bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Effect of Middle Ear Effusions on Wideband Acoustic Immittance Using Optical Coherence Tomography
Authors: Won Jungeun , Monroy Guillermo L. , Huang Pin-Chieh , Hill Malcolm C. , Novak Michael A. , Porter Ryan G. , Spillman Darold R. , Chaney Eric J. , Barkalifa Ronit , Boppart Stephen A. 
Published: October 2019

Objectives:
Wideband acoustic immittance (WAI) noninvasively assesses middle ear function by measuring the sound conduction over a range of audible frequencies. Although several studies have shown the potential of WAI for detecting the presence of middle ear effusions (MEEs), determining the effects of MEE type and amount on WAI in vivo has been challenging due to the anatomical location of middle ear cavity. The purpose of this study is to correlate WAI measurements with physical characteristics of the middle ear and MEEs determined by optical coherence tomography (OCT), a noninvasive optical imaging technique.

Design:
Sixteen pediatric subjects (average age of 7 ± 4 years) were recruited from the primary care clinic at Carle Foundation Hospital (Urbana, IL). A total of 22 ears (normal: 15 ears, otitis media with effusion: 6 ears, and acute otitis media: 1 ear, based on physician’s diagnosis) were examined via standard otoscopy, tympanometry, OCT imaging, and WAI measurements in a busy, community-based clinical setting. Cross-sectional OCT images were analyzed to quantitatively assess the presence, type (relative turbidity based on the amount of scattering), and amount (relative fluid level) of MEEs. These OCT metrics were utilized to categorize subject ears into no MEE (control), biofilm without a MEE, serous-scant, serous-severe, mucoid-scant, and mucoid-severe MEE groups. The absorbance levels in each group were statistically evaluated at α = 0.05.

Results:
The absorbance of the control group showed a similar trend when compared with a pediatric normative dataset, and the presence of an MEE generally decreased the power absorbance. The mucoid MEE group showed significantly less power absorbance from 2.74 to 4.73 kHz (p < 0.05) when compared with the serous MEE group, possibly due to the greater mass impeding the middle ear system. Similarly, the greater amount of middle ear fluid contributed to the lower power absorbance from 1.92 to 2.37 kHz (p< 0.05), when compared with smaller amounts of fluid. As expected, the MEEs with scant fluid only significantly affected the power absorbance at frequencies greater than 4.85 kHz. A large variance in the power absorbance was observed between 2 and 5 kHz, suggesting the dependence on both the type and amount of MEE.

Conclusions:
Physical characteristics of the middle ear and MEEs quantified from noninvasive OCT images can be helpful to understand abnormal WAI measurements. Mucoid MEEs decrease the power absorbance more than serous MEEs, and the greater amounts of MEE decreases the power absorbance, especially at higher (>2 kHz) frequencies. As both the type and amount of MEE can significantly affect WAI measurements, further investigations to correlate acoustic measurements with physical characteristics of middle ear conditions in vivo is needed.
The Pararectus Approach in Acetabular Surgery: Radiological and Clinical Outcome
Authors: Wenzel Lisa , von Rüden Christian , Thannheimer Andreas , Becker Johannes , Brand Andreas , Augat Peter , Perl Mario 
Published: October 2019

Objectives:
To evaluate radiological fracture reduction and clinical results using the pararectus approach in complex acetabular fractures involving the anterior column.

Design:
Retrospective database analysis of prospectively collected data.

Setting:
Level 1 trauma center.

Patients/Participants:
61 patients (48 male and 13 female) with a median age of 55 (range 17–91) years were included. According to the chosen surgical approach, they were divided into 2 groups. The P-group included 43 patients, among them 32 male and 11 female patients with a median age of 55 (range 17–90) years. Eighteen patients [16 male, 2 female; median age: 53 (range 23–91) years] were treated through the ilioinguinal approach (I-group).

Intervention:
Anterior surgical procedures through the pararectus or the ilioinguinal approach.

Main Outcome Measured:
Reduction results were rated according to the modified Matta criteria using a measurement protocol of hip joint gaps and steps in computed tomography scans. Operation time, complications, and clinical outcomes median one year postoperatively were compared.

Results:
In the pararectus group reduction was anatomical in 21 out of 40 analyzed patients (52.5%), imperfect in 11 patients (27.5%), and poor in 8 patients (20%). The mean joint step reduction was 3.7 mm, and the mean joint gap reduction was 12.1 mm. In the ilioinguinal group reduction was anatomical in 9 out of 18 patients (50%), imperfect in 4 patients (22%), and poor in 5 patients (28%). The mean joint step reduction was 1 mm, and the mean joint gap reduction was 7 mm. Operation time was significantly shorter in the P-group (mean: 49 minutes; P < 0.001).

Conclusions:
This study indicates that acetabular fracture reduction using the pararectus approach is at least comparable with the ilioinguinal approach independent of patients' age. A relevant advantage of the pararectus approach was seen in a significantly shorter operation time.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Mechanical Effects of Bone Substitute and Far-Cortical Locking Techniques in 2-Part Proximal Humerus Fracture Reconstruction: A Cadaveric Study
Authors: Hast Michael W. , Chin Matthew , Schmidt Elaine C. , Sanville Jennifer , Van Osten George Karl , Mehta Samir 
Published: October 2019

Objectives:
To make direct comparisons of the biomechanical properties of a control (CTL) group and implants that were augmented with far cortical locking (FCL), bone substitute material (BSM), and a combination of both (ALL) to determine which fixation is most effective in reducing implant failure.

Methods:
The constructs were tested with osteopenic cadaveric specimens in a two-part fracture model. Specimens were subjected to a battery of nondestructive torsion and axial compression tests, followed by a cyclic test. Construct stiffness and cycles to failure were documented, pre- and post-test fluoroscopy was performed, and implant and bone kinematics were quantified.

Results:
During nondestructive testing, the BSM group exhibited significantly increased torsional and axial stiffness compared with the FCL (P = 0.006, P < 0.001) group and ALL group (P < 0.001, P = 0.006). There were no significant differences in resistance to cyclic loading between groups. Fluoroscopic analysis indicated significant differences in the motions of nonlocked cannulated screws (used in BSM and ALL) versus locked screws (used in CTL and FCL).

Conclusions:
Patients with poor bone quality and proximal humerus fracture may necessitate added compliance or rigidity to achieve fixation. Both have exhibited favorable biomechanical characteristics in this cadaveric 2-part proximal humerus fracture model.
Increased Staphylococcus aureus Biofilm Formation on Biodegradable Poly(3-Hydroxybutyrate)-Implants Compared with Conventional Orthopedic Implants: An In Vitro Analysis
Authors: Ferlic Peter W. , Liebensteiner Michael , Nogler Michael , Weinberg Annelie M. , Kühn Klaus-Dieter , Coraça-Huber Débora 
Published: October 2019

Objective:
To compare the biofilm formation on a biodegradable material, poly(3-hydroxybutyrate) (PHB), with that on conventional titanium (Ti) and steel (St) implant material.

Methods:
Pins made of the different materials were incubated in Müller-Hinton broth inoculated with 2 × 105 colony-forming units (CFU)·mL−1 of Staphylococcus aureus for 2 and 7 days and then sonicated for the disruption of the biofilms. CFU were counted to quantify the number of bacteria in the biofilm, and the cell proliferation assay 2,3-Bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H- tetrazolium-5-carboxanilid salt was used to evaluate their metabolic activity. Scanning electron microscopy visualized the structure of the biofilm.

Results:
We found a significantly higher metabolic activity and CFU count in the biofilm of PHB pins compared with St and Ti pins (analysis of variance, P < 0.0001). Scanning electron microscopy revealed structured biofilms on PHB pins already after 2 days of incubation, which was not observed on the other tested implants.

Conclusion:
PHB implants seem to provide an environment that advantages the formation of biofilms of S. aureus, a common pathogen in implant-related infections. The amount of biofilm is higher on PHB implant compared with conventionally used orthopedic titanium and steel implants. To overcome the potential risk of surgical site infections linked to the clinical use of PHB implants, possible modifications of the material, increasing its antibacterial properties, need to be further investigated.
Tantalum Fusion Device in Anterior Cervical Discectomy and Fusion For Treatment of Cervical Degeneration Disease
Authors: Wang Yufu , Wei Rongzhi , Subedi Dipendra , Jiang Hongxing , Yan Jinglong , Li Jing 
Published: October 2019

Study Design:
This is a systematic review and meta-analysis study.

Objective:
The purpose of this systematic review and meta-analysis study is to evaluate the outcomes of a tantalum fusion device in anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degeneration disease.

Summary of Background Data:
A great interest has raised for porous tantalum in cervical fusion, but several studies reported the divergent clinical outcome and fusion rate. No systematic review and meta-analysis has been conducted up to present to evaluate the outcomes of the tantalum fusion device.

Methods:
We comprehensively searched multiple databases for studies that investigated the tantalum fusion device in ACDF. The retrieved results were last updated on February 15, 2018. Outcomes of interest comprised of operative parameters, fusion rate, the incidence of adverse events as well as patient-reported outcomes, including the Neck Disability Index (NDI) score, Visual Analog Scale (VAS) score, Short Form-36 Physical Component Scores and complications.

Results:
Ten studies included were included in this review and 6 randomized controlled trial studies included. All studies were pooled to evaluate the outcome of fusion rate, NDI, and VAS after tantalum fusion treatment. The results of the meta-analysis showed that implantation of the tantalum fusion device is associated with significantly shorter operative and fewer adverse events when compared with autologous iliac crest bone graft. However, no difference was found with regards to the fusion rate, NDI, VAS, and global assessment.

Conclusions:
Through this systemic review and meta-analysis, no significant difference was found with regards to fusion rate, postoperative NDI, and VAS between tantalum fusion and iliac crest bone graft in ACDF. More longer-term and randomized studies with large samples are warranted to validate any association found in this study.

Level of Evidence:
Level II.
Host-Response Subphenotypes Offer Prognostic Enrichment in Patients With or at Risk for Acute Respiratory Distress Syndrome*
Authors: Kitsios Georgios D. , Yang Libing , Manatakis Dimitris V. , Nouraie Mehdi , Evankovich John , Bain William , Dunlap Daniel G. , Shah Faraaz , Barbash Ian J. , Rapport Sarah F. , Zhang Yingze , DeSensi Rebecca S. , Weathington Nathaniel M. , Chen Bill B. , Ray Prabir , Mallampalli Rama K. , Benos Panayiotis V. , Lee Janet S. , Morris Alison , McVerry Bryan J. 
Published: October 2019

Objectives:
Classification of patients with acute respiratory distress syndrome into hyper- and hypoinflammatory subphenotypes using plasma biomarkers may facilitate more effective targeted therapy. We examined whether established subphenotypes are present not only in patients with acute respiratory distress syndrome but also in patients at risk for acute respiratory distress syndrome (ARFA) and then assessed the prognostic information of baseline subphenotyping on the evolution of host-response biomarkers and clinical outcomes.

Design:
Prospective, observational cohort study.

Setting:
Medical ICU at a tertiary academic medical center.

Patients:
Mechanically ventilated patients with acute respiratory distress syndrome or ARFA.

Interventions:
None.

Measurements and Main Results:
We performed longitudinal measurements of 10 plasma biomarkers of host injury and inflammation. We applied unsupervised latent class analysis methods utilizing baseline clinical and biomarker variables and demonstrated that two-class models (hyper- vs hypoinflammatory subphenotypes) offered improved fit compared with one-class models in both patients with acute respiratory distress syndrome and ARFA. Baseline assignment to the hyperinflammatory subphenotype (39/104 [38%] acute respiratory distress syndrome and 30/108 [28%] ARFA patients) was associated with higher severity of illness by Sequential Organ Failure Assessment scores and incidence of acute kidney injury in patients with acute respiratory distress syndrome, as well as higher 30-day mortality and longer duration of mechanical ventilation in ARFA patients (p < 0.0001). Hyperinflammatory patients exhibited persistent elevation of biomarkers of innate immunity for up to 2 weeks postintubation.

Conclusions:
Our results suggest that two distinct subphenotypes are present not only in patients with established acute respiratory distress syndrome but also in patients at risk for its development. Hyperinflammatory classification at baseline is associated with higher severity of illness, worse clinical outcomes, and trajectories of persistently elevated biomarkers of host injury and inflammation during acute critical illness compared with hypoinflammatory patients. Our findings provide strong rationale for examining treatment effect modifications by subphenotypes in randomized clinical trials to inform precision therapeutic approaches in critical care.
Agmatine Protects Against the Progression of Sepsis Through the Imidazoline I2 Receptor-Ribosomal S6 Kinase 2-Nuclear Factor-κB Signaling Pathway
Authors: Li Xuanfei , Zhu Junyu , Tian Lixing , Ma Xiaoyuan , Fan Xia , Luo Li , Yu Jing , Sun Yu , Yang Xue , Tang Wanqi , Ma Wei , Yan Jun , Xu Xiang , Liang Huaping 
Published: October 2019

Objectives:
The knowledge that agmatine is found in the human body has existed for several years; however, its role in sepsis has not yet been studied. In the present study, we investigate the role of agmatine in the progression and treatment of sepsis.

Design:
Clinical/laboratory investigations.

Setting:
Medical centers/University-based research laboratory.

Subjects:
Elective ICU patients with severe sepsis and healthy volunteers; C57BL/6 mice weighing 18–22 g.

Interventions:
Serum agmatine level and its associations with inflammatory markers were assessed in patients with sepsis. Agmatine was administered intraperitoneally to mice before a lipopolysaccharide challenge. Human peripheral blood mononuclear cells and murine macrophages were pretreated with agmatine followed by lipopolysaccharide stimulation.

Measurements and Main Results:
Serum agmatine levels were significantly decreased in patients with sepsis and lipopolysaccharide-induced mice, and correlated with Acute Physiology and Chronic Health Evaluation II score, procalcitonin, tumor necrosis factor-α, and interleukin-6 levels. In a therapeutic experiment, exogenous agmatine attenuated the cytokine production of peripheral blood mononuclear cells from patients with sepsis and healthy controls. Agmatine also exerted a significant beneficial effect in the inflammatory response and organ damage and reduced the death rate in lipopolysaccharide-induced mice. Imidazoline I2 receptor agonist 2-benzofuran-2-yl blocked the pharmacological action of agmatine; whereas, other imidazoline receptor ligands did not. Furthermore, agmatine significantly impaired the inflammatory response by inactivating nuclear factor-κB, but not protein 38 mitogen-activated protein kinase, c-Jun N-terminal kinase, extracellular signal-regulated kinase, and inducible nitric oxide synthase signaling in macrophages. Activation of imidazoline I2 receptor or knockdown of ribosomal S6 kinase 2 counteracted the effects of agmatine on phosphorylation and degradation of inhibitor of nuclear factor-κBα.

Conclusions:
Endogenous agmatine metabolism correlated with the progression of sepsis. Supplemental exogenous agmatine could ameliorate the lipopolysaccharide-induced systemic inflammatory responses and multiple organ injuries through the imidazoline I2 receptor-ribosomal S6 kinase 2-nuclear factor-κB pathway. Agmatine could be used as both a clinical biomarker and a promising pharmaconutrient in patients with severe sepsis.
High-Frequency Oscillatory Ventilation and Ventilator-Induced Lung Injury: Size Does Matter
Authors: Herrmann Jacob , Lilitwat Weerapong , Tawhai Merryn H. , Kaczka David W. 
Published: October 2019

Objectives:
The theoretical basis for minimizing tidal volume during high-frequency oscillatory ventilation may not be appropriate when lung tissue stretch occurs heterogeneously and/or rapidly. The objective of this study was to assess the extent to which increased ventilation heterogeneity may contribute to ventilator-induced lung injury during high-frequency oscillatory ventilation in adults compared with neonates on the basis of lung size, using a computational model of human lungs.

Design:
Computational modeling study.

Setting:
Research laboratory.

Subjects:
High-fidelity, 3D computational models of human lungs, scaled to various sizes representative of neonates, children, and adults, with varying injury severity. All models were generated from one thoracic CT image of a healthy adult male.

Interventions:
Oscillatory ventilation was simulated in each lung model at frequencies ranging from 0.2 to 40 Hz. Sinusoidal flow oscillations were delivered at the airway opening of each model and distributed through the lungs according to regional parenchymal mechanics.

Measurements and Main Results:
Acinar flow heterogeneity was assessed by the coefficient of variation in flow magnitudes across all acini in each model. High-frequency oscillatory ventilation simulations demonstrated increasing heterogeneity of regional parenchymal flow with increasing lung size, with decreasing ratio of deadspace to total acinar volume, and with increasing frequency above lung corner frequency and resonant frequency. Potential for resonant amplification was greatest in injured adult-sized lungs with higher regional quality factors indicating the presence of underdamped lung regions.

Conclusions:
The potential for ventilator-induced lung injury during high-frequency oscillatory ventilation is enhanced at frequencies above lung corner frequency or resonant frequency despite reduced tidal volumes, especially in adults, due to regional amplification of heterogeneous flow. Measurements of corner frequency and resonant frequency should be considered during high-frequency oscillatory ventilation management.
Acute Respiratory Distress Syndrome Following Pediatric Trauma: Application of Pediatric Acute Lung Injury Consensus Conference Criteria
Authors: Killien Elizabeth Y. , Huijsmans Roel L. N. , Ticknor Iesha L. , Smith Lincoln S. , Vavilala Monica S. , Rivara Frederick P. , Watson R. Scott 
Published: October 2019

Objectives:
To assess the incidence, severity, and outcomes of pediatric acute respiratory distress syndrome following trauma using Pediatric Acute Lung Injury Consensus Conference criteria.

Design:
Retrospective cohort study.

Setting:
Level 1 pediatric trauma center.

Patients:
Trauma patients less than or equal to 17 years admitted to the ICU from 2009 to 2017.

Interventions:
None.

Measurements and Main Results:
We queried electronic health records to identify patients meeting pediatric acute respiratory distress syndrome oxygenation criteria for greater than or equal to 6 hours and determined whether patients met complete pediatric acute respiratory distress syndrome criteria via chart review. We estimated associations between pediatric acute respiratory distress syndrome and outcome using generalized linear Poisson regression adjusted for age, injury mechanism, Injury Severity Score, and serious brain and chest injuries. Of 2,470 critically injured children, 103 (4.2%) met pediatric acute respiratory distress syndrome criteria. Mortality was 34.0% among pediatric acute respiratory distress syndrome patients versus 1.7% among patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 3.7; 95% CI, 2.0–6.9). Mortality was 50.0% for severe pediatric acute respiratory distress syndrome at onset, 33.3% for moderate, and 30.5% for mild. Cause of death was neurologic in 60.0% and multiple organ failure in 34.3% of pediatric acute respiratory distress syndrome nonsurvivors versus neurologic in 85.4% of nonsurvivors without pediatric acute respiratory distress syndrome (p = 0.001). Among survivors, 77.1% of pediatric acute respiratory distress syndrome patients had functional disability at discharge versus 30.7% of patients without pediatric acute respiratory distress syndrome patients (p < 0.001), and only 17.5% of pediatric acute respiratory distress syndrome patients discharged home without ongoing care versus 86.4% of patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 1.5; 1.1–2.1).

Conclusions:
Incidence and mortality associated with pediatric acute respiratory distress syndrome following traumatic injury are substantially higher than previously recognized, and pediatric acute respiratory distress syndrome development is associated with high risk of poor outcome even after adjustment for underlying injury type and severity.
CA 19-9 Response
Authors: Diaz Celso L. , Cinar Pelin , Hwang Jimmy , Ko Andrew H. , Tempero Margaret A. 
Published: October 2019

Objective:
The objective of this study was to determine the features of carbohydrate antigen (CA) 19-9 decline that correlates best with survival benefit in patients with metastatic pancreatic cancer.

Methods:
This is a retrospective study of 225 patients with metastatic pancreatic cancer receiving first-line therapy. Analysis was performed by the Kaplan-Meier method and Cox-proportional hazards ratios. CA 19-9 decline was grouped into quartiles within different CA 19-9 baseline groups. Time to nadir and CA 19-9 decline at month-2 (M2) of therapy were evaluated for patients with a baseline level ≥1000 U/mL.

Results:
No significant trend in survival was observed across baseline CA 19-9 levels. The greatest survival benefit was seen with a ≥75% decline to nadir. Among those with a ≥75% decline and baseline ≥1000 U/mL, 43 of 57 patients had a >50% decline at M2 of therapy and additional survival benefit was observed with a slower decline to nadir. Small sample sizes limited analysis of other baseline groups. CA 19-9 decline at M2 was not predictive.

Conclusions:
In patients with a CA 19-9 ≥1000 U/mL, serial CA 19-9 levels may be considered as a surrogate for serial imaging to evaluate treatment response, with a ≥75% decline indicating the greatest survival benefit. Survival was improved further in the setting of a slower decline to nadir with the highest benefit seen in patients with a nadir occurring at 4 months or longer.