bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal Duration of Antibiotics Following Appendectomy for Patients With Complicated Appendicitis
Authors: Panshin Maclean S. , Alnachoukati Omar K. , Schroeppel Thomas J. , Metzler Michael , McFann Kim , Dunn Julie A. 
Published: October 2020

Background Complicated appendicitis patients typically undergo appendectomy followed by antibiotics. The optimal course of antibiotics for complicated appendicitis is poorly defined. Methods Data were collected from patients presenting with acute appendicitis and underwent appendectomy at the index hospitalization (2015-2017). Primary outcomes were readmission rate, superficial surgical site infection (SSI), deep space infection (DSI), which includes abscess. Length of post-operative antibiotic use was recorded and an average intent-to-treat (ITT) by operative grade was calculated. Results Two hundred seventy-two patients (23%) were diagnosed with complicated appendicitis. SSI occurred in 4% of patients (n = 11); SSI rates ranged from 0% to 14.6% by ITT group with 3-4 days being the lowest (0%) and <3 days the highest (14.6%) ( P = .008). DSI including abscesses occurred in 27 (9.9%) patients; least frequently in the 5-6 day ITT group (7.4%). Length of stay (LOS) was significantly related to longer antibiotic use ( P < .001) and increasing operative grade ( P < .01). Conclusions Given the lower incidence of postoperative complications between 3 and 6 days and no added benefit for ITT >6 days, we recommend limiting antibiotic treatment to 3-6 days for all complicated appendicitis cases with additional workup warranted if infectious symptoms persist.
The Enhanced Recovery After Surgery (ERAS) Elements that Most Greatly Impact Length of Stay and Readmission
Authors: Olson Kristofor A. , Fleming R. Y. Declan , Fox April W. , Grimes Andrew E. , Mohiuddin S. Sameer , Robertson Henry T. , Moxham Jamie , Wolf J. Stuart 
Published: October 2020

Background Enhanced recovery after surgery (ERAS) protocols have been shown to decrease length of stay (LOS) and improve patient outcomes in a wide variety of surgical fields; however, barriers exist preventing the implementation of all elements. We hypothesize that a subset of ERAS elements are most influential on LOS and readmission following colorectal surgery. Study Design A retrospective review of 840 patients was performed and their compliance with 24 ERAS components evaluated. Two independent machine-learning statistical algorithms were employed to determine which subset of ERAS elements was most impactful on LOS <3 days and hospital readmission. Results Increasing compliance with ERAS elements had an inverse linear relationship with LOS. Open (vs minimally invasive) surgery was associated with increased LOS. Early mobilization and multimodal pain management are the elements most protective against increased LOS. Readmissions increase with the number of morphine milligram equivalents (MME)/day. The subset of patients who underwent minimally invasive procedures, had multimodal pain control, and less than 16 MME per day were least likely (23%) to have >3-day LOS. Those patients who underwent an open procedure with less than 15 ERAS elements completed were most likely (84%) to have >3-day LOS. Conclusion While increasing compliance with ERAS protocols and minimally invasive procedures decrease LOS and readmission overall, a subset of components—multimodal pain control, limited opioid use, and early mobilization—was most associated with decreased LOS and readmission. This study provides guidance on which ERAS elements should be emphasized.
Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma
Authors: Ren Yin , MacDonald Bridget V. , Tawfik Kareem O. , Schwartz Marc S. , Friedman Rick A. 
Published: October 2020

ObjectiveTo identify clinical predictors of facial nerve (FN) outcomes after microsurgical resection of vestibular schwannoma (VS).Study DesignProspective cohort study.SettingAcademic medical center.MethodsConsecutive patients undergoing VS resection from November 2017 to October 2019 were included. FN function was evaluated with the House‐Brackmann (HB) scale and stratified into good (HB I‐II) and poor (HB III‐VI) function. Analyses included descriptive statistics, correlation, and logistic regression.ResultsOf 256 patients who met criteria (mean age, 47.7 years; 62.5% female), 227 (88.7%) achieved good FN function postoperatively and 238 (93.0%) at latest follow‐up (mean, 154.8 days). Operative approaches consisted of translabyrinthine (50.8%), retrosigmoid (25.0%), and middle fossa craniotomies (24.2%). Extent of resection was decided intraoperatively, and gross or near total resection was accomplished in 237 (92.6%) cases. Postoperative HB grade correlated with latest HB grade (0.615, P <. 001). Factors associated with good postoperative FN function included small tumor size (≤15 mm; odds ratio [OR], 2.425; P =. 042), gross or near total resection (OR, 3.170; P =. 041), and ≥100‐µV intraoperative FN electromyographic response to a 0.05‐mA stimulus (OR, 22.242; P <. 001). Factors associated with good FN function at latest follow‐up included gross total resection (OR, 7.764; P =. 003) and ≥100‐µV FN electromyographic response (OR, 8.518; P <. 001), accounting for surgical approach and tumor size.ConclusionMicrosurgical resection of VS can be accomplished with excellent FN outcomes. Gross total resection and ≥100‐µV intraoperative FN electromyographic response predicted excellent FN outcomes. Immediate postoperative FN function is a prognosticator of long‐term FN function.
In‐Practice Endocrine Surgery Fellowship: A Novel Training Model
Authors: Tierney Hien T. , Eldeiry Leslie S. , Garber Jeffrey R. , Haddad Chia A. , Varvares Mark A. , Iannuzzi Ralph A. , Randolph Gregory W. 
Published: October 2020

ObjectiveEndocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in‐practice otolaryngologists could result in expert‐level training.Study DesignQualitative clinical study with chart review.SettingUrban community practice and academic medical center.MethodsTwo board‐certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively.ResultsA total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty‐seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty‐five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism.ConclusionThis is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.
Myringoplasty With an Ultrathin Cartilage‐Perichondrium Complex Graft Versus Temporalis Fascia Graft: A Propensity Score–Matched Analysis
Authors: Huang Yi‐Bo , Hu Lu‐lu , Ren Dong‐Dong , Han Zhao 
Published: October 2020

ObjectiveTo compare endoscopic myringoplasty using the cartilage‐perichondrium complex as a graft (test group) with temporalis fascia microscopic myringoplasty (control group).Study DesignA retrospective cohort study.SettingDepartment of Otorhinolaryngology in a tertiary Chinese hospital.MethodsData were collected on patients between 2017 and 2019. To balance the baseline characteristics between groups, we performed a propensity score–matched analysis, and 44 patients were included in each group. Hearing improvement and eardrum closure rates were compared, and risk factors affecting them were analyzed.ResultsIn the control and test groups, 90.90% and 86.36% of patients had a mean air‐bone gap ≤20 dB after the surgery, respectively (P =. 843). The air conduction (AC) threshold gain at each frequency was similar in the 2 groups (P >. 05). The closure rates were 95.45% and 93.18%, respectively (P =. 645). The air‐bone gap improved significantly after surgery, F(1, 61) = 6.729, P =. 012. Age, group, middle ear mucosal status, and location of the perforation did not affect the change in air‐bone gap or the drum closure rate (P >. 05). However, there was an interaction between the change in air‐bone gap and the size of the perforation, F(1, 61) = 11.067, P = 0001.ConclusionEndoscopic myringoplasty using a cartilage‐perichondrium complex graft is comparable with traditional surgery. Age, location of the perforation, and middle ear mucosal status did not significantly affect the change in air‐bone gap or the drum closure rate. A perforation size ≥50% was always associated with a better air‐bone gap improvement.
Lion Conservation and the Lion Bone Trade in South Africa: On CITES, Shifting Paradigms, “Sustainable Use” and Rehabilitation
Authors: Turner Jason , Wels Harry 
Published: October 2020

In lion conservation, the International Union for Conservation of Nature (IUCN), the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), and Trade Records Analyses of Flora and Fauna in Commerce (TRAFFIC) are considered key United Nations (UN) institutions for “science-based decisions” on global policy formulation for conservation and combating wildlife crime. CITES, but probably also TRAFFIC and IUCN, still adheres to and operates in the paradigm of the “sustainable use” of animals, based on the long leading philosophical Cartesian paradigm in academia that premises that humans and animals differ in kind, and that animals do not “feel” and have the neurological capacities to think like us. But this Cartesian worldview can no longer withstand the latest scientific evidence, developments, and new insights that show how people and animals only differ in degree and not in kind. The concept of “sustainable use” of wildlife, including lions, therefore needs to be rethought in the light of this new paradigm. In South Africa, the “sustainable use” of lions includes the trade in lion’s bones from captive lions, which was legalized in 2016. The Wildlife Animal Protection Forum of South Africa (WAPFSA) appealed against this legalized trade, based on rational arguments that fit CITES and its Cartesian approach to animals but also on the paradigm shift where humans and animals are no longer considered different in kind but only in degree. This paradigm shift has led to initiatives to try and suggest possible ways forward for a political order that matches this “new normal.” Probably the most developed in this context is the concept of “zoopolis,” which is explored in this article. The four “vulnerabilities” on which the concept is based were all found to be relevant to lion conservation and fighting wildlife crime in South Africa.
The Setswana speech rhythm of 6–7 year-old Setswana–English bilingual children
Authors: Sebina Boikanyego , Setter Jane , Daller Michael 
Published: October 2020

Aims and objectives: This study investigates the acquisition of Setswana speech rhythm, considered to be typically syllable-timed, by early sequential Setswana–English bilingual children aged 6–7 years old growing up in Botswana, a country with a diglossic setting, where English is the dominant high-status language in educational and public contexts. For this group of children, taught full-time in English from the age of 3 years, the L2 becomes their dominant language through exposure to English-medium education. The aim was to ascertain if the prosodic patterns of Setswana spoken by the bilingual children are similar to those of the monolingual children or if English, considered to be stress-timed, has an effect on these prosodic features. Data and analysis: The speech rhythm patterns of 10 Setswana–English bilingual children were compared with those of 10 age-matched Setswana monolingual children educated in public schools for whom English is a learner language. The study primarily examines spontaneous speech from the telling of a wordless picture storybook, and utilises rhythm metrics nPVI-V and Varco V to examine the speech rhythm of the children. Findings: The results showed that the prosodic pattern of Setswana in the bilingual group diverged from that of the non-bilingual group. Originality: This is the first such study on speech rhythm in bilingual children in Setswana. Significance: The research provides evidence in this population of effects from English bilingualism on L1 Setswana speech prosody, and challenges the assumption that speech rhythm prosody is established early in life, especially when the language is a less marked, syllable-timed language like Setswana.
Stim‐activated TRPC‐ORAI channels in pulmonary hypertension induced by chronic intermittent hypoxia
Authors: Castillo‐Galán Sebastian , Arenas German A. , Reyes Roberto V. , Krause Bernardo J. , Iturriaga Rodrigo 
Published: October 2020

Obstructive sleep apnea (OSA), a breathing disorder featured by chronic intermittent hypoxia (CIH) is associated with pulmonary hypertension (PH). Rodents exposed to CIH develop pulmonary vascular remodeling and PH, but the pathogenic mechanisms are not well known. Overexpression of Stim‐activated Transient Receptor Potential Channels (TRPC) and Calcium Release‐Activated Calcium Channel Protein (ORAI) TRPC‐ORAI Ca2+ channels (STOC) has been involved in pulmonary vascular remodeling and PH in sustained hypoxia. However, it is not known if CIH may change STOC levels. Accordingly, we studied the effects of CIH on the expression of STOC subunits in the lung and if these changes paralleled the progression of the vascular pulmonary remodeling and PH in a preclinical model of OSA. Male Sprague‐Dawley rats (∼200 g) were exposed to CIH (5%O2, 12 times/h for 8 h) for 14, 21, and 28 days. We measured right ventricular systolic pressure (RVSP), cardiac morphometry with MRI, pulmonary vascular remodeling, and wire‐myographic arterial responses to KCl and endothelin‐1 (ET‐1). Pulmonary RNA and protein STOC levels of TRPC1, TRPC4, TRPC6, ORAI 1, ORAI 2, and STIM1 subunits were measured by qPCR and western blot, and results were compared with age‐matched controls. CIH elicited a progressive increase of RVSP and vascular contractile responses to KCl and ET‐1, leading to vascular remodeling and augmented right ventricular ejection fraction, which was significant at 28 days of CIH. The levels of TRPC1, TRPC4, TRPC 6, ORAI 1, and STIM 1 channels increased following CIH, and some of them paralleled morphologic and functional changes. Our findings show that CIH increased pulmonary STOC expression, paralleling vascular remodeling and PH.
Residence at moderately high altitude and its relationship with WHO Group 1 pulmonary arterial hypertension symptom severity and clinical characteristics: the Pulmonary Hypertension Association Registry
Authors: Fakhri Shoaib , Hannon Kelly , Moulden Kelly , Peterson Ryan , Hountras Peter , Bull Todd , Maloney James , De Marco Teresa , Ivy Dunbar , Thenappan Thenappan , Sager Jeffrey S. , Ryan John J. , Mazimba Sula , Hirsch Russel , Chakinala Murali , Shlobin Oksana , Lammi Matthew , Zwicke Dianne , Robinson Jeffrey , Benza Raymond L. , Klinger James , Grinnan Daniel , Mathai Stephen , Badesch David 
Published: October 2020

BackgroundWHO Group 1 pulmonary arterial hypertension is a progressive and potentially fatal disease. Individuals living at higher altitude are exposed to lower barometric pressure and hypobaric hypoxemia. This may result in pulmonary vasoconstriction and contribute to disease progression. We sought to examine the relationship between living at moderately high altitude and pulmonary arterial hypertension characteristics.MethodsForty‐two US centers participating in the Pulmonary Hypertension Association Registry enrolled patients who met the definition of WHO Group 1 pulmonary arterial hypertension. We utilized baseline data and patient questionnaire responses. Patients were divided into two groups: moderately high altitude residence (home ≥4000 ft) and low altitude residence (home <4000 ft) based on zip‐code. Clinical characteristics, hemodynamic data, patient demographics, and patient reported quality of life metrics were compared.ResultsControlling for potential confounders (age, sex at birth, body mass index, supplemental oxygen use, race, 100‐day cigarette use, alcohol use, and pulmonary arterial hypertension medication use), subjects residing at moderately high altitude had a 6‐min walk distance 32 m greater than those at low altitude, despite having a pulmonary vascular resistance that was 2.2 Wood units higher. Additionally, those residing at moderately high altitude had 3.7 times greater odds of using supplemental oxygen.ConclusionPatients with pulmonary arterial hypertension who live at moderately high altitude have a higher pulmonary vascular resistance and are more likely to need supplemental oxygen. Despite these findings, moderately high altitude Pulmonary Hypertension Association Registry patients have better functional tolerance as measured by 6‐min walk distance. It is possible that a “high‐altitude phenotype” of pulmonary arterial hypertension may exist. These findings warrant further study.
Communication Skills for Extended Duties Dental Nurses: The Childsmile Perspective
Authors: O'Keefe Emma 
Published: October 2020

Good communication and influencing skills are key competency areas for dental nurses and are highly relevant when working with children and their families/carers in Childsmile, a national oral health improvement programme for children in Scotland. The General Dental Council (GDC) identifies communication skills as one of the nine principles for registrants; a large number of complaints seen by the GDC relate to allegations around communication and patient expectations not being fully met. Much time and investment has been spent in researching the role of the Extended Duties Dental Nurse (EDDN) and ensuring appropriate training is provided. While there is specific training for EDDNs delivering the Childsmile programme, the programme appreciates that good communication skills are a core component of all training programmes for dental nurses. This paper sets out to explore the role of EDDNs in Childsmile and specifically looks at the importance of good communication skills and how it facilitates and impacts on the delivery of the Childsmile programme in a variety of settings.
Learning from a Special Care Dentistry Needs Assessment
Authors: Johnson Ilona 
Published: October 2020

The General Dental Council recognised special care dentistry (SCD) as a speciality in 2008 and local service reviews have been carried out in order to develop SCD services. A needs assessment was completed to inform the implementation of recommendations from a 2010 review of SCD in Wales. Aim The aim of this paper is to outline the process, findings and learning from the needs assessment and the implications for SCD. Method A focused needs assessment approach was used. Stakeholder consultations were used to develop a working definition for the needs assessment. Data were collected from existing health and social care sources and analysed using descriptives and geographic information system (GIS) mapping. Results Data sources for needs assessment were limited. Analysis showed that health conditions were common in the population and increased with age. The majority of people who reported seeing a dentist were seen in general dental practice. Older people with health conditions were less likely to report seeing a dentist. Patients often needed to travel for specialist care services. Conclusion General dental practice teams have a significant role in caring for SCD patients. Careful planning of specialist care, joint working and enhancing skills across the general practice team will reduce the burden of care and enhance patient safety. Improvements in data for assessment of SCD needs are required to help this process.
Introduction to Pain
Authors: Renton Tara 
Published: October 2020

This edition of PDJ is intended to provide a wide overview on orofacial pain for dental and medical teams. Both acute and chronic orofacial conditions relevant to dentistry and medicine will be covered, and emphasising a holistic and pragmatic approach. Orofacial pain is the most common presenting symptom for patients presenting to their dentist and increasingly commonly presenting to doctors in general practice and A&E departments. Pain in the trigeminal system causes much higher psychological and neurophysiological distress compared with other body regions, as the trigeminal nerve is the great sensory protector to the eyes, ears, nose, mouth and meninges, the senses that underpin our very existence. It is an anathema that surgery in and around the face and mouth is predominantly undertaken by dentists on conscious patients, unlike other surgical specialties. This explains the expectation of pain by patients when seeing their dentists, sadly an expectation which is frequently fulfilled, fuelling high levels of anxiety and fear, which in turn increases the pain experience.
Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis
Authors: Bhambhvani Hriday P. , Kasman Alex M. , Zhang Chiyuan A. , Hu Serena S. , Eisenberg Michael L. 
Published: October 2020

Study Design: Retrospective cohort. Objectives: Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine. Methods: We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE. Results: We identified 117 918 men who underwent 162 646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE. Conclusions: DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.
Diagnosis and treatment of mixed phenotype (T-myeloid/lymphoid) acute leukemia with novel ETV6-FGFR2 rearrangement
Authors: Carll Timothy , Patel Anand , Derman Benjamin , Hyjek Elizabeth , Lager Angela , Wanjari Pankhuri , Segal Jeremy , Odenike Olatoyosi , Fidai Shiraz , Arber Daniel 
Published: October 2020

Key Points
Myeloid/lymphoid neoplasms with eosinophilia are driven by aberrant tyrosine kinases in pluripotent cells and display variable phenotypes. FGFR-driven hematolymphoid neoplasms are targetable by TKI inhibitors such as ponatinib; studies of specific FGFR inhibitors are ongoing.