bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secondary Acquired Nasolacrimal Duct Obstruction as a Specific Complication of Treatment With Radioactive Iodine (Morphological Study)
Authors: Fedorov Anatoly A. , Atkova Eugenia L. , Yartsev Vasily D. 
Published: November 2019

Purpose:
To conduct a morphological study of structural changes in the nasolacrimal duct in secondary acquired nasolacrimal duct obstruction (SALDO) as a result of treatment with radioiodine.

Methods:
Twenty patients (20 cases) were involved: 10 cases with secondary acquired nasolacrimal duct obstruction at Hasner’s valve level due to the treatment with radioiodine (group 1) and 10 cases with primary acquired nasolacrimal duct obstruction (group 2). During surgery, a biopsy of nasolacrimal duct tissue from Hasner’s valve area was taken. A morphological study was performed using semi-fine sections technique.

Results:
Patients of group 1 showed the following: desquamation of columnar epithelium, pinpoint ulceration of nasolacrimal duct wall, collapse of a significant part of the capillary bed, and absence of blood cells in their lumen. State of secretory cells of mucous glands varied from necrobiotic to the different stages of dystrophic, decreased lumens of acini with abundant microvesicles in cell cytoplasm were revealed. A specific sign noted in patients of group 2 was mixed inflammatory infiltration of the mucosa of the nasolacrimal duct. The picture corresponds to the exacerbation of a chronic inflammatory process.

Conclusions:
Changes revealed in patients of group 1 include desquamation of nasolacrimal duct epithelium, mucous gland lesion, and moderate fibrosis that indicate a probable primary character of the lesion. In patients of group 2, fibrotic changes were more significant and were due to a chronic inflammatory process. Thus, secondary acquired nasolacrimal duct obstruction after treatment with radioactive iodine has a specific pathogenesis and should be classified as a separate nosological form.
Submental and Anterior Neck Originated Full-Thickness Skin Grafts for Periocular Procedures
Authors: Ben Artsi Elad , Ullrich Katja , Malhotra Raman 
Published: November 2019

Purpose:
The submental and neck regions share cutaneous features with the face and are suitable donor sites for facial full-thickness skin grafts (FTSGs). Age-related laxity and skin redundancy in the cervicomental region may be an additional motivator to use its skin. We aim to describe, raise awareness, and remind surgeons of the utilization of submental and anterior neck as sources of FTSG for the periocular region, particularly when traditional donor sites are unavailable.

Methods:
Retrospective case series of 5 patients who underwent periocular FTSG from anterior neck and submental regions between January 2017 and January 2019. All patients had contraindications to the usually preferred graft donor sites. Main outcome measures were surgical functional results and cosmesis.

Results:
Five patients (all female) received FTSGs using anterior neck and submental regions as donor sites. Two patients required skin grafts due to eyelid retraction and anterior lamella shortening; one due to previous multiple basal cell carcinoma excisions with FTSG reconstructions and the other due to chronic Bell’s palsy. Three patients required skin grafts for Hughes flap reconstruction after excision of lower eyelid basal cell carcinoma. In all patients, conventional skin donor sites were unavailable or unsuitable due to previous skin grafting, actinic changes, postauricular situated hearing aids or patient’s preference. All patients achieved good cosmesis and functional results. None of the patients experienced donor site morbidities.

Conclusions:
Submental and anterior neck regions are useful FTSG donor sites for periocular procedures, particularly in elderly female patients with submental fullness and neck skin redundancy.
Leveraging Teledermatology for Patient Triage
Authors: Maloney Megan 
Published: November 2019

ABSTRACT
Nurses in outpatient settings face challenges balancing heavy patient caseloads while accommodating unplanned acute visits. Nurses also spend significant time triaging patients' symptoms on the telephone. Patients often find it difficult to accurately describe symptoms, and without accompanying images, unnecessary office visits are scheduled. Teledermatology, involving the exchange of digital images remotely between patient and provider, has shown promise in accurately triaging patients and decreasing unnecessary visits. At one outpatient dermatology site at a multisite comprehensive cancer center, a 6-month performance improvement initiative was conducted to evaluate the effectiveness of teledermatology using an electronic patient portal. Nurses instructed prescreened patients to send digital images via the portal. On the basis of image appearance and patients' symptoms, nurses provided assessment and education over the phone, and patients either kept their future appointments or came in for an earlier evaluation. More complex cases were escalated to the physician. This initiative reduced the number of unnecessary patient visits, which opened more visit slots for those with acute issues. Teledermatology improved overall efficiency of care, and patients and clinicians have reported satisfaction with the process.
Safe and Effective Laser Hair Removal Treatments
Authors: Moore Christine 
Published: November 2019

ABSTRACTObjectiveThe aim of this study was to review the current literature regarding safe and effective laser hair removal (LHR) treatments.MethodsSignificant and current studies (2008–2017) were retrieved through a series of searches conducted in CINAHL, Cochrane, and MEDLINE databases using Boolean terms/phrases. Pertinent results are explained in narrative form with supporting tables and figures.ResultsToday, there is a vast amount of current literature on the need for LHR treatments and on its side effects and comparative studies using various lasers on the market. There is an ongoing concern associated with the lack of standards and guidelines.ConclusionPractitioners interested in offering LHR within the primary care setting must verify that operating a Class 4 medical device is within their scope of practice. Despite the increased popularity of LHR treatments and the advancement of technology, there are limited up-to-date information on safe and effective treatment parameters and minimal information regarding the importance of patient education. More research is necessary to determine the efficacy of LHR treatments in both men and women of all ages and skin types. With no LHR guidelines in place, the best practice for LHR treatments is contained within this literature review using the most recent research available to date.
Kava-Induced Ichthyosis
Authors: Peterman Kaeleigh , Reynolds Emily 
Published: November 2019

ABSTRACT
Acquired ichthyosis is an uncommon finding in the outpatient dermatology clinic. This case portrays a presentation of ichthyosis induced by the medicinal drink, kava, which is becoming a more mainstream beverage in American culture. This case provides an overview of the clinical presentation of ichthyosis and a historical background on kava as well as recent studies on kava-induced ichthyosis or kava dermopathy. It also highlights the need to consider the use of herbal and alternative therapies when considering the underlying causes of skin disorders.
Lack of an Exposure Response and Interaction With HLA-DPβ1 and DRβ1 Polymorphisms in the Development of Beryllium Toxicity in a High Beryllium Exposure Cohort
Authors: Widyaningsih Vitri , Rosenman Kenneth , Reilly Mary Jo , Wang Ling , Pathak Dorothy R. , Gardiner Joseph C. , Rice Carol , Monos Dimitri , Rossman Milton 
Published: November 2019

Objective:
To evaluate interaction of HLA-DPβ1 and DRβ1 polymorphisms with metrics of beryllium exposure, in the development of beryllium sensitization (BeS) and chronic beryllium disease (CBD).

Methods:
A matched case-control study of 61 CBD, 41 BeS, and 259 controls from two beryllium-processing facilities.

Results:
BES and CBD were significantly associated with presence of DPβE69. Dose response of exposure was not observed for the development of BES and CBD with/without adjustment for DPβE69 (P > 0.05). The DRβE71 polymorphism was more common in BeS than CBD after adjusting for exposure and maybe a protective factor (aOR 0.4, 95% CI 0.2 to 0.9) against the progression of BeS to CBD.

Conclusion:
No exposure–response association was found, which may reflect that the workers in this high exposure cohort were above a threshold level where an exposure–response could be observed.
Male and Female Adolescent Athletes' Readiness to Return to Sport After Anterior Cruciate Ligament Injury and Reconstruction
Authors: Kostyun Regina O. , Burland Julie P. , Kostyun Kyle J. , Milewski Matthew D. , Nissen Carl W. 
Published: November 2019

Objective:
The purpose of this study was to examine whether readiness to return to sport (RTS) differed between adolescent male and female athletes after anterior cruciate ligament reconstruction (ACLR).

Design:
Longitudinal, prospective cohort.

Setting:
Outpatient office associated with tertiary-care hospital.

Patients:
A total of 93 adolescent athletes, 17 years of age and younger, who underwent ACLR surgery with a hamstring autograft were included.

Independent Variables:
Male and female athletes.

Main Outcome Measures:
Anterior cruciate ligament–return to sport after injury (ACL-RSI) completed at 3 time points: (1) preoperatively (Pre-op), (2) approximately 3 months into rehabilitation (Post-op 1), and (3) during RTS phases of recovery (Post-op 2).

Results:
There was a significant main effect for both sex (P < 0.010) and time (P < 0.0001) with male athletes having higher ACL-RSI scores than female athletes at all 3 time points; however, there was no significant time by sex interaction. All ACL-RSI scores increased significantly across time, regardless of sex. There were no statistically significant differences between ACL-RSI scores at all 3 time points between individuals who did and did not receive physician clearance.

Conclusions:
This study provides a longitudinal depiction of adolescent athletes' readiness to RTS after ACL injury throughout recovery. Both male and female athletes demonstrated diminished ACL-RSI scores before undergoing surgery, with increasing scores at both postoperative time points for both sexes. Overall, female athletes reported lower readiness to RTS at all 3 time points compared with male athletes.
Long-Term Stability and Functional Outcome of an Active Middle Ear Implant Regarding Different Coupling Sites
Authors: Spiegel Jennifer L. , Kutsch Luise , Jakob Mark , Weiss Bernhard G. , Canis Martin , Ihler Friedrich 
Published: November 2019

Objectives:
Indication and implantation of active middle ear implants (AMEI) are well established. Choice of the coupling site depends from the individual anatomical situation. Long-term stability of different coupling sites in terms of functional outcome and complications are rare and were investigated in this study.

Design:
Retrospective analysis of 41 consecutive patients (45 ears) with coupling of the AMEI at the incus, stapes, and round window. Analysis of preoperative, postoperative, and long-term results of pure-tone average, speech discrimination in quiet at 65 dB (German language Freiburg Monosyllabic Test) and noise (German language Oldenburger Sentence Test), rate of revision surgeries as well as explantations and the novel parameter patient years (py).

Results:
Mean of follow-up was 3.0 ± 1.7 years resulting in a total of 135.6 py. Bone conduction was stable in all patients pre- to postoperatively as well as preoperatively to the long-term. Round window patients had the broadest air-bone gap (31.4 ± 19.4 dB HL) benefitting the most from the AMEI (functional gain = 39.0 ± 12.8 dB HL). Regarding speech discrimination, incus patients performed the best both in quiet (77.7 ± 22.8%) and noise (3.4 ± 2.9 dB SNR). In terms of revision surgery and explantations, round window patients exhibited the highest rates (20%).

Conclusions:
Regarding all coupling sites, satisfying long-term stability results and comparable complication rates were reported with best performance of coupling to the incus. Implementation of patient years might be a novel parameter for the comparison of revisions and explantations.
Electrode Array Type and Its Impact on Impedance Fluctuations and Loss of Residual Hearing in Cochlear Implantation
Authors: Thompson Nicholas J. , Dillon Margaret T. , Buss Emily , Park Lisa R. , Pillsbury Harold C. , O’Connell Brendan P. , Brown Kevin D. 
Published: November 2019

Hypothesis/Objective:
Determine variables associated with electrode impedance fluctuations and loss of residual hearing in cochlear implant (CI) recipients.

Background:
CI recipients with postoperative hearing preservation demonstrate superior speech perception with an electric-acoustic stimulation (EAS) device as compared with a CI-alone device. Maintaining superior speech perception over time relies on long-term hearing preservation; therefore, understanding variables that may contribute to loss of residual hearing is needed. Recent reports suggest a relationship between changes in electrode impedance and loss of residual hearing. The variables influencing this relationship have yet to be determined.

Methods:
Review of pediatric and adult CI cases from 2013 to 2016 who presented with preoperative residual hearing. Regression analysis was performed to evaluate effects of array type (lateral wall vs. perimodiolar), manufacturer, age at implantation, and preoperative hearing on impedance. The correlation between peak impedance change and change in low-frequency hearing was determined.

Results:
One hundred forty-six CI recipients presented with preoperative residual hearing. A multivariate regression analysis demonstrated a statistically significant association between preoperative hearing thresholds (p = 0.017), device manufacturer (p = 0.011), and array type (p = 0.038) on postoperative impedance changes. Hearing preservation rates and change in impedance differed by electrode array type. The association between peak impedance changes and loss of residual hearing differed between manufacturers (R2 = 0.208, p = 0.029 vs. R2 = 0.016, p = 0.609).

Conclusion:
Impedance fluctuation appears to be a marker for loss of residual hearing for specific electrode array types and manufacturers. Specific arrays may affect the cochlear microenvironment differently, with different effects on postoperative hearing preservation.
The Importance of the Temporal Bone 3T MR Imaging in the Diagnosis of Menière's Disease
Authors: Paškonienė Aistė , Baltagalvienė Renata , Lengvenis Givi , Beleškienė Vilma , Ivaška Justinas , Markevičiūtė Vėtra , Mickevičienė Vaiva , Lesinskas Eugenijus 
Published: November 2019

Background:
The aim of this study was to evaluate endolymphatic hydrops using the 3T temporal bone magnetic resonance imaging (MRI), performed according to the chosen protocol, and determine whether it could be applied as an objective diagnostic tool for Menière's disease.

Methods:
105 participants diagnosed with probable (n = 50) and definite (n = 55) Menière's disease were included in this prospective study at Vilnius University Hospital, Santaros Clinics. Audiometry, vestibular function tests, videonystagmography, and computer posturography were performed before MRI. The 3T MRI with gadolinium contrast was performed to evaluate the endolymphatic hydrops. Imaging protocol consisted of 3D-FLAIR and 3D T2DRIVE sequences. Vestibular endolymphatic sac was interpreted as enlarged if occupied more than 50% of the vestibular area.

Results:
78.1% of subjects had abnormal MRI findings other than hydrops, and it was more than 90% (50/55) of patients in the definite MD group (p < 0.001). Changes in caloric test were observed in 63.8% of subjects in general, and in 76.4% of patients with a definite Menière's disease. The side of the endolymphatic hydrops observed on MR imaging corresponded to the clinical diagnosis of the Menière's disease based on the results of audiometry (p < 0.001) and unilateral weakness (p < 0.001). Endolymphatic hydrops on MRI and directional preponderance in caloric test were two independent predictors of the definite Menière's disease.

Conclusions:
Temporal bone 3T MRI with gadolinium contrast is clinically superior to confirm the diagnosis of Menière's disease. Grade II endolymphatic hydrops on MRI, directional preponderance, and unilateral weakness on caloric test were independent predictors for the definite Menière's disease.
Systematic Review and Network Meta-analysis of Cognitive and/or Behavioral Therapies (CBT) for Tinnitus
Authors: Landry Evie C. , Sandoval Xochitl Citlalli Romo , Simeone Calla N. , Tidball Glynnis , Lea Jane , Westerberg Brian D. 
Published: November 2019

Objective:
To evaluate the efficacy of cognitive and/or behavioral therapies in improving health-related quality of life (HRQOL), depression, and anxiety associated with tinnitus.

Data Sources:
EMBASE, MEDLINE, PubMed, PsycINFO, and the Cochrane Registry were used to identify English studies from database inception until February 2018.

Study Selection:
Randomized controlled trials (RCTs) comparing cognitive and/or behavioral therapies to one another or to waitlist controls for the treatment of tinnitus were included.

Data Extraction:
Quality and risk were assessed using GRADE and Cochrane's Risk of Bias tool respectively.

Data Synthesis:
Pairwise meta-analysis (12 RCTs: 1,144 patients) compared psychological interventions to waitlist controls. Outcomes were measured using standardized mean differences (SMDs) and 95% confidence intervals (CI). I2 and subgroup analyses were used to assess heterogeneity. Network meta-analysis (NMA) (19 RCTS: 1,543 patients) compared psychological therapies head-to-head. Treatment effects were presented by network diagrams, interval plots, and ranking diagrams indicating SMDs with 95% CI. Direct and indirect results were further assessed by inconsistency plots.

Conclusions:
Results are consistent with previously published guidelines indicating that CBT is an effective therapy for tinnitus. While guided self-administered forms of CBT had larger effect sizes (SMD: 3.44; 95% CI: −0.022, 7.09; I2: 99%) on tinnitus HRQOL, only face-to-face CBT was shown to make statistically significant improvements (SMD: 0.75; 95% CI: 0.53, 0.97; I2: 0%). Guided self-administered CBT had the highest likelihood of being ranked first in improving tinnitus HRQOL (75%), depression (83%), and anxiety (87%), though statistically insignificant. This NMA is the first of its kind in this therapeutic area and provides new insights on the effects of different forms of cognitive and/or behavioral therapies for tinnitus.
3D-Printed Microneedles Create Precise Perforations in Human Round Window Membrane in Situ
Authors: Chiang Harry , Yu Michelle , Aksit Aykut , Wang Wenbin , Stern-Shavit Sagit , Kysar Jeffrey W. , Lalwani Anil K. 
Published: November 2019

Hypothesis:
Three-dimensional (3D)-printed microneedles can create precise holes on the scale of micrometers in the human round window membrane (HRWM).

Background:
An intact round window membrane is a barrier to delivery of therapeutic and diagnostic agents into the inner ear. Microperforation of the guinea pig round window membrane has been shown to overcome this barrier by enhancing diffusion 35-fold. In humans, the challenge is to design a microneedle that can precisely perforate the thicker HRWM without damage.

Methods:
Based on the thickness and mechanical properties of the HRWM, two microneedle designs were 3D-printed to perforate the HRWM from fresh frozen temporal bones in situ (n = 18 total perforations), simultaneously measuring force and displacement. Perforations were analyzed using confocal microscopy; microneedles were examined for deformity using scanning electron microscopy.

Results:
HRWM thickness was determined to be 60.1 ± 14.6 (SD) μm. Microneedles separated the collagen fibers and created slit-shaped perforations with the major axis equal to the microneedle shaft diameter. Microneedles needed to be displaced only minimally after making initial contact with the RWM to create a complete perforation, thus avoiding damage to intracochlear structures. The microneedles were durable and intact after use.

Conclusion:
3D-printed microneedles can create precise perforations in the HRWM without damaging intracochlear structures. As such, they have many potential applications ranging from aspiration of cochlear fluids using a lumenized needle for diagnosis and creating portals for therapeutic delivery into the inner ear.
Postoperative Healthcare Utilization of Elderly Adults After Cochlear Implantation
Authors: Raymond Mallory J. , Dong Andy , Naissir Samir Ballestas , Vivas Esther X. 
Published: November 2019

Objective:
To determine the association between geriatric age and postoperative healthcare utilization after cochlear implantation.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
Older adults (>59 yr) who underwent unilateral cochlear implantation from 2009 until 2016.

Intervention(s):
Standard electrode length cochlear implantation.

Main Outcome Measure(s):
Postoperative surgical and audiological visit rate after cochlear implantation for those aged 60 to 69, 70 to 79, and 80+ years.

Results:
Fifty-nine older adult patients were included in the study with a mean age of 71.5 ± 6.9 years (range, 60–88 yr), mean duration of hearing loss of 25.4 ± 19.6 years (range, 0.25–67 yr), and mean length of follow up of 37 ± 24.6 months (range, 6–107 mo). There was no significant difference in the mean number of surgical and audiological visits over both the first and second postoperative years between those aged 60 to 69, 70 to 79, and 80+ years. Additionally, on one-way multivariate analysis of covariance (MANCOVA), there was no significant difference in cumulative postoperative healthcare utilization measures between each age group, when controlling for postoperative AzBio scores, estimated household income, and driving distance to the hospital.

Conclusions:
Older geriatric adults do not have higher rates of postoperative healthcare utilization after cochlear implantation than their younger, geriatric hearing impaired counterparts, despite presumed higher rates of frailty and comorbidity.