bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Bicuspid Aortic Valve–Associated Aortopathy in Childhood
Authors: Grattan Michael , Prince Andrea , Rumman Rawan K. , Morgan Conall , Petrovic Michele , Hauck Amanda , Young Luciana , Franco-Cereceda Anders , Loeys Bart , Mohamed Salah A. , Dietz Harry , Mital Seema , Fan Chun-Po Steve , Manlhiot Cedric , Andelfinger Gregor , Mertens Luc ,   on behalf of MIBAVA Leducq Consortium
Published: March 2020

Background:
Bicuspid aortic valve (BAV) is the most prevalent congenital heart defect affecting 1% to 2% of the population. It is associated with ascending aorta dilatation. Valve morphology, aortic stenosis (AS), and aortic insufficiency (AI) have been proposed as potential risk factors; however, evaluating their role is difficult, as these factors are inherently related. The aim of this study was to determine whether BAV morphology and dysfunction are independent determinants for ascending aorta dilatation in pediatric patients.

Methods:
A multicenter, retrospective, cross-sectional study of pediatric BAV patients followed since 2004 was performed. Imaging data were assessed for BAV morphology, severity of AS and AI, history of coarctation, and aortic dimensions. Associations were determined using multivariable regression analysis. A subset of patients undergoing aortic interventions (balloon dilation or Ross) were assessed longitudinally.

Results:

Data were obtained from 2122 patients (68% male; median age 10.2 years). Fifty percent of patients had ascending aorta dilatation. Right and noncoronary cusp fusion, increasing AS and AI, and older age were independently associated with ascending aorta dilatation. A history of coarctation was associated with less ascending aorta dilatation. In patients with neither AS nor AI, 37% had ascending aorta dilatation (4% severe). No complications related to aortic dilatation occurred in this cohort. Aortic
Z
scores were determined, and a
Z
-score calculator was created for this population.

Conclusions:
In this large pediatric cohort of patients with BAV, valve morphology, AS, and AI are independently associated with ascending aorta dilatation, suggesting that hemodynamic factors influence aortopathy. However, even in BAVs with no AS or AI, there is significant ascending aorta dilatation independent of valve morphology. Interventions that led to changes in degree of AI and AS did not seem to influence change in aortic dimensions. The current BAV cohort can be used as a reference group for expected changes in aortic dimensions during childhood.
Post-Classical Greek from a Scribal Perspective
Authors: Stolk Joanne Vera 
Published: March 2020

Abstract
Spelling deviations are often considered to be the result of random variation or plain mistakes by the scribes. Based on the examples in this paper, I argue that some of the apparent deviations may actually be in accordance with contemporary norms. Close study of the spelling of five lexemes in the corpus of documentary papyri shows that the orthographic conventions at the time may have been different than suggested by contemporary grammarians and modern editors.
Changes of Decadal SST Variations in the Subpolar North Atlantic under Strong CO2 Forcing as an Indicator for the Ocean Circulation’s Contribution to Atlantic Multidecadal Variability
Authors: Hand Ralf , Bader Jürgen , Matei Daniela , Ghosh Rohit , Jungclaus Johann H. 
Published: March 2020

AbstractThe question of whether ocean dynamics are relevant for basin-scale North Atlantic decadal temperature variability is the subject of ongoing discussions. Here, we analyze a set of simulations with a single climate model consisting of a 2000-yr preindustrial control experiment, a 100-member historical ensemble, and a 100-member ensemble forced with an incremental CO2 increase by 1% yr−1. Compared to previous approaches, our setup offers the following advantages: First, the large ensemble size allows us to robustly separate internally and externally forced variability and to robustly detect statistical links between different quantities. Second, the availability of different scenarios allows us to investigate the role of the background state for drivers of the variability. We find strong evidence that ocean dynamics, particularly ocean heat transport variations, form an important contribution to generate the Atlantic multidecadal variability (AMV) in the Max Planck Institute Earth System Model (MPI-ESM). Particularly the northwest North Atlantic is substantially affected by ocean circulation for the historical and preindustrial simulations. Anomalies of the Labrador Sea deep ocean density precede a change of the Atlantic meridional overturning circulation (AMOC) and heat advection to the region south of Greenland. Under strong CO2 forcing, the AMV–SST regression pattern shows crucial changes: SST variability in the northwestern part of the North Atlantic is strongly reduced, so that the AMV pattern in this scenario is dominated by the low-latitude branch. We found a connection to changes in the deep-water formation that cause a strong reduction of the mean AMOC and its variability. Consequently, ocean heat transport convergence becomes less important for the SST variability south of Greenland.
Assessment of Numerical Simulations of Deep Circulation and Variability in the Gulf of Mexico Using Recent Observations
Authors: Morey Steven L. , Gopalakrishnan Ganesh , Sanz Enric Pallás , Azevedo Correia De Souza Joao Marcos , Donohue Kathleen , Pérez-Brunius Paula , Dukhovskoy Dmitry , Chassignet Eric , Cornuelle Bruce , Bower Amy , Furey Heather , Hamilton Peter , Candela Julio 
Published: March 2020

AbstractThree simulations of the circulation in the Gulf of Mexico (the “Gulf”) using different numerical general circulation models are compared with results of recent large-scale observational campaigns conducted throughout the deep (>1500 m) Gulf. Analyses of these observations have provided new understanding of large-scale mean circulation features and variability throughout the deep Gulf. Important features include cyclonic flow along the continental slope, deep cyclonic circulation in the western Gulf, a counterrotating pair of cells under the Loop Current region, and a cyclonic cell to the south of this pair. These dominant circulation features are represented in each of the ocean model simulations, although with some obvious differences. A striking difference between all the models and the observations is that the simulated deep eddy kinetic energy under the Loop Current region is generally less than one-half of that computed from observations. A multidecadal integration of one of these numerical simulations is used to evaluate the uncertainty of estimates of velocity statistics in the deep Gulf computed from limited-length (4 years) observational or model records. This analysis shows that the main deep circulation features identified from the observational studies appear to be robust and are not substantially impacted by variability on time scales longer than the observational records. Differences in strengths and structures of the circulation features are identified, however, and quantified through standard error analysis of the statistical estimates using the model solutions.
Oxymetazoline, Mupirocin, Clotrimazole—Safe, Effective, Off-Label Agents for Tympanostomy Tube Care
Authors: Isaacson Glenn 
Published: March 2020

Objectives: Only a few medications have a United States Food and Drug Administration indications for prevention and/or treatment of infections in patients with tympanic perforations or tympanostomy tubes. We examined 3 off-label agents that have become important in tympanostomy tube care hoping to demonstrate the effectiveness and safety of each in experimental assays and human application. Methods: Computerized literature review. Results: (1) Oxymetazoline nasal spray applied at the time of surgery is equivalent to fluoroquinolone ear drops in the prevention of early postsurgical otorrhea and tympanostomy tube occlusion at the first postoperative visit. (2) Topical mupirocin 2% ointment is effective alone or in combination with culture-directed systemic therapy for the treatment of tympanostomy tube otorrhea caused by community-acquired, methicillin-resistant Staphylococcus aureus. (3) Topical clotrimazole 1% cream is highly active against the common yeast and fungi that cause otomycosis. A single application after microscopic debridement will cure fungal tympanostomy tube otorrhea in most cases. None of these 3 agents is ototoxic in animal histological or physiological studies, and each has proved safe in long-term clinical use. Conclusions: Oxymetazoline nasal spray, mupirocin ointment, and clotrimazole cream are safe and effective as off-label medications for tympanostomy tube care in children.
Influence of Age at Cochlear Implantation and Frequency‐to‐Place Mismatch on Early Speech Recognition in Adults
Authors: Canfarotta Michael W. , O’Connell Brendan P. , Buss Emily , Pillsbury Harold C. , Brown Kevin D. , Dillon Margaret T. 
Published: March 2020

ObjectiveDefault frequency filters of cochlear implant (CI) devices assign frequency information irrespective of intracochlear position, resulting in varying degrees of frequency‐to‐place mismatch. Substantial mismatch negatively influences speech recognition in postlingually deafened CI recipients, and acclimatization may be particularly challenging for older adults due to effects of aging on the auditory pathway. The present report investigated the influence of mismatch and age at implantation on speech recognition within the initial 6 months of CI use.Study DesignRetrospective review.SettingTertiary referral center.Subjects and MethodsForty‐eight postlingually deafened adult CI recipients of lateral wall electrode arrays underwent postoperative computed tomography to determine angular insertion depth of each electrode contact. Frequency‐to‐place mismatch was determined by comparing spiral ganglion place frequencies to default frequency filters. Consonant‐nucleus‐consonant (CNC) scores in the CI‐alone condition at 1, 3, and 6 months postactivation were compared to the degree of mismatch at 1500 Hz and age at implantation.ResultsYounger adult CI recipients experienced more rapid growth in speech recognition during the initial 6 months postactivation. Greater degrees of frequency‐to‐place mismatch were associated with poorer performance, yet older listeners were not particularly susceptible to this effect.ConclusionsWhile older adults are not necessarily more sensitive to detrimental effects of frequency‐to‐place mismatch, other factors appear to limit early benefit with a CI in this population. These results suggest that minimizing mismatch could optimize outcomes in adult CI recipients across the life span, which may be particularly beneficial in the elderly considering auditory processing deficits associated with advanced age.
Cranial Base Manifestations of Granulomatosis with Polyangiitis
Authors: Kiessling Patrick T. , Marinelli John P. , Peters Pierce A. , DeLone David R. , Lane John I. , Koster Matthew J. , Carlson Matthew L. 
Published: March 2020

ObjectiveAlthough granulomatosis with polyangiitis (GPA; Wegener’s granulomatosis) is classically characterized by systemic disease involving the kidneys and airway, approximately 10% of patients who have it present with isolated central nervous system disease. When involving the skull base, GPA frequently mimics more common pathology, resulting in diagnostic challenges and delay. The primary objective of this study is to characterize the cranial base manifestations of GPA, highlighting aspects most relevant to the skull base surgeon.Study DesignRetrospective review.SettingTertiary academic referral center.Subjects and MethodsRetrospective analysis of all patients with skull base GPA treated at a tertiary referral center from January 1, 1996, to May 1, 2018.ResultsTwenty‐nine patients met inclusion criteria. Twenty‐one (72%) initially presented with skull base symptomatology as their cardinal manifestation of GPA. Twenty‐four (82%) presented with cranial neuropathy at some point in their disease course. The trigeminal nerve was most commonly involved (12 of 24, 50%), followed by the facial (11 of 24, 46%) and optic (8 of 24, 33%) nerves. Eighteen patients reported hearing loss attributed to the GPA disease process, presenting as conductive, sensorineural, or mixed. The most common locations for GPA‐derived inflammatory skull base disease on imaging included the cavernous sinus (12 of 29, 41%) and the orbit (7 of 29, 24%).ConclusionEstablishing the diagnosis of skull base GPA remains challenging. Cranial neuropathy is diverse in presentation and often mimics more common conditions. Imaging findings are also unpredictable and frequently nonspecific. Careful review of patient history, clinical presentation, serology and biopsy results, and imaging can reveal important clues toward the diagnosis.
Elevated Central and Mixed Apnea Index after Upper Airway Stimulation
Authors: Patel Jena , Daniels Kelly , Bogdan Lauren , Huntley Colin , Boon Maurits 
Published: March 2020

ObjectiveUpper airway stimulation (UAS) is used to treat patients with moderate to severe obstructive sleep apnea (OSA). The aim of this study is to report the incidence and potential predictors of elevated central and mixed apnea index (CMAI) after UAS.Study DesignRetrospective chart review of patients undergoing UAS.SettingTertiary care center.Subjects and MethodsIncluded patients underwent UAS for OSA at our institution between 2014 and 2018. Data collected included demographic information, implantation records, and pre‐ and postoperative polysomnography (PSG) results. CMAI ≥5 was considered elevated. Post hoc univariate analysis was performed to evaluate factors associated with elevated CMAI.ResultsIn total, 141 patients underwent UAS at our institution. This included 94 men and 47 women with a mean age of 61.2 ± 11.0 years and a mean body mass index of 29.1 ± 3.9 kg/m2. Five patients had an elevated CMAI after surgery during UAS titration. Demographics, comorbid conditions, and device settings were not associated with an elevated postoperative CMAI (P >. 05).ConclusionThe occurrence of an elevated CMAI after surgery may represent treatment‐emergent events. Demographics, comorbid conditions, and UAS device settings were not associated with central and mixed apneic events.Level of Evidence4
High expression of RAD21 predicts poor survival in patients with operated non-small-cell lung cancer
Authors: Zhu Tao , Gao Zhaojia , Yuan Kai , Wang Yong 
Published: March 2020

Purpose: To investigate the expression profile and prognostic value of RAD21 in patients with non-small cell lung cancer (NSCLC). Methods: A tissue microarray (TMA) containing 60 paired NSCLC tissues and peritumor tissues was purchased and another TMA containing 140 NSCLC tissues was constructed. Then, immunohistochemical staining was performed and scored. Finally, the expression profile and prognostic value of RAD21 were evaluated. Results: RAD21 was predominantly detected in the nucleus of tumor and peritumor cells. RAD21 was more highly expressed in tumor tissues compared to peritumor tissues. High RAD21 expression was correlated with more lymph node metastases and advanced pathological stage, but not with any other clinicopathological features. High RAD21 expression led to worsened overall survival (OS) and was an independent prognostic factor for worsened OS in NSCLC, especially in stage II–III. Conclusion: High RAD21 expression indicates poor survival in patients with NSCLC. RAD21 may become a novel prognostic biomarker and therapeutic target in patients with NSCLC.
Safer and Cheaper: An Enhanced Milestone-Based Return to Play Program After Anterior Cruciate Ligament Reconstruction in Young Athletes Is Cost-Effective Compared With Standard Time-Based Return to Play Criteria
Authors: DeFrancesco Christopher J. , Lebrun Drake G. , Molony Joseph T. , Heath Madison R. , Fabricant Peter D. 
Published: March 2020

Background: Safe return to play (RTP) after anterior cruciate ligament (ACL) reconstruction is critical to patient satisfaction. Enhanced rehabilitation after ACL reconstruction with appropriate objective criteria for RTP may reduce the risk of subsequent injury. The cost-effectiveness of an enhanced RTP (eRTP) strategy relative to standard post-ACL reconstruction rehabilitation has not been investigated. Purpose: To determine if an eRTP strategy after ACL reconstruction is cost-effective compared with standard rehabilitation. Study Design: Economic and decision analysis. Methods: A decision-analysis model was utilized to compare standard rehabilitation with an eRTP strategy, which includes additional neuromuscular retraining, advanced testing, and follow-up physician visits. Cost-effectiveness was evaluated from a payer perspective. Costs of surgical procedures and rehabilitation protocols, risks of graft rupture and contralateral ACL injury, risk reductions as a result of the eRTP strategy, and relevant health utilities were derived from the literature. An incremental cost-effectiveness ratio of <$100,000/quality-adjusted life-year was used to determine cost-effectiveness. Sensitivity analyses were performed on pertinent model parameters to assess their effect on base case conclusions. In the base case analysis, the eRTP strategy cost was conservatively estimated to be $969 more than the standard rehabilitation protocol. Completion of the eRTP strategy was considered to confer a 25% risk reduction for graft rupture in comparison with standard rehabilitation. Results: The eRTP strategy was more cost-effective than standard rehabilitation alone. Based on 1-way threshold analyses, the eRTP strategy was cost-effective as long as its additional cost over standard rehabilitation was <$2092 or the eRTP strategy decreased the incidence of contralateral ACL rupture by >13.8%. Conclusion: The eRTP strategy in this study adds additional neuromuscular retraining and additional physician follow-up—as well as advanced testing goals upon which RTP is contingent—to traditional physical therapy. Our data suggest that these additions are cost-effective, even assuming only modest associated decreases in ACL graft failure. This study also determined that the only variable that had the potential to change the cost-effectiveness conclusion based on predetermined ranges was the additional cost of rehabilitation based on 1-way sensitivity analysis. Clinical Relevance: This study provides evidence of cost-effectiveness for payers, supporting the use of enhanced RTP programs. The sensitivity analyses herein may be used to determine if any given RTP program going forward is cost-effective, regardless of the exact components of the program.
Autologous Chondrocyte Implantation as Treatment for Unsalvageable Osteochondritis Dissecans: 10- to 25-Year Follow-up
Authors: Carey James L. , Shea Kevin G. , Lindahl Anders , Vasiliadis Haris S. , Lindahl Carl , Peterson Lars 
Published: March 2020

Background:An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI).Hypothesis:Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty.Study Design:Case series; Level of evidence, 4.Methods:All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires to assess the Knee injury and Osteoarthritis Outcome Score, Tegner-Wallgren activity score, and Lysholm score. In addition, patients were asked whether they had to undergo further surgery, including knee replacement, of the knee that underwent ACI. They were asked whether they would have the surgery again if in the same situation.Results:A total of 55 patients (93%) with 61 OCD lesions (91%) responded. The median follow-up duration was 19 years (range, 10-26 years) and the median age at follow-up was 43 years (range, 28-69 years). Subsequent arthroscopy was performed in the majority of cases, although many of these were scheduled “second looks” as part of a study. With respect to other subsequent surgery, 12 knees (20%) underwent any additional open surgery, but only 2 knees (3%) underwent arthroplasty. Eight knees (13%) underwent revision ACI. Most patients reached their preinjury activity level (62%) and would undergo ACI again if in the same situation (85%). If failure is defined as revision of the graft or conversion to arthroplasty, then survivorship after ACI for OCD in the current study would be 87% at 10 years, 85% at 15 years, and 82% at 20 years.Conclusion:ACI for OCD provides a durable treatment option. At a median follow-up of 19 years, there was a very low (~3%) conversion to total knee arthroplasty.
Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial
Authors: Porter Mark , Shadbolt Bruce 
Published: March 2020

Background:The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain.Purpose:To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures ( P < .05).Results:A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; P = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; P = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; P = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; P = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; P = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; P < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; P = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; P = .99) relative to group B.Conclusion:The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores.Registration:ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry)