bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cochlear Implantation in Cases of Inner Ear Malformation: A Novel and Simple Grading, Intracochlear EABR, and Outcomes of Hearing
Authors: Minami Shujiro B. , Yamamoto Nobuko , Hosoya Makoto , Enomoto Chieko , Kato Hidetoshi , Kaga Kimitaka 
Published: September 2020

Objective:
To propose a simple grading of inner ear malformation (IEM) and investigate intracochlear electrical auditory brainstem response (EABR) and outcomes for hearing in terms of the novel grading system.

Study Design:
Retrospective case review.

Setting:
Tertiary referral center.

Patients:
Sixty patients with IEMs who received cochlear implants.

Intervention:
Grading according to observation of modiolus deficiency and/or internal auditory canal (IAC) cochlear nerve deficiency (CND).

Main Outcome Measure:
Intracochlear EABR and categories of auditory performance (CAP) scores were assessed; children in school were categorized according to the type of school attended.

Results:
Among 60 patients, 38% were classified as Grade I (modiolus present + normal cochlear nerve), 22% as grade II (modiolus deficiency + normal cochlear nerve), 33% as grade III (modiolus present + IAC CND), and 7% as grade IV (modiolus deficiency + IAC CND). During the operation, 93% of Grade I, 36% of Grade II, 23% of Grade III, and 50% of Grade IV patients showed typical EABR waves. CAP scores of 4 or more were obtained from 91% of Grade I, 62% of Grade II, 35% of Grade III, and 25% of Grade IV. Whereas none of children in Grades III and IV entered main stream school, 55% of Grade I and 25% of Grade II entered mainstream schools.

Conclusions:
Outcomes of hearing with cochlear implantations in IEM children depend on the severity of IEM and IAC CND. Our novel grading of IEM is simple and can be useful for understanding the severity of IEM.
Y90 selective internal radiation therapy and peptide receptor radionuclide therapy for the treatment of metastatic neuroendocrine tumors: combination or not?
Authors: Yilmaz Ebru , Engin Müge Nur , Özkan Zeynep Gözde , Kovan Bilal , Büyükkaya Fikret , Poyanli Arzu , Sağlam Sezer , Başaran Mert , Türkmen Cüneyt 
Published: September 2020

Background
Peptide receptor radionuclide therapy and selective internal radiation therapy are effective radionuclide therapy modalities for unresectable metastatic neuroendocrine tumor patients that cannot be controlled with somatostatin analogs. The present study is intended to evaluate the therapeutic efficacy and toxicity of the combined therapy of selective internal radiation therapy and peptide receptor radionuclide therapy and stand-alone selective internal radiation therapy in patients with neuroendocrine tumor, a liver-dominant disease.

Methods
This cohort consists of 27 patients with metastatic neuroendocrine tumor and liver-dominant disease. They were grouped as the patients who were treated with selective internal radiation therapy for unresectable liver metastasis (n = 15) and the patients who received a combination of selective internal radiation therapy and peptide receptor radionuclide therapy (n = 12) for hepatic and extrahepatic metastasis. Treatment efficacy and treatment-associated toxicity were retrospectively assessed in both groups.

Results
The objective treatment response and stable disease were found in 13 patients (86.6%) in the selective internal radiation therapy group and eight patients (66.6%) in the selective internal radiation therapy + peptide receptor radionuclide therapy group. The median overall survival rate was found to be 34.9 months, in the selective internal radiation therapy group and 67.5 months in the selective internal radiation therapy + peptide receptor radionuclide therapy group (P = 0.217). The median progression-free survival data was not reached, and the mean values of progression-free survival were 53.1 ± 9.9 months in the selective internal radiation therapy group, and 27.2 ± 5.9 months in the selective internal radiation therapy + peptide receptor radionuclide therapy group (P = 0.561). Temporary lymphopenia was the most common side effect. Grade 1–2 hepatotoxicity was observed to be 6.6% in the selective internal radiation therapy group, while it was not observed in selective internal radiation therapy + peptide receptor radionuclide therapy group.

Conclusions
In the neuroendocrine tumors with liver-dominant metastatic disease, personalized selective internal radiation therapy and peptide receptor radionuclide therapy and their combinations result in increased survival rates. Selective internal radiation therapy alone could be an effective treatment in patients with liver-limited and -dominant disease.
Diagnostic performance of F-18 fluorodeoxyglucose PET/computed tomography for diagnosis of polymyalgia rheumatica: a meta-analysis
Authors: Kim Keunyoung , Kim Seong-Jang 
Published: September 2020

Objective
The purpose of the current study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) PET/computed tomography (CT) for diagnosis of polymyalgia rheumatic (PMR) through a meta-analysis.

Methods
The PubMed, Cochrane and EMBASE database, from the earliest available date of indexing up to 29 February 2020, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for diagnosis of PMR.

Results
Across the 11 results of seven studies selected for analysis (684 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.76 [95% confidence interval (CI), 0.67–0.83] with heterogeneity (I
2 = 74.9, P < 0.001) and a pooled specificity of 0.87 (95% CI, 0.82–0.91) with heterogeneity (I
2 = 61.2, P < 0.001). Likelihood ratio syntheses gave an overall positive likelihood ratio of 5.7 (95% CI, 4.3–7.7) and negative likelihood ratio of 0.28 (95% CI, 0.2–0.38). The pooled diagnostic odds ratio was 21 (95% CI, 13–32). The hierarchical summary receiver operating characteristic curve indicated the areas under the curve as 0.93 (95% CI, 0.90–0.95).

Conclusion
The current meta-analysis showed a moderate sensitivity and specificity of F-18 FDG PET/CT for the diagnosis of PMR. Currently, the literature on the use of F-18 PET/CT for the diagnosis of PMR is limited. Thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-18 FDG PET/CT for the detection of PMR.
A correlation study of ischiocavernosus muscle injury with different types of pelvic fractures and erectile dysfunction after pelvic fracture
Authors: Chen Zongping , Song Tao , Zhuang Yongxiang , Yan Yong , Liu Tong , Mao Kaiyi , Li Xu , Zou Chenghong , Wen Xin , Yao Yuhong , Chen Chao , Zhao Sicong 
Published: September 2020

Abstract

Objective:
To explore the correlation between ischiocavernosus muscle injury (ICMI) with different types of pelvic fractures and erectile dysfunction (ED) after pelvic fracture.

Design:
Retrospective analysis of a prospective database.

Setting:
The study was carried out at the affiliated hospital of Zunyi Medical University.

Patients/participants:
A total of 776 male patients with pelvic fracture, aged 18 to 67 years, were recruited for this study by retrospective analysis, and based on the diagnosis of ED and the presence of ICMI, the participants were divided into ED and non-ED groups as well as ICMI and non-ICMI groups.

Intervention:
No.

Main outcome measurements:
ICMI, the type of pelvic fracture, International Index of Erectile Function-5 scores. Computed tomography/magnetic resonance imaging scans, electromyography (motor unit potential) was used to diagnose ICMI.

Results:
The International Index of Erectile Function-5 score was 19.7 ± 5.9. The incidence of ED was 27.3%, the duration time of ED was 30 ± 23 months, and the incidence of reversible ED was 39.6% and of irreversible ED was 60.4%. The incidence of ICMI was 29.4%, among which the incidence of unilateral injury was 57.9%, and the incidence of bilateral injury was 42.1%. Among all pelvic fractures, the incidence of pubic ramus fracture was 88.1%. Bilateral pubic ramus fractures, bilateral fractures of the ischial ramus, and ICMI were independent risk factors for ED after pelvic fracture. Bilateral pubic ramus fractures and pubic symphysis separation were independent risk factors for ICMI. Unilateral ICMI was an independent risk factor for reversible ED, while bilateral ICMI was an independent risk factor for irreversible ED.

Conclusions:
ICMI is associated with ED and may be a cause for ED, while pubic ramus fracture, ischial ramus fracture, and pubic symphysis separation may be the main causes of ICMI. Unilateral ICMI may be the main risk factor for transient ED, and bilateral ICMI may be the main risk factor for permanent ED.
Undiagnosed Normocephalic Pancraniosynostosis Presenting as Bilateral Abducens Nerve Palsy
Authors: Baron Marissa E. , Dvoracek Lucas A. , Bykowski Michael R. , Goldstein Jesse A. , Losee Joseph E. 
Published: September 2020

Abstract
Primary pancraniosynostosis is a rare variant of craniosynostosis in which the major cranial sutures prematurely fuse. Single-suture craniosynostosis is often recognized early in life due to an abnormal head shape. In contrast, primary pancraniosynostosis may be diagnosed later in life due to a grossly normal head shape and size. As such, these children can present with symptoms related to chronically elevated intracranial pressure (eg, vision loss or cognitive impairment). This report highlights a patient with primary pancraniosynostosis associated with unique neurologic sequelae—namely, bilateral abducens nerve palsy. A 9-year-old boy presented to the ophthalmologist with a 1-month history of double vision, drifting of his right eye toward the nasal bridge, and intracranial hypertension evident with papilledema. Physical examination was notable for mild bitemporal narrowing. A computed tomography study demonstrated radiologic thumbprinting, diffuse osseous sclerosis, and fusion of the bilateral coronal, sagittal, metopic, and lambdoid sutures. The patient underwent emergent cranial vault expansion with fronto-orbital advancement. Papilledema had resolved 4 months following surgery. At 2-year follow-up, abducens nerve palsy and head shape were significantly improved. This study brings attention to an unreported presenting symptom of pancraniosynostosis (bilateral abducens nerve palsy). This information may lead to quicker diagnosis and treatment of pancraniosynostosis-induced intracranial hypertension, which is critical to prevent long-term sequelae.
A Meta-Analysis of Palatal Repair Timing
Authors: Wlodarczyk Jordan R. , Brannon Brooke , Munabi Naikhoba C. O. , Wolfswinkel Erik M. , Nagengast Eric S. , Yao Caroline A. , Magee William 
Published: September 2020

Abstract
Developing midface hypoplasia is common after palatoplasty and has been hypothesized to be influenced by the timing of hard palate repair. This meta-analysis assesses the risk of developing midface hypoplasia based on age at hard palate repair. A Pubmed PRISMA systematic review and meta-analysis was completed for literature focused on palatoplasty and midface hypoplasia published between 1970 and 2019. Cephalometric data were extracted and categorized by age at hard palate repair: <6, 7 to 12, 13 to 18, 19 to 24, and 25 to 83 months. Analysis of these groups and a control were compared using independent T-tests and Spearman correlation coefficients. SNA angles for each group were 77.9 ± 3.1° (<6 months), 77.7 ± 4.2° (7–12 months), 78.7 ± 4.2° (13–18 months), 75.1 ± 4.2° (19–24 months), 75.5 ± 4.8° (25–83 months), and were statistically different than the control group 82.4 ± 3.5° (P < 0.0001). Hard palate repair at 13 to 18 months had a statistically significant greater SNA angle than all other groups except for the repair at <6 months group (P = 0.074). As age at hard palate closure increased beyond 18 months, the SNA decreased, corresponding to a more hypoplastic maxilla (Spearman's correlation coefficient −0.381, P = 0.015). Analysis suggests that younger age at the time of repair is less likely to create in midface hypoplasia in adulthood. Minimizing midface hypoplasia in cleft palate patients by optimizing algorithms of care is a practical way to decrease the burden of disease on patients, families and medical systems. Further studies are needed to evaluate the role of technique on outcomes.

Level of Evidence: IV
Two-Stage Repair of Bilateral Cleft Lip: Indications for This Treatment Strategy
Authors: Madaree Anil 
Published: September 2020

Background:
The aesthetic outcomes of a bilateral cleft lip (BCL) are inferior to that of unilateral cases. With this in mind, the authors reviewed our BCL outcomes in patients having a 2-stage repair. Strategies in repair protocols may be employed to improve outcomes in a particular group of patients.

Methods:
All patients who had a 2-stage repair of BCL in the last 17 years were reviewed. This protocol strategy was specifically employed in patients who had a complete cleft lip on one side and an incomplete cleft lip on the opposite side. The complete side was repaired first followed by the incomplete side a minimum of 6 weeks later. The outcomes in patients undergoing the 2-stage repair in this cohort were assessed. There were 25 patients in this group with 15 males and 10 females. The age at the first stage ranged from 3 to 9 months.

Results:
It was found that the results in this group resulted in better aesthetic outcomes than patients who had a single-stage repair. There was less stigmata of a tension type repair and a more harmonious relationship between the upper and lower lips.

Conclusion:
It is recommended that a 2-stage strategy be employed in repair of BCL if one side is complete and the other is incomplete.
Does Surgical Specialty Impact Mandibular Fracture Outcomes?
Authors: Sun Alexander , Nguyen Kevin , Mehta Sumarth K. , Allam Omar , Park Kitae Eric , Alperovich Michael 
Published: September 2020

Purpose:
Maxillofacial trauma is treated by two medical specialties, plastic surgery (PRS) and otolaryngology (ENT). Differences in training exposure and practice patterns exist between specialties, but their respective outcomes have never been compared.

Methods:
Mandible fracture data were reviewed from the National Surgical Quality Improvement Program from 2005 to 2016. Demographics variables, repair types, and adverse outcomes were compared between PRS and ENT.

Results:
From 2005 to 2016, one thousand two hundred eighty-two cases were identified with 756 cases managed by ENT and 526 cases managed by PRS. Mean patient age was 34.6 years for both specialties (P = 0.95). Patient demographics between both cohorts were not statistically different except for higher rates of hypertension among ENT patients (10.2% for ENT versus 6.7% for PRS, P = 0.027) and higher rates of smoking history among PRS patients (46.8% versus 52.3%, P = 0.055). Mean operative time (131.3 versus 124.0 min, P = 0.090) had a trend toward being longer for ENT and mean length of stay (1.3 versus 2.0, P = 0.002) was significantly longer for PRS. Despite a greater proportion of high ASA class patients in the ENT group (P = 0.012) and patients with dirty/infected wounds in the PRS group (P = 0.013), there were no significant differences in 30-day readmission rates, 30-day reoperation rates, or wound infection rates.

Conclusions:
No significant differences in 30-day readmission rates, reoperation rates, or wound infection rates for mandible fracture management exist between specialties. Despite differences in training between PRS and ENT, both specialties have comparable perioperative outcomes for mandible fracture management.
Endoscopic Per-oral Pyloromyotomy for Gastroparesis: Initial Experience and Postoperative Comparison to Predicted Complications Following Laparoscopic Pyloromyotomy as Calculated by the ACS Risk Calculator
Authors: Ward Marc A. , Hasan Salman S. , Whitfield Edward P. , Ogola Gerald O. , Leeds Steven G. 
Published: September 2020

Introduction:
Per-oral endoscopic pyloromyotomy (POP) is a promising new therapy in the treatment of gastroparesis, where the pyloric muscle is cut using an endoscopic tunneling technique. This study was designed to report outcomes from our initial experience and compare the rate of complications to the laparoscopic equivalent using the American College of Surgeons (ACS) risk calculator.

Methods:
Patients who underwent POP between August 2018 to May 2019 were prospectively followed in a database approved by the institutional review board. Preoperatively, patients were evaluated objectively with a 4-hour gastric emptying study (GES). Following POP, all patients were invited for repeat GES 3 months postoperatively. The same cohort was entered into the ACS risk calculator using laparoscopic pyloromyotomy (LPM) as the selected procedure. Complication risk of LPM was then compared with the actual complication rate of POP.

Results:
There were 11 patients that met study criteria (median age 52). Sixty-four percent (7/11) of patients agreed to do repeat GES postoperatively. Of those, 6 of 7 (86%) had normal GES (<10% emptying at 4 h) and the mean improvement was 36.4%. All patients were entered into the ACS risk calculator in which LPM (CPT code 43800) was used as a control. The postoperative complication rate was less than the median predicted risk of LPM in all categories including overall complications (0% vs. 10.05%), return to the operating room, (0% vs. 2.68%), and sepsis (0% vs. 1.42%). The rate of readmission (9% vs. 6.29%, P=0.65) was higher in the POP group than LPM predicted. Length of stay for all patients was significantly shorter than predicted (1.8 vs. 4.6 d, P<0.001).

Conclusions:
All POP patients had objective improvement in their GES and 86% had normal GES following this procedure. POP had significantly lower morbidity and reduced length of stay compared with that predicted of the laparoscopic equivalent using the ACS risk calculator.
Cost-effectiveness of Surgical Treatment Pathways for Prolapse
Authors: Wang Rui , Hacker Michele R. , Richardson Monica 
Published: September 2020

Objective
To evaluate the cost-effectiveness of surgical treatment pathways for apical prolapse.

Study Design
We constructed a stochastic Markov model to assess the cost-effectiveness of vaginal apical suspension, laparoscopic sacrocolpopexy, and robotic sacrocolpopexy. We modeled over 5 and 10 years, with 9 pathways accounting for up to 2 separate surgical repairs, recurrence of symptomatic apical prolapse, reoperation, and complications, including mesh excision. We calculated costs from the health care system’s perspective.

Results
Over 5 years, compared with expectant management, all surgical treatment pathways cost less than the willingness-to-pay threshold of US $50,000 per quality adjusted life-years. However, among surgical treatments, all but 2 pathways were dominated. Of the remaining 2, laparoscopic sacrocolpopexy followed by vaginal repair for apical recurrence was not cost-effective compared with the vaginal-only approach (incremental cost-effectiveness ratio [ICER], >$500,000). Over 10 years, all but the same 2 pathways were dominated. However, starting with the laparoscopic approach in this case was more cost-effective with an ICER of US $6,176. If the laparoscopic approach was not available, starting with the robotic approach similarly became more cost-effective at 10 years (ICER, US $35,479).

Conclusions
All minimally invasive surgical approaches for apical prolapse repair are cost-effective when compared with expectant management. Among surgical treatments, the vaginal-only approach is the only cost-effective option over 5 years. However, over a longer period, starting with a laparoscopic (or robotic) approach becomes cost-effective. These results help inform discussions regarding the surgical approach for prolapse.
The impact of COVID-19 in diabetic kidney disease and chronic kidney disease: A population-based study
Authors: Leon-Abarca Juan A. , Memon Roha S. , Rehan Bahar , Iftikhar Maimoona , Chatterjee Antara 
Published: September 2020

AbstractBackgroundThe spectrum of pre-existing renal disease is known as a risk factor for severe COVID-19 outcomes. However, little is known about the impact of COVID-19 on patients with diabetic nephropathy in comparison to patients with chronic kidney disease.MethodsWe used the Mexican Open Registry of COVID-19 patients 11 to analyze anonymized records of those who had symptoms related to COVID-19 to analyze the rates of SARS-CoV-2 infection, development of COVID-19 pneumonia, admission, intubation, Intensive Care Unit admission and mortality. Robust Poisson regression was used to relate sex and age to each of the six outcomes and find adjusted prevalences and adjusted prevalence ratios. Also, binomial regression models were performed for those outcomes that had significant results to generate probability plots to perform a fine analysis of the results obtained along age as a continuous variable.ResultsThe adjusted prevalence analysis revealed that that there was a a 87.9% excess probability of developing COVID-19 pneumonia in patients with diabetic nephropathy, a 5% excess probability of being admitted, a 101.7% excess probability of intubation and a 20.8% excess probability of a fatal outcome due to COVID-19 pneumonia in comparison to CKD patients (p< 0.01).ConclusionsPatients with diabetic nephropathy had nearly a twofold rate of COVID-19 pneumonia, a higher probability of admission, a twofold probability of intubation and a higher chance of death once admitted compared to patients with chronic kidney disease alone. Also, both diseases had higher COVID-19 pneumonia rates, intubation rates and case-fatality rates compared to the overall population.
Testing an analogue game to promote peer support and person-centredness in education for people with type 2 diabetes: a realist evaluation
Authors: Stenov Vibeke , Lindgreen Pil , Willaing Ingrid , Basballe Henning Grubb , Joensen Lene Eide 
Published: September 2020

ABSTRACTAimTo explore the outcomes of testing an analogue game to incorporate person-centredness and peer dialogues in group-based diabetes education targeting people with type 2 diabetesDesignA quasi-experimental design inspired by realistic evaluation focusing on context, mechanisms and outcomes of the interventionMethodsIn March-July 2019, the game was tested among 76 people with type 2 diabetes and 17 healthcare professionals in 19 settings across nine Danish municipalities. Data consisted of audio recordings, individual and group interviews and questionnaires. Data were analysed using systematic text condensation and descriptive statistics.ResultsOutcomes of using the analogue game in diabetes education were: 1) a playful and relaxed atmosphere; 2) active engagement 3) reflections on diabetes-specific experiences; 4) structured and focused dialogues; 5) healthcare professionals gaining insight into the preferences and needs of participants; and 6) healthcare professionals experiencing peer dialogue as important to incorporate into education. Questionnaire responses showed that 92% of people with type 2 diabetes and 94% of healthcare professionals found that the game incorporated person-centredness and peer dialogues into diabetes education.ConclusionImplementing the analogue game as part of patient education facilitated peer support and person-centredness in a fun and playful way. Lack of time in diabetes education programmes and complicated game rules inhibited person-centeredness and peer dialogue.ImpactThe study provides novel insights into gaming as a method for promoting peer dialogue and person-centredness in diabetes education targeting people with type 2 diabetes.The game proved feasible as a structured tool to implement in group-based diabetes education.Implementing the game in diabetes education can help healthcare professionals provide diabetes education and support, which may improve quality of life and diabetes self-management skills.