bluuebunny/crossref_metadata_2025 huggingface dataset:
Petrous Apex Cholesterol Granuloma Involving the Sphenoid Sinus
Authors: Korbmacher Dirk , Lehmann Martin , Gehl Hans-Björn , Ebmeyer Jörg , Sudhoff Holger
Published: January 2019

Petrous apex cholesterol granulomas are slowly expanding lesions that clinically present with a variety of cranial nerve deficits. We present a case of a 40-year-old man with a right-sided, sudden-onset hearing loss. Apart from a 60-dB high-frequency sensorineural hearing loss in the right ear, all other neurotologic examinations were normal. Computed tomography revealed partial destruction of the right carotid canal, petrous apex, and clivus. Surgical treatment was performed via an endoscopic transnasal, trans-sphenoid approach using an image-guidance system. Postoperative magnetic resonance imaging showed a significant reduction in the size of the cholesterol granuloma and a stable hearing threshold.
Nasal Eosinophilia as a Marker for Allergic Rhinitis: A Controlled study of 50 Patients
Authors: Ahmadiafshar Akefeh , Taghiloo Daryoosh , Esmailzadeh Abdolreza , Falakaflaki Behnaz
Published: January 2019

Eosinophils are the principal effector cells involved in the pathogenesis of allergic inflammation. We conducted a study to investigate the validity of the nasal smear examination for detecting eosinophilia in patients with allergic rhinitis. Our study group was made up of 50 patients with allergic rhinitis and 50 age- and sex-matched controls without allergic rhinitis. Smears were obtained from nasal secretions in both groups and then fixed, stained, and studied under light microscopy. Statistical analysis revealed that the odds ratio for eosinophilia positivity in nasal smears in the rhinitis group was 25.61 with a 95% confidence interval of 8 to 78. The sensitivity, specificity, positive predictive value, and negative predictive value of this test were 74, 90, 88, and 77%, respectively. We conclude that the nasal eosinophilia test is highly specific and moderately sensitive in diagnosing allergic rhinitis, and that it therefore can be used as an easy, noninvasive, and inexpensive procedure for screening patients and for conducting epidemiologic studies of this disorder.
The Effects of Tumor Size, Degree of Differentiation, and Depth of Invasion on the risk of Neck Node Metastasis in Squamous Cell carcinoma of the Oral Cavity
Authors: Haksever Mehmet , İnançlí Hasan Mete , Tunçel Ümit , Kürkçüoğlu Şefik Sinan , Uyar Melek , Genç Ömer , Irkkan Çiğdem
Published: January 2019

Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables—tumor size, degree of differentiation, and depth of invasion—on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We conclude that the prevalence of neck lymph node metastasis inpatients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases and as the degree of tumor differentiation decreases from well to poor, as has been shown in previous studies. It is interesting that tumor size, which is the most important component of the TNM system, was not significantly associated with neck node involvement.
The Association between Helicobacter Pylori and Laryngopharyngeal Reflux in Laryngeal Pathologies
Authors: Çekin Engin , Ozyurt Mustafa , Erkul Evren , Ergunay Koray , Cincik Hakan , Kapucu Burak , Gungor Atila
Published: January 2019

We conducted a study to determine the presence or absence of Helicobacter pylori and laryngopharyngeal reflux (LPR) in 43 previously untreated patients who had presented with a laryngeal lesion. Our aim was to determine if there was any association among H pylori, LPR, and laryngeal lesions. H pylori status was determined by real-time polymerase chain reaction (PCR) assays of biopsy tissue obtained during direct laryngoscopy. The presence or absence of LPR was determined on the basis of patients’ reflux symptom index (RSI) and reflux finding score (RFS), which were based on their questionnaire responses and findings on endoscopic examination of the larynx, respectively. Patients with an RSI of 14 or more and/or an RFS of 8 or more were considered to have LPR. H pylori was present in 24 patients (55.8%) and absent in 19 (44.2%)—not a statistically significant difference. The prevalence of LPR was higher than the prevalence of H pylori; it was present in 30 patients (69.8%) and absent in 13 (30.2%). The difference was statistically significant (p = 0.01). We found no association between H pylori status and LPR status. Additionally, we analyzed two subgroups based on whether their lesions were benign or malignant/premalignant and found a significant relationship between LPR positivity and the presence of malignant/premalignant laryngeal lesions (p = 0.03). We found no association between H pylori status and either of the two subgroup categories.
Two-Flap Palatoplasty: Description of the Surgical Technique and reporting of Results at a Single Center
Authors: Koudoumnakis Emmanouel , Vlastos Ioannis M. , Parpounas Kostas , Houlakis Michael
Published: January 2019

Two-flap palatoplasty is commonly used to treat cleft palate defects, but only a few reports on outcomes have been published in the literature. We conducted a retrospective analysis of 257 cases of cleft palate treated with two-flap palatoplasty at a single center in Greece over a 13-year period. Our outcomes data included surgical complication rates, the results of speech assessments, midface development, and other parameters. We found a low rate of short- and long-term complications that required revision surgery, such as symptomatic fistula (5.4%) and velopharyngeal insufficiency (5.3%). Speech outcomes in relation to intelligibility, hypernasality, and nasal emissions were satisfactory in 70 to 86% of patients. Dental arch relationships, as estimated by the 5-Year-Olds Index, were judged to be either good or excellent in 62% of those evaluated. A considerable proportion of patients (45%) who had otitis media with effusion experienced a spontaneous resolution without the use of tympanostomy tubes 2 to 8 months after their operation. We conclude that two-flap palatoplasty is an effective procedure that warrants further attention. We describe the surgical technique in detail. Our technique includes a modified intravelar veloplasty that incorporates near-total muscle retropositioning.
Active Olfactory Training for the treatment of Smelling Disorders
Authors: Fleiner Franca , Lau Larissa , Göktas Önder
Published: January 2019

Olfactory function appears to be influenced by repeated odor stimulation. We conducted a nonrandomized, non-blinded, retrospective study of the impact of an 8-month period of olfactory training in patients with olfactory dysfunction. Our study population was made up of 46 adults—14 men and 32 women (mean age: 59.17 ± 13.25 yr)—with olfactory dysfunction of different etiologies (sinonasal: n = 15; post-upper-respiratory-tract infection [URTI]: n = 16; post-traumatic: n = 7; and idiopathic: n = 8). All patients had been previously treated without success with systemic or topical corticosteroids. For their training, patients exposed themselves to four different odors twice a day. Olfactory function was evaluated at baseline and again at 4 and 8 months, and results were quantified in the form of each patient's TDI (threshold, discrimination, and identification) score. Of the 46 patients, 28 had undergone olfactory trainingonly, while the remaining 18 had received topical corticosteroids in addition to training. At study's end, the mean overall TDI score in the entire group increased by 4.09 points over baseline—a statistically significant increase (p = 0.01); this increase was mainly attributable to improvement in the identification component of the TDI, which increased by 2.51 points (p = 0.02). Among the 18 patients who received a topical corticosteroid in addition to training, the mean TDI increased by 6.83 points (p = 0.001), primarily because of improvements in the discrimination and identification components. The 28 patients who underwent olfactory training alone experienced a mean increase in the identification component of only 2.20 points (p = 0.14) after 8 months. Olfactory function in the post-URTI patients increased significantly at 4 months. We conclude that olfactory discrimination and identification can be enhanced by the addition of a topical corticosteroid to a program of defined, daily, short-term exposure to olfactory training.
Laryngeal Schwannoma Excised under Direct Laryngoscopy: Case Report
Authors: Vital Iosif , Fliss Dan M. , Cohen Jacob T.
Published: January 2019

Laryngeal schwannomas (neurilemmomas) are extremely rare, and they present the otorhinolaryngologist with diagnostic and management challenges. These lesions usually present as a submucosal mass, and they are always a potential threat to the airway. We describe the case of a 75-year-old woman with a laryngeal schwannoma that arose from the left postcricoid area and covered the piriform sinus and arytenoid cartilage on that side. The tumor was completely excised under direct laryngoscopy with the use of a CO2 laser, and preservation of the mucosal lining of the larynx was achieved.
Primary Nk/T-Cell lymphoma of the Larynx
Authors: Uri Nechama , Schindler Yaakov , Quitt Miriam , Valkovsky Olga , Barzilai Geva
Published: January 2019

Laryngeal extranodal non-Hodgkin lymphoma is uncommon, accounting for less than 1% of all laryngeal neoplasms; the B-cell phenotype is predominant. Lymphomas outside the nasal cavity are rare and highly aggressive. We present a case of primary natural killer T-cell (NK/T-cell) lymphoma of the larynx that arose in a 45-year-old man. Because only a limited amount of data is available on laryngeal NK/T-cell lymphoma, the mainstay of treatment remains unclear, although some data suggest that radiotherapy alone is the best option. Our patient was treated with chemotherapy and radiotherapy, and he remained in remission 2 years later.
Inflammatory Myofibroblastic Tumor of the Nose and Paranasal Sinuses Masquerading as a Malignancy
Authors: Amin Mohamed , Ali Rohana , Kennedy Susan , Timon Conrad
Published: January 2019

Inflammatory myofibroblastic tumor (IMT) of the nose and paranasal sinuses is a rare entity that exhibits a diverse histologic pattern that can mimic malignant tumors clinically and radiologically. We present a case of IMT in an 88-year-old man who presented with an aggressive tumor-like lesion in the nose and paranasal sinuses that had a malignant appearance on radiology. We discuss this tumor's clinicoradiologic resemblance to a malignancy, and we review the treatment options following careful histologic and immunohistochemical analysis.
Mycobacterial Tuberculosis Superimposed on a Warthin Tumor
Authors: Wu Kang-Chao , Chen Bo-Nien
Published: January 2019

The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.
A Concha Bullosa Mucopyocele Manifesting as Migraine Headaches: A Case Report and Literature Review
Authors: Shihada Rabia , Luntz Michal
Published: January 2019

A concha bullosa is a common anatomic variant that represents an aerated turbinate, usually the middle turbinate. It is usually asymptomatic. When extensively pneumatized, a large concha bullosa may cause significant problems, including headache, nasal obstruction, and blockage of sinus drainage. We report a case of a large concha bullosa mucopyocele that manifested as recurring migraine headaches. It was successfully treated with surgical excision. We also review the available literature.
Parry-Romberg Syndrome in an Adult: Report of a Case
Authors: Fornwalt Brandon E. , Altman Jerald S.
Published: January 2019

Parry-Romberg syndrome is an uncommon degenerative disorder characterized by a slow and progressive atrophy of the subcutaneous tissue on one side of the face. Its etiology is unknown, and there is no cure. It is usually seen in children. Surgical reconstruction is often the best treatment option, and a wide variety of techniques have been employed. It is often difficult to diagnose Parry-Romberg syndrome because its signs and symptoms overlap with those of several other disorders. We describe a case of Parry-Romberg syndrome in a 42-year-old woman, whose age at onset was the unusual feature of this case.
Acute Dystonic Reaction to General Anesthesia with Propofol and Ondansetron: A Graded Response
Authors: Size Matthew H.J. , Rubin John S. , Patel Anil
Published: January 2019

Propofol and ondansetron, alone and in combination, have been associated with acute dystonic reactions during recovery from anesthesia. We report the case of a 44-year-old woman who had undergone microlaryngoscopic fat injection to the vocal folds three times over a period of 10 months. Each procedure was performed by the same surgeon. On each occasion, the patient received an identical anesthetic that was administered by the same anesthetist. The anesthetic regimen included propofol and ondansetron. Following the first procedure, the patient experienced no reaction to these agents. However, she experienced a mild reaction after the second procedure and a severe acute dystonic reaction after the third. We believe this is the first report of a graded reaction to either propofol or ondansetron.
A Case of Lipoma Arising in the Eustachian Tube
Authors: Dabiri Jonathan , Choufani Georges , Delpierre Isabelle , Hassid Sergio
Published: January 2019

We report a case of a lipoma inside the eustachian tube, an extremely rare location for this lesion. To the best of our knowledge, this is only the second such case that has been described in the literature. The patient was a 47-year-old man, a fighter pilot, who was referred to our hospital with a 3-year history of (1) fullness in the right ear secondary to recurrent serous otitis media and (2) right ear pain, which was especially acute during fights. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging detected the presence of a well-encapsulated lesion inside the eustachian tube; macroscopic and radiologic findings identified the mass as a lipoma. The lesion was completely removed via transnasal endoscopy. Histopathologic evaluation confirmed the diagnosis of lipoma. The patient's postoperative course was favorable, and he was able to fly again without any ear complaints. Radiologic examination is useful for the diagnosis and preoperative evaluation of this benign tumor. Lesions located in the lower part of the eustachian tube can be easily removed via a transnasal endoscopic approach.
Swallowing Frequency: Impact of Accumulated Oropharyngeal Secretion Levels and Gustatory Stimulation
Authors: Brady Susan L. , Wesling Michele W. , Donzelli Joseph J. , Kaszuba Scott
Published: January 2019

We conducted a prospective, descriptive study of 27 individuals with known or suspected dysphagia to investigate the relationship between swallowing frequency, accumulated oropharyngeal secretion levels, and gustatory stimulation. Assessment of the secretion level was quantified with the use of a previously published 5-point rating scale using endoscopy. Overall, we found a moderate relationship between the baseline swallowing frequency at rest and the accumulated oropharyngeal secretion level (Pearson correlation 0.470; p = 0.01). The study sample was divided into two groups based on their secretion level. Group 1 (n = 19; mean age 59.7 ± 21.5 years) included patients whose accumulated oropharyngeal secretion level was rated as 1 (normal) or 2 (mild). Group 2 (n = 8; mean age 69.78 ± 8.35 years) included patients whose accumulated oropharyngeal secretion level was rated as 4 (severe) or 5 (profound). For Group 1, swallowing frequency increased from a baseline of 1.05 to 5.26 swallows over 2 minutes, following gustatory stimulation; for Group 2 it increased from a baseline of 0.125 swallows to 3.5 swallows. These results indicate that individuals with a lower baseline swallowing frequency at rest demonstrated a higher accumulated oropharyngeal secretion level as viewed by nasal endoscopy and that, regardless of secretion level, gustatory stimulation was effective at increasing swallowing frequency. Increasing swallowing frequency may be a functional dysphagia treatment objective in efforts to improve the efficiency of the swallow and may offer better management of accumulated oropharyngeal secretions.
The Immediate Use of a Silicone Sheet Wound Closure Device in Scar Reduction and Prevention
Authors: Parry James R. , Stupak Howard D. , Johnson Calvin M.
Published: January 2019

Silicone has been used successfully postoperatively in the prevention of hypertrophic and other types of adverse scars. The Silicone Suture Plate (SSP) is a new, minimally invasive, sterile wound closure device that is applied intraoperatively to prevent adverse scarring. The SSP device permits immediate application of silicone while concurrently allowing for wound-edge tension redistribution. In this prospective, controlled, single-blinded clinical study, 8 consecutive patients undergoing deep-plane rhytidectomy were selected. SSP devices were placed on the patients’ posterior rhytidectomy hairline incision; the mirror-image controlsite underwent standard suturing techniques. Three blinded, independent raters assessed the treatment and control sides at 6-week and 4-month follow-up visits, using the Objective Scar Assessment Scale (OSAS), a validated scar assessment tool. The 6-week OSAS scores revealed an 18.4% improvement on the side with the SSP device (13.3) when compared to the control side (16.3). The 4-month OSAS scores showed a 27.3% improvement on the treatment side from 12.7 (control) to 9.2 (SSP). These OSAS results were found to be statistically significant when taken as an aggregate of the observers’ scores, but not when observers’ scores were measured individually (p < 0.05). In our series of patients, we showed promising results with the use of the SSP device. Early silicone application and tissue tension distribution contributed to an overall more aesthetically pleasing scar compared to those seen with standard suturing techniques, although more testing is required.
Concurrent Chemoradiotherapy with Capecitabine/Cisplatin versus 5-Fluorouracil/Cisplatin in Resectable Laryngohypopharyngeal Squamous Cell Carcinoma
Authors: Ahn Dongbin , Ho Sohn Jin , Hyug Kim Jae , Eun Lee Jeong , Hyung Park Shin , Kim Jae Chul
Published: January 2019

A combination of 5-fluorouracil and cisplatin (FP regimen) is widely used as a standard treatment for head and neck cancer. Recently, capecitabine has received increased attention. We conducted a retrospective study to compare the efficacy and safety of the FP regimen with that of the “XP regimen,” which entails concurrent chemoradiotherapy (CCRT) with capecitabine and cisplatin, in patients with resectable laryngohypopharyngeal squamous cell carcinoma (SCC). We retrospectively reviewed the records of 71 patients—67 men and 4 women, mean age 63.1 years—who had undergone CCRT from August 2004 through March 2010 as a primary treatment for resectable laryngohypopharyngeal SCC. There were 19 patients in the FP group and 52 in the XP group. With regard to chemotherapy morbidity, the XP group had less need for healthcare resources and fewer delays in treatment due to toxicity. After CCRT, a higher (but not statistically significant) rate of complete response was observed in the XP group than in the FP group (71.2 vs. 57.9%; p = 0.291); the XP group also had a better, although not significant, response among patients with neck metastases (67.7 vs. 30%; p = 0.063). During follow-up (mean: 34.8 ± 30.6 mo), recurrence rates were 25.6% in the XP group and 21.4% in the FP group—again, not a statistically significant difference (p = 0.745). At the time of the fnal follow-up, 20 of the 71 patients (28.2%) had died of disease. Compared with the FP group, the XP group had a significantly lower incidence of disease-specific death (21.2 vs. 47.4% respectively; p = 0.030). However, the Kaplan-Meier method identified no significant difference between the two groups in the 3-year survival rate (69.6 vs. 63.2%; p = 0.263). Overall toxicities and grade 3 or 4 toxicities (with the exception of hand-foot syndrome) were generally far less common in the XP group, with statistical significance identified for patients who experienced anemia, nausea, and vomiting. On the basis of our experience, we conclude that the results of the XP regimen were comparable to those of the FP regimen for CCRT in patients with resectable laryngohypopharyngeal SCC in terms of treatment efficacy, toxicity, and patient convenience.
The Impact of State-imposed Fiscal Rules on Municipal Government Fiscal Outcomes: Does Institutional Configuration Matter?
Authors: Park Sungho
Published: January 2019

This study explores the impact of state-imposed fiscal rules on municipal fiscal outcomes. It provides a recent profile of state-imposed fiscal rules. Further, with particular attention to the years before, during, and after the Great Recession, this study tests whether municipal fiscal outcomes vary depending on the institutional configuration of state-imposed fiscal rules. This study identifies that there has been a large variation in the institutional design of state-imposed fiscal rules at least since 1991. Using the Government Finance Officers Association’s financial indicator database from 2006 to 2011, this study finds that different rule compositions have distinctive impacts on municipal fiscal outcomes.
Video Self-Modeling to Treat Aggression in Students Significantly Impacted by Autism Spectrum Disorder
Authors: Sadler Kate M.
Published: January 2019

Research suggests that individuals with autism spectrum disorder (ASD) are at risk of exhibiting aggressive behaviors due to deficits in social communication and restricted and repetitive interests. Individuals with greater symptom severity and/or low cognitive abilities are at the greatest risk of developing aggressive behaviors that tend to be resistant to treatment. Additional research to treat persistently high rates of aggressive behaviors in this population is needed. Video self-modeling (VSM) is an evidence-based practice that has proven effective for individuals with ASD. This study implemented a VSM intervention with three middle school children significantly impacted by ASD who displayed aggressive behaviors using single case design with intersubject replication. Findings demonstrated that all three children decreased in aggressive behavior and maintained that decrease postintervention. Further educational implications are addressed on the use of VSM for addressing aggressive behaviors in children significantly impacted by ASD.
The State of Theory in LGBTQ Aging: Implications for Gerontological Scholarship
Authors: Fabbre Vanessa D. , Jen Sarah , Fredriksen-Goldsen Karen
Published: January 2019

Social research in lesbian, gay, bisexual, transgender, and queer (LGBTQ) aging is a rapidly growing field, but an examination of the use of theory has not yet been conducted for its impact on the field’s direction. We conducted a systematic review of empirical articles published in LGBTQ aging in the years 2009–2017 ( N = 102). Using a typology of theory use in scholarly articles, we analyzed these articles for the types of theories being used, the degree to which theories were used in each article, and the analytical function they served. We found that 52% of articles consistently applied theory, 23% implied or partially applied theory, and 25% presented as atheoretical. A wide range of theories were used and served multiple analytical functions such as concept development and explanation of findings. We discuss the strengths and weaknesses of theory use in this body of literature, especially with respect to implications for future knowledge development in the field.
Too big to fault? Effects of the 2010 Nobel Peace Prize on Norwegian exports to China and foreign policy
Authors: Kolstad Ivar
Published: January 2019

In October 2010, the Norwegian Nobel Committee awarded the Nobel Peace Prize to Chinese dissident Liu Xiaobo. The Chinese Government responded by freezing political and economic relations with Norway, introducing sanctions on imports of fish and other products, and limiting diplomatic interaction. Using a synthetic control approach, we estimate the effect of Chinese sanctions on Norwegian exports to China and on Norwegian foreign policy. We find that the sanctions reduced direct exports of fish to China by between 125 and 176 million US$ in the period 2011–2013, and direct total exports from Norway to China by between 780 and 1300 million US$. Moreover, immediately following the peace prize, Norwegian agreement with Chinese voting on UN human rights resolutions increased. The results suggest that the Chinese Government can effectively use economic sanctions to affect the foreign policy positions of democratic governments, with potentially chilling effects for international progress on human rights.
World Religions and Human Capital Investment: The Case of Primary Education
Authors: Feldmann Horst
Published: January 2019

Using data on 150 countries, this article studies if and how the largest world religions have affected the extent of primary education at the national level over the period 1972–2010. Although primary education has been compulsory in most countries for at least several decades, the regression results suggest that these religions have indeed still been able to exert an influence on this type of education. Specifically, whereas Protestantism and Catholicism had a positive effect on the male primary enrolment rate, Hinduism and Buddhism had a negative effect on the female primary enrolment rate. Islam had a negative effect on both. While the magnitude of the estimated effects is small for boys, it is more substantial for girls, particularly the negative effect of Islam. The estimates are robust to endogeneity of all five religion adherence variables. They are also robust to numerous controls and variations in specification.

JEL: I21, N30, O15, Z12
The Relative Power of Negativity: The Influence of Language Intensity on Perceived Strength
Authors: Liebrecht Christine , Hustinx Lettica , van Mulken Margot
Published: January 2019

Negative utterances and words have been found to be stronger than positive utterances and words, but what happens if positive and negative utterances are intensified? Two online experiments were carried out in which participants judged the strength of (un)intensified positive and negative evaluations in written dialogues. Both studies showed intensified language was perceived as stronger than unmarked language (i.e., language that was not intensified), and negative evaluations were stronger than positive evaluations. What is more, intensification and polarity interact; the increment of perceived strength for intensified positive adjectives (Study 1) and purely intensified adverbs ( really, very; Study 2) was bigger than the increment in perceived strength of intensified negative adjective and adverbs. When a meaningful intensifier ( deliciously, disgustingly) was used, the negativity effect remained. The findings were discussed within cognitive frameworks such as relevance theory, theory of mind, and theory on verbal aggression.
Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes
Authors: Broocks Gabriel , Flottmann Fabian , Hanning Uta , Schön Gerhard , Sporns Peter , Minnerup Jens , Fiehler Jens , Kemmling Andre
Published: January 2019

Studies evaluating the effect of reperfusion on ischemic edema in acute stroke described conflicting results. Net water uptake (NWU) per brain volume is a new quantitative imaging biomarker of space-occupying ischemic edema, which can be measured in computed tomography (CT). We sought to investigate the effects of vessel recanalization on the formation of ischemic brain edema using quantitative NWU. In this multicenter observational study, acute ischemic stroke patients with a large vessel occlusion (LVO) in the anterior circulation were consecutively screened. Patients with vessel recanalization (thrombolysis in cerebral infarction (TICI) 2 b or 3) versus persistent vessel occlusion (no thrombectomy, TICI 0-1) were compared. Lesion-NWU was quantified in multimodal admission CT and follow-up CT (FCT), and ΔNWU was calculated as difference. Of 194 included patients, 150 had successful endovascular recanalization and 44 persistent LVO. In FCT after treatment, the mean (standard deviation) ΔNWU was 15.8% (5.7) in patients with persistent LVO and 9.8% (5.8) with vessel recanalization ( p < 0.001). In multivariate regression analysis, vessel recanalization was independently associated with a lowered ΔNWU by 6.3% compared to LVO (95% confidence interval: 3.7–9.0, p < 0.001). Successful vessel recanalization was associated with a significantly reduced formation of ischemic brain edema. Quantitative NWU may be used to compare the treatment effects in acute stroke.
Perceiving Rhythmic Repetition and Change Across Development: Effects of Concurrent Pitch
Authors: Martins Marta , Silva Susana , Castro São Luís
Published: January 2019

The ability to perceive repetition and change in rhythm is fundamental to music understanding. How is this ability affected by other musical dimensions, such as pitch? We compared the perception of rhythmic repetition and change in rhythm-only stimuli versus rhythm-and-pitch stimuli. A sample of 357 participants, aged from 6 to 22 years, performed Same (repetition) versus Different (change) judgments on rhythmic stimuli with and without concurrent pitch variation. Rhythm-and-pitch stimuli impaired the perception of rhythmic repetition but not the perception of change, and this was independent from participants’ age. Our findings are consistent with two concurrent effects of pitch on rhythmic perception: a change-highlighting effect, acting only in rhythmic change, and a working-memory-overload effect that acts in both repetition and change. We discuss the implications regarding composer–listener communication across development.
Evaluation of CT enterography findings for endoscopic complete remission after anti-TNF-α therapy in patients with Crohn’s disease
Authors: Kim Jieun , Kim Seung Ho , Kim Tae Oh
Published: January 2019

Background

Unnecessary prolonged treatment with biologic agents for Crohn’s disease (CD) patients with endoscopic complete remission (CR) might increase the opportunistic infections.

Purpose

To evaluate computed tomography enterography (CTE) findings obtained on CD patients achieving endoscopic CR after anti-tumor necrosis factor (TNF)-α therapy.

Material and Methods

Thirty-six consecutive patients with CD who had received anti-TNF- α therapy and undergone pre-and post-therapy CTE and ileocolonoscopy were initially enrolled. CTE was performed with a standard-dose enteric-phase scan. Eleven patients were excluded due to a mismatch of follow-up intervals or a long interval (>2 weeks) between CTE and ileocolonoscopy; additionally, five patients were excluded due to surgical intervention during the follow-up period. Therefore, 20 patients finally were analyzed. Two blinded readers evaluated the pre-and post-therapy CTE images by consensus for active inflammation, i.e. mural hyperenhancement, mural thickening (thickness > 3 mm), mural stratification, and increased peri-enteric fat attenuation in the rectum, colon, and terminal ileum. Endoscopic CR indicated mucosal healing identified by ileocolonoscopy and served as the reference standard.

Results

Nine patients with 16 bowel segments showed endoscopic CR. Ten of those segments showed residual abnormalities including mild mural hyperenhancement (9/16, P = 0.03), mild mural thickening (6/16, P < 0.001), and both findings (5/16, P < 0.001) on post-therapy CTE. The non-CR group (11 patients; 17 bowel segments) showed a higher concordance rate with post-therapy CTE (88%, 15/17) than did the CR group (38%, 6/16) ( P = 0.004).

Conclusion

Residual mild mural hyperenhancement and mild mural thickening were seen on post-therapy CTE in over half of the bowel segments showing endoscopic CR.
Terrestrial laser scanning and structure-from-motion photogrammetry concordance analysis for describing the surface layer of gravel beds
Authors: Neverman Andrew J , Fuller Ian C , Procter Jon N , Death Russell G
Published: January 2019

Terrestrial laser scanning (TLS) and structure-from-motion photogrammetry (SfMp) offer rapid, non-invasive surveying of in situ gravels. Numerous studies have used the point clouds derived from TLS or SfMp to quantify surface layer characteristics, but direct comparison of the methods for grain-scale analysis has received relatively little attention to date. Comparing equivalent products of different data capture methods is critical as differences in errors and sampling biases between the two methods may produce different outputs, effecting further analysis. The sampling biases and errors related to SfMp and TLS lead to differences in the point clouds produced by each method. The metrics derived from the point clouds are therefore likely to differ, potentially leading to different inputs for entrainment threshold models, different trends in surface layer development being identified and different trajectories for physical processes and habitat quality being predicted.

This paper provides a direct comparison between TLS and SfMp surveys of an exposed gravel bar for three different survey periods following inundation and reworking of the bar surface during high flow events. The point clouds derived from the two methods are used to describe changes in the character of the surface layer between bar inundation events, and comparisons are made with descriptions derived from conventional pebble counts. The results found differences in the metrics derived using each method do exist, but the grid resolution used to detrend the surfaces and identify spatial variations in surface layer characteristics had a greater impact than survey method. Further research is required to understand the significance of these variations for quantifying surface texture and structure and for predicting entrainment thresholds and transport rates.
Anaesthetic Issues in Robotic-Assisted Minimally Invasive Surgery
Authors: Pathirana S. , Kam P. C. A.
Published: January 2019

Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.
High Flow Humidified Nasal Oxygen in Pregnant Women
Authors: Tan P. C. F. , Dennis A. T.
Published: January 2019

Failed airway management in the obstetric patient undergoing general anaesthesia is associated with major sequelae for the mother and/or fetus. Effective and adequate pre-oxygenation is an important safety strategy and a recommendation in all current major airway guidelines. Pre-oxygenation practice in the obstetric population may be suboptimal based on current literature. Recently, clinical applications for high flow nasal oxygen, also known as transnasal humidified rapid insufflation ventilatory exchange or THRIVE, are expanding in the non-obstetric population and may have theoretical benefits if used for pre-oxygenation and apnoeic oxygenation in the obstetric population. We review the current literature surrounding high flow nasal oxygen relevant to the pregnant woman. We also propose a basis for potential advantages and complications for its use in this context.
The Effect of Sevoflurane on the Transmural Dispersion of Repolarisation in Patients with Type 2 Diabetes Mellitus: A Prospective Observational Study
Authors: Thiruvenkatarajan V. , Jeyadoss J. , Kadam V. Rao , Du L. Y. , Liu W.-M. , Van Wijk R. M.
Published: January 2019

The ‘torsadogenic’ property of a drug is linked to its ability to increase the transmural dispersion of repolarisation, represented by the interval between the peak of, and the end of, the T-wave (Tp-e interval) in an electrocardiogram. Reports have consistently shown that sevoflurane does not increase the Tp-e interval. Type 2 diabetes is a risk factor for increased QTc (rate-corrected QT interval), QTcd (rate-corrected QTc dispersion: difference between the maximum and the minimum QTc interval), and Tp-e, as well as the rate-corrected Tp-e (Tp-e/QTc ratio). The study aimed to ascertain whether sevoflurane increased the Tp-e interval and Tp-e/QTc ratio in patients with diabetes, thereby increasing their risk of torsades. We enrolled 35 female patients; 17 with type 2 diabetes and 18 controls undergoing non-laparoscopic surgery under sevoflurane anaesthesia. The Tp-e interval, Tp-e/QTc ratio, QTc and QTcd were recorded after intubation, 5, 10, 30 and 60 minutes into the anaesthetic, and were compared between the groups. No significant increase in the Tp-e interval or Tp-e/QTc was observed between or within the groups (a 13 ms increase was considered significant). In the control group, the QTc was significantly increased from baseline immediately after intubation (449 versus 414 ms, P <0.001); at 5 minutes (434 versus 414 ms, P=0.01); at 10 minutes (444 versus 414 ms, P=0.002); at 30 minutes (439 versus 414 ms, P=0.001) and at 60 minutes (442 versus 414 ms; P <0.001) (a 20 ms increase was considered significant). No significant increase in QTc was observed in the diabetic group. There were no between or within group differences observed for QTcd. Our findings suggest that sevoflurane does not have a significant predictable pro-arrhythmic effect in type 2 diabetic patients in the absence of other factors affecting ventricular repolarisation.
The Impact of Alcohol-Related Admissions on Resource Use in Critically Ill Patients from 2009 to 2015: An Observational Study
Authors: Secombe P. J. , Stewart P. C.
Published: January 2019

Excessive alcohol use is associated with increased health care utilisation and increased mortality. This observational study sought to identify the proportion of patients admitted with a critical illness in which alcohol misuse contributed, and to examine the resource use for this group. We performed an observational retrospective database review of all admissions to the Alice Springs Hospital intensive care unit (ICU) between 1 January 2009 and 31 December 2015. The Alice Springs Hospital ICU is a ten-bed unit located in Central Australia, with approximately 600 admissions annually. The per capita consumption of alcohol in Central Australia is approximately 1.5 times the national average. The primary aim was to determine the proportion of admissions to intensive care in which alcohol misuse was identified as a contributing cause. Secondary aims examined resource utilisation including ICU and hospital length of stay, need for and duration of mechanical ventilation, and ICU re-admission. There were 3,768 admissions involving 2,670 individual patients. Of these admissions 947 (25%) were associated with alcohol misuse. Admissions associated with alcohol were significantly more likely to require mechanical ventilation (30% versus 20%, P <0.01), and had a significantly longer ICU length of stay (2.1 versus 1.9 days, P <0.05). The proportion of admissions in which alcohol misuse was implicated is amongst the highest in the published literature. The results of this study should drive further policy change directed at harm minimisation, and warrant more detailed epidemiological work at both a local and national level.
The Effect of Inhalational Anaesthesia during Deceased Donor Organ Procurement on Post-Transplantation Graft Survival
Authors: Perez-Protto S. , Nazemian R. , Matta M. , Patel P. , Wagner K. J. , Latifi S. Q. , Lebovitz D. J. , Reynolds J. D.
Published: January 2019

Many deceased by neurologic criteria donors are administered inhalational agents during organ recovery surgery—a process that is characterised by warm and cold ischaemia followed by warm reperfusion. In certain settings, volatile anaesthetics (VA) are known to precondition organs to protect them from subsequent ischaemia–reperfusion injury. As such, we hypothesised that exposure to VA during organ procurement would improve post-graft survival. Lifebanc (organ procurement organisation [OPO] for NE Ohio) provided the investigators with a list of death by neurologic criteria organ donors cared for at three large tertiary hospitals in Cleveland between 2006 and 2016—details about the surgical recovery phase were extracted from the organ donors’ medical records. De-identified data on graft survival were obtained from the United Network for Organ Sharing (UNOS). The collated data underwent comparative analysis based on whether or not VA were administered during procurement surgery. Records from 213 donors were obtained for analysis with 138 exposed and 75 not exposed. Demographics, medical histories, and organ procurement rates were similar between the two cohorts. For the primary endpoint, there were no significant differences observed in either early (30-day) or late (five-year) graft survival rates for kidney, liver, lung, or heart transplants. Our findings from this retrospective review of a relatively small cohort do not support the hypothesis that the use of VA during the surgical procurement phase improves graft survival. Reviews of larger datasets and/or a prospective study may be required to provide a definitive answer.
Should Ongoing Airway Education be a Mandatory Component of Continuing Professional Development for College of Intensive Care Medicine Fellows?
Authors: Brewster D. J. , Nickson C. P. , Gatward J. J. , Staples M. , Hawker F.
Published: January 2019

This study aimed to determine whether airway education should be introduced to the continuing professional development (CPD) program for College of Intensive Care Medicine (CICM) Fellows. A random representative sample of 11 tertiary intensive care units (ICUs) was chosen from the list of 56 units accredited for 12 or 24 months of CICM training. All specialist intensive care Fellows (n=140) currently practising at the eleven ICUs were sent the questionnaire via email. Questionnaire data collection and post-collection data analysis was used to determine basic respondent demographics, frequency of certain airway procedures in the past 12 months, confidence with advanced airway practices in ICU, participation in airway education in the past three years, knowledge of can't intubate, can't oxygenate (CICO) algorithms, preference for certain airway equipment/techniques, and support for required airway education as a component of the CICM CPD program. All responses were tabled for comparison. Data was analysed to establish any significant effect of another specialty qualification and current co-practice in anaesthesia on volume of practice, confidence with multiple airway procedures, use of airway equipment, and support for airway education. In total, 112 responses (response rate 80%) to the questionnaire were received within four weeks; 107 were completed in full (compliance 96%). All results were tabled. There is currently widespread support amongst CICM Fellows for airway skills education as a CPD requirement for CICM Fellows. Volumes of practice and confidence levels with different airway procedures vary amongst Fellows and further support the need for education.
An Observational Study of Perioperative Risk Associated with Aortic Stenosis in Non-Cardiac Surgery
Authors: MacIntyre P. A. , Scott M. , Seigne R. , Clark A. , Deveer F. , Minchin I.
Published: January 2019

This prospective multicentre observational study investigated the risk of non-cardiac surgery in patients with moderate or severe aortic stenosis (AS). Patients with AS undergoing non-cardiac surgery in five New Zealand hospitals between August 2011 and September 2015 were studied. Preoperative variables were analysed for a significant association with postoperative major adverse cardiac events (MACE) and 30–day mortality. Of the 147 patients recruited, 13 (9%) died within 30 days and 33 (22%) had a MACE. Using univariate analysis, patients with severe AS had four times higher 30-day mortality than patients with moderate AS (16% versus 4%, P=0.007). Other factors associated with increased 30-day mortality included having a smaller aortic valve area, smaller dimensionless severity index, concomitant mitral regurgitation, and higher overall surgical risk. Patients with symptoms attributable to AS had a higher incidence of MACE compared to patients without symptoms (36% versus 16%, P=0.011). Variables significantly associated with both 30-day mortality and MACE were age, American Society of Anesthesiologists physical status, emergency surgery, New York Heart Association classification, preoperative albumin level, frailty, and history of congestive heart failure. Using multivariate analysis, emergency surgery, symptoms attributable to AS, preoperative albumin level, and AVA remained significantly associated with adverse outcome. While these findings should be interpreted with caution due to the observational nature of the study, limited power and multiple simultaneous comparisons, they suggest that patients with severe AS have a higher risk of adverse outcome after non-cardiac surgery than patients with moderate AS.