bluuebunny/crossref_metadata_2025 huggingface dataset:
Pitfalls and Key Features of a Case of Sclerosing Pneumocytoma: A Cytological Challenge?
Authors: Onorati Monica , Nicola Marta , Bianchi Chiara Luisa , Bini Francesco , Bellaviti Nadia , Di Nuovo Franca
Published: March 2016

Background: The aim of the current case report is to re-evaluate the key features and pitfalls of fine-needle aspiration cytology (FNAC) in the diagnosis of sclerosing pneumocytoma (previously named sclerosing hemangioma) and to establish the importance of FNAC in addressing a proper surgical strategy. Case: Herein we documented a case of a 70- year-old man with a lung nodule which showed a hypermetabolic uptake on positron emission tomography. He therefore underwent FNAC under computed tomography scan guidance with a 22-gauge needle. The cytopathological examination allowed a diagnosis of sclerosing pneumocytoma. A wedge surgical excision was performed and the histological examination confirmed the cytological diagnosis. Conclusion: FNAC is a fundamental tool for distinguishing sclerosing pneumocytoma from a malignant lung tumour and together with clinical, radiological and pathological multidisciplinary assessment is indispensable in planning appropriate surgical management. Cytopathologists should be aware of the pitfalls and key features of the cytopathological diagnosis of sclerosing pneumocytoma, which can significantly change the surgical approach to the patient and protect him from aggressive overtreatment.
Predictive Capacity of Biomarkers for Severe Acute Pancreatitis
Authors: Sternby Hanna , Hartman Hannes , Johansen Dorthe , Thorlacius Henrik , Regnér Sara
Published: March 2016

Background: Early prediction of severe acute pancreatitis (SAP) substantially improves treatment of patients. A large amount of biomarkers have been studied with this objective. The aim of this work was to study predictive biomarkers using preset cut-off levels in an unselected population of patients with acute pancreatitis (AP). Methods: 232 patients (52.2% males, median age 66 years) with AP admitted to Skåne University Hospital, Malmö, were consecutively enrolled. Blood samples were collected upon admission and clinical data were gathered both prospectively at inclusion and through review of medical notes. Cut-off levels were defined based on the reports of prior studies, and through their results eight biomarkers (IL-1β, IL-6, IL-8, IL-10, TNF-α, MCP-1, procalcitonin and D-dimer) were selected for analysis. Results: Of the patients, 83.2% had mild AP and 16.8% had SAP. Levels of IL-1β, IL-6 and IL-10 were significantly (p < 0.05) higher upon admission in the group with SAP. When applying the preset cut-off levels on our material, sensitivity and specificity for prediction of severity were low. Receiver operating characteristic curves showed that selected cut-off levels were acceptable, but areas under the curves were inferior compared to other studies. The results did not improve when using the revised Atlanta 2012 classification. Conclusions: Previous studies on severity prediction of AP are difficult to compare due to large variations in setups and outcomes. Calculated cut-offs in our cohort were in acceptable range from preset levels, however areas under the curves were low, indicating suboptimal biomarkers for the unselected population investigated. For comparable results and possible clinical implementations, future studies need large consecutive series with a reasonable percentage of severe cases. Additionally, novel biomarkers need to be explored.
Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin
Authors: Mochmann Hans-Christian , Scheitz Jan F. , Petzold Gabor C. , Haeusler Karl Georg , Audebert Heinrich J. , Laufs Ulrich , Schneider Christine , Landmesser Ulf , Werner Nikos , Endres Matthias , Witzenbichler Bernhard , Nolte Christian H.
Published: March 2016

Background—

A relevant proportion of patients with acute ischemic stroke (AIS) have elevated levels of cardiac troponins (cTn). However, the frequency of coronary ischemia as the cause of elevated cTn is unknown. The aim of our study was to analyze coronary vessel status in AIS patients with elevated cTn compared with patients presenting with non–ST-segment–elevation acute coronary syndrome (NSTE-ACS).

Methods and Results—

Among 2123 consecutive patients with AIS prospectively screened at 2 tertiary hospitals, 13.7% had cTn elevation (>50 ng/L). According to a prespecified sample size estimation, 29 patients with AIS (median age, 76 years [first–third quartiles, 70–82 years]; 52% male) underwent conventional coronary angiography and were compared with age- and sex-matched patients with NSTE-ACS. The primary end point was presence of coronary culprit lesions on coronary angiograms as analyzed by independent interventional cardiologists blinded for clinical data. Median cTn on presentation did not differ between patients with AIS or NSTE-ACS (95 versus 94 ng/L;
P
=0.70). Compared with patients with NSTE-ACS, patients with AIS were less likely to have coronary culprit lesions (7 of 29 versus 23 of 29;
P
<0.001) or any obstructive coronary artery disease (15 of 29 versus 25 of 29;
P
=0.02; median number of vessels with >50% stenosis, 1 [first–third quartiles, 0–2] versus 2 [first–third quartiles, 1–3];
P
<0.01).

Conclusions—

Coronary culprit lesions are significantly less frequent in AIS patients compared with age- and sex-matched patients with NSTE-ACS despite similar baseline cTn levels. Half of all AIS patients had no angiographic evidence of coronary artery disease. Further studies are needed to clinically identify the minority of patients with AIS and angiographic evidence of a culprit lesion.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01263964.
Marital Transition and Risk of Stroke
Authors: Honjo Kaori , Iso Hiroyasu , Ikeda Ai , Inoue Manami , Sawada Norie , Tsugane Shoichiro ,   on behalf of the JPHC Study Group
Published: March 2016

Background and Purpose—

There have been consistent findings reported that marital transition (ie, change in marital status during a given time period) is associated with risk of cardiovascular disease; however, few studies have been conducted on stroke risk, particularly stroke subtypes. Moreover, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk.

Methods—

We examined sex-specific associations between marital transition and stroke risk using data from Japan Public Health Center–based Prospective Study. We included 24 162 men and 25 626 women who were married at prebaseline (5 years before baseline). Marital transition was determined by marital status at baseline. Weighted hazard ratios of stroke risk were estimated by Cox proportional regression analysis with inverse probability of weighting using a propensity score.

Results—

An increased risk of stroke, particularly hemorrhagic stroke, was observed among men and women with marital transition (ie, married to unmarried); weighted hazard ratios (95% confidence interval [CI]) for men and women were 1.26 (1.13–1.41) and 1.26 (1.09–1.45), respectively. Participants with marital transition and lived with children had increased stroke risk. Living with parents buffered the increased stroke risk owing to marital transition among men; however, no such effect was identified among women. Elevated stroke risk owing to marital transition was magnified among women if they were unemployed; weighted hazard ratio=2.98 (95% CI, 1.66–5.33).

Conclusions—

Living arrangement and employment status modified the positive associations between marital transition and stroke risk, which differed by sex.
Complex Autocatalysis in Simple Chemistries
Authors: Virgo Nathaniel , Ikegami Takashi , McGregor Simon
Published: March 2016

Life on Earth must originally have arisen from abiotic chemistry. Since the details of this chemistry are unknown, we wish to understand, in general, which types of chemistry can lead to complex, lifelike behavior. Here we show that even very simple chemistries in the thermodynamically reversible regime can self-organize to form complex autocatalytic cycles, with the catalytic effects emerging from the network structure. We demonstrate this with a very simple but thermodynamically reasonable artificial chemistry model. By suppressing the direct reaction from reactants to products, we obtain the simplest kind of autocatalytic cycle, resulting in exponential growth. When these simple first-order cycles are prevented from forming, the system achieves superexponential growth through more complex, higher-order autocatalytic cycles. This leads to nonlinear phenomena such as oscillations and bistability, the latter of which is of particular interest regarding the origins of life.
A General Statistical Method for Identifying Adaptations by Parameterizing Trait Space
Authors: Blount Drew
Published: March 2016

It is obviously useful to think of evolved individuals in terms of their adaptations, yet the task of empirically classifying traits as adaptations has been claimed by some to be impossible in principle. I reject that claim by construction, introducing a formal method to empirically test whether a trait is an adaptation. The method presented is general, intuitive, and effective at identifying adaptations while remaining agnostic about their adaptive function. The test follows directly from the notion that adaptations arise from variation, heritability, and differential fitness in an evolving population: I operationalize these three concepts at the trait level, formally defining measures of individual traits. To test whether a trait is an adaptation, these measures are evaluated, locating the trait within a three-dimensional parameterized trait space. Within this space, I identify a region containing all adaptations; a trait's position relative to this adaptive region of trait space describes its status as an adaptation. The test can be applied in any evolving system where a few domain-specific statistical measures can be constructed; I demonstrate the construction of these measures, most notably a measure of an individual's hypothetical fitness if it were born with a different trait, in Packard's Bugs ALife model. The test is applied in Bugs, and shown to conform with our intuitive classification of adaptations.
What is Out There to Resist?
Authors: Hout Syrine
Published: March 2016

This article demonstrates that Philippe Aractingi’s 2007 Under the Bombs—produced in response to the July 2006 war between Lebanon and Israel—is a docudrama in the form of a road(block) movie, whose internal borders are both material and discursive. Under the Bombs presents two sets of opposed attitudes and coping strategies vis-à-vis this war; these are manifest, respectively, in the two cinematic strains which make up the film. Applying Ken Seigneurie’s terms, I argue that the actual footage displays the new ‘mythic utopianist’, whereas the fictional storyline tries to uphold the old ‘elegiac humanist’ tradition of standing-by-the-ruins. What differentiates these two discourses is the definition/meaning of resistance in the Lebanese international and local political contexts.
Alternative Remembrances
Authors: Sacranie Nour K.
Published: March 2016

Memory of the civil war in Lebanon is fractured if not completely broken, and its history remains officially unwritten. A lack of reconciliation or peace-building initiatives suggests that the causes for the conflict have simply been masked or ignored rather than cured. Existing scholarship has examined the absence of a national collective memory or unified history in Lebanon, with some speculation that the persistent fault lines in the country’s multi-factional and multi-religious society may lead to a relapse of the violence. While there have been some curatorial endeavors in the field, little popular criticism and even less academic writing focuses on contemporary visual culture in Lebanon or the wider Middle East. It is only in recent years that due attention has been paid to the vibrant art scene in the region, and the dearth in critical material has been addressed. With this in mind, this paper aims to contribute to the wider burgeoning conversation about critical art practices in the Middle East. In analyzing the work of three Lebanese ‘post-war’ artists, questions about the nature of wartime history and memory are asked in relation to visual culture. The article asks what art is doing in the context of Lebanese post-war society, and while it may not be possible to answer this question fully, there is an underlying need to re-evaluate the way the arts are viewed in contemporary discourse, as pioneered by Jacques Ranciere and Jill Bennet, among others.
The Dynamic and Theatrical Worlds of the ‘Midan’
Authors: ElHalawani Amina
Published: March 2016

‘All the world’s a stage …’ tells us the Bard of Avon. Goffman’s application of Shakespeare’s age-old metaphor to our everyday practices helps us understand the complexity of social interaction. His dramaturgical sociology allows us to engage better with the frames of repeated behaviors that we ‘perform’ in social contexts. However, emphasizing the theatricality of action and interaction, especially for problems at the macro-level like acts of revolution, is crucial to make sense of the form of spectacle that results in popular demonstrations, sit-ins etc., in which everyone contributes as actors/spectators to imagine and/or negotiate a different way of being or governance. This paper aims to study the active dynamics of turning an everyday locale such as Midan al-Tahrir into a liminal space in which staged performances on political and artistic levels take place in an attempt to shed light on the inseparability of the political and the aesthetic, the event and the performance. The Egyptian revolution of 2011 highlights the public’s awareness of the symbolic and performative importance of occupying a space, and the creative power that both nurtures and feeds on this liminal experience. In this very example, the Arabic word midan is helpful because of its dynamic connotations as opposed to the static English ‘square’, as this paper examines the experience of Tahrir as a ‘Midan’ where the real, the ritualistic and the playful actively coexist.
European Muslim Diasporic Geographies
Authors: Tsagarousianou Roza
Published: March 2016

This article, based on extensive fieldwork among Muslim communities in five western European countries, explores the ways in which European Muslims ‘situate’ themselves emotionally, culturally and politically vis-à-vis fellow Muslims in Europe and the Muslim world. Drawing on theories of space, place and identity, the article examines processes that amount to the construction of translocal/transnational phenomenological geographies through the utilization of time/space distanciating technologies to cultivate long-distance relations that are crucial to the identification process of European Muslims. Through these they engage in processes of cultural negotiation and translation, of forging of local and translocal links and solidarities that rest on making cognitive and emotional investments and thereby constructing and disseminating narratives shared among themselves and other Muslims.
Islam and the White House
Authors: al-Rahim Ahmed H.
Published: March 2016

A reified Islam has been used to delineate the creed, the politics and the culture of about a fifth of the world population. While defining what ‘Islam’ is and is not, before and after the events of September 11, may be a necessary first step to understanding certain ‘facts’ about the theology, law and history of the world’s second largest religion, the semantics of official US government discourse about ‘Islam’ and terrorism have proved to be problematic. The purpose of this article is to provide an analytical survey of the thematics of American presidential public diplomacy. It also analyzes the construction of ideology in the context of the global war on terror, as it relates to Islam as a religion, the variants of political Islam and more broadly on the question of terrorism and the ‘Muslim world’. I begin with the Clinton presidency and continue to George Bush and end with Obama’s first term. This period of American political and public diplomatic history was selected because it clearly illustrates American presidential rhetoric on ‘Islam’ before and after al-Qaʿida’s second attacks on the World Trade Center and before the events of the ‘Arab Spring’ in late 2010.
Mexico and the R2P Challenge: The Commitment Trap
Authors: Sotomayor Arturo C.
Published: March 2016

In recent years, Mexico has presented mostly favourable views of the R2P concept. This is a radical change, since historically it had been a strong advocate of non-intervention norms. This essay argues that Mexico’s R2P position has been shaped and constrained by two incoherent domestic narratives: democratization and the war on drugs. These two narratives have led to an inconsistent and ambiguous record of compliance with human rights norms and R2P principles. Mexican authorities, who had been championing for the implementation of R2P, have now become victims of their own international commitments. This Latin American country thus needs to reconcile its two distinct domestic agendas if it aims to be seen as an R2P advocate. The goal of this study is to explore the inherent complex and at times contradictory relationship between domestic demands for democratization and securitization and R2P commitments, using Mexico as a critical case study.
Species discovery and diversity in Lobocriconema (Criconematidae: Nematoda) and related plant-parasitic nematodes from North American ecoregions
Authors: POWERS T.O. , BERNARD E.C. , HARRIS T. , HIGGINS R. , OLSON M. , OLSON S. , LODEMA M. , MATCZYSZYN J. , MULLIN P. , SUTTON L. , POWERS K.S.
Published: March 2016

There are many nematode species that, following formal description, are seldom mentioned again in the scientific literature. Lobocriconema thornei and L. incrassatum are two such species, described from North American forests, respectively 37 and 49 years ago. In the course of a 3-year nematode biodiversity survey of North American ecoregions, specimens resembling Lobocriconema species appeared in soil samples from both grassland and forested sites. Using a combination of molecular and morphological analyses, together with a set of species delimitation approaches, we have expanded the known range of these species, added to the species descriptions, and discovered a related group of species that form a monophyletic group with the two described species. In this study, 148 specimens potentially belonging to the genus Lobocriconema were isolated from soil, individually measured, digitally imaged, and DNA barcoded using a 721 bp region of cytochrome oxidase subunit 1 (COI). One-third of the specimens were also analyzed using amplified DNA from the 3’ region of the small subunit ribosomal RNA gene (18SrDNA) and the adjacent first internal transcribed spacer (ITS1). Eighteen mitochondrial haplotype groups, falling into four major clades, were identified by well-supported nodes in Bayesian and maximum likelihood trees and recognized as distinct lineages by species delimitation metrics. Discriminant function analysis of a set of morphological characters indicated that the major clades in the dataset possessed a strong morphological signal that decreased in comparisons of haplotype groups within clades. Evidence of biogeographic and phylogeographic patterns was apparent in the dataset. COI haplotype diversity was high in the southern Appalachian Mountains and Gulf Coast states and lessened in northern temperate forests. Lobocriconema distribution suggests the existence of phylogeographic patterns associated with recolonization of formerly glaciated regions by eastern deciduous forest, but definitive glacial refugia for this group of plant parasitic nematodes have yet to be identified. Unlike agricultural pest species of plant-parasitic nematodes, there is little evidence of long-distance dispersal in Lobocriconema as revealed by haplotype distribution. Most haplotype groups were characterized by low levels of intragroup genetic variation and large genetic distances between haplotype groups. The localization of nematode haplotypes together with their characteristic plant communities could provide insight into the historical formation of these belowground biotic communities.
Comparative morphology on the egg chorion characters of some Noctuidae (Lepidoptera)
Authors: Dolinskaya Irina V.
Published: March 2016

A comparative morphological analysis is provided for 70 species belonging to 59 genera of 13 subfamilies of Noctuidae from Ukraine. Diagnostic characters of the eggs for some species are identified. A comparison with representatives from other families of Noctuoidea is conducted. Some characters typical for separate species and general characters typical for most species are discussed.
Sinocatops gen. nov., an apterous genus of Cholevini (Coleoptera: Leiodidae: Cholevinae) from China, with emphasis on differences with allied Rybinskiella Reitter, 1906
Authors: WANG CHENG-BIN , ZHOU Hong-Zhang
Published: March 2016

A new apterous genus (Sinocatops gen. nov.) with a single new species (S. ruzickai sp. nov.) of Cholevini, is described from Sichuan Province, China. It is compared in detail to allied Rybinskiella Reitter, 1906 with some selected but important morphological characters to show their differences presented in a table. Color plates are presented to illustrate important morphological characters of S. ruzickai sp. nov. and examined species of Rybinskiella. The taxonomic state of Rybinskiella is also briefly disscussed.
A new species of Limnephilidae (Insecta: Trichoptera) from the Western Alps (Insecta: Trichoptera)
Authors: GRAF WOLFRAM , VITECEK SIMON
Published: March 2016

A new species of the alpine caddisfly genus Consorophylax (Trichoptera, Limnephilidae, Stenophylacini) and the female of the recently described C. vinconi Graf & Malicky 2015 are described. The new species C. lepontiorum sp. nov. is a microendemic of the Southwestern Alps and differs from its congeners in the shape of the superior and inferior appendages and the unique setation of the aedeagus, absent in all other Consorophylax species. The female of C. vinconi is characterized by the unique formation of the anal tube. Potential effects of alpine orogenesis, phenology and climatic oscillation on speciation of aquatic insects inhabiting high-altitude habitats are discussed. The description of C. lepontiorum sp. nov. accentuates the significance of watersheds in the Western Alps as harbours of aquatic insect biodiversity, and demonstrates the necessity of additional faunal and taxonomic studies in Europe—a supposedly well-explored region.
Interleukin-17 Impairs Salivary Tight Junction Integrity in Sjögren’s Syndrome
Authors: Zhang L.W. , Cong X. , Zhang Y. , Wei T. , Su Y.C. , Serrão A.C.A. , Brito A.R.T. , Yu G.Y. , Hua H. , Wu L.L.
Published: March 2016

Sjögren’s syndrome (SS) is an inflammatory autoimmune disease that causes secretory dysfunction of the salivary glands. It has been reported that proinflammatory cytokine interleukin-17 (IL-17) was elevated and tight junction (TJ) integrity disrupted in minor salivary glands from SS patients. However, whether the elevated IL-17 in SS affects TJ integrity and thereby alters the function of salivary gland is unknown. Here, by using nonobese diabetic (NOD) mice as SS model, we found that the stimulated salivary flow rate was significantly decreased in NOD mice. Lymphocyte infiltration was mainly observed in submandibular glands (SMGs), but not parotid glands (PGs), of NOD mice. IL-17 was significantly increased and mainly located in lymphocytic-infiltrating regions in SMGs but not detectable in PGs of NOD mice. Meanwhile, the epithelial barrier function was disrupted, as evidenced by an increased paracellular tracer clearance and an enlarged acinar TJ width in SMGs of NOD mice. Furthermore, claudin-1 and -3 were elevated especially at the basolateral membranes, whereas claudin-4, occludin, and zonula occludens–1 (ZO-1) were reduced in SMGs of NOD mice. Moreover, occludin and ZO-1 were dispersed into cytoplasm in SMGs of NOD mice. However, no change in the expression and distribution of TJ proteins was found in PGs. In vitro, IL-17 significantly decreased the levels and apical staining of claudin-4 and ZO-1 proteins in the cultured SMG tissues, as well as claudin-1, occludin, and ZO-1 in PG tissues. Moreover, IL-17 activated the phosphorylation of IκBα and p65 in SMG cells, whereas pretreatment with NF-κB inhibitor pyrrolidine dithiocarbamate suppressed the IL-17-induced downregulation of claudin-4 and ZO-1 in SMG tissues. Taken together, these findings indicate that IL-17 derived from infiltrating lymphocyte impairs the integrity of TJ barrier through NF-κB signaling pathway, and thus might contribute to salivary gland dysfunction in SS.
Organising precarious workers: Can a public campaign overcome weak grassroots mobilisation at workplace level?
Authors: Murphy Caroline , Turner Thomas
Published: March 2016

This article examines union efforts to recruit and mobilise precarious workers in a hostile environment. Formidable obstacles confront organisers’ attempts to mobilise workers to engage in collective action at workplace level in the Irish hotel sector. After an initial grassroots organising campaign, the Services Industrial Professional and Technical Union (SIPTU) adopted a public campaign as an alternative strategy to secure improvements in pay and working conditions in the sector. Our findings indicate that the union’s inability to create a sense of collective identity among workers or establish strong support for union organisation at workplace level was due to a combination of external economic factors and challenges at this level. In the absence of such support, the impact of a public union campaign is less widely felt by employers. We evaluate the extent to which this type of campaign can substitute for weak grassroots mobilisation and provide a sustainable basis for union presence in the sector.
Children’s sleep and academic achievement
Authors: Diaz Anjolii , Berger Rebecca , Valiente Carlos , Eisenberg Nancy , VanSchyndel Sarah K. , Tao Chun , Spinrad Tracy , Doane Leah D. , Thompson Marilyn S. , Silva Kassondra M. , Southworth Jody
Published: March 2016

Poor sleep is thought to interfere with children’s learning and academic achievement (AA). However, existing research and theory indicate there are factors that may mitigate the academic risk associated with poor sleep. The purpose of this study was to examine the moderating role of children’s effortful control (EC) on the relation between sleep and AA in young children. One hundred and three 4.5- to 7-year-olds (M = 5.98 years, SD = 0.61) wore a wrist-based actigraph for five continuous weekday nights. Teachers and coders reported on children’s EC. EC was also assessed with a computer-based task at school. Additionally, we obtained a standardized measure of children’s AA. There was a positive main effect of sleep efficiency to AA. Several relations between sleep and AA were moderated by EC and examination of the simple slopes indicated that the negative relation between sleep and AA was only significant at low levels of EC.
Searching for the Family Legal Status of Mexican-Origin Children
Authors: Oropesa R.S. , Landale Nancy S. , Hillemeier Marianne M.
Published: March 2016

Interest in the consequences of family legal status for children has grown in response to immigration-related changes in the ethnic composition of American society. However, few population-based empirical studies devote attention to family legal status because of data limitations. Using restricted data from the California Health Interview Survey (2009), the primary objectives of this research are to identify and evaluate strategies for measuring this important determinant of life chances among Mexican-origin children. The results indicate that measurement strategies matter. Estimates of the size of status-specific segments of this population and their risks of living in poverty are sensitive to how family legal status is operationalized. These findings provide the foundation for a discussion of how various “combinatorial” measurement strategies may rely on untenable assumptions that can be avoided with less reductionist approaches.
Endoscopic Radiofrequency Ablation–Assisted Resection of Juvenile Nasopharyngeal Angiofibroma
Authors: McLaughlin Eamon J. , Cunningham Michael J. , Kazahaya Ken , Hsing Julianna , Kawai Kosuke , Adil Eelam A.
Published: March 2016

Objectives

To evaluate the feasibility of radiofrequency surgical instrumentation for endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) and to test the hypothesis that endoscopic radiofrequency ablation–assisted (RFA) resection will have superior intraoperative and/or postoperative outcomes as compared with traditional endoscopic (TE) resection techniques.

Study Design

Case series with chart review.

Setting

Two tertiary care pediatric hospitals.

Subjects and Methods

Twenty‐nine pediatric patients who underwent endoscopic transnasal resection of JNA from January 2000 to December 2014.

Results

Twenty‐nine patients underwent RFA (n = 13) or TE (n = 16) JNA resection over the 15‐year study period. Mean patient age was not statistically different between the 2 groups (P =.41); neither was their University of Pittsburgh Medical Center classification stage (P =.79). All patients underwent preoperative embolization. Mean operative times were not statistically different (P =.29). Mean intraoperative blood loss and the need for a transfusion were also not statistically different (P =.27 and. 47, respectively). Length of hospital stay was not statistically different (P =.46). Recurrence rates did not differ between groups (P =. 99) over a mean follow‐up period of 2.3 years.

Conclusion

There were no significant differences between RFA and TE resection in intraoperative or postoperative outcome parameters.
Cholesterol Granuloma Development following Temporal Bone Surgery
Authors: Sweeney Alex D. , Osetinsky L. Mariel , Hunter Jacob B. , Haynes David S. , Carlson Matthew L.
Published: March 2016

Objective

To describe the clinical presentation and management of patients with cholesterol granulomas (CGs) that develop following temporal bone surgery.

Study Design

Case series with chart review.

Setting

Two independent tertiary academic referral centers.

Subjects and Methods

A multicenter retrospective review was performed to identify all patients between 2001 and 2014 who were diagnosed with a CG that developed following temporal bone surgery. Patients with a history of idiopathic petrous apex CGs were excluded, as were those with <6 months of follow‐up after diagnosis. Demographic and clinical data were recorded at presentation, and the main outcome measure was symptom evolution over time.

Results

A total of 20 patients met inclusion criteria (median age, 55.0 years; 70.0% female), and their cases were analyzed. Diagnosis was made, on average, 149.5 months (median, 94.5; range, 13.0‐480.0) following a temporal bone operation, which was for chronic ear disease in 75.0% of cases. The most common presenting symptoms were otalgia (55.0%) and otorrhea (40.0%). In patients initially managed with observation, 71.4% required no surgical intervention through a mean of 56.8 months (median, 30; range, 12.0‐178.0) of follow‐up. For those who initially underwent surgical excision, durable symptom relief was achieved in 66.7% of cases.

Conclusion

Postoperative CG formation in the temporal bone is a rare occurrence that can be encountered years following surgery. The present study suggests that conservative management can be appropriate for many cases in which patients are relatively asymptomatic.
Nonvisualization of Sialoliths during Sialendoscopy
Authors: Galinat Lauren , Curry Joseph , Luginbuhl Adam , Rosen David , Cognetti David M.
Published: March 2016

Objectives

Analyze the characteristics of patients undergoing interventional sialendoscopy for sialolithiasis whose stones were not visualized intraoperatively.

Study Design

Case series with chart review.

Setting

Tertiary care hospital.

Subjects and Methods

Patients (n = 276) undergoing sialendoscopy between June 2008 and December 2014 were reviewed for patient characteristics, imaging characteristics, and outcomes. Nonvisualization was defined as a sialolith that was documented on imaging preoperatively but not visualized intraoperatively during sialendoscopy, despite successful ductal cannulation and evaluation.

Results

A total of 337 sialendoscopy procedures were preformed. Preoperative imaging documented a sialolith in 203 (60%) cases. Nonvisualization occurred in 31 (15%) cases with sialolith. The parotid gland was involved in 58% (18 of 31) of nonvisualization cases, as opposed to 21% (43 of 203) of all sialolith cases. The submandibular gland was involved in 42% (13 of 31) of nonvisualization cases, as compared with 79% (160 of 203) of all sialolith cases. Nonvisualization occurred in 42% (18 of 43) of parotid cases versus 8% (13 of 160) of submandibular cases, a statistically significant difference (P <. 001). Parotid stones located posterior to the plane of insertion of the posterolateral edge of the masseter were significantly more likely to experience nonvisualization (73%) than those along and anterior to the masseter (25% and 0%, respectively; P =. 009).

Conclusions

Intraoperative nonvisualization of a sialolith is more likely to occur in the parotid gland. Proximal stone location may predict nonvisualization. These factors should be considered during treatment planning and counseling for patients with sialolithiasis.
Long‐term Outcomes of Titanium Ossiculoplasty in Chronic Otitis Media
Authors: O’Connell Brendan P. , Rizk Habib G. , Hutchinson Tanisha , Nguyen Shaun A. , Lambert Paul R.
Published: March 2016

Objective

The primary objective is to report long‐term hearing outcomes (>2 years) after titanium ossiculoplasty in patients with chronic otitis media.

Study Design

Case series with chart review.

Setting

Tertiary care hospital.

Subjects and Methods

In total, 156 patients with chronic otitis media undergoing titanium ossiculoplasty were included. The primary outcome measure was the long‐term postoperative ABG. The stability of hearing over time was determined by comparing short‐term and long‐term postoperative air‐bone gap (ABG). Secondary outcome measures included ΔABG, postoperative speech reception thresholds, air‐conduction pure‐tone average (AC PTA), word recognition scores, and percentage of patients achieving ABG ≤20 dB. Revision and extrusion rates were examined.

Results

At short‐term follow‐up (<6 months), mean postoperative ABG was 18.4 ± 10.6 dB and AC PTA was 31.7 ± 15.2 dB; 67% of patients achieved ABG ≤20 dB. At long‐term follow‐up (>2 years), mean ABG was 20.0 dB ± 15.4 and AC PTA was 35.3 ± 16.1 dB; 60% of patients achieved ABG ≤20. At both short‐ and long‐term follow‐up, ABG and AC PTA were significantly improved compared with preoperative values. No difference in hearing outcomes was observed when comparing partial titanium ossicular prostheses (PORPs) to total titanium ossicular prostheses (TORPs) at either short‐ or long‐term follow‐ups. In patients with both short‐ and long‐term follow‐up (n = 50), deterioration in hearing was noted (3.4 dB, P =. 04). When analyzed by type of prosthesis, PORPs demonstrated statistically significant deterioration in ABG over time (4.9 dB, P =. 02), while TORPs did not (2.5 dB, P =. 50). The long‐term extrusion rate was 3.2%.

Conclusion

With a minimum follow‐up of 2 years, titanium ossiculoplasty provides good long‐term hearing results. Modest deterioration in hearing is noted over time.
Antibiotic and Duration of Perioperative Prophylaxis Predicts Surgical Site Infection in Head and Neck Surgery
Authors: Langerman Alexander , Thisted Ronald , Hohmann Samuel , Howell Michael
Published: March 2016

Objective

To examine the effect of giving antibiotics on the day of surgery (DOS) vs DOS and first postoperative day (DOS+1) for prophylaxis against surgical site infection (SSI) in clean‐contaminated head and neck surgery (CCHNS).

Study Design

Retrospective multi‐institution analysis using University HealthSystem Consortium data.

Methods

A multivariate logistic regression model of 8836 discharge records from patients undergoing CCHNS was used to determine the odds of SSI for antibiotic agent/duration combinations.

Setting

Ninety‐two academic and affiliated medical centers from 2008 to 2011.

Results

Ampicillin/sulbactam, clindamycin, cefazolin + metronidazole, and cefazolin alone were the most common antibiotics. For patients receiving antibiotics only on DOS, there was no significant difference in odds of SSI based on antibiotic choice. When given on the DOS and DOS+1, patients receiving ampicillin/sulbactam had a reduction in odds of SSI by over two‐thirds (odds ratio [OR], 0.28 [95% confidence interval, 0.13‐0.61], P =. 001, compared with ampicillin/sulbactam on DOS only), whereas this effect was not seen with clindamycin (1.82 [0.93‐3.56], P =. 078, compared with clindamycin on DOS only). Prolonging clindamycin beyond the DOS was associated with a higher odds of SSI compared with DOS‐only ampicillin/sulbactam (OR, 2.66; 95% CI, 1.33‐5.30; P =. 006). These relationships held in a subset of physicians and hospitals that used multiple different regimens. DOS+1 regimens were not associated with an increased odds of antibiotic‐induced complications.

Conclusion

Prolonging ampicillin/sulbactam beyond the day of surgery may have a protective effect against SSI, and 1 or more days of ampicillin/sulbactam may be preferable to multiple days of clindamycin. New randomized trials are needed to define the ideal regimen for CCHNS.
Lean Belt Certification
Authors: Elghouche Alhasan N. , Lobo Brian C. , Wannemuehler Todd J. , Johnson Kimberly E. , Matt Bruce H. , Woodward‐Hagg Heather K. , Kokoska Mimi S.
Published: March 2016

Since July 2013, 20 trainee participants have completed the quality improvement curriculum within the Indiana University Department of Otolaryngology–Head & Neck Surgery, including 7 otolaryngology residents, 6 otolaryngology‐bound medical students, and 7 psychiatry residents. Nine faculty and staff attended. Participants were highly satisfied with the quality and effectiveness of the program. Following program implementation, 2 otolaryngology residents and 2 medical students initiated their own quality improvement projects. Lean training directly resulted in oral and poster presentations at national conferences, journal publications, and institutional research and quality awards. Students completing the program established a local affiliate group of an international health care quality organization. Quality improvement training can be successfully incorporated into residency training with overwhelming program satisfaction and results in greater scholarly and professional development for motivated participants. The skillset acquired by participants leads to projects that improve patient care, increase value, and justify equipment and personnel retention and expansion.
Cutaneous Lymphoma at Injection Sites
Authors: Roccabianca P. , Avallone G. , Rodriguez A. , Crippa L. , Lepri E. , Giudice C. , Caniatti M. , Moore P. F. , Affolter V. K.
Published: March 2016

Feline primary cutaneous lymphomas (FPCLs) account for 0.2% to 3% of all lymphomas in cats and are more frequently dermal nonepitheliotropic small T-cell tumors. Emergence of FPCL seems unrelated to feline leukemia virus (FeLV) serological positivity or to skin inflammation. A total of 17 cutaneous lymphomas with a history of vaccine injection at the site of tumor development were selected from 47 FPCLs. Clinical presentation, histology, immunophenotype, FeLV p27 and gp70 expression, and clonality were assessed. A majority of male (12/17), domestic short-haired (13/17) cats with a mean age of 11.3 years was reported. Postinjection time of development ranged from 15 days to approximately 9 years in 5 cats. At diagnosis, 11 of 17 cats had no evidence of internal disease. Lymphomas developed in interscapular (8/17), thoracic (8/17), and flank (1/17) cutaneous regions; lacked epitheliotropism; and were characterized by necrosis (16/17), angiocentricity (13/17), angioinvasion (9/17), angiodestruction (8/17), and peripheral inflammation composed of lymphoid aggregates (14/17). FeLV gp70 and/or p27 proteins were expressed in 10 of 17 tumors. By means of World Health Organization classification, immunophenotype, and clonality, the lesions were categorized as large B-cell lymphoma (11/17), anaplastic large T-cell lymphoma (3/17), natural killer cell–like (1/17) lymphoma, or peripheral T-cell lymphoma (1/17). Lineage remained uncertain in 1 case. Cutaneous lymphomas at injection sites (CLIS) shared some clinical and pathological features with feline injection site sarcomas and with lymphomas developing in the setting of subacute to chronic inflammation reported in human beings. Persistent inflammation induced by the injection and by reactivation of FeLV expression may have contributed to emergence of CLIS.
Static load sharing by tooth pairs in contact in internal involute spur gearing with thin rimmed pinion
Authors: Sahoo Vineet , Maiti Rathindranath
Published: March 2016

Involute toothed internal−external standard gear sets are modeled for load-sharing by the teeth pairs in mesh along the line of contact. An analytical solution is proposed. Considering the rigid body in rotation, it is assumed that angular rotation of a gear with respect to the other gear due to deformation along the line of contact is equal. The sum of the normal loads in all tooth pairs in contacts, which equals to the total transmitted load, is considered constant. All possible deformations such as, tooth bending deflection, tooth compressive (contact) deformation, tooth foundation deflection and tooth shearing deflection are considered in analyses. Detailed tooth geometries are incorporated in modeling. Ultimately, the map of load sharing by tooth pairs in contacts, at different angular position, over a cycle of similar contact pattern, is established. Finally, considering thin rimmed gears, the effects of the rim thickness on load sharing, which is the aim of the present investigation are analyzed and the results are presented in terms of backup ratios.
The Use of ‘The Saracen Opinion’ on Knighthood in Medieval French Literature
Authors: Çeçen Zeynep Kocabiyikoğlu
Published: March 2016

This article aims to examine the differences and the similarities regarding the outlook on knighthood of two French poems, the anonymous Ordene de chevalerie, written sometime during the early thirteenth century, and Honoré Bovet’s L’Apparicion maistre Jehan de Meun, written in the late fourteenth century. Whereas both works contain a Saracen figure who works as the agent conveying the state of Christian knighthood, the former gives an exalted portrait of Christian knighthood and the latter a critical one. The reasons for the change in attitude, from that of L’Ordene where knighthood is an order held in high regard, on a par with the clergy, to that of L’Apparicion, where it is seen as corrupted and failing in its duties, may be looked for in the crusaders’ defeat at Nicopolis, which had been inflicted on them just before Bovet penned his work. In this respect, L’Apparicion shares characteristics with its contemporary works, just like L’Ordene does with works of its time.
The Patient-Centered Medical Home
Authors: Reibling Nadine
Published: March 2016

This study investigates whether patient-reported characteristics of the medical home are associated with improved quality and equity of preventive care, advice on health habits, and emergency department use. We used adjusted risk ratios to examine the association between medical home characteristics and care measures based on the 2010 Medical Expenditure Panel Survey. Medical home characteristics are associated with 6 of the 11 outcome measures, including flu shots, smoking advice, exercise advice, nutrition advice, all advice, and emergency department visits. Educational and income groups benefit relatively equally from medical home characteristics. However, compared with insurance and access to a provider, medical home characteristics have little influence on overall disparities in care. In sum, our findings support that medical home characteristics can improve quality and reduce emergency visits but we find no evidence that medical home characteristics alleviate disparities in care.
Risk and Protective Factors for Suicidal Ideation in African American Women With a History of Sexual Violence as a Minor
Authors: Vinson Ebony S. , Oser Carrie B.
Published: March 2016

Compared with other ethnic groups, African Americans have the highest rate of childhood victimization. The literature is sparse with regard to suicidal ideation among African American women with a history of sexual violence as a minor. Using survey data, this study utilized logistic regression to investigate the roles of a risk factor, criminal justice involvement, and protective factors, ethnic identity, and spiritual well-being, in experiencing suicidal ideation. Findings suggest that criminal justice involvement and the interaction of ethnic identity and spiritual well-being are important factors in understanding which African American women may be at a greater risk of experiencing suicidal ideation.
Feline hip dysplasia
Authors: Perry Karen
Published: March 2016

Practical relevance:

The reported incidence of hip dysplasia (HD) in cats varies dramatically between studies, but the condition is likely more common than we realise. There is little doubt that cats with HD and associated osteoarthritis (OA) suffer pain, and this warrants appropriate therapy.

Diagnostic challenges:

Clinical signs of HD in cats are often gradual in onset, making them difficult to appreciate, but may include inactivity, pelvic limb lameness, difficulty jumping and climbing stairs, and reluctance to squat to defecate. Often lameness is bilateral, and can be particularly difficult to recognise. The most common radiographic finding is an abnormally shallow acetabulum. Subluxation, however, is not consistently associated with OA in cats and therefore the role that joint laxity plays in disease progression remains uncertain. Degenerative changes of the femoral head and neck seem to develop later than in the dog, and are less marked.

Therapeutic challenges:

The majority of cats respond to non-surgical management with environmental modulation, physical therapy, dietary modulation, weight loss, nutraceuticals and drug therapy. Should non-surgical management not provide sufficient relief, two salvage surgical options are available: femoral head and neck excision (FHNE) and total hip replacement (THR). While there is a risk of complications with micro-THR, the positive outcomes that have been reported indicate that it should be considered in the treatment of coxofemoral pathology in cats in the same way that THR is considered for larger dogs, especially given the inconsistent results associated with FHNE. Monitoring the effect of treatment is challenging as the assessment of pain in cats is complex and there is no validated scoring system or owner-completed questionnaire yet available for cats.

Evidence base:

There is a paucity of clinical reports focusing solely on HD in cats. The author draws on a combination of published studies, in cats, dogs and humans, as well as personal clinical experience.