bluuebunny/crossref_metadata_2025 huggingface dataset:
Two Hours on the Minnesota
Authors: Whitman Walt
Published: February 2024

From 7 to 9, aboard the United States school-ship Minnesota, lying up the North river. Captain Luce sent his gig for us about sundown, to the foot of Twenty-third street, and receiv’d us aboard with officer-like hospitality and sailor heartiness. There are several hundred...
Mature Summer Days and Nights
Authors: Whitman Walt
Published: February 2024

Aug. 4. — Forenoon — as I sit under the willow shade, (have retreated down in the country again,) a little bird is leisurely dousing and flirting himself amid the brook almost within reach of me. He evidently fears me not — takes me for some concomitant of...
Exposition Building —  New City Hall — River Trip
Authors: Whitman Walt
Published: February 2024

Philadelphia, Aug. 26. — Last night and to-night of unsurpass’d clearness, after two days’ rain; moon splendor and star splendor. Being out toward the great Exposition building, West Philadelphia, I saw it lit up, and thought I would go in. There was...
Missouri State
Authors: Whitman Walt
Published: February 2024

We should have made the run of 960 miles from Philadelphia to St. Louis in thirty-six hours, but we had a collision and bad locomotive smash about two-thirds of the way, which set as back. So merely stopping over night that time in St....
New Senses — New Joys
Authors: Whitman Walt
Published: February 2024

We follow the stream of amber and bronze brawling along its bed, with its frequent cascades and snow-white foam. Through the cañon we fly — mountains not only each side, but seemingly, till we get near, right in front of us — every rood a new...
Steam-Power, Telegraphs, &c.
Authors: Whitman Walt
Published: February 2024

I get out on a ten minutes’ stoppage at Deer creek, to enjoy the unequal’d combination of hill, stone and wood. As we speed again, the yellow granite in the sunshine, with natural spires, minarets, castellated perches far aloft — then long stretches of straight-upright palisades, rhinoceros...
The Spanish Peaks — Evening on the Plains
Authors: Whitman Walt
Published: February 2024

Between Pueblo and Bent’s fort, southward, in a clear afternoon sun-spell I catch exceptionally good glimpses of the Spanish peaks. We are in southeastern Colorado — pass immense herds of cattle as our first-class locomotive rushes us along — two or three times crossing the Arkansas, which we...
Prairie Analogies — The Tree Question
Authors: Whitman Walt
Published: February 2024

The word Prairie is French, and means literally meadow. The cosmical analogies of our North American plains are the Steppes of Asia, the Pampas and Llanos of South America, and perhaps the Saharas of Africa. Some think the plains have been originally lake-beds; others...
An Interviewer’s Item
Authors: Whitman Walt
Published: February 2024

Oct. 17, ’79. — To-day one of the newspapers of St. Louis prints the following informal remarks of mine on American, especially Western literature: “We called on Mr. Whitman yesterday and after a somewhat desultory conversation abruptly asked him: ‘Do you think we are to have...
President Hayes’s Speeches
Authors: Whitman Walt
Published: February 2024

Sept. 30. — I see President Hayes has come out West, passing quite informally from point to point, with his wife and a small cortege of big officers, receiving ovations, and making daily and sometimes double-daily addresses to the people. To these addresses — all impromptu, and some...
A Hint of Wild Nature
Authors: Whitman Walt
Published: February 2024

Feb. 13. — As I was crossing the Delaware to-day, saw a large flock of wild geese, right overhead, not very high up, ranged in V-shape, in relief against the noon clouds of light smoke-color. Had a capital though momentary view of them, and then of...
Reminiscence of Elias Hicks
Authors: Whitman Walt
Published: February 2024

June 8. — To-day a letter from Mrs. E. S. L., Detroit, accompanied in a little post-office roll by a rare old engraved head of Elias Hicks, (from a portrait in oil by Henry Inman, painted for J. V. S.,* must have been 60...
The Savage Saguenay
Authors: Whitman Walt
Published: February 2024

Up these black waters, over a hundred miles — always strong, deep, (hundreds of feet, sometimes thousands,) ever with high, rocky hills for banks, green and gray — at times a little like some parts of the Hudson, but much more pronounc’d and defiant. The hills rise higher — keep...
Death of Thomas Carlyle
Authors: Whitman Walt
Published: February 2024

Feb. 10, ’81. — And so the flame of the lamp, after long wasting and flickering, has gone out entirely.

As a representative author, a literary figure, no man else will bequeath to the future more significant hints of our stormy era, its fierce paradoxes, its...
A Couple of Old Friends — A Coleridge Bit
Authors: Whitman Walt
Published: February 2024

Latter
April. — Have run down in my country haunt for a couple of days, and am spending them by the pond. I had already discover’d my kingfisher here (but only one — the mate not here yet.) This fine bright morning, down by the creek, he has...
My Native Sand and Salt Once More
Authors: Whitman Walt
Published: February 2024

July 25, ’81. — Far Rockaway, L.I. — A good day here, on a jaunt, amid the sand and salt, a steady breeze setting in from the sea, the sun shining, the sedge-odor, the noise of the surf, a mixture of hissing and booming, the milk-white crests curling...
A Discovery of Old Age
Authors: Whitman Walt
Published: February 2024

Perhaps the best is always cumulative. One’s eating and drinking one wants fresh, and for the nonce, right off, and have done with it — but I would not give a straw for that person or poem, or friend, or city, or work of art, that...
Other Concord Notations
Authors: Whitman Walt
Published: February 2024

Though the evening at Mr. and Mrs. Sanborn’s, and the memorable family dinner at Mr. and Mrs. Emerson’s, have most pleasantly and permanently fill’d my memory, I must not slight other notations of Concord. I went to the old Manse, walk’d through the ancient...
Boston Common — More of Emerson
Authors: Whitman Walt
Published: February 2024

Oct. 10–13. — I spend a good deal of time on the Common, these delicious days and nights — every mid-day from 11.30 to about 1 — and almost every sunset another hour. I know all the big trees, especially the old elms along Tremont and Beacon streets, and have...
An Ossianic Night — Dearest Friends
Authors: Whitman Walt
Published: February 2024

Nov.,’81. — Again back in Camden. As I cross the Delaware in long trips to-night, between 9 and 11, the scene overhead is a peculiar one — swift sheets of flitting vapor-gauze, follow’d by dense clouds throwing an inky pall on everything. Then a spell of that transparent...
Death of Longfellow
Authors: Whitman Walt
Published: February 2024

Camden, April 3, ’82. — I have just return’d from an old forest haunt, where I love to go occasionally away from parlors, pavements, and the newspapers and magazines — and where, of a clear forenoon, deep in the shade of pines and cedars and a tangle of...
By Emerson’s Grave
Authors: Whitman Walt
Published: February 2024

May 6, ’82. — We stand by Emerson’s new-made grave without sadness — indeed a solemn joy and faith, almost hauteur — our soul-benison no mere

“Warrior, rest, thy task is done,”

for one beyond the warriors of the world lies surely symboll’d here. A just man, poised on himself,...
Sherlock Holmes Gives a Demonstration
Authors: Doyle Arthur Conan
Published: February 2024

‘Now, Watson,’ said Holmes, rubbing his hands, ‘we have half an hour to ourselves. Let us make good use of it. My case is, as I have told you, almost complete; but we must not err on the side of over-confidence. Simple as the...
The Episode of the Barrel
Authors: Doyle Arthur Conan
Published: February 2024

The police had brought a cab with them, and in this I escorted Miss Morstan back to her home. After the angelic* fashion of women, she had borne trouble with a calm face as long as there was someone weaker than herself...
A Break in the Chain
Authors: Doyle Arthur Conan
Published: February 2024

It was late in the afternoon before I woke, strengthened and refreshed. Sherlock Holmes still sat exactly as I had left him, save that he had laid aside his violin and was deep in a book. He looked across at me as I stirred,...
The Strange Story of Jonathan Small
Authors: Doyle Arthur Conan
Published: February 2024

A very patient man was that inspector in the cab, for it was a weary time before I rejoined him. His face clouded over when I showed him the empty box.

‘There goes the reward!’ said he gloomily. ‘Where there is no money there is...
The Memoirs of Sherlock Holmes
Authors: Doyle Arthur Conan , Killeen Jarlath
Published: February 2024

Silver Blaze*

‘I am afraid, Watson, that I shall have to go,’ said Holmes, as we sat down together to our breakfast one morning.

‘Go! Where to?’

‘To Dartmoor* — to King’s Pyland.’*

I was not surprised. Indeed, my only wonder...
Austin Ruthyn, of Knowl, and his daughter
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

It was winter — that is, about the second week in November — and great gusts were rattling at the windows, and wailing and thundering among our tall trees and ivied chimneys — a very dark night, and a very cheerful fire blazing, a pleasant mixture of good round coal...
Uncle Silas
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

When we reached the drawing-room, I resumed my chair, and my father his slow and regular walk to and fro, in the great room. Perhaps it was the uproar of the wind that disturbed the ordinary tenor of his thoughts; but, whatever was the...
A new face
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

I think it was about a fortnight after that conversation in which my father had expressed his opinion, and given me the mysterious charge about the old oak cabinet in his library, as already detailed, that I was one night sitting at the...
Madame de la Rougierre
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

On a sudden, on the grass before me, stood an odd figure — a very tall woman in grey draperies, nearly white under the moon, courtesying extraordinarily low, and rather fantastically.

I stared in something like a horror upon the large and rather hollow features which I...
A walk in the wood
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

Two little pieces of by-play in which I detected her confirmed my unpleasant suspicion. From the corner of the gallery I one day saw her, when she thought I was out and all quiet, with her ear at the keyhole of papa’s study, as...
Lady Knollys sees the features
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

Perhaps, if Madame had murmured, ‘It is quite well — pray permit me to sleep,’ she would have escaped an awkwardness. But having adopted the rôle of the exhausted slumberer, she could not consistently speak at the moment; neither would it do, by main force, to...
An adventure
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

For many days after our quarrel, Madame hardly spoke to me. As for lessons, I was not much troubled with them. It was plain, too, that my father had spoken to her, for she never after that day proposed our extending our walks beyond...
A midnight visitor
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

The frightful warnings of Lady Knollys haunted me too. Was there no escape from the dreadful companion whom fate had assigned me? I made up my mind again and again to speak to my father and urge her removal. In other things he indulged...
Au revoir
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

Mrs. Rusk was fond of assuring me that Madame ‘did not like a bone in my skin’. Instinctively I knew that she bore me no good-will, although I really believe it was her wish to make me think quite the reverse. At...
Somebody in the room with the coffin
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

When we returned, a ‘young’ gentleman had arrived. We saw him in the parlour as we passed the window. It was simply a glance, but such a one as suffices to make a photograph, which we can study afterwards, at our leisure. I remember...
The opening of the will
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

Perhaps the terror with which I anticipated the hour of one, and the disclosure of the unknown undertaking to which I had bound myself, was irrational and morbid. But, honestly, I doubt it; my tendency has always been that of many other weak characters,...
I am persuaded
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

So now at last I had heard the story of Uncle Silas’s mysterious disgrace. We sat silent for a while, and I, gazing into vacancy, sent him in a chariot of triumph, chapletted,* ringed, and robed through the city of imagination, crying...
On the road
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

All at Knowl was indicative of the break-up that was so near at hand. Doctor Bryerly arrived according to promise. He was in a whirl of business all the time. He and Mr. Danvers conferred about the management of the estate. It was agreed...
Uncle Silas
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

I thought my odd cousin was also impressed with a kind of awe, though different in degree from mine, for a shade overcast her face, and she was silent as we walked side by side along the gallery, accompanied by the crone who...
The windmill wood
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

I had not time to explore this noble old house as my curiosity prompted; for Milly was in such a fuss to set out for the ‘blackberry dell’ that I saw little more than just so much as I necessarily traversed in making...
An arrival at dead of night
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

I have sometimes been asked why I wear an odd little tourquoise ring — which to the uninstructed eye appears quite valueless and altogether an unworthy companion of those jewels which flash insultingly beside it. It is a little keepsake, of which I became possessed...
Cousin Monica and Uncle Silas meet
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

Cousin Monica, with her hands upon Milly’s shoulders, looked amusedly and kindly in her face. ‘And,’ said she, ‘we must be very good friends — you funny creature, you and I. I’m allowed to be the most saucy old woman in Derbyshire — quite incorrigibly privileged; and nobody...
Elverston and its people
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

So Milly and I drove through the gabled high street of Feltram next day. We saw my gracious cousin smoking with a man like a groom, at the door of the ‘Plume of Feathers’. I drew myself back as we passed, and Milly popped...
Doctor Bryerly reappears
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

No one who has not experienced it can imagine the nervous disgust and horror which such a spectacle as we had been forced in part to witness, leaves upon the mind of a young person of my peculiar temperament.

It affected ever after my involuntary...
Question and answer
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

My uncle, after all, was not ill that day, after the strange fashion of his malady, be it what it might. Old Wyat repeated in her sour laconic way that there was ‘nothing to speak of amiss with him.’ But there remained with me...
The foot of Hercules
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

I stood at the window — still the same leaden sky and feathery sleet before me — trying to estimate the magnitude of the discovery I had just made. Gradually a kind of despair seized me, and I threw myself passionately on my bed, weeping aloud.

Good Mary Quince...
The letter
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

‘Come away, lass,’ whispered Beauty, very pale; ‘he’s here — Tom Brice.’

And she led the way, shoving aside the leafless underwood, and we reached Tom. The slender youth, groom or poacher — he might answer for either — with his short coat and gaitered legs, was sitting on a...
Lady Knollys’ carriage
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

Next morning, it was Sunday, I lay in my bed in my dressing-gown, dull, apathetic, with all my limbs sore, and, as I thought, rheumatic, and feeling so ill that I did not care to speak or lift my head. My recollection of what...
A sudden departure
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

‘Mary,’ said I, ‘I am miserably anxious to hear what Madame may have to tell; she knows the state I am in, and she would not take so much trouble as to look in at my door to say a word. Did you...
Our bed-chamber
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

I had passed a miserable night, and, indeed, for many nights had not had my due proportion of sleep. Still I sometimes fancy that I may have swallowed something in my tea that helped to make me so irresistibly drowsy. It was a...
Conclusion
Authors: Le Fanu Sheridan , Connolly Claire
Published: February 2024

Oh, my beloved Cousin Monica! Thank Heaven, you are living still; and younger, I think, than I in all things but in years.

And Milly, my dear companion, she is now the happy wife of that good little clergyman, Sprigge Biddlepen. It has been...
Place Names The Name
Authors: Proust Marcel
Published: February 2024

Of all the bedrooms I pictured to myself as I lay awake at night, none was less like the rooms in Combray, powdery with a grainy, pollenated, almost edible atmosphere, redolent of piety, than the room at the Grand-Hôtel de la Plage at...
The Little White Bird (1902)
Authors: Barrie J. M.
Published: February 2024

The Grand Tour of the Gardens

You must see for yourselves that it will be difficult to follow our adventures unless you are familiar with the Kensington Gardens,* as they now became known to David.* They are in London,...
Peter Pan or The Boy Who Would Not Grow Up (1928)
Authors: Barrie J. M.
Published: February 2024

CHARACTERS (in order of appearance)

Nana (a dog and the children’s nursemaid)

Michael

Mrs Darling

JohnWendy

Mr Darling

Peter Pan

Liza

Tinker Bell

Slightly

Tootles

Nibs

Curly

First Twin

Second Twin

Captain Hook

Cecco

Bill Jukes

Cookson

Gentleman Starkey

Skylights

Mullins

Noodler

Smee

Tiger...
Canadian developmental pediatrics workforce survey
Authors: McLeod Scott A , Eliason Sabrina , Penner Melanie , Mickelson Elizabeth , Marello Ana , Fehlings Darcy
Published: February 2024

BACKGROUND

Neurodevelopmental conditions are common, and many of these conditions benefit from specialized developmental assessments or services from a developmental pediatric clinic. There is limited data about the supply of developmental pediatric subspecialists and limited knowledge about the sustainability of the current workforce providing this care in Canada.

OBJECTIVES

To understand the current Canadian developmental pediatric workforce, we conducted a survey to determine: (1) The demographic profile of developmental pediatric professionals who comprise the current workforce and their career plans; (2) The challenges and trends to inform future resource planning; and (3) Opportunities for innovative provision of developmental care in pediatrics.

DESIGN/METHODS

A 31-item questionnaire was cross-sectionally distributed to practicing developmental pediatricians in Canada. The Royal College of Physicians and Surgeons and Canadian Pediatric Society Section of Developmental Pediatrics assisted with the distribution of the survey to its membership. Results were analyzed with descriptive statistics.

RESULTS

A total of 145 participants completed the study (91% response). Forty-six percent (n = 65) of the participants had >20 years of experience. Within the next 3 to 5 years, 23% (n = 32) of respondents’ plan to retire completely from practice. Trends influencing the present workload of developmental pediatricians included: (1) requirements for translation services (endorsed by 70% of respondents); (2) coordination issues with multidisciplinary assessments (endorsed by 64%); and (3) the influence of government funding resources for specific neurodevelopmental disorders (endorsed by 32%).

CONCLUSIONS

Addressing issues affecting developmental pediatrician workload and increasing the developmental pediatric workforce will be vital to address current needs. The viability of specialized developmental care in Canada will rely on recruitment and identifying barriers that inhibit trainees and physicians from choosing to practice in the field of developmental pediatrics.
Image quality in CT thorax: effect of altering reconstruction algorithm and tube load
Authors: Kataria Bharti , Woisetschläger Mischa , Nilsson Althén Jonas , Sandborg Michael , Smedby Örjan
Published: February 2024

Non-linear properties of iterative reconstruction (IR) algorithms can alter image texture. We evaluated the effect of a model-based IR algorithm (advanced modelled iterative reconstruction; ADMIRE) and dose on computed tomography thorax image quality. Dual-source scanner data were acquired at 20, 45 and 65 reference mAs in 20 patients. Images reconstructed with filtered back projection (FBP) and ADMIRE Strengths 3–5 were assessed independently by six radiologists and analysed using an ordinal logistic regression model. For all image criteria studied, the effects of tube load 20 mAs and all ADMIRE strengths were significant (p < 0.001) when compared to reference categories 65 mAs and FBP. Increase in tube load from 45 to 65 mAs showed image quality improvement in three of six criteria. Replacing FBP with ADMIRE significantly improves perceived image quality for all criteria studied, potentially permitting a dose reduction of almost 70% without loss in image quality.
Guided Online Mindfulness-Based Intervention for Community Residents with Emotional Distress during the COVID-19 Pandemic
Authors: Young Daniel Kim-wan , Carlbring Per , Cheng Daphne Yi-ting , Ng Siu-man , Ng Petrus Yat-nam , Chen Joseph Qi-rong
Published: February 2024

This study aimed to assess the efficacy of a guided online mindfulness-based intervention (iMBI) for community residents experiencing emotional distress during the COVID-19 pandemic in Hong Kong. In a randomized controlled trial, 64 participants were recruited from collaborating community-based mental health service units in Hong Kong and assigned to either the treatment (n = 32) or control (n = 32) groups. The treatment group received a guided iMBI consisting of 16 online modules, weekly telephone counseling, and two half-day online workshops on mindfulness practice. In contrast, the waitlist control group did not receive any intervention during the initial stage. Using a 2 (two groups) × time (pre versus post) repeated measures linear mixed model and one-way analysis of variance, authors demonstrated that the treatment group experienced a significantly larger reduction in anxiety and depressive symptoms with a large effect size compared with the control group. Additionally, the treatment group showed a significantly greater improvement in mindfulness with a moderate effect size. The findings support the effectiveness of guided iMBI for community residents experiencing emotional distress during the COVID-19 pandemic in Hong Kong.
Top 50 most cited articles about female sexual dysfunction: a bibliometric analysis
Authors: Gong Susan , Yim Samuel , Kabarriti Abdo
Published: February 2024

Introduction

Female sexual dysfunction (FSD) consists of low libido, sexual arousal problems, anorgasmia, and dyspareunia. Sexual function is an important aspect of life for many women and is closely correlated with overall well-being. FSD is often underrepresented in the academic space when compared with male sexual disorders, such as erectile dysfunction. As FSD spans many fields (eg, urology, gynecology, psychology), bibliometric analyses are an important resource to highlight landmark articles.

Objectives

To identify key articles about FSD by citation number and bibliometric analysis to facilitate future scholarly efforts into more FSD research.

Methods

We searched for articles in the Web of Science Core Collection between 1900 and 2023 using terms specific to FSD. We identified relevant FSD articles and selected the top 50 most cited. A bibliometric analysis was performed to collect and analyze data about title, authorship, publication year, citation number, journal and impact factor, country and institution, study type, citation index, specialty, and conflict of interest.

Results

An overall 6858 results were identified. The top 50 most cited articles were published between 1997 and 2014 in 12 countries, across 32 institutions, and in 20 journals. The United States produced the most articles. The Journal of Sexual Medicine published the most articles. The mean number of citations per article was 351.64. Observational studies were most common. More than half were sponsored. Of all the specialties, most articles were categorized as urology and nephrology. Research about FSD has been much less impactful than research about male sexual dysfunction, possibly owing to stigma and decreased clinical training.

Conclusion

As FSD covers many fields, bibliometric analyses are invaluable to understand the vast body of knowledge. We hope that this research emphasizes the lack of attention that FSD has had and that it provides health care professionals with a valuable tool to understand the trajectory of FSD to guide future education efforts.
Deciphering a crucial dimeric interface governing Norrin dimerization and the pathogenesis of familial exudative vitreoretinopathy
Authors: Zhao Rulian , Liu Min , Dai Erkuan , Chen Chen , Lv Liting , Peng Li , He Yunqi , Li Shujin , Yang Mu
Published: February 2024

Familial exudative vitreoretinopathy (FEVR) is a hereditary eye disease that could cause blindness. It has been established that Norrin forms dimers to activate β‐catenin signaling, yet the core interface for Norrin dimerization and the precise mechanism by which Norrin dimerization contributes to the pathogenesis of FEVR remain elusive. Here, we report an NDP variant, c.265T>C (p.Phe89Leu), that interrupted β‐catenin signaling by disrupting Norrin dimerization. Structural and functional analysis revealed that the Phe‐89 of one Norrin monomer interacts with Pro‐98, Ser‐101, Arg‐121, and Ile‐123 of another, forming two core symmetrical dimerization interfaces that are pivotal for the formation of a “hand‐by‐arm” dimer. Intriguingly, we proved that one of the two core symmetrical interfaces is sufficient for dimerization and activation of β‐catenin signaling, with a substantial contribution from the Phe‐89/Pro‐98 interaction. Further functional analysis revealed that the disruption of both dimeric interfaces eliminates potential binding sites for LRP5, which could be partially restored by over‐expression of TSPAN12. In conclusion, our findings unveil a core dimerization interface that regulates Norrin/LRP5 interaction, highlighting the essential role of Norrin dimerization on β‐catenin signaling and providing potential therapeutic avenues for the treatment of FEVR.
Assessment of Interaural Attenuation in Infants and Young Children Using Bone-Conducted Auditory Brainstem Response
Authors: Kariv Liron , Taitelbaum-Swead Riki , Levit Yael
Published: February 2024

Objectives:

In hearing assessment, the term interaural attenuation (IAA) is used to quantify the reduction in test signal intensity as it crosses from the side of the test ear to the nontest ear. In the auditory brainstem response (ABR) testing of infants and young children, the size of the IAA of bone-conducted (BC) stimuli is essential for the appropriate use of masking, which is needed for the accurate measurement of BC ABR thresholds. This study aimed to assess the IAA for BC ABR testing using 0.5 to 4 kHz narrowband (NB) CE-chirp LS stimuli in infants and toddlers with normal hearing from birth to three years of age and to examine the effects of age and frequency on IAA.

Design:

A total of 55 infants and toddlers with normal hearing participated in the study. They were categorized into three age groups: the young group (n = 31, infants from birth to 3 mo), middle-aged group (n = 13, infants aged 3–12 mo), and older group (n = 11, toddlers aged 12–36 mo). The participants underwent BC ABR threshold measurements for NB CE-chirp LS stimuli at 0.5 to 4 kHz. For each participant, one ear was randomly defined as the “test ear” and the other as the “nontest ear.” BC ABR thresholds were measured under two conditions. In both conditions, traces were recorded from the channel ipsilateral to the test ear, whereas masking was delivered to the nontest ear. In condition A, the bone oscillator was placed on the mastoid of the test ear, whereas in condition B, the bone oscillator was placed on the mastoid contralateral to the test ear. The difference between the thresholds obtained under conditions A and B was calculated to assess IAA.

Results:

The means of IAA (and range) in the young age group for the frequencies 0.5, 1, 2, and 4 kHz were 5.38 (0–15) dB, 11.67 (0–30) dB, 21.15 (10–40) dB, and 23.53 (15–35) dB, respectively. Significant effects were observed for both age and frequency on BC IAA. BC IAA levels decreased with age from birth to 36 mo. In all age groups, smaller values were observed at lower frequencies and increased values were observed at higher frequencies.

Conclusions:

BC IAA levels were both age and frequency dependent. The study found that the BC IAA values for lower stimulus frequencies were smaller than previously assumed, even in infants younger than 3 mo. These results suggest that masking should be applied in BC ABR threshold assessments for NB CE-chirp LS stimuli at 0.5, 1, and 2 kHz, even in young infants. Masking may not be necessary for testing at 4 kHz if a clear response is obtained at 15 dB normal-hearing level (nHL) in infants younger than 3 mo.
Low osteotomy cut of Dega procedure for older children with developmental dysplasia of the hip
Authors: Du Ming-Hua , Xu Rui-Jiang , Li Wen-Chao , Zhu Hai-Yan
Published: February 2024

The effect on acetabular management in developmental dysplasia of the hip (DDH) patients aged 7 or older with modified low Dega osteotomy procedure was evaluated. Patients between 7 and 14 years old were managed with modified low Dega osteotomy and open reduction and concomitant procedures to evaluate whether low level osteotomy improved the clinical and radiologic outcomes after treatment. Clinical status was assessed using the modified McKay’s criteria; radiologic evaluations were assessed for the modified Severin classification, the mean acetabular index (AI), Sharp angle and center-edge (CE) angle. And occurrence of triradiate cartilage injury and complications was recorded. Forty-two DDH patients (57 hips) between 7 and 14 years old were managed with modified low Dega osteotomy. The results demonstrated the latest follow-up 43 hips (75.4%) were rated excellent and 10 hips (17.5%) rated good according to the modified McKay criteria and 41 hips (71.9%) were rated excellent and 11 hips (19.3%) rated good according to Modified Severin classification, respectively. The mean Hip Score improved from 69.53 ± 7.14 before the operation to 93.17 ± 8.43 at the final follow-up. The mean AI changed from 31.9° to 20.2°, mean Sharp angle decreased from 59.3° to 38.8° and mean CE angle increased from −10.9° to 35.2°, preoperatively and at latest follow-up, respectively. The modified low Dega osteotomy combined with open reduction and concomitant procedures were found to be adequate in improving instant and sustained clinical and radiographic outcomes for the late detected pediatric walking DDH patients.
Third Time’s the Charm? Indications and Outcomes for Redo-Redo Ileal Pouch-Anal Anastomosis
Authors: Maspero Marianna , Lavryk Olga , Holubar Stefan D. , Lipman Jeremy , Steele Scott R , Hull Tracy
Published: February 2024

BACKGROUND:

Up to 20% to 40% cases of redo ileal pouch anal anastomosis will result in pouch failure. Whether to offer a second redo procedure to maintain intestinal continuity remains a controversial decision.

OBJECTIVE:

To report our institutional experience of second redo ileal pouch anal anastomosis procedures.

DESIGN:

This was a retrospective review. Patient-reported outcomes were compared between patients undergoing second redos with those of patients undergoing first redos using propensity score matching to balance the 2 cohorts.

SETTINGS:

Tertiary referral center.

PATIENTS:

Patients who underwent second redo ileal pouch anal anastomosis procedures between 2004 and 2021.

INTERVENTIONS:

Second redo ileal pouch anal anastomosis.

MAIN OUTCOME MEASURES:

Pouch survival, patient-reported outcomes measured using the Cleveland Global Quality of Life survey.

RESULTS:

Twenty-three patients were included (65% female), 20 (87%) with an index diagnosis of ulcerative colitis and 3 (13%) with indeterminate colitis. Final diagnosis was changed to Crohn’s disease in 8 (35%) cases. The indication for pouch salvage was the same for the first and second redo in 21 (91%) cases: 20 (87%) patients had both redo ileal pouch anal anastomoses for septic complications. After a median follow up of 39 months (interquartile range, 18.5 – 95.5), pouch failure occurred in 8 (30%) cases (7 cases due to sepsis, of which 3 never had their stoma closed, and 1 case due to poor function); all patients who experience pouch failure underwent the second redo due to septic complications. Overall pouch survival at 3 years was 76%: 62.5% in patients with final diagnosis of Crohn’s disease, versus 82.5% in ulcerative/indeterminate colitis (p = 0.09). Overall quality of life score (0 -1) was 0.6 (0.5 – 0.8). Quality of life and functional outcomes were comparable between first and second redos, except incontinence, which was higher in second redos.

LIMITATIONS:

Single center retrospective review.

CONCLUSIONS:

A second pouch salvage procedure may be offered with acceptable outcomes to selected patients with high motivation to keep intestinal continuity. See Video Abstract.
Pharmacogenetic considerations in therapy with novel antiplatelet and anticoagulant agents
Authors: Yazbeck Anthony , Akika Reem , Awada Zainab , Zgheib Nathalie K.
Published: February 2024

Antiplatelets and anticoagulants are extensively used in cardiovascular medicine for the prevention and treatment of thrombosis in the venous and arterial circulations. Wide inter-individual variability has been observed in response to antiplatelets and anticoagulants, which triggered researchers to investigate the genetic basis of this variability. Data from extensive pharmacogenetic studies pointed to strong evidence of association between polymorphisms in candidate genes and the pharmacokinetics and pharmacodynamic action and clinical response of the antiplatelets clopidogrel and the anticoagulant warfarin. In this review, we conducted an extensive search on Medline for the time period of 2009–2023. We also searched the PharmGKB website for levels of evidence of variant-drug combinations and for drug labels and clinical guidelines. We focus on the pharmacogenetics of novel antiplatelets and anticoagulants while excluding acetylsalicylic acid, warfarin and heparins, and discuss the current knowledge with emphasis on the level of evidence.
A modified Hospital Frailty Risk Score for patients with cirrhosis undergoing abdominal operations
Authors: Calthorpe Lucia , Chiou Sy Han , Rubin Jessica , Huang Chiung-Yu , Feng Sandy , Lai Jennifer
Published: February 2024

Background and Aims:

Existing tools for perioperative risk stratification in patients with cirrhosis do not incorporate measures of comorbidity. The Hospital Frailty Risk Score (HFRS) is a widely used measure of comorbidity burden in administrative dataset analyses. However, it is not specific to patients with cirrhosis, and application of this index is limited by its complexity.

Approach and Results:

Adult patients with cirrhosis who underwent nontransplant abdominal operations were identified from the National Inpatient Sample, 2016–2018. Adjusted associations between HFRS and in-hospital mortality and length of stay were computed with logistic and Poisson regression. Lasso regularization was used to identify the components of the HFRS most predictive of mortality and develop a simplified index, the cirrhosis-HFRS. Of 10,714 patients with cirrhosis, the majority were male, the median age was 62 years, and 32% of operations were performed electively. HFRS was associated with an increased risk of both in-hospital mortality (OR=6.42; 95% CI: 4.93, 8.36) and length of stay (incidence rate ratio [IRR]=1.79; 95% CI: 1.72, 1.88), with adjustment. Using lasso, we found that a subset of 12 of the 109 ICD-10 codes within the HFRS resulted in superior prediction of mortality in this patient population (AUC = 0.89 vs. 0.79, p < 0.001).

Conclusions:

While the 109-component HFRS was associated with adverse surgical outcomes, 12 components accounted for much of the association between the HFRS and mortality. We developed the cirrhosis-HFRS, a tool that demonstrates superior predictive accuracy for in-hospital mortality and more precisely reflects the specific comorbidity pattern of hospitalized patients with cirrhosis undergoing general surgery procedures.
Office-Based Transperineal Laser Ablation for Benign Prostatic Hyperplasia Under Local Anesthesia: 2-Year Results from a Dose Range Confirmatory Trial
Authors: Bianco Fernando J. , Luna Eusebio , Lopez-Prieto Alberto , González Pedro , Gheiler Edward L. , Kaufman Ariel M. , Avila Luis , Maiolino Giuseppe
Published: February 2024

Purpose:

To evaluate the safety and tolerability profile of transperineal laser ablation (TPLA) for patients with benign prostatic hyperplasia in an office setting under sedative-free anesthesia, including the functional outcome results at 24 months.

Materials and Methods:

This is a prospective, single-center, dose range confirmatory trial involving 20 male patients. TPLA was performed by urologists in an office setting, using nonsedative local anesthesia. Self-administered nitrous oxide/oxygen dissociating gas was optional. Tolerability was assessed using a visual analog scale. Safety was evaluated by recording Grade 3 or worse adverse events within 30 days after the procedure. International Prostate Symptom Score, Sexual Health Inventory for Men, ejaculation function, and uroflowmetry parameters were assessed at 6, 12, and 24 months.

Results:

All 20 procedures were performed as intended without request of cessation from any patient, who tolerated them very well, recording a median pain score of 2 (range 1-4). It is important to note that there was a rapid escalation of dose, and the last 18 consecutive patients were initiated at the maximal energy dose of 7 watts. No hospital transfers were recorded, and no urgent hospital admissions within 30 days post-procedure occurred. There was 1 Grade 3 complication registered during the 24-month study interval. We observed a statistically significant and sustained reduction in the median International Prostate Symptom Score at 6 months (6, 3-8), 12 months (3, 5-2), and 24 months (3, 2-4) when compared with baseline values (14, 12-17). Uroflowmetry parameters showed a similar trend. The median Sexual Health Inventory for Men values did not change significantly, and only approximately 10% of patients reported absence of anterograde ejaculation at 12 and 24 months.

Conclusions:

TPLA for benign prostatic hyperplasia is a safe and well-tolerated office-based procedure, with durable benefits on functional outcomes over 2 years of follow-up. Further studies are required to confirm these results.

NCT:

NCT04760483.
Management of Fallopian Canal Spontaneous CSF Leaks, Implications of Elevated Intracranial Pressure: Case Report and Systematic Review of the Literature
Authors: Saltagi Abdul K. , Saltagi Mohamad Z. , Kedo Mahmood , Shah Mitesh V. , Nelson Rick F.
Published: February 2024

Objectives

Describe the diagnosis and management of a spontaneous cerebrospinal fluid leak (sCSF-L) through the facial nerve fallopian canal and determine the role of intracranial hypertension (IH).

Study Design

Retrospective case study and systematic review of the literature.

Methods

Reviewed patient characteristics, radiographic findings, and management of the facial nerve canal CSF leak and postoperative IH. Conducted systematic literature review according to the PRISMA guidelines for surgical management and rates of IH.

Results

A 50-year-old female with bilateral tegmen defects and temporal encephaloceles underwent left middle cranial fossa (MCF) repair. Intraoperative CSF egressed from the temporal bone tegmen defects. Facial nerve decompression revealed CSF leak from the labyrinthine segment. A nonocclusive temporalis muscle plug was placed in the fallopian canal, and tegmen repair was completed with bone cement. A ventriculoperitoneal shunt was placed for IH. Postoperative facial nerve function and hearing were normal. A total of 20 studies met inclusion criteria with a total of 25 unique patients. Of 13 total adult cases of fallopian canal CSF leak, there is a 46% recurrence rate, and 86% of patients had documented IH when tested.

Conclusions

Fallopian canal CSF leaks are rare and challenging to manage. Assessment of intracranial hypertension and CSF diversion is recommended along with MCF skull base repair to preserve facial nerve function and conductive hearing.
The Role of Lumbar Drains in the Perioperative Management of Primary Spontaneous Temporal Lobe Encephaloceles and Cerebrospinal Fluid Leaks
Authors: Schwam Zachary G. , Mavrommatis Maria , Gidumal Sunder , Carrasquilla Alejandro , Shrivastava Raj , Perez Enrique R. , Cosetti Maura K. , Wanna George B.
Published: February 2024

Objective

To examine the role of lumbar drains (LDs) in the success of spontaneous temporal cerebrospinal fluid (CSF) leak and encephalocele repair.

Study design

Retrospective cohort study.

Setting

Tertiary academic health system.

Patients

Patients undergoing repair of spontaneous temporal lobe encephaloceles or middle fossa CSF leaks during years 2017 to 2023.

Interventions

Transmastoid, middle fossa craniotomy, or combination approaches to CSF leak repair.

Outcome measures

Failure rate, complication rate, length of stay (LOS), readmission.

Results

Sixty-nine patients were included, with a combination approach performed in 78.3%, transmastoid in 17.4%, and isolated middle fossa craniotomy in 4.3%. Mean body mass index was 33.2, mean bony defect size width was 6.51 mm, and defect locations included the epitympanum, antrum, mastoid, and petrous apex. Multilayer closure with three or more layers was performed in 87.0%. LD was used in 73.9% of cases for a mean duration 2.27 days and was associated with longer LOS (3.27 vs. 1.56 d, p = 0.006) but not with failure rate, complications, discharge destination, or readmission. Only one major complication occurred as a result of the drain, but low-pressure headache was anecdotally common.

Conclusions

Use of LD in the repair of spontaneous CSF leaks and temporal lobe encephaloceles is associated with longer LOS but not failure rates or other admission-level outcomes.
Intermediate Cervical Plexus Block in the Management of Refractory Somatosensory Tinnitus Following Whiplash: Prospective Series in 30 Patients
Authors: Kukreja Yuvraj , Lee Hayun , Morsy Mohamed , Niraj G
Published: February 2024

Objective

Whiplash-associated disorder comprises of a constellation of persistent symptoms after neck trauma. Tinnitus that develops postwhiplash is termed somatosensory tinnitus. The objective is to assess the role of intermediate cervical plexus block (iCPB) in patients with somatosensory tinnitus secondary to whiplash.

Methods

Prospective service evaluation in adults with whiplash-associated disorder and concomitant somatosensory tinnitus. Patients underwent specialist otorhinolaryngology review before pain clinic referral. Patients were offered ultrasound-guided iCPB with steroids. Intensity of tinnitus was recorded on a numerical rating scale at baseline, 3 and 6 months posttreatment. Brief Pain Inventory Short Form and Hospital Anxiety Depression Scale questionnaires were also completed.

Results

Over a 36-month period, 32 patients with refractory somatosensory tinnitus following whiplash were offered iCPB(s). Two patients refused because of needle phobia. iCPB(s) was performed in 30 patients as an outpatient procedure. One patient (1/30, 3.3%) was lost to follow-up. Twenty-three patients (23/30, 77%) reported clinically significant reduction in intensity of tinnitus at 3 months postprocedure. Nineteen patients (19/30, 63%) reported ongoing benefit at 6-month follow-up. Six patients failed to report any benefit (6/30, 20%).

Conclusion

The cervical plexus could play a significant role in the development of somatosensory tinnitus after whiplash. iCPB may have a role in the management of somatosensory tinnitus in this cohort.
Variability in Manual Segmentation of Temporal Bone Structures in Cone Beam CT Images
Authors: Lee Julian W. , Andersen Steven Arild Wuyts , Hittle Bradley , Powell Kimerly A. , Al-Fartoussi Hagar , Banks Laura , Brannen Zachary , Lahchich Mariam , Wiet Gregory J.
Published: February 2024

Purpose

Manual segmentation of anatomical structures is the accepted “gold standard” for labeling structures in clinical images. However, the variability in manual segmentation of temporal bone structures in CBCT images of the temporal bone has not been systematically evaluated using multiple reviewers. Therefore, we evaluated the intravariability and intervariability of manual segmentation of inner ear structures in CBCT images of the temporal bone.

Methods

Preoperative CBCTs scans of the inner ear were obtained from 10 patients who had undergone cochlear implant surgery. The cochlea, facial nerve, chorda tympani, mid-modiolar (MM) axis, and round window (RW) were manually segmented by five reviewers in two separate sessions that were at least 1 month apart. Interreviewer and intrareviewer variabilities were assessed using the Dice coefficient (DICE), volume similarity, mean Hausdorff Distance metrics, and visual review.

Results

Manual segmentation of the cochlea was the most consistent within and across reviewers with a mean DICE of 0.91 (SD = 0.02) and 0.89 (SD = 0.01) respectively, followed by the facial nerve with a mean DICE of 0.83 (SD = 0.02) and 0.80 (SD = 0.03), respectively. The chorda tympani had the greatest amount of reviewer variability due to its thin size, and the location of the centroid of the RW and the MM axis were also quite variable between and within reviewers.

Conclusions

We observed significant variability in manual segmentation of some of the temporal bone structures across reviewers. This variability needs to be considered when interpreting the results in studies using one manual reviewer.