bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Spontaneous Temporal Bone Cerebrospinal Fluid Leaks From the Middle and Posterior Fossa
Authors: Cooper Timothy , Choy Matthew H. , Gardner Paul A. , Hirsch Barry E. , McCall Andrew A. 
Published: November 2019

Objectives:
To compare patients surgically managed for spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone arising from the middle cranial fossa (MCF) and posterior cranial fossa (PCF) and to describe the surgical management of posterior fossa CSF leaks.

Study Design:
Retrospective case review.

Setting:
Academic tertiary center.

Patients:
Adult patients presenting with spontaneous temporal bone CSF leaks undergoing operative repair between January 2010 and August 2018. Patients with a history of trauma, previous mastoid surgery, and iatrogenic CSF leaks were excluded.

Intervention:
Transmastoid or MCF CSF leak repair.

Main Outcome Measures:
Patient demographics, body mass index (BMI), comorbidities, presenting features, and lumbar puncture opening pressures were compared between groups and the management of the PCF CSF leaks described.

Results:
Forty-six patients (26 women, 20 men) were included. The mean age at the time of repair was 58.0 ± 12.9 years (±SD). The origin of the CSF leak was from the PCF in three patients and MCF in 43 patients. All three patients with PCF leaks presented with an acute history of meningitis compared with only seven (16%) in the MCF group. This difference was statistically significant (p = 0.01, Fisher's exact test). There were no statistically significant differences in age, sex, BMI, or lumbar puncture opening pressures. The PCF leaks were repaired using a transmastoid approach with multilayer closure of the bony defect and fat graft obliteration of the mastoid.

Conclusions:
Spontaneous CSF leaks arising from the PCF are rare and may present more commonly with meningitis. Identification requires careful review of imaging.
Risks of Intracochlear Pressures From Laser Stapedotomy
Authors: Misch Emily S. , Banakis Hartl Renee M. , Gubbels Samuel P. , Greene Nathaniel T. 
Published: November 2019

Hypothesis:
Surgical manipulations during laser stapedotomy can produce intracochlear pressure changes comparable to pressures created by high-intensity acoustic stimuli.

Background:
New-onset sensorineural hearing loss is a known risk of stapes surgery and may result from pressure changes from laser use or other surgical manipulations. Here, we test the hypothesis that high sound pressure levels are generated in the cochlea during laser stapedotomy.

Methods:
Human cadaveric heads underwent mastoidectomy. Fiber-optic sensors were placed in scala tympani and vestibuli to measure intracochlear pressures during key steps in stapedotomy surgery, including cutting stapedius tendon, lasering of stapedial crurae, crural downfracture, and lasering of the footplate.

Results:
Key steps in laser stapedotomy produced high-intensity pressures in the cochlea. Pressure transients were comparable to intracochlear pressures measured in response to high intensity impulsive acoustic stimuli.

Conclusion:
Our results demonstrate that surgical manipulations during laser stapedotomy can create significant pressure changes within the cochlea, suggesting laser application should be minimized and alternatives to mechanical downfracture should be investigated. Results from this investigation suggest that intracochlear pressure transients from stapedotomy may be of sufficient magnitude to cause damage to the sensory epithelium and affirm the importance of limiting surgical traumatic exposures.
A Possible Role of Video-Head Impulse Test in Detecting Canal Involvement in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus
Authors: Castellucci Andrea , Malara Pasquale , Delmonte Silvia , Ghidini Angelo 
Published: November 2019

Objective:
To describe the possible diagnostic role of video-head impulse test (vHIT) in patients presenting with positional downbeat nystagmus (PDN) due to benign paroxysmal positional vertigo (BPPV) involving the anterior canal (AC) or the non-ampullary arm of the posterior canal (PC).

Patients:
Three patients presenting with positional vertigo, PDN, symmetrical cervical and ocular vestibular-evoked myogenic potentials, and selective deficit of the vestibulo-ocular reflex (VOR) gain for a single vertical canal on vHIT.

Interventions:
Diagnostic evaluation and rehabilitative treatment for BPPV involving the deficient canals.

Main Outcome Measures:
Video-oculographic and vHIT findings before and after canalith repositioning procedures (CRP) for AC-BPPV and apogeotropic PC-BPPV.

Results:
Each patient was treated with CRP for BPPV involving the hypoactive canal. In one case, symptoms receded with physical therapy, whereas two patients developed a paroxysmal positional upbeat nystagmus consistent with BPPV involving the ampullary arm of the ipsilateral PC and were treated with Epley CRP. Posttreatment evaluation showed resolution of symptoms and signs and restitution of canal function in all cases.

Conclusions:
PDN can be due to both peripheral and central vestibular pathologies. In case of BPPV, involvement of the non-ampullary arm of the PC is hardly distinguishable from contralateral AC canalolithiasis. In these situations, vHIT may play a key role in the differential diagnosis. Considering these findings, we propose to include vHIT in the test battery of patient with PDN, as it may provide clues to the differential diagnosis with central pathologies enabling the identification of the canal involved by BPPV.
Cochlear Implantation in Craniometaphyseal Dysplasia
Authors: Huang Alice E. , Adkins Weston J. , Patel Neil S. 
Published: November 2019

Objective:
Describe the first case of cochlear implantation (CI) for auditory rehabilitation of a patient with craniometaphyseal dysplasia (CMD) and progressive mixed hearing loss.

Patients:
A 65-year-old woman with known autosomal dominant CMD presented with progressive mixed hearing loss and declining benefit from conventional hearing aids. Computed tomography and magnetic resonance imaging revealed hyperostosis of the entire craniofacial skeleton. Hearing evaluation demonstrated pure-tone thresholds in the profound range bilaterally by air conduction, and bone conduction thresholds that matched aided thresholds for her left ear, though testing was somewhat limited by inability to mask at high air-conduction thresholds. CI candidacy testing confirmed poor word and sentence scores in the right ear.

Intervention:
Due to the inability to access the cochlea via a conventional mastoidectomy and facial recess approach, cochlear implantation via a postauricular subtotal petrosectomy approach with ear canal overclosure was performed.

Main Outcome Measures:
Post-implantation word and sentence testing.

Results:
Despite extensive internal auditory canal stenosis, the patient demonstrated excellent early speech understanding results 5 weeks after device activation. Postimplantation audiologic evaluation showed thresholds between 20 and 30 dB HL from 250 to 6000 Hz. Word and sentence testing scores were 76% Consonant-nucleus-consonant in quiet (up from 2% preoperatively) and 77% AzBio sentences in quiet (up from 10% preoperatively).

Conclusion:
This report describes the first description of CI for CMD. Despite the extensive radiologic abnormalities, the patient has demonstrated excellent benefit from implantation. Further study of rare temporal bone dysplasias, such as CMD, is critical to better characterize the progression of otologic disease and determine optimal treatment.
Balloon Eustachian Tuboplasty Combined With Tympanocentesis Is not Superior to Balloon Eustachian Tuboplasty in Chronic Otitis Media With Effusion—A Randomized Clinical Trial
Authors: Formánková Debora , Formánek Martin , Školoudík Lukáš , Zeleník Karol , Tomášková Hana , Chrobok Viktor , Komínek Pavel 
Published: November 2019

Objective:
Balloon Eustachian tuboplasty (BET) appears to be a promising therapeutic option for Eustachian tube dysfunction. However, data are lacking on its effect in adults with chronic otitis media with effusion (COME) and whether it should be combined with tympanocentesis. The aim of our study was to determine if there is a beneficial effect of BET combined with tympanocentesis compared with BET only and provide data on the effect of BET in adults with COME.

Study Design:
Randomized clinical trial.

Setting:
Tertiary referral hospital.

Participants:
Adults with COME lasting more than 6 months after tympanostomy tube exclusion. Among 40 eligible ears, 30 were randomized to treatment.

Intervention:
BET (group 1) versus BET with concurrent tympanocentesis (group 2).

Main Outcome Measures:
Tympanometry, Valsalva or Toynbee maneuver with tympanometry verification, Eustachian Tube Dysfunction Questionnaire, and pure-tone audiometry.

Results:
A total of 25 patients (14 ears in group 1 and 15 ears in group 2) were included in the analysis. No significant difference in the effect of treatment was found between the groups. When patients were evaluated as one group, after 2, 6, and 12 months, improvement was found in tympanometry in 55, 48, and 48%; in the ability to perform maneuvers in 55, 41, and 41%; in audiometry in 69, 62, and 59%; and in questionnaire scores in 76, 72, and 69%, respectively.

Conclusions:
There was no beneficial outcome of tympanocentesis performed concurrently with BET and therefore it should not be routinely recommended. The success of therapy appears to be reduced compared with other pathologies caused by Eustachian tube dysfunction.
Diagnostic performance of extrinsic apoptosis pathway in hepatitis C virus patients: apoptosis fibrosis crosstalk
Authors: Toson El-Shahat A. , Shiha Gamal E. , El-sharkawy Aml M. , El-mezayen Hatem A. 
Published: November 2019

Background/aim:
Liver fibrosis assessment and evaluation of disease severity in hepatitis C virus (HCV) patients provides useful information for therapeutic decisions. Chronic HCV infection is associated with increased levels of peripheral T cell apoptosis. The aim was to study whether peripheral blood T lymphocyte apoptosis markers may contribute to clinical progression, and develop a simple index based on combination of apoptosis and routine biomarkers for accurate evaluation of fibrosis stages in HCV patients.

Patients and methods:
Peripheral blood T lymphocytes were isolated from 72 patients with hepatitis C virus and 25 healthy control individuals. Serum samples were collected at time of liver biopsy. Liver fibrosis was tested in biopsies using the Metavair score system. Stepwise linear discriminate analysis and area under receiver-operating characteristic curves were utilized to produce a predictive score comprising significant apoptosis biomarkers.

Results:
A novel score named apoptosis fibrosis index (AFI) was created on the basis of a combination of CD8/Annexin, albumin and platelets. The multivariate discriminate analysis selected a score based on absolute values of the three biochemical markers; score = 5.8 + 0.008×CD8/Annexin-V (%) - 1.4×Albumin (g/dl) - 0.001×Platelet count (109/L), where 5.8 considered numerical constant. AFI produce an area under the curve of one for significant fibrosis, 0.80 for advanced fibrosis, and 0.889 for cirrhosis.

Conclusion:
Apoptosis biomarkers in HCV patients were associated with liver fibrosis. AFI score, a novel noninvasive test, can be used easily for the prediction of liver fibrosis stage and may decrease the need for liver biopsy in hepatitis C virus Egyptian patients.
Paternal Smoking Before Conception and During Pregnancy Is Associated With an Increased Risk of Childhood Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of 17 Case-Control Studies
Authors: Cao Yue , Lu Jing , Lu Jing 
Published: November 2019

Objective:
Current evidence regarding the association between paternal smoking before conception or during pregnancy and the risk of childhood acute lymphoblastic leukemia (ALL) are inconsistent. We aimed to systematically summarize the current evidence regarding this potential association.

Methods:
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE), we systematically retrieved PubMed, Embase, Web of Science, and Scopus, screened relevant literature, and assessed the methodologic quality of the included studies. We calculated the pooled estimates using random-effects models. We assessed statistical heterogeneity by I
2 values and χ2 tests for the Cochrane Q statistic. We further investigate the dose-response relation using 2-stage nonlinear models.

Results:
A total of 17 case-control studies were identified, and the synthesized risk ratios (RRs) for smoking before conception (RR=1.15, 95% confidence interval: 1.04-1.27) and during pregnancy (RR=1.20, 95% confidence interval: 1.12-1.28) were both statistically significant. Moreover, the dose-response analysis showed a positive association as well.

Conclusion:
Current evidence from observational studies suggests the association between paternal smoking before conception or during pregnancy and the increased risk of childhood ALL, which needs to be confirmed in prospective studies.
Self-efficacy, Hope as Mediators Between Positive Coping and Resilience Among Patients With Gastric Cancer Before the First Chemotherapy
Authors: Wu Xiaoting , Xu Haibo , Zhang Xiaomin , Han Shiyu , Ge Liuna , Li Xiaohui , Zhang Xinqiong 
Published: November 2019

Background
Patients with gastric cancer experience severe psychological distress as a result of their cancer diagnosis and chemotherapy. Resilience is a defense mechanism that enables one to thrive amid distress. However, little research has been done to explore the formation and development mechanism of resilience among patients with gastric cancer before their first chemotherapy treatment.

Objective
The mediating roles of self-efficacy and hope on the relationship between positive coping and resilience among patients with gastric cancer before their first chemotherapy treatment were examined to inform the future resilience intervention.

Methods
A total of 253 patients with gastric cancer before their first chemotherapy treatment were investigated using the Simplified Coping Style Questionnaire, the General Self-efficacy Scale, the Herth Hope Index, and the 14-Item Resilience Scale. Structural equation modeling was conducted using Mplus version 7.03 to test the hypothesized mediational model.

Results
Structural equation modeling analysis showed self-efficacy and hope completely mediated the relationship between positive coping and resilience; the indirect effects were 0.242 (P < .01) and 0.258 (P < .01), respectively; indirect effects accounted for 81% of the total effect.

Conclusions
Positive coping is not the independent predictor that may contribute to resilience among patients with gastric cancer before their first chemotherapy treatment, but it can indirectly affect resilience through self-efficacy and hope.

Implications
Self-efficacy and hope may increase the positive influence of positive coping on resilience among patients with gastric cancer before their first chemotherapy treatment. Resilience intervention might be enhanced by addressing the impact of positive coping on self-efficacy and hope.
Innovating Fall Safety
Authors: Radecki Bethany , Keen Alyson , Miller Joan , McClure Janelle K. , Kara Areeba 
Published: November 2019

Background:
Injury falls are common, with nearly a million hospitalized patients falling annually. Fall risk identification and prevention are largely clinician-centric, lacking patient input.

Local Problem:
Our fall rates were below the national mean; however, patients who fell and sustained injury were at or above the mean. We lacked processes that engaged patients as safety collaborators.

Methods:
This was a quality improvement study examining the effect of a collaborative fall intervention on (1) patient knowledge in action and (2) incidence of falls.

Intervention:
The patient fall assessment tool was implemented to facilitate collaborative safety conversations.

Results:
We achieved a statistically significant improvement (P = .0007) in the patient's participation in the development of the safety plan, with a 25% reduction in total falls and a 67% reduction in injury falls.

Conclusions:
The patient fall assessment tool may be a successful strategy to engage patients in the development of their safety plan and positively affect safety partnerships.
Intravenous Access in Gastrointestinal Hemorrhage
Authors: Koop Andree H. , Cowdell Jed , Patel Neej , Kesler Alex , Mwakyanjala Edson , Heckman Alexander , Padmanabhan Menon Divya , Patel Neil , Narciso Patricia , Reid Ashley , Decicco Nicholl , Speicher Leigh 
Published: November 2019

Background:
The management of acute gastrointestinal hemorrhage (GIH) is focused on early resuscitation through 2 large-bore intravenous (2LBIV) catheters, although adherence to this recommendation is low.

Local Problem:
Of 100 patients hospitalized with GIH in 2017, only 14 received 2LBIV access. The goal of this study was to improve this measure.

Methods:
A multidisciplinary team used the DMAIC (define, measure, analyze, improve, and control) framework to perform a quality improvement initiative.

Interventions:
The team used quality tools including a stakeholder survey, swimlane diagram, and fishbone diagram. The first intervention involved education of the hospitalists directing admissions, and the second intervention involved education of emergency department (ED) physicians and nurses regarding the importance of 2LBIV placement.

Results:
Following the second intervention, there was a substantial increase in 2LBIV placement to 37 of 86 (43%).

Conclusions:
Carefully directed education of ED physicians and nurses with monthly feedback was effective in improving appropriate intravenous placement in patients with GIH.
Assessing the Effect of Unit Champion-Initiated Audits on Fall Rates
Authors: Loresto Figaro L. , Grant Casey , Solberg Jamie , Eron Kathryn 
Published: November 2019

Background:
Inpatient falls remain challenging with repercussions that can include patient injury and increased hospital expense. Fall rates were consistently above the national benchmark. An initiative to reduce fall rates was use of Fall Champion Audits (FCAs).

Purpose:
The aim of this study was to assess the effect of FCAs on patient fall rates.

Methods:
FCAs were piloted on a medical-oncology unit. An interrupted time series design was used to assess the effect of FCAs on fall rates.

Intervention:
FCA is an audit conducted by the unit fall champion that assesses fall risk, interventions, and barriers among staff and patients.

Results:
Analysis suggested a significant decrease in fall rates from pre- (3.75) to postimplementation (1.62). FCAs worked in conjunction with a division-wide fall program in reducing fall rate.

Conclusions:
FCAs, in conjunction with a fall program, are a feasible intervention in reducing fall rates.
Impact of Patient-Engaged Video Surveillance on Nursing Workforce Safety
Authors: Quigley Patricia A. , Votruba Lisbeth , Kaminski Jill 
Published: November 2019

Background:
Health care workers are 4 times more likely to suffer violence than workers in other industries.

Purpose:
The aim was to examine types of patients' verbal/physical abuse against the nursing workforce observed through patient-engaged video surveillance (PEVS) and interventions initiated by monitor technicians.

Methods:
A descriptive study was conducted to analyze all types of patient-initiated abuse, physical and verbal, reported from 73 hospitals and patient response to PEVS.

Results:
Of 150 434 patients whom RNs enrolled into 24-hour PEVS, 5034 patients (3%) were identified by RNs as at risk for aggressive/violent behavior as their primary or secondary reason for PEVS enrollment, and 32 (0.60%) patients exhibited such behavior. A total of 221 patients demonstrated aggressive/violent behaviors, 32 (15%) were identified as at risk, and 189 (85%) were not. However, 5002 (99%; 5002/5034) of the patients identified as a risk for aggressive/violent behaviors did not exhibit these behaviors.

Conclusions:
Patient-engaged video surveillance is an effective method to track and trend patient aggression toward nursing staff, increasing patient and nursing workforce safety. Because 99% of the patients who exhibited aggressive/violent behavior were not identified by RNs as at risk, organizations should consider adding violence risk tools as part of patients' admission assessment.
Undetectable viral load and HIV transmission dynamics on an individual and population level: where next in the global HIV response?
Authors: Bavinton Benjamin R. , Rodger Alison J. 
Published: November 2019

Purpose of review
To examine recent literature on the efficacy and effectiveness of HIV treatment in preventing HIV transmission through sexual exposure, at both an individual and at a population level.

Recent findings
Two recent studies on the individual-level efficacy of treatment as prevention (TasP) have added to the now conclusive evidence that HIV cannot be transmitted sexually when the virus is suppressed. However, four large cluster-randomized population-level trials on universal HIV testing and treatment in Africa have not delivered the expected impact in reducing HIV incidence at a population level. Two of these trials showed no differences in HIV incidence between the intervention and control arms, one demonstrated a nonsignificant lower incidence in the intervention arm, and the fourth trial found a reduction between the communities receiving a combination prevention package and the control arm, but no difference between the immediate treatment plus the prevention package and the control arm. Factors contributing to the disconnect between individual high-level efficacy and population-level effectiveness of TasP include undiagnosed infection, delays in linkage to care, challenges in retention and adherence to antiretroviral therapy (ART), time between ART initiation and viral suppression, and stigma and discrimination.

Summary
Suppressive ART renders people living with HIV sexually noninfectious. However, epidemic control is unlikely to be achieved by TasP alone.
Value of Dual-Energy Computed Tomography for Diagnosing Cervical Lymph Node Metastasis in Patients With Papillary Thyroid Cancer
Authors: He Muzhen , Lin Cailing , Yin Lei , Lin Yang , Zhang Shengjian , Ma Mingping 
Published: November 2019

Objective
The objective of this study was to determine the value of dual-energy computed tomography (DECT) for the diagnosis of cervical lymph node metastasis in papillary thyroid cancer.

Methods
The normalized iodine concentration (NIC) and the slope of the spectral Hounsfield unit curve (λ
HU) in the arterial and venous phases were measured using iodine-overlay images and spectral curves. Quantitative DECT data and qualitative conventional CT data were analyzed by radiologists.

Results
The best qualitative parameter for lymph node metastasis detection was obvious node enhancement, and the best quantitative parameter for detection was arterial-phase NIC, which showed high sensitivity, specificity, and accuracy values at an optimal threshold of 25.8%. The best combination of qualitative and quantitative parameters consisted of obvious enhancement and arterial-phase NIC; this combination showed a sensitivity of 90.8% and a specificity of 80.5%.

Conclusions
The DECT quantitative parameters NIC and λ
HU can be an additional tool to diagnose cervical lymph node metastasis.