bluuebunny/crossref_metadata_2025_split huggingface dataset:
Qualitative and Quantitative Analysis of the Corneal Endothelium With Smartphone Specular Microscopy
Authors: Fliotsos Michael J. , Deljookorani Shiva , Dzhaber Daliya , Chandan Subhangi , Ighani Mehrnaz , Eghrari Allen O. 
Published: February 2020

Purpose:
We sought to demonstrate the feasibility of a lower-cost, portable method for qualitative and quantitative analysis of the corneal endothelium using a smartphone and slit-lamp biomicroscope.

Methods:
In this study, at a single academic center, we recruited healthy participants to undergo imaging of the corneal endothelium using both a smartphone-based method and a specular microscope. Participants first had their eyes imaged with a CellChek NSP-9900 Specular Microscope (Konan Medical, Inc, Irvine, CA). For image capture on the smartphone, a beam of light approximately 0.2 mm in diameter was directed to the center of the cornea with a slit-lamp biomicroscope to achieve specular reflection. With 40× zoom on the slit-lamp and 4K video mode set on an iPhone 7 Plus held to an ocular, the corneal endothelium was recorded until the hexagonal pattern of cells was identified and the sharpest frame from the video was selected.

Results:
The videos were analyzed from 14 sets of eyes (average length 2 minutes 40 seconds). The average intraclass correlation coefficient was 0.67 (95% confidence interval, 0.43–0.82). The mean difference between smartphone endothelial cell count and specular endothelial cell count was −209 cells/mm2 (SD = 483 cells/mm2), which did not achieve significance (P = 0.14). A Bland–Altman analysis with simple linear regression showed no proportional bias when comparing the 2 modalities (coefficient = −0.20; t-value = −0.42; P = 0.68).

Conclusions:
Smartphone specular microscopy is capable of qualitative and quantitative analysis of the corneal endothelium. Further refinement to standardize the light source and automate analysis will increase feasibility.
Differential modulation of excitatory and inhibitory populations of superficial dorsal horn neurons in lumbar spinal cord by Aβ-fiber electrical stimulation
Authors: Fan Wei , Sdrulla Andrei D. 
Published: February 2020

Abstract
Activation of Aβ-fibers is fundamental to numerous analgesic therapies, yet its effects on dorsal horn neuronal activity remain unclear. We used multiphoton microscopy of the genetically encoded calcium indicator GCaMP6s to characterize the effects of Aβ-fiber electrical stimulation (Aβ-ES) on neural activity. Specifically, we quantified somatic responses evoked by C-fiber intensity stimulation before and after a 10-minute train of dorsal root Aβ-ES in superficial dorsal horn (SDH) neurons, in mouse lumbar spinal cord. Aβ-ES did not alter C-fiber-evoked activity when GCaMP6s was virally expressed in all neurons, in an intact lumbar spinal cord preparation. However, when we restricted the expression of GCaMP6s to excitatory or inhibitory populations, we observed that Aβ-ES modestly potentiated evoked activity of excitatory neurons and depressed that of inhibitory neurons. Aβ-ES had no significant effects in a slice preparation in either SDH population. A larger proportion of SDH neurons was activated by Aβ-ES when delivered at a root rostral or caudal to the segment where the imaging and C-fiber intensity stimulation occurred. Aβ-ES effects on excitatory and inhibitory populations depended on the root used. Our findings suggest that Aβ-ES differentially modulates lumbar spinal cord SDH populations in a cell type– and input-specific manner. Furthermore, they underscore the importance of the Aβ-ES delivery site, suggesting that Aβ stimulation at a segment adjacent to where the pain is may improve analgesic efficacy.
Health Literacy, Drug Knowledge, and Drug Misuse Behaviors Among North Korean Refugees
Authors: Jeon Jeong Hee , Lee In Sook 
Published: February 2020

Purpose
This study measured levels of health literacy, drug knowledge, and drug misuse behavior and analyzed the relationship among major variables related to 137 North Korean refugees who could only receive limited medical benefits owing to cultural and linguistic barriers.

Method
The data were analyzed using descriptive statistics, t test, and the Pearson correlation coefficient using SPSS.

Results
The subjects' health literacy and drug knowledge levels were low; however, drug misuse behavior was not high. The drug dosage was significant considering the health literacy of the subjects; notably, the functional health literacy of women was high. However, many drug misuse cases were identified among women in their 40s. Health literacy and drug knowledge levels showed a significant relationship.

Conclusion
It is necessary to provide community-based information to vulnerable groups to ensure safe use of medications and to develop a level-based and tailored educational program considering North Korean refugees' literacy levels and cultural characteristics.
On-Demand and Low Dose Intratympanic Gentamicin for Meniere's Disease: A Customized Approach
Authors: Celis-Aguilar Erika , Castro-Bórquez Karla Mariana , Obeso-Pereda Alejandra , Escobar-Aispuro Lucero , Burgos-Paez Alan , Alarid-Coronel José M. , Verdiales-Lugo Sergio , León-Leyva Ivonne Carolina , Trejo-González Cosme Francisco , López-Favela Lilia Miriam , Martínez-Román Leticia 
Published: February 2020

Objective:To evaluate the efficacy of on demand and low dose intratympanic gentamicin (ITG) in patients with intractable Meniere's disease (MD).Study Design:Clinical chart review.Setting:Secondary care center.Patients:Subjects with MD who failed conventional treatment and underwent on demand ITG infiltration from June 2013 to December 2018.Intervention:0.4 to 0.5 ml of buffered gentamicin were administered through an intratympanic route. A total of 5 mg in case of low dose and 20 mg as a standard dose.Main Outcome Measures:Vertigo control, Meniere's Disease Functional Level Scale (MDFLS), Dizziness Handicap Inventory (DHI), and pure tone audiometry pre and posttreatment.Results:Thirty-one patients, 16 women and 15 men with a mean age of 52.81 (22–79) years were included. The number of ITG injections ranged from 1 to 7, with a mean of 2.52 applications per patient. Mean interval between doses was 212.15 (21–1442) days. Average follow-up was 24.03 months. An improvement on MDFLS was seen on 77.4% (n = 24) patients. DHI score improved after gentamicin treatment (mean 55.23 versus 24.06,p ≤ 0.001). Thirty patients (96.8%) reached complete or substantial vertigo control. Only one patient did not achieve control. Hearing was preserved in 43.5% (n = 10) of analyzed audiograms, whereas 17.4% (n = 4) developed hearing loss greater than 20 dB, which was not statistically significant (p = 0.099).Conclusions:In our study, on demand and low dose ITG was effective for vertigo control in patients with intractable MD. Individualized therapy is recommended in all patients to minimize vestibular and cochlear toxicity.
Speech Perception Gap Is Predictive of an Active Middle Ear Implant Advantage
Authors: Shohet Jack A. , Gende Deanna M. , Bibee Jacqueline , Patzkowski Gina , Tanita Cheryl 
Published: February 2020

Objective:
Evaluate whether the difference between word recognition score (WRS) obtained unaided under earphone and with a hearing aid (HA), the speech perception gap (SPgap), is predictive of performance with a totally implantable active middle ear implant (AMEI).

Study Design:
Retrospective review of systematically collected data.

Setting:
Private otologic practice.

Patients:
One hundred thirty six ears (133 patients) with sensorineural hearing loss implanted with an AMEI. Subjects were 73.5% men, with mean age = 61.3 years.

Intervention:
Previous AMEI.

Main Outcome Measures:
WRS with earphone at phonetically balanced maximum (PB-MAX), and with HA and AMEI at 50 dB HL. Differences between earphone, HA and AMEI word recognition, grouped as positive or negative speech perception gap (+SPgap/–SPgap) between two devices.

Results:
A +SPgap (WRS poorer with device than earphone) occurred in 86.0% of patients with HA and 42.3% with the AMEI. Mean SPgap = 24.7% with HA and 3.0% with AMEI (p ≤ 0.001). With a HA +SPgap, AMEI performance was better than HA by an average difference of 23.2% WRS, with AMEI more than HA in 82.9% of subjects. With HA –SPgap, the mean difference was 1.1% correct and AMEI more than HA in 47.4% of subjects (p ≤ 0.001 and p ≤ 0.002, for mean difference and percent of subjects, respectively). The larger the +SPgap (earphone-HA), the greater the advantage of AMEI over HA (r = 0.62, p ≤ 0.001).

Conclusion:
A speech perception gap between earphone PB-MAX and aided word recognition score suggests a patient may have better speech perception with an AMEI than with his/her hearing aid. This information is useful for counseling patients who are not performing well or are unsatisfied with their hearing aid.
Evaluation of Insertion Forces and Cochlea Trauma Following Robotics-Assisted Cochlear Implant Electrode Array Insertion
Authors: Kaufmann Christopher R. , Henslee Allan M. , Claussen Alex , Hansen Marlan R. 
Published: February 2020

Hypothesis:
The objective was to evaluate the effect of cochlear implant (CI) insertion technique on electrode insertion forces and intracochlear trauma. We hypothesize that robotics-assisted insertions will reduce insertion forces and intracochlear trauma compared with manual insertions.

Background:
Variability in CI outcomes exists across patients, implant centers, surgeons, and electrode types. While surgical techniques that reduce electrode insertion trauma are well established, insertion trauma remains one contributing factor to variability in CI outcomes. Previous work demonstrates that micromechanically controlled insertion tools reduce both maximum insertion forces and insertion variability compared with manual insertions.

Methods:
CI electrode insertions were performed either by hand (n = 12) or utilizing a robotics-assisted tool (n = 12) in fresh frozen, human cadaveric cochleae using electrodes from four different CI manufacturers. Electrodes array insertion forces were additionally evaluated in benchtop cochlea models. Following cadaveric insertions, samples were imaged via high resolution x-ray microscopy to evaluate electrode position and intracochlear trauma events based on a modified Eshraghi scale.

Results:
Electrode array insertions performed by robotics-assisted system showed significantly lower insertion forces and variability. Manual electrode array insertions had a significantly higher overall trauma score of 3.1 ± 2.0 compared with 0.9 ± 1.0 for robotics-assisted insertions. Robotics-assisted insertions had higher rate of basilar membrane elevations while manual insertions showed higher rates of severe trauma events.

Conclusions:
The robotic-assisted insertion system reduced trauma events associated with CI electrode insertions in cadaveric cochleae compared with manual insertions. Surgical devices which help to precisely and more consistently insert electrodes may improve CI outcomes and hearing preservation.
Influenza management with new therapies
Authors: O'Sullivan Shane , Torres Antoni , Rodriguez Alejandro , Martin-Loeches Ignacio 
Published: February 2020

Purpose of review
Influenza represents a significant treatment burden to critical care services. A variety of treatment strategies exist, with more and more therapeutic avenues opening up as research progresses. We examined both pharmacological and supportive treatment strategies currently available to see how they might be applied in an ICU setting.

Recent findings
Supportive care in Influenza centres around optimizing respiratory failure, particularly through well established and recognized ventilatory strategies. Noninvasive ventilation and high-flow nasal oxygen may have a limited role in selected patients under carefully monitored circumstances. Drug therapy exerts only a modest clinical effect and has been poorly studied in the critically ill, though there is some evidence to support the use of neuraminidase inhibitors (NAI) – particularly oseltamivir – as early as possible in this cohort. Newer agents have failed to demonstrate superiority over NAIs but may be useful options if the patient fails to respond or should resistant influenza strains emerge. Steroid therapy, in the absence of another indication, must be recommended against given the repeated trend towards increased mortality in this group.

Summary
Influenza management is an evolving field of significant interest to any critical care provider. Currently, good respiratory supportive care and early enteral oseltamivir are the best supported treatment strategies. Further study in the intensive care setting will be needed before the use of novel agents can be recommended.
Correlation of PD-L1 expression on tumor cell and tumor infiltrating immune cell with 18F-fluorodeoxyglucose uptake on PET/computed tomography in surgically resected pulmonary adenocarcinoma
Authors: Hu Bingxin , Xiao Jie , Xiu Yan , Fu Zhequan , Shi Hongcheng , Cheng Dengfeng 
Published: February 2020

Objective
The uptake of 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) is known to be linked to programmed death ligand 1 (PD-L1) expression on tumor cells (TC). However, the association between PD-L1 expression on immune cells (IC) and 18F-FDG accumulation is still unclear. Here, we conducted a clinicopathological study to investigate the relationship between PD-L1 expression on TC/IC and 18F-FDG uptake in patients with surgically resected pulmonary adenocarcinoma (ADC).

Methods
A total of 450 ADC patients who underwent preoperative 18F-FDG-PET/CT imaging were analyzed retrospectively. Immunohistochemistry analysis was performed for PD-L1 expression on TC and IC in ADC specimens with SP142. PD-L1 expression was performed on whole-tissue sections and given scores (0/1/2/3) according to percent of PD-L1+ cells in TC and IC.

Results
Compared to TC0 and IC0, PD-L1 positive expression was 90.4% (407/450) in ADC specimens. Both PD-L1 expression score on TC and IC were associated with maximum standardized uptake (SUVmax). SUVmax augmented with increasing PD-L1 expression (TC0 and IC0, 4.3 ± 3.4; TC or IC1/2/3, 7.7 ± 5.6; TC or IC2/3, 8.1 ± 5.6; TC or IC3, 8.4 ± 5.4). The best cut-off value of PD-L1 expression, determined by receiver operating characteristic curve, was 5.1 for TC or IC1/2/3 [area under the curve (AUC) = 0.713, sensitivity 62.2%, specificity 72.1%]. Multivariate analysis demonstrated that TC or IC1/2/3 subset was correlated with histological subtype, PD-1 expression on IC and SUVmax.

Conclusion
High SUVmax is associated with PD-L1 expression on TC and IC in surgically resected pulmonary ADC. 18F-FDG-PET/CT imaging can be a potential tool to evaluate PD-L1 expression in pulmonary ADC.
Evaluation of a child with suspected nephrolithiasis
Authors: Reusz George S. , Hosszu Adam , Kis Eva 
Published: February 2020

Purpose of review
As the incidence of nephrolithiasis in children doubles every 10 years it is becoming a common disease associated with significant morbidity along with considerable economic burden worldwide. The aim of this review is to summarize current data on the epidemiology and causes of renal stones in children and to provide a frame for the first clinical evaluation of a child with suspected nephrolithiasis.

Recent findings
Dietary and environmental factors are the driving force of changing epidemiology. Diagnosis should be based on medical history, presenting signs, examination, first laboratory and radiological workup. Ultrasound should be the initial diagnostic imaging performed in pediatric patients while low-dose computed tomography is rarely necessary for management. Metabolic factors including hypercalciuria, hypocitraturia, low fluid intake as well as specific genetic diseases should be explored after the resolution of initial signs and symptoms.

Summary
Appropriate initial evaluation, imaging technique, identification of risk factors and other abnormalities are essential for early diagnosis and prevention of stone-related morbidity in children with suspected nephrolithiasis.
The interplay between acute bacterial skin and skin structure infections and depression: a vicious circle of major clinical importance
Authors: Bassetti Matteo , Almirante Benito , Giamarellos-Bourboulis Evangelos J. , Gournellis Rossetos , Grande Iria , Marini Maria Giulia , Balestrieri Matteo 
Published: February 2020

Purpose of review
Previous studies suggest an association between depression and increased risk of various type of infections, including acute bacterial skin and skin structure infections (ABSSSI). Here, we review the latest advancement in our understanding of immunity in patients with depression and its relevance to disease management and diagnosis, with a special focus on patients suffering from ABSSSI.

Recent findings
Recent studies have highlighted the role of hypothalamic–pituitary–adrenal axis, neuro-endocrine stress signaling pathways and behavioral attitudes (substance abuse and homelessness) in the pathogenesis of infections in depressed patients. Furthermore, acute bacterial infections, in turn, have emerged as a possible risk for depression development because of different mechanisms including antibiotic-driven changes in the microbiota.

Summary
Recent evidences have emphasized the threat that comanagement of depression and infection pose to infectious disease physician and psychiatrist. Depressed patients with ABSSSI must be closely monitored for drug side-effects, drug–drug interactions, toxicity, and adequate compliance. New management strategies including new long-acting antibiotics (e.g., dalbavancin) are welcome.
Outcomes following penetrating neck injury during the Iraq and Afghanistan conflicts: A comparison of treatment at US and United Kingdom medical treatment facilities
Authors: Breeze John , Bowley Douglas M. , Combes James G. , Baden James , Orr Linda , Beggs Andrew , DuBose Joseph , Powers David B. 
Published: February 2020

INTRODUCTION
The United States and United Kingdom (UK) had differing approaches to the surgical skill mix within deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan.

METHODS
The US and UK combat trauma registries were scrutinized for patients with penetrating neck injury (PNI) at deployed coalition MTF between March 2003 and October 2011. A multivariate mixed effects logistic regression model (threshold, p < 0.05) was used stratified by MTF location and year of injury. The dependent variable was fatality on leaving Role 3, and the independent variables were ISS on arrival, nationality, MTF nationality, and presence of head and neck surgeon.

RESULTS
A total of 3,357 (4.9%) of 67,586 patients who arrived alive at deployed military MTF were recorded to have sustained neck injuries; of which 2,186 (83%) were PNIs and the remainder were blunt injuries. When service members killed in action were included, the incidence of neck injury rose from 4.9% to 10%. Seven hundred nine (32%) of 2,186 patients with PNI underwent neck exploration; 555 patients were recorded to have sustained cervical vascular injury, 230 (41%) of 555 underwent vascular ligation or repair. Where it was recorded, PNI directly contributed to death in 64 (28%) of 228 of patients. Fatality status was positively associated with ISS on arrival (odds ratio, 1.05; 95% confidence interval, 1.04–1.06; p < 0.001) and the casualty being a local national (odds ratio, 1.74; 95% confidence interval, 1.28–2.38; p < 0.001).

CONCLUSION
Significant differences in the treatment and survival of casualties with PNI were identified between nations in this study; this may reflect differing cervical protection, management protocols, and surgical capability and is worthy of further study. In an era of increasing specialization within surgery, neck exploration remains a skill that must be retained by military surgeons deploying to Role 2 and Role 3 MTF.

LEVEL OF EVIDENCE
Retrospective cohort study, level III.
A spatial framework to explore needs and opportunities for interoperable urban flood management
Authors: Dawson David A. , Vercruysse Kim , Wright Nigel 
Published: February 2020

Managing current and future urban flood risks must consider the connection (i.e. interoperability) between existing (and new) infrastructure systems to manage stormwater (pluvial flooding). Yet, due to a lack of systematic approaches to identify interoperable flood management interventions, opportunities are missed to combine investments of existing infrastructure (e.g. drainage, roads, land use and buildings) with blue-green infrastructure (e.g. sustainable urban drainage systems, green roofs, green spaces). In this study, a spatial analysis framework is presented combining hydrodynamic modelling with spatial information on infrastructure systems to provide strategic direction for systems-level urban flood management (UFM). The framework is built upon three categories of data: (i) flood hazard areas (i.e. characterize the spatial flood problem); (ii) flood source areas (i.e. areas contributing the most to surface flooding); (iii) the interoperable potential of different systems (i.e. which infrastructure systems can contribute to water management functions). Applied to the urban catchment of Newcastle-Upon-Tyne (UK), the study illustrates the novelty of combining spatial data sources in a systematic way, and highlights the spatial (dis)connectivity in terms of flood source areas (where most of the flood management intervention is required) and the benefit areas (where most of the reduction in flooding occurs). The framework provides a strategic tool for managing stormwater pathways from an interoperable perspective that can help city-scale infrastructure development that considers UFM across multiple systems.
This article is part of the theme issue ‘Urban flood resilience’.
Flood resilience
Authors: Zevenbergen Chris , Gersonius Berry , Radhakrishan Mohan 
Published: February 2020

Three different conceptual frameworks of resilience, including engineering, ecological and social–ecological have been presented and framed within the context of flood risk management. Engineering resilience has demonstrated its value in the design and operation of technological systems in general and in flood resilient technologies in particular. Although limited to the technical domain, it has broadened the objectives of flood resilient technologies and provided guidance in improving their effectiveness. Socio-ecological resilience is conceived as a broader system characteristic that involves the interaction between human and natural systems. It acknowledges that these systems change over time and that these interactions are of complex nature and associated with uncertainties. Building (socio-ecological) resilience in flood risk management strategies calls for an adaptive approach with short-term measures and a set of monitoring criteria for keeping track of developments that might require adaptation in the long-term (adaptation pathways) and thus built-in adaptive capacity as opposed to building engineering resilience which involves a static approach with a fixed time horizon a set of robust measures designed for specific future conditions or scenarios. The two case studies, from a developing and a developed country, indicate that the concepts of ecological and socio-ecological resilience provide guidance for building more resilient flood risk management systems resulting in an approach that embraces flood protection, prevention and preparedness. The case studies also reveal that the translation of resilience concepts into practice remains a challenge. One plausible explanation for this is our inability to arrive at a quantification of socio-ecological resilience taking into account the various attributes of the concept.This article is part of the theme issue ‘Urban flood resilience’.