev chain exhibiting the identical nonanalyticity is the local electron density. As a byproduct, we show that there exists a different type of phase transition, whereby the pattern of the two-site entanglements undergoes a sudden change. This transition is characterised solely by quantum information theory and does not accompany the closure of the spectral gap. We analyse the scaling behaviours of the entanglement in the vicinities of the transition points.

Topological electronic effects in exfoliated thin films of bismuth telluride

AbstractAn important aspect of band gap engineering in 2D thin films of topological insulators is determining their surface electronic properties at various atomic terminations. In this work, the electronic structure evolution of thin films of bismuth telluride () with varying surface termination is discussed based on density functional theory. The reported electronic effects include closure of the hybridization energy band gap and distinct spatial charge localization of topological surface states on two types of defected surfaces –Te and Bi‐terminated. The observed band gap value changes periodically every five monolayers following the quintuple‐based layered structure. The studied system shares, to a large extent, the main features with thin films of bismuth selenide (), although with a stronger size effect.

Closure of Medicare Part D coverage gap by the Affordable Care Act (ACA) and use of oral anti-myeloma agents.

6522 Background: Medicare Part D pays for oral anti-myeloma immunomodulatory drugs (IMiDs, lenalidomide and thalidomide), but has a coverage gap resulting in an out-of-pocket (OOP) expense of &gt; $ 3000 for the 1st prescription (Rx). Patients (pts) eligible for Low Income Subsidies (LIS) are exempt from cost sharing, and LIS is associated with IMiD receipt ( Olszewski, ASH 2016). In 2011, the ACA partly closed the coverage gap with a 50% manufacturer discount on the price of brand-name drugs within the gap. We examined effects of this policy on IMiD use. Methods: From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we selected Part D enrollees who started anti-myeloma chemotherapy in 2008-2012. We identified IMiD use in periods pre-ACA (2008-10) and post-ACA (2011-12), among pts with or without LIS. After confirming parallel trends in IMiD use before the ACA, we examined the effect of ACA discount on IMiD use in a difference-in-differences (DiD) model, using LIS recipients as controls whose OOP costs were not influenced by the ACA. Results: Among 3,313 Part D enrollees (of whom 31% received LIS), 41% received IMiDs as part of their anti-myeloma regimen. Compared with the pre-ACA period, in the post-ACA period the median gross IMiD cost of the 1st Rx increased for all pts (Table). OOP costs for the 1st Rx, and for the 1st year of IMiD therapy, decreased for LIS non-recipients. Proportion of pts entering catastrophic coverage with their 1st IMiD Rx decreased from 71% to 49%. However, there was no statistically significant effect of the ACA discount on the proportion of pts treated with IMiDs (DiD estimator, 3% [95%CI, -4 to 10]; P=.40), or on the time from diagnosis to 1st Rx (median 1.5 mo. in all groups). Conclusions: The ACA-mandated partial closure of coverage gap lowered the OOP costs for Part D enrollees treated with IMiDs. As the median OOP cost remains &gt; $2400 for the 1st Rx, and &gt; $4900 for the 1st year of therapy, the policy may be insufficient to overcome the financial barrier for beneficiaries who do not receive the LIS. [Table: see text]

Rising Prices of Targeted Oral Anticancer Medications and Associated Financial Burden on Medicare Beneficiaries.

Purpose The high cost of oncology drugs threatens the affordability of cancer care. Previous research identified drivers of price growth of targeted oral anticancer medications (TOAMs) in private insurance plans and projected the impact of closing the coverage gap in Medicare Part D in 2020. This study examined trends in TOAM prices and patient out-of-pocket (OOP) payments in Medicare Part D and estimated the actual effects on patient OOP payments of partial filling of the coverage gap by 2012. Methods Using SEER linked to Medicare Part D, 2007 to 2012, we identified patients who take TOAMs via National Drug Codes in Part D claims. We calculated total drug costs (prices) and OOP payments per patient per month and compared their rates of inflation with general health care prices. Results The study cohort included 42,111 patients who received TOAMs between 2007 and 2012. Although the general prescription drug consumer price index grew at 3% per year over 2007 to 2012, mean TOAM prices increased by nearly 12% per year, reaching $7,719 per patient per month in 2012. Prices increased over time for newly and previously launched TOAMs. Mean patient OOP payments dropped by 4% per year over the study period, with a 40% drop among patients with a high financial burden in 2011, when the coverage gap began to close. Conclusion Rising TOAM prices threaten the financial relief patients have begun to experience under closure of the coverage gap in Medicare Part D. Policymakers should explore methods of harnessing the surge of novel TOAMs to increase price competition for Medicare beneficiaries.

Transcanal totally endoscopic stapes surgery: step-by-step procedure

ObjectivesThe purpose of the present work was to evaluate the role of otoendoscopy in performing stapedotomy in clinically otosclerotic patients.Patients and methodsTwenty patients presenting with clinically diagnosed otosclerosis were randomly selected from the outpatient ENT clinic in a tertiary referral Institutional Hospital. All patients were subjected to transcanal totally endoscopic stapes surgery (TTESS) from early 2013 to the fall of 2014.MethodsThis prospective study demonstrated the detailed technique of TTESS using mainly 0° lens of 14 cm length rigid endoscope for elevating the tympanomeatal flap, handling the chorda tympani nerve, curettage of posterior bony canal wall, visualization of oval window niche structures, creation of stapedotomy, and accurate prosthesis insertion. Postoperative audiogram was performed after 2 months. Assessment of postoperative complications, especially change in taste sensation, was carried out.ResultsThe chorda tympani nerve was preserved in all cases. Two cases had change in taste sensation that was improved within 6 months postoperatively. There was a significant improvement in hearing. The preoperative air-bone gap mean value was 40.30±6.38, and the postoperative mean value was 7.15±4.27 (P=0.001), with complete closure of air-bone gap in four cases. No facial paralysis or tympanic membrane perforation was encountered during the follow-up period.ConclusionTranscanal totally endoscopic stapes surgery is a feasible and safe technique for the surgical management of conductive hearing loss associated with otosclerosis, which is recommended in bilateral and revision cases.

Comparison of Temporalis Fascia and Full-Thickness Cartilage Palisades in Type-I Underlay Tympanoplasty for Large/Subtotal Perforations.

To demonstrate surgical techniques and to compare the anatomical and functional outcomes between temporalis fascia and cartilage palisade grafting in type-I underlay tympanoplasty in patients with large/subtotal perforation. Temporalis fascia and cartilage palisade grafting were conducted in Group A and Group B, respectively, each containing 30 patients with large/subtotal perforations. Pure tone audiogram (PTA) and speech reception thresholds (SRT) were performed preoperatively and at each postoperative visit; i.e. at the end of Month 1,3,6, and 24. A 10-dB closure of air bone gap (ABG) and a 10-dB improvement in SRT were considered significant. The graft uptake rates were 80% and 96.7% in Group A and Group B, respectively, at the end of 24 months. In total, 90% of Group A and 88% in Group B had significant improvement in hearing (ABG ≥10 dB). The mean improvement in SRT in the fascia and cartilage groups was 10 dB and 9 dB, respectively. Seventy-five percent of patients in Group A and 60% of patients in Group B had a significant gain in SRT. Although both temporalis fascia and cartilage palisades can effectively be used for tympanic membrane (TM) grafting in difficult perforations, the latter is considered to be the better autograft, not only because of superior graft uptake but also because it results in a comparable hearing outcome.

Treatment of infected non-unions with segmental defects with a rail fixation system

We conducted this study to evaluate the use of rail fixation system in infected gap non-union of femur and tibia as an alternative to the established Ilizarov circular fixator technique. Prospective study. The study was done in the Department of Orthopaedic surgery in a medical school and level I trauma center to which the authors are/were affiliated. Between June 2010 and June 2015, 40 patients with infected gap non-union of femur and tibia were treated with the rail fixation system. Patients who were willing to undergo surgery and participate in the post-operative rehabilitation were included in the study. After radical debridement, the system was applied and corticotomy done. For closure of bone gap, acute docking and distraction was done in 18 cases and segmental bone transport in 22 cases. Early mobilization of patient was done along with aggressive physiotherapy. Bone and functional results were calculated according to ASAMI scoring system, and complications were classified according to Paley classification. The mean follow-up period was 22.56 months (range 8–44). Bone union with eradication of infection was achieved in all but 1 case (97.5%). Bone results were excellent in 57.5%, good 40%, fair 0% and poor in 2.5% cases, while functional result was excellent in 32.5%, good 65%, fair 0% and poor in 2.5% cases. The rail fixation system is an excellent alternative method to treat infected gap non-union of femur and tibia. It is simple, easy to use and patient-friendly.