bluuebunny/crossref_metadata_2025_split huggingface dataset:
Salivary gland diseases
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip 
Published: November 2020

Abstract
The salivary glands consist of three paired major glands—parotid, sub­mandibular, and sublingual—and the countless minor salivary glands found in almost every part of the oral cavity, except the gingiva and anterior regions of the hard palate. The secretion of saliva is essential for the normal function and health of the mouth, and disorders of salivary gland function predispose to oral disease. Functional disorders in salivary secretion may be associated with primary salivary gland disease but in other cases are a consequence of systemic factors, such as medi­cations, endocrine disturbances, and neurological disease, which are discussed in Chapter 10. Developmental anomalies of the salivary glands are rare. Aplasia of one or more major glands and atresia of one or more major salivary gland ducts have been reported. Congenital aplasia of the parotid gland may be associated with other facial abnormalities, e.g. ectodermal dysplasia, mandibulofacial dysostosis, and hemifacial microsomia. Heterotopic salivary tissue has been reported from a variety of sites in the head and neck region, the most frequent being its inclusion at the angle, or within the body, of the mandible, called a Stafne bone cavity. It is usually an incidental radiological finding and appears as a round or oval, well-demarcated radiolucency between the premolar region and angle of the jaw, and is typically located beneath the inferior dental canal. The radiographic appearances are due to a saucer-shaped depression or concavity of varying depth on the lingual aspect of the mandible, which contains salivary tissue in continuity with the submandibular gland. Accessory parotid tissue within the cheek or masseter muscle is rela­tively common and is subject to the same diseases that may affect the main gland. Age changes can be detected in both major and minor salivary glands. Reduction in the weights of submandibular and parotid glands has been reported with increasing age, associated in the submandibular gland with an age-dependent reduction in flow rates. By contrast, sev­eral studies have demonstrated that there is no significant reduction in parotid flow rates in the elderly.
Long-Term Clinical and Radiological Results After Hook Plate Osteosynthesis of Lateral Clavicle Fractures
Authors: Baunach Daniel , Eid Karim , Ricks Matthew , Borbas Paul 
Published: November 2020

Objectives:
To assess both clinical and radiological long-term outcomes after hook plate osteosynthesis for Neer type II lateral clavicle fractures.

Design:
Retrospective case series.

Setting:
Level-1 trauma center.

Patients/Participants:
Patients who underwent open reduction internal fixation with a hook plate for displaced fractures of the lateral third of the clavicle (Neer type II) at a single trauma hospital were identified.

Intervention:
Lateral clavicle open reduction internal fixation with a hook plate.

Main Outcome Measures:
At the first of 2 long-term follow-up appointments, bilateral magnetic resonance imaging (MRI) scans and strength measurements were performed, Constant–Murley score, subjective shoulder value (SSV), and Oxford shoulder score (OSS) of both shoulders were obtained. At the second follow-up, specific acromioclavicular (AC) score, SSV, and OSS were obtained.

Results:
Twenty-one patients (mean age, 29.5 ± 9.7 years) could be included who were available for at least 1 of 2 follow-ups after 7.4 years (±2.3) and 13.9 years (±2.2). Bony union was achieved in all patients (100%) at an average of 3.4 months (±1.4). The hook plate was removed at an average of 5.5 months (±3.3) after initial surgery in all patients. No significant side-to-side differences were found in OSS, Constant–Murley score, SSV, and specific AC score and for strength testing and MRI scans.

Conclusions:
Long-term outcome after hook plate fixation of Neer type II lateral clavicle fractures demonstrated good clinical results and shoulder strength without higher radiographic rates of AC joint osteoarthritis, subacromial impingement, or rotator cuff lesions. That may be related to a standardized early plate removal after bony fracture union.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Effect of a Multifaceted Family Participation Program in an Adult Cardiovascular Surgery ICU*
Authors: Yoo Hye Jin , Shim JaeLan 
Published: November 2020

OBJECTIVES:
To develop and implement a patient- and family-centered care program for patients in a cardiovascular surgery ICU.

DESIGN:
Prospective, pre- and postintervention evaluations were conducted.

SETTING:
The cardiovascular surgery ICU was located in a tertiary hospital.

PARTICIPANTS:
Participants included 56 family members of patients in cardiovascular surgery ICU between May and July 2019.

INTERVENTIONS:
Providing personalized treatment plans for patients by: 1) providing an ICU diary, 2) communicating with the medical staff, 3) providing personal care using ICU visitation kit, and 4) guiding bedside range of motion exercises. The experimental group received a guided ICU diary and education program from a nurse, including the application of a family participation visitation program. Family members were provided with customized information from the ICU diary and communicated with the medical staff for approximately 10 minutes. Family members were instructed on how to perform personal care using an “ICU visitation kit” during visitation hours when permitted to participate in bedside activities for approximately 10-minute intervals.

MEASUREMENTS AND MAIN RESULTS:
Scores for satisfaction with the provided care and information increased significantly for the experimental group compared with the control group (t = 8.62; p < 0.001). Anxiety levels decreased significantly after intervention in both groups (t = –7.05; p < 0.001 and t = –12.94; p < 0.001) with a significant association observed between group and time point (F = 20.50; p < 0.001). However, no significant change was observed in satisfaction with decision-making following intervention in either group, and no significant association was noted between groups and time points for this variable (F = 0.24; p = 0.626).

CONCLUSIONS:
This set of implemented family participation processes significantly improved satisfaction and reduced anxiety in family members of critically ill patients.
Mortality and use of angiotensin-converting enzyme inhibitors in COVID 19 disease: a systematic review
Authors: Nunes José Pedro L. 
Published: November 2020

Abstract

Background:
Interest exists concerning the use of angiotensin-converting enzyme inhibitors (ACEis) in patients with COVID-19 disease.

Objectives:
The aim of the study was to perform a systematic review on mortality associated to the use of ACEi in patients with COVID-19 disease.

Methods:
Search in Medline (PubMed), in ISI Web of Knowledge and in medRxiv database; use of other sources.

Results:
A total of 33 articles were evaluated. Concerning the papers used to produce the meta-analyses, 7 studies were selected, 5 of which were used. These 5 studies involved a total number of 944 patients treated with ACEi and 5173 not treated with ACEi. Increased mortality was seen in association to the use of ACEi in the context of COVID-19 disease (ACEi users vs nonusers; odds ratio, 1.48; 95% confidence interval, 1.02–2.15; P = .04). When compared to mortality in patients treated with angiotensin receptor blockers, mortality of patients treated with ACEi was not significantly different (odds ratio, 0.96; 95% confidence interval, 0.76–1.21; P = .74). Concerning the remaining reports, different types of data adjustments were used by several authors, after which increased mortality was not seen in association to the use of ACEi in this context.

Conclusions:
ACEi use could act as a marker of increased mortality risk in some but not all COVID-19 disease settings. The data now presented do not prove a causal relation but argue in favor of carrying out clinical trials studying ACEi in COVID-19 patients, to establish the safety of ACEi use in this context.
Comparison of the Metabolic Characteristics of Newer Second Generation Antipsychotics
Authors: Greger Jessica , Aladeen Traci , Lewandowski Emily , Wojcik Rachael , Westphal Erica , Rainka Michelle , Capote Horacio 
Published: November 2020

Abstract

Purpose/Background
Extensive research has been conducted comparing the metabolic characteristics of older second-generation antipsychotics (SGAs); minimal data exist comparing the long-term metabolic effects of SGAs approved in the last 10 years.

Methods/Procedures
A retrospective chart review of patients treated with brexpiprazole, lurasidone, asenapine, cariprazine, and iloperidone (newer SGAs) for at least 6 weeks at an outpatient psychiatric practice was conducted. Patients treated with olanzapine, an older SGA, were included as a comparator. Metabolic characteristics were collected at baseline, approximately 6 weeks, 12 weeks, and for up to 12 months.

Findings/Results
Of the newer SGAs, there were statistically significant increases in patients' average weight at 12 weeks and 1 year or less with brexpiprazole (2.48 lb, P = 0.02; 5.97 lb, P = 0.01) and iloperidone (4.54 lb, P < 0.01; 5.13 lb, P = 0.02). Brexpiprazole and iloperidone resulted in significant increases in body mass index, up to a 0.90-kg/m2 average increase in patients taking brexpiprazole at 1 year or less. Minimal weight gain was seen with cariprazine (4.25 lb, P = 0.42) and asenapine (1.80 lb, P = 0.62) at 1 year or less after treatment initiation. Although not statistically significant, lurasidone showed an average weight loss of up to 0.60 lb at 1 year or less (P = 0.56).

Implications/Conclusions
Although some weight gain was seen with the newer SGAs, all demonstrated significantly favorable metabolic characteristics compared with olanzapine. Monitoring of weight and metabolic parameters remain important in patients treated with SGAs.
Association Between Use of EHR-Generated Dashboards and Hospital Outcomes in 30-Day Heart Failure Readmissions
Authors: Gasoyan Hamlet , Aaronson William E. 
Published: November 2020

EXECUTIVE SUMMARY
This study examined whether usage of clinical data from the electronic health record (EHR) to create organizational- and unit-level performance dashboards and assess adherence to clinical practice guidelines is associated with hospital outcomes in risk-adjusted 30-day readmissions for patients with a principal diagnosis of heart failure (HF). It further assesses the association between the metrics of hospital financial health and the usage of those EHR-generated tools.
A cross-sectional study design was used. The study used data from the 2016 American Hospital Association Annual Survey Information Technology Supplement, the Pennsylvania Health Care Cost Containment Council’s (PHC4’s) 2017 Hospital Performance Report, and the PHC4 General Acute Care Hospitals Financial Analysis Report for fiscal year 2017. Contingency tables, likelihood-ratio chi-square tests, and logistic regression were applied for data analysis.
Usage of the EHR to assess adherence to clinical practice guidelines and create EHR-generated unit-level performance dashboards, rather than organizational performance dashboards, was more strongly associated with the hospitals’ rating in risk-adjusted 30-day readmissions for HF patients. An increase in hospitals’ operating margin was associated with greater odds of the usage of the discussed EHR tools, after controlling for hospital control/ownership and the total number of beds.
Usage of some EHR-generated analytical tools may be more strongly associated with lower-than-expected 30-day hospital readmissions in HF patients than with other tools. Better hospital financial health is linked with greater uptake of the discussed analytical tools. Further research could help to determine which EHR-generated tools are more effective in improving hospital outcomes in HF.
The effect of using long-acting octreotide as adjuvant therapy for patients with grade 2 pancreatic neuroendocrine tumors after radical resection
Authors: Gao Suizhi , Shi Xiaohan , Ma Hongyun , Wang Huan , Li Bo , Song Bin , Guo Shiwei , Jin Gang 
Published: November 2020

Abstract

Objective:
To investigate the effect of long-acting octreotide as adjuvant therapy in the prevention of tumor recurrence in patients with grade 2 pancreatic neuroendocrine tumors (pNETs) after radical resection.

Methods:
The postoperative follow-up data of 130 patients with resectable G2 pNET treated in the Changhai Hospital from 2008 to 2018 were retrospectively analyzed: 59 patients received long-acting octreotide as adjuvant therapy for 6 to 12 months (Oct group) and 71 patients received active follow-up (control group), both of which began after the radical resection, with the primary observation endpoint of disease-free survival (DFS) and the secondary study endpoint of overall survival.

Results:
The median age of the patients in the Oct group and control group was 52 and 54 years, respectively. There were 28 male cases (47.5%) and 33 male cases (46.5%) in the 2 groups. The median maximum tumor diameter was 3.5 and 3.0 cm, respectively; lymph node metastasis was positive in 13 cases (22.0%) and 9 cases (12.7%); there was peripancreatic nerve invasion in 11 cases (18.6%) and 6 cases (8.5%). Survival analysis revealed that there were significant differences in 2-year DFS% (98.3% vs 88.7%, P = .0371) and 3-year DFS% (96.6% vs 85.9%, P = .0498) between the Oct group and control group. Long-acting octreotide treatment was found to reduce the risk of 3-year recurrence of G2 pNET after radical resection (HR = 0.2, P = .044) with the application of inverse-probability-of-treatment weighted to balance the limited data bias.

Conclusion:
Using long-acting octreotide as adjuvant therapy for G2 pNET patients after radical surgery may improve the rate of 3y-DFS, but the benefit needs to be confirmed in a well-designed random control clinical trial.
Efficacy of Ultrasonography in the Diagnosis of Transudative Pleural Fluids
Authors: Doğan Coşkun , Demirer Ersin 
Published: November 2020

Aims:
We aimed to evaluate the efficacy of thoracic ultrasonography (USG) in diagnosis of pleural exudates and transudates using pleural thickness (PT) measurement.

Patients and Methods:
Patients who underwent investigations for pleural fluid between January 2018 and May 2018 were included in this prospective study. The patients were evaluated using radiologic imaging modalities to detect pleural fluid, and PT was measured using thoracic USG. The patients were then divided into 2 groups according to Light’s criteria as transudative pleural fluid (TPF) and exudative pleural fluid (EPF), and the results were compared between the groups.

Results:
A total of 73 patients were included in the study. The mean age was 62±15.1 years. Forty-eight patients (65.8%) had EPF and 25 (34.2%) had TPF. Thoracic USG revealed a mean PT of 0.3±0.1 cm in the TPF group and 0.6±0.3 cm in the EPF group (P<0.001). The optimal cut-off value for PT was 0.2 cm in the TPF group. The sensitivity and specificity of thoracic USG were calculated as 87.5% and 56%, respectively.

Conclusion:
The measurement of PT using thoracic USG in this study has a high sensitivity but low specificity for identifying transudates from exudates. This approach may be useful in patients who refuse thoracentesis or have a contraindication for the procedure, and in emergency and intensive care unit settings. We recommend further studies to determine the efficacy of thoracic USG studies in patients with pleural fluids.
Prevalence, Surgical Management, and Audiologic Impact of Sigmoid Sinus Dehiscence Causing Pulsatile Tinnitus
Authors: Ettyreddy Abhinav R. , Shew Matthew A. , Durakovic Nedim , Chole Richard A. , Herzog Jacques , Buchman Craig A. , Wick Cameron C. 
Published: November 2020

Objective:
To evaluate the prevalence, surgical management, and audiologic impact of pulsatile tinnitus caused by sigmoid sinus dehiscence.

Study Design and Setting:
Retrospective chart review at a tertiary care hospital.

Patients:
Adults with unilateral pulsatile tinnitus attributable to sigmoid sinus dehiscence who underwent resurfacing between January 2010 and January 2020.

Interventions:
Transmastoid sigmoid resurfacing.

Main Outcome Measures:
Resolution of pulsatile tinnitus; audiologic outcomes; complications; tinnitus etiologies.

Results:
Nineteen patients (89.4% women) had surgery for suspected sigmoid sinus dehiscence. The mean dehiscence size was 6.1 mm (range, 1–10.7 mm). Eight patients had concurrent sigmoid sinus diverticulum and one patient also had jugular bulb dehiscence. Only two patients (10.5%) had the defect identified by radiology. Low-frequency pure-tone average, measured at frequencies of 250 and 500 Hz, showed a significant median improvement of 8.8 dB following resurfacing (18.8 dB versus 10.0 dB, p = 0.02). The majority of patients had complete resolution of pulsatile tinnitus (16/19, 84.2%). Of those without complete resolution, two patients had partial response and one patient had no improvement. There were no significant complications. Of 41 consecutively tracked patients with a pulsatile tinnitus chief complaint, sigmoid pathology represented 32% of cases.

Conclusions:
Sigmoid sinus dehiscence represents a common vascular cause of pulsatile tinnitus that, if properly assessed, may be amenable to surgical intervention. Sigmoid sinus resurfacing is safe, does not require decompression, and may improve low-frequency hearing. Radiographic findings of dehiscence are often overlooked without a high index of clinical suspicion. Its relationship with transverse sinus pathology and idiopathic intracranial hypertension remain unclear.
Performance of artificial intelligence for prognostic prediction with the albumin-bilirubin and platelet-albumin-bilirubin for cirrhotic patients with acute variceal bleeding undergoing early transjugular intrahepatic portosystemic shunt
Authors: Zhong Bin-Yan , Tang Hao-Huan , Wang Wan-Sheng , Shen Jian , Zhang Shuai , Li Wan-Ci , Yin Yu , Yang Jun , Liu Fang , Ni Cai-Fang , Zhao Jian-Bo , Zhu Xiao-Li 
Published: November 2020

Purpose
The aim of this study was to validate and compare the prognostic performance of the albumin-bilirubin (ALBI) grade, platelet-albumin-bilirubin (PALBI) grade, Child-Pugh (CP) grade, and Model for End-Stage Liver Disease (MELD) score in predicting the 1-year variceal rebleeding probability using artificial intelligence for patients with cirrhosis and variceal bleeding undergoing early transjugular intrahepatic portosystemic shunt (TIPS) procedures.

Materials and methods
This dual-center retrospective study included two cohorts, with patients enrolled between January 2016 and September 2018 in the training cohort and January 2017 and September 2018 in the validation cohort. In the training cohort, independent risk factors associated with the 1-year variceal rebleeding probability were identified using univariate and multivariate logistic analyses. ALBI-, PALBI-, Child-Pugh-, and MELD-based nomograms and an artificial neural network (ANN) model were established and validated internally in the training cohort and externally in the validation cohort, which included patients with variceal bleeding who were treated with preventive TIPS.

Results
A total of 259 patients were included. The median follow-up periods were 24.1 and 18.9 months, and the 1-year variceal rebleeding rates were 12.3% (14/114) and 10.3% (15/145) in the training and validation cohorts, respectively. In the training cohort, all four variables were identified as independent risk factors. Four nomograms were then established and showed comparable prognostic performances after internal (C-index: 0.879, 0.829, 0.874, and 0.798) and external (C-index: 0.720, 0.719, 0.718, and 0.703) validation. The ANN demonstrated that these four variables had comparable importance in predicting the 1-year variceal rebleeding probability.

Conclusion
None of the four variables are optimal in predicting the 1-year variceal rebleeding probability for patients with cirrhosis and variceal bleeding undergoing early TIPS.
Progressive Postnatal Pansynostosis in Crouzon Syndrome
Authors: Geisler Emily L. , Hallac Rami R. , Perez Jeyna K. , Kane Alex A. 
Published: November 2020

Abstract
Crouzon syndrome is a known craniosynostosis syndrome with a heterogenous presentation. Suture closure can rapidly develop postnatally and involve multiple sutures, requiring vigilant clinical monitoring to prevent delay in diagnosis and developing intracranial hypertension. The authors present the case of a male patient with Crouzon syndrome who developed postnatal pansynostosis at 18 months of age when several missed appointments led to diagnosis after complete closure of all sutures and signs of elevated intracranial pressure. Posterior cranial vault distraction was performed soon after, and the patient improved clinically. There is a need for improved monitoring and management of these patients to prevent delay in diagnosis and potential permanent sequelae as well as minimizing radiation exposure through watchful CT scanning.
Surgical Treatment of Brooke-Spiegler Syndrome
Authors: Engels Patricia Esther , Fritsche Elmar , Pabst Gunther , Hug Urs 
Published: November 2020

Abstract
Brooke-Spiegler Syndrome (BSS) is a very rare autosomal dominant hereditary disease which arises from heterozygous mutations in the CYLD gene. Patients with BSS are predisposed to multiple skin appendage tumors such as cylindromas, which are benign tumors occurring mainly on the scalp. The tumors mostly appear around puberty and usually show slow growth throughout life. Malignant cylindroma formation in BSS patients has been reported. Apart from the skin, major and minor salivary glands have rarely been involved.
We here report a case of a 46-year-old female patient with BSS presenting with multiple aesthetically and functionally unpleasing cylindromas covering almost her entire hair-bearing scalp with further tumors on her face. Interestingly, her parotid glands were enlarged and showed multiple lesions with a diameter up to 18 to 20 mm. She was successfully treated by total subgaleal scalp excision and coverage through a dermal substitute and split thickness skin graft. Constant follow-up imaging was initiated to prevent unhindered tumor growth of salivary glands.