bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lessons Learned From a Single‐Surgeon Experience of More Than 1700 Parathyroidectomies
Authors: Terris David J. , Eltelety Ahmad , Zimmerman Zachary , Edelmayer Luke 
Published: May 2020

ObjectiveTo define critical elements that contribute to successful parathyroidectomy based on a high‐volume single‐surgeon experience and explore learning curve characteristics.Study DesignSystematic analysis of prospectively maintained quality assurance database.SettingAcademic tertiary care endocrine surgery practice.Subjects and MethodsIn total, 4737 consecutive patients who underwent thyroid or parathyroid surgery from 2004 to 2020 were identified. Demographic data acquisition was undertaken on a subset of these patients who had initial surgery for primary hyperparathyroidism during the academic years 2005 to 2018. Patients with renal or syndromic hyperparathyroidism and those undergoing reoperative surgery were excluded.ResultsFrom 1710 patients who underwent parathyroid surgery, 1082 met inclusion criteria in order to focus on a homogeneous data set. These patients had a mean age of 60.1 ± 12.5 years and 76.4% were female. The overall cure rate was 98.3%, reflecting a success rate that increased from 95.5% during the first 200 cases to 99.7% over the final 300 cases. The complication rate was 1.7%. Over 2 decades, the patient phenotype evolved toward milder disease and smaller adenomas. A learning curve of 200 cases was required to become a proficient parathyroid surgeon; to achieve exceptional results required several hundred additional cases. Parathyroid surgery represents a higher proportion of an endocrine surgery practice than previously (54.0% in 2019 compared with 25.5% in 2004).ConclusionA focused practice dedicated to endocrine surgery yields surgical volumes exceeding 500 cases annually. There has been a steady shift toward parathyroid surgery. A lengthy learning curve can be shortened by pursuit of several specific strategies that are outlined in detail.
Evolving Management of COVID‐19: A Multi‐institutional Otolaryngology Perspective
Authors: Wickemeyer Johanna L. , Billings Kathleen R. , Valika Taher S. 
Published: May 2020

ObjectiveTo provide evolving information on active protocols regarding inpatient, outpatient, procedural, and surgical case management taking place in otolaryngology practices in response to COVID‐19.Study TypeCross‐sectional multi‐institutional survey.MethodsAn online survey of 55 otolaryngology departments across North America.ResultsAs of March 25, 2020, almost all (n = 53 of 55, 96.3%) otolaryngology departments had canceled elective cases and were performing only urgent consults. Most residents continued to participate in operative cases (n = 45 of 49, 91.8%) and take call (n = 48 of 50, 96.0%). Of the respondents, 27 of 29 (93.1%) stated that they were deferring nonemergent tracheostomy procedures for the time being. The use of personal protective equipment followed a general trend of an increasing level of protection with an increased risk of the procedure; most (n = 49 of 54, 90.7%) incorporated N95 mask usage for bedside/clinic examinations with flexible laryngoscopy. Powered air‐purifying respirators and N95 masks were used mainly for procedures involving the mucosal surfaces.DiscussionDue to the high viral density in the nasal cavity and nasopharynx of patients with COVID‐19, basic examinations and common otolaryngology procedures place practitioners at high risk of exposure. Although there is variability in practice among otolaryngologists across North America in managing the COVID‐19 outbreak, most are primarily seeing urgent ambulatory and inpatient consultations. Most are also incorporating personal protective equipment appropriate to the level of transmission across mucous membranes.Implications for PracticeIn these rapidly evolving times, it is helpful to find solidarity and assurance among health care providers. Current data aimed to provide (1) perceived methods regarding the safe care of otolaryngology patients and (2) updated practice patterns at a national level.
Outcomes of Airway Stents in the Palliative Care of Patients With Cancer
Authors: Catarata Maria Joana Pereira , Saleiro Sandra , Araújo Vânia Sá 
Published: May 2020

Introduction: A significant proportion of patients with advanced primary or metastatic intrathoracic malignancy will eventually develop central airway obstruction. The morbidity associated with malignant airway obstruction (MAO) is considerable and the management is difficult. Our aim was to evaluate the outcomes of tracheobronchial stenting in patients with MAO and its role in palliative care. Material and Methods: This retrospective study involved a consecutive case series of patients with advanced cancer with MAO who underwent tracheobronchial stenting between August 2014 and August 2019. The European Cooperative Oncology Group (ECOG) scale was used to evaluate patient functional status before and after tracheobronchial stenting. Univariate survival analysis included Kaplan-Meier curves with Log-Rank test, while Cox regression was used as a multivariate analysis. Results: We included 28 patients with median age of 55.0 years (interquartile range = 49.3-66.5) and 89.3% male. The most frequent primary tumour was the esophagus followed by lungs. The majority of the patients (75%) expressed immediate symptom relief after stenting and there was a significant improvement in the mean ECOG performance status (PS; P = .005). There was no intraprocedure mortality and complications were observed in 6 patients. The median survival after airway stenting was 39.0 days (95% CI = 32.2-45.8) with poorer PS after stent insertion associated with lower overall survival (hazard ratio = 2.3 [95% CI = 1.1-4.9], P = .030) on multivariate analysis. Conclusion: Airway stent is a safe and effective procedure that offers rapid palliation of symptoms with no major complications. Therefore, stent placement should be considered as part of the treatment of patients with terminal cancer.
One-year real-life results on effect of intravitreal aflibercept in patients with diabetic macular oedema switched from ranibizumab
Authors: Lukic Marko , Williams Gwyn , Shalchi Zaid , Patel Praveen J , Hykin Philip G , Hamilton Robin D , Rajendram Ranjan 
Published: May 2020

Purpose To assess visual and optical coherence tomography–derived anatomical outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in patients switched from intravitreal ranibizumab (Lucentis®). Design Retrospective, cohort study. Participants Ninety eyes (of 67 patients) receiving intravitreal anti–vascular endothelial growth factor therapy were included. Methods This is a retrospective, real-life, cohort study. Each patient had visual acuity measurements and optical coherence tomography scans performed at baseline and 12 months after the first injection of aflibercept was given. Main Outcome Measures We measured visual acuities in Early Treatment Diabetic Retinopathy Study letters, central foveal thickness and macular volume at baseline and at 12 months after the first aflibercept injection was given. Results Ninety switched eyes were included in this study. The mean (standard deviation) visual acuity was 63 (15.78) Early Treatment Diabetic Retinopathy Study letters. At baseline, the mean (standard deviation) central foveal thickness was 417.7 (158.4) μm and the mean macular volume was 9.96 (2.44) mm3. Mean change in visual acuity was +4 Early Treatment Diabetic Retinopathy Study letters (p = 0.0053). The mean change in macular volume was −1.53 mm 3 in SW group (p = 0.21), while the change in central foveal thickness was −136.8 μm (p = 0.69). Conclusion There was a significant improvement in visual acuity and in anatomical outcomes in the switched group at 12 months after commencing treatment with aflibercept for diabetic macular oedema.
Ophthalmology and SARS-CoV-2: Blind toward those who fight blindness?
Authors: Arrigo Alessandro , Aragona Emanuela , Parodi Maurizio Battaglia , Loperfido Francesco , Bandello Francesco 
Published: May 2020

SARS-CoV-2 infection recently reached pandemic proportions, with high risk of death for the worldwide population. In this dramatic scenario, all the resources are addressed to the intensive care units for the assessment of the emergency. However, more attention should be paid with respect to the risk of viral diffusion among asymptomatic people. Italy is the second most involved country in the world, and we needed to gain a lot of experience in a very limited time. At least 1 m of distance among people is recommended; however, some clinical practices cannot allow this distance. In this context, we believe that the careful safety assessment of clinical settings, like ophthalmologic ones, may have a remarkable impact on the fight against SARS-CoV-2 spread.
Looking for contact-induced language change: Converbs in heritage Turkish
Authors: Turan Dilek , Antonova-Ünlü Elena , Sağın-Şimşek Çiğdem , Akkuş Mehmet 
Published: May 2020

Aims and objectives/purpose/research questions: The aim of the study is to contribute to the debate about a possible contact-induced change in the heritage language and to examine whether there is contact-induced language change at the morpho-syntactic level in Turkish spoken in Germany. We focus on the perception and use of the converbs –Ip and –IncA in heritage Turkish. Design/methodology/approach: The perception and production of the converbs –Ip and –IncA by 30 German–Turkish bilinguals, who were born and have resided in Germany, are compared with those of the control group. Data and analysis: Two tasks are used in the study: a grammaticality judgement task and a picture-story description task. Both quantitative and qualitative analyses are utilized. Findings/conclusions: The analysis of the perception of the converbs by the participants revealed that the bilinguals’ perception of the grammatical constructions with –IncA and of the ungrammatical constructions with –Ip and –IncA differed significantly from that of the monolinguals; however, the perception of the grammatical constructions with –Ip was found to be similar between the bilingual and monolingual groups. The analysis of the production of the converbs by the bilingual participants showed that they tended to use the converbs significantly less than the monolingual control group did. The qualitative analysis of the production task also revealed that there were several cases in the use of the converbs that could be considered as ungrammatical and/or unconventional.
Adult Asthma Diagnosis: Physician Reported Challenges in Alberta-Based Primary Care Practices
Authors: Sharpe H. , Claveria-Gonzalez F. C. , Davidson W. , Befus A. D. , Leung J. P. , Young E. , Walker B. ,   on behalf of the Asthma Working Group, Respiratory Health Strategic Clinical Network, Alberta Health Services
Published: May 2020

Introduction An estimated 8.1% of Canadians adults have asthma. While there are challenges associated with the use of objective measurement of lung function in the diagnosis of asthma, we are uncertain of the barriers that impact the use of objective measures, and have limited understanding of the challenges experienced by primary care providers in diagnosis of asthma. The objectives of this quality improvement initiative were to identify primary care providers’ methods of diagnosing asthma and to identify challenges with diagnosis. Methods An online survey was disseminated using a snowball methodology. Setting Primary care practices in Alberta, Canada. Participants A total of 84 primary care providers completed the survey. Main Outcome Measures Participants were asked their ideal and sufficient methods for diagnosing asthma and to identify challenges in their practice related to asthma diagnosis. Results They identified full pulmonary function testing (54%), pre- and postbronchodilator spirometry (54%), complete history and physical (42%), peak flow measurement overtime (26%), pulmonary consult (26%), and trial of asthma medication(s) (23%), as ideal methods of diagnosing asthma. The most significant barriers to diagnosis included episodic care–care provided typically during times of worsening symptoms without ongoing preventative/maintenance care (55%), patient follow-up (44%), conflict between clinical impression and pulmonary function results (43%), patient already on asthma medications (43%), and interpreting spirometry/pulmonary function results (39%). Conclusion The results of this survey indicate that the majority of primary care providers would choose full pulmonary function testing or pre- and postbronchodilator spirometry as the ideal methods of diagnosing asthma. However, barriers related to the nature of asthma care, patient factors, and challenges with diagnostic testing create challenges. This study also highlights that primary care providers have adapted to challenges in leveraging objective measurement and may rely upon other methods for diagnosis such as trials of medications.
Increasing Internal Medicine Resident Confidence in Leading Inpatient Cardiopulmonary Resuscitations and Improving Patient Outcomes
Authors: Douthit Nathan T , McBride Christine M , Townsley Erin Coleman 
Published: May 2020

Introduction: Residents do not feel confident or competent in leading inpatient resuscitations. This is a crucial part of training future internists. Our objective was to develop a low-cost intervention to improve resident confidence in leading cardiopulmonary resuscitations and patient outcomes. Methods: A “code-conference” including a lecture on a high-yield topic, a low-fidelity simulation, and review of resident-led resuscitations was created at our institution for the 2017-2018 academic year. Patient outcomes were assessed using objective measures of return of spontaneous circulation (ROSC) and survival to discharge (sDC). Confidence was assessed via survey before and after the intervention, with a focus on beginning postgraduate year 2 (PGY-2) residents. Results: In 2017, 8 out of 8 (100%) PGY-2 residents responded, while in 2018, 8 out of 10 (80%) responded. Patient outcomes did not show a statistically significant improvement. There was a trend toward positive outcomes in the resident group alone. Return of spontaneous circulation increased from 63% to 79% ( P = .08, total n = 97). Resident confidence was not improved in a statistically significant way, but there was a trend toward improvement and residents agreed it was an important part of their training. Discussion: There was no statistically significant improvement in code-blue outcomes; however, there was a positive trend with increased ROSC and stable sDC for resident-led resuscitations, despite hospital-wide decreases in both. Resident confidence also showed a positive trend with no statistical significant changes. It is possible to institute a low-cost high-yield intervention to improved resident confidence in leading code-blue resuscitations. It may also improve patient outcomes; however, further studies are needed to determine if it can improve patient survival outcomes.
Unexpected enhancement of FVIII immunogenicity by endothelial expression in lentivirus-transduced and transgenic mice
Authors: Shi Qizhen , Carman Christopher V. , Chen Yingyu , Sage Peter T. , Xue Feng , Liang Xin M. , Gilbert Gary E. 
Published: May 2020

AbstractFactor VIII (FVIII) replacement therapy for hemophilia A is complicated by development of inhibitory antibodies (inhibitors) in ∼30% of patients. Because endothelial cells (ECs) are the primary physiologic expression site, we probed the therapeutic potential of genetically restoring FVIII expression selectively in ECs in hemophilia A mice (FVIIInull). Expression of FVIII was driven by the Tie2 promoter in the context of lentivirus (LV)-mediated in situ transduction (T2F8LV) or embryonic stem cell–mediated transgenesis (T2F8Tg). Both endothelial expression approaches were associated with a strikingly robust immune response. Following in situ T2F8LV-mediated EC transduction, all FVIIInull mice developed inhibitors but had no detectable plasma FVIII. In the transgenic approach, the T2F8Tg mice had normalized plasma FVIII levels, but showed strong sensitivity to developing an FVIII immune response upon FVIII immunization. A single injection of FVIII with incomplete Freund adjuvant led to high titers of inhibitors and reduction of plasma FVIII to undetectable levels. Because ECs are putative major histocompatibility complex class II (MHCII)-expressing nonhematopoietic, “semiprofessional” antigen-presenting cells (APCs), we asked whether they might directly influence the FVIII immune responses. Imaging and flow cytometric studies confirmed that both murine and human ECs express MHCII and efficiently bind and take up FVIII protein in vitro. Moreover, microvascular ECs preconditioned ex vivo with inflammatory cytokines could functionally present exogenously taken-up FVIII to previously primed CD4+/CXCR5+ T follicular helper (Tfh) cells to drive FVIII-specific proliferation. Our results show an unanticipated immunogenicity of EC-expressed FVIII and suggest a context-dependent role for ECs in the regulation of inhibitors as auxiliary APCs for Tfh cells.
Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?
Authors: Aslan Kiper , Orhan Adnan , Türkgeldi Engin , Suer Ebru , Duzok Nergis , Özerkan Kemal , Ata Barış , Uncu Gürkan 
Published: May 2020

Abstract
Objective
To determine whether hemorrhage and complication rates vary according to the location of the dominant fibroid following laparoscopic myomectomy.

Background
Laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury, and conversion to laparotomy may be seen in laparoscopic myomectomy. We do not know whether the fibroid location affects these complications.

Materials and methods
Women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4, or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e., anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery and complication rates were compared across categories.

Results
Two hundred nineteen women with a mean age of 35.7 ± 6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. The other ten women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 ± 2.6, 6.6 ± 2.3, and 6.7 ± 2.3 cm in the fundal, anterior, and posterior groups, respectively (p = 0.9). The median (25th–75th percentile) changes in hemoglobin levels were 1.5 (0.8–2.2), 1.3 (0.6–2.1), and 1.3 (0.9–2) g/dl in fundal, anterior, and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33).

Conclusion
The incidence of hemorrhage or complication does not seem to vary depending on the fibroid location. However, the sample size was limited; observed values suggest that fibroid location does not affect hemorrhage and complication rates.
Improving the Conductivity of Solid Polymer Electrolyte by Grain Reforming
Authors: Wei Zhaohuan , Ren Yaqi , Wang Minkang , He Jijun , Huo Weirong , Tang Hui 
Published: May 2020

AbstractPolyethylene oxide (PEO)-based solid polymer electrolyte (SPE) is considered to have great application prospects in all-solid-state li-ion batteries. However, the application of PEO-based SPEs is hindered by the relatively low ionic conductivity, which strongly depends on its crystallinity and density of grain boundaries. In this work, a simple and effective press-rolling method is applied to reduce the crystallinity of PEO-based SPEs for the first time. With the rolled PEO-based SPE, the LiFePO4/SPE/Li all-solid li-ion battery delivers a superior rechargeable specific capacity of 162.6 mAh g−1 with a discharge-charge voltage gap of 60 mV at a current density of 0.2 C with a much lower capacity decay rate. The improvement of electrochemical properties can be attributed to the press-rolling method, leading to a doubling conductivity and reduced activation energy compared with that of electrolyte prepared by traditional cast method. The present work provides an effective and easy-to-use grain reforming method for SPE, worthy of future application.
SCSIM: Jointly simulating correlated single-cell and bulk next-generation DNA sequencing data
Authors: Giguere Collin , Dubey Harsh Vardhan , Sarsani Vishal Kumar , Saddiki Hachem , He Shai , Flaherty Patrick 
Published: May 2020

AbstractBackgroundRecently, it has become possible to collect next-generation DNA sequencing data sets that are composed of multiple samples from multiple biological units where each of these samples may be from a single cell or bulk tissue. Yet, there does not yet exist a tool for simulating DNA sequencing data from such a nested sampling arrangement with single-cell and bulk samples so that developers of analysis methods can assess accuracy and precision.ResultsWe have developed a tool that simulates DNA sequencing data from hierarchically grouped (correlated) samples where each sample is designated bulk or single-cell. Our tool uses a simple configuration file to define the experimental arrangement and can be integrated into software pipelines for testing of variant callers or other genomic tools.ConclusionsThe DNA sequencing data generated by our simulator is representative of real data and integrates seamlessly with standard downstream analysis tools.