bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss
Authors: Vroegop Jantien , Rodenburg-Vlot Marian , Goedegebure André , Doorduin Agnes , Homans Nienke , van der Schroeff Marc 
Published: February 2021

Objectives:
Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss.

Design:
We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs.

Results:
The average speech reception threshold (SRT) was −3.6 dB (SD 3.6) for the first list and significantly improved to −4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child’s hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list.

Conclusion:
The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.
Predicting Depression From Hearing Loss Using Machine Learning
Authors: Crowson Matthew G. , Franck Kevin H. , Rosella Laura C. , Chan Timothy C. Y. 
Published: February 2021

Objectives:
Hearing loss is the most common sensory loss in humans and carries an enhanced risk of depression. No prior studies have attempted a contemporary machine learning approach to predict depression using subjective and objective hearing loss predictors. The objective was to deploy supervised machine learning to predict scores on a validated depression scale using subjective and objective audiometric variables and other health determinant predictors.

Design:
A large predictor set of health determinants from the National Health and Nutrition Examination Survey 2015–2016 database was used to predict adults’ scores on a validated instrument to screen for the presence and severity of depression (Patient Health Questionnaire-9 [PHQ-9]). After model training, the relative influence of individual predictors on depression scores was stratified and analyzed. Model prediction performance was determined by prediction error metrics.

Results:
The test set mean absolute error was 3.03 (95% confidence interval: 2.91 to 3.14) and 2.55 (95% confidence interval: 2.48 to 2.62) on datasets with audiology-only predictors and all predictors, respectively, on the PHQ-9’s 27-point scale. Participants’ self-reported frustration when talking to members of family or friends due to hearing loss was the fifth-most influential of all predictors. Of the top 10 most influential audiometric predictors, five were related to social contexts, two for significant noise exposure, two objective audiometric parameters, and one presence of bothersome tinnitus.

Conclusions:
Machine learning algorithms can accurately predict PHQ-9 depression scale scores from National Health and Nutrition Examination Survey data. The most influential audiometric predictors of higher scores on a validated depression scale were social dynamics of hearing loss and not objective audiometric testing. Such models could be useful in predicting depression scale scores at the point-of-care in conjunction with a standard audiologic assessment.
Implementation of a Critical Care Asthma Pathway in the PICU
Authors: Miksa Michael , Kaushik Shubhi , Antovert Gerald , Brown Sakar , Ushay H. Michael , Katyal Chhavi 
Published: February 2021

Objectives:
Acute asthma management has improved significantly across hospitals in the United States due to implementation of standardized care pathways. Management of severe acute asthma in ICUs is less well studied, and variations in management may delay escalation and/or deescalation of therapies and increase length of stay. In order to standardize the management of severe acute asthma in our PICU, a nurse- and respiratory therapist–driven critical care asthma pathway was designed, implemented, and tested.

Design:
Cross-sectional study of severe acute asthma at baseline followed by implementation of a critical care asthma pathway.

Setting:
Twenty-six–bed urban quaternary PICU within a children’s hospital.

Patients:
Patients 24 months to 18 years old admitted to the PICU in status asthmaticus. Patients with severe bacterial infections, chronic lung disease, heart disease, or immune disorders were excluded.

Interventions:
Implementation of a nurse- and respiratory therapist–driven respiratory scoring tool and critical care asthma pathway with explicit escalation/deescalation instructions.

Measurements and Main Results:
Primary outcome was PICU length of stay. Secondary outcomes were time to resolution of symptoms and hospital length of stay. Compliance approached 90% for respiratory score documentation and critical care asthma pathway adherence. Severity of illness at admission and clinical baseline characteristics were comparable in both groups. Pre intervention, the median ICU length of stay was 2 days (interquartile range, 1–3 d) with an overall hospital length of stay of 4 days (interquartile range, 3–6 d) (n = 74). After implementation of the critical care asthma pathway, the ICU length of stay was 1 day (interquartile range, 1–2 d) (p = 0.0013; n = 78) with an overall length of stay of 3 days (interquartile range, 2–3.75 d) (p < 0.001). The time to resolution of symptoms was reduced from a median of 66.5 hours in the preintervention group to 21 hours in the postintervention compliant group (p = 0.036).

Conclusions:
The use of a structured critical care asthma pathway, driven by an ICU nurse and respiratory therapist, is associated with faster resolution of symptoms, decreased ICU, and overall hospital lengths of stay in children admitted to an ICU for severe acute asthma.
Pearls and perils in the management of germ cell tumors
Authors: Wei Cynthia X. , Einhorn Lawrence H. , Adra Nabil 
Published: February 2021

Purpose of review
Research and innovation over the past half century have rendered testicular cancer a highly curable malignancy. Challenges and uncertainty remain in several aspects related to the management and surveillance of patients with germ cell tumors (GCT). Long-term effects of treatment on survivors of testicular cancer remain as continued areas of interest. This review aims to highlight pearls and perils in the management of patients with GCT.

Recent findings
Uncertainty remain regarding complex aspects of first-line and salvage treatments of GCT, interpretation of tumor markers in cases of α-fetoprotein levels less than 25 ng/ml, plateau of β-human chorionic gonadotropin (hCG) levels in patients with initial hCG greater than 50 000 mIU/ml, supportive therapies throughout chemotherapy regimens, and long-term survivorship of patients who underwent surgery or received platinum-based chemotherapy. This review aims to highlight challenges that remain in GCT, review the emerging data in these areas, and provide our institutional opinion on the management in several aspects of GCT.

Summary
Testicular cancer continues to present challenging clinical scenarios with respect to treatment, surveillance, and long-term management of patients. We review the data and share our institutional knowledge in several challenging areas related to the management of GCT.
miRNA-296-5p functions as a potential tumor suppressor in human osteosarcoma by targeting SND1
Authors: Huang Ya-Zeng , Zhang Jun , Shen Jian-Jian , Zhao Ting-Xiao , Xu You-Jia 
Published: February 2021

Abstract

Background:
The pathogenesis of osteosarcoma (OS) is still unclear, and it is still necessary to find new targets and drugs for anti-OS. This study aimed to investigate the role and mechanism of the anti-OS effects of miR-296-5p.

Methods:
We measured the expression of miR-296-5p in human OS cell lines and tissues. The effect of miR-296-5p and its target gene staphylococcal nuclease and tudor domain containing 1 on proliferation, migration, and invasion of human OS lines was examined. The Student's t test was used for statistical analysis.

Results:
We found that microRNA (miR)-296-5p was significantly downregulated in OS cell lines and tissues (control vs. OS, 1.802 ± 0.313 vs. 0.618 ± 0.235, t = 6.402, P < 0.01). Overexpression of miR-296-5p suppressed proliferation, migration, and invasion of OA cells. SND1 was identified as a target of miR-296-5p by bioinformatic analysis and dual-luciferase reporter assay. Overexpression of SND1 abrogated the effects induced by miR-296-5p upregulation (miRNA-296-5p vs. miRNA-296-5p + SND1, 0.294 ± 0.159 vs. 2.300 ± 0.277, t = 12.68, P = 0.003).

Conclusion:
Our study indicates that miR-296-5p may function as a tumor suppressor by targeting SND1 in OS.
A Systematic Review of Primary, Adjuvant, and Salvage Radiation Therapy for Cutaneous Squamous Cell Carcinoma
Authors: Krausz Aimee E. , Ji-Xu Antonio , Smile Timothy , Koyfman Shlomo , Schmults Chrysalyne D. , Ruiz Emily S. 
Published: February 2021

BACKGROUND
The gold standard of treatment for cutaneous squamous cell carcinoma (cSCC) is surgery radiation therapy (RT) is used selectively as definitive treatment for low-risk tumors or as adjuvant/salvage treatment for high-risk tumors. There is a lack of standardized studies evaluating the efficacy of RT in either clinical scenario.

OBJECTIVE
To determine the efficacy of primary and adjuvant/salvage RT for the treatment of cSCC.

MATERIALS AND METHODS
A systematic review of PubMed, Embase, Cochrane, and Web of Science was performed for studies that reported outcomes of cSCC treated with RT to the primary site alone. Outcomes included local control (LC), local recurrence (LR), nodal metastases (NM), distant metastases (DM), disease-specific death (DSD), and recurrence-free survival (RFS).

RESULTS
Forty-six studies with 4,141 tumors were included. Pooled LC and LR rates were 87.3% and 8.6%, respectively. The rates of NM, DM, DSD, and RFS were 4.8%, 3.5%, 5.3%, and 73.5%, respectively. Local recurrence was significantly higher for T3 and T4 tumors, with rates above 25.9%.

CONCLUSION
LR after RT to the primary site increased with increasing tumor stage, highlighting the importance of clear surgical margins for high-risk tumors. Prospective randomized studies characterizing outcomes by tumor stage for RT compared with surgery are needed to inform guidelines.
Simultaneous Determination of 6 Antiretroviral Drugs in Human Hair Using an LC-ESI+-MS/MS Method: Application to Adherence Assessment
Authors: Wu Yan , Chu Liuxi , Yang Haoran , Wang Wei , Zhang Quan , Yang Jin , Qiao Shan , Li Xiaoming , Shen Zhiyong , Zhou Yuejiao , Liu Shuaifeng , Deng Huihua 
Published: February 2021

Background:
The determination of antiretroviral drugs in hair is receiving considerable research interest to assess long-term adherence to antiretroviral therapy (ART). Currently in China, lamivudine, zidovudine, nevirapine, efavirenz, ritonavir, and lopinavir are combined as first-line and second-line free therapy regimens and are recommended for people living with HIV (PLWH). Simultaneous determination of the 6 antiretroviral drugs in human hair is important for accurately and widely assessing long-term adherence in Chinese PLWH receiving different ART regimens.

Methods:
Six drugs were extracted from 10-mg hair samples incubated in methanol for 16 hours at 37°C and then analyzed by liquid chromatography with tandem mass spectrometry using a mobile phase of 95% methanol, with an electrospray ionization source in multiple reaction monitoring and positive mode.

Results:
The LC-ESI+-MS/MS method exhibited a linear range (R
2 > 0.99) within 6–5000, 10–5000, 6–50,000, 12–50,000, 8–5000, and 8–12,500 pg/mg for lamivudine, zidovudine, nevirapine, efavirenz, ritonavir, and lopinavir. For all 6 drugs, the limits of quantification ranged between 6 and 12 pg/mg. The intraday and interday coefficients of variation were within 15%, and the recoveries ranged from 91.1% to 113.7%. Furthermore, the other validation parameters (ie, selectivity, matrix effect, stability, and carryover) met the acceptance criteria stipulated by guidelines of the US Food and Drug Administration and European Medicines Agency. Significant intergroup differences were observed between high-adherence and low-adherence groups, with high intercorrelations in the hair content of the 6 drugs.

Conclusions:
The developed method demonstrated good reliability, to comprehensively and accurately assess adherence in PLWH receiving different ART regimens.
Two Cases of Preaxial Polydactyly of the Foot: Important Implications for Plastic Surgeons
Authors: Silverstein Max L. , Burke Leah W. , Laub Donald R. 
Published: February 2021

Summary:
Although polydactyly is quite common in general, preaxial polydactyly of the foot is rare (0.4 per 10,000 patients) and specifically associated with certain congenital abnormalities and syndromes, which can include craniosynostosis, corpus callosum agenesis, and renal malformations. We present 2 recent cases of preaxial polydactyly of the foot that highlight the importance of maintaining a high level of suspicion for associated abnormalities in these patients. The first patient, who presented with supernumerary preaxial digits on both feet, pre- and postaxial polydactyly of the hands, was also macrocephalic and hyperteloric; this presentation strongly suggested a diagnosis of Greig cephalopolysyndactyly, a GLI3-variant syndrome. The second patient, who had 2 preaxial digits on one foot, was found to also have a horseshoe kidney, a malformation that has been associated with limb defects as part of an acrorenal syndrome. These cases emphasize the importance of a thorough clinical approach to patients with preaxial polydactyly of the foot. Although many patients with this anomaly may be well known to geneticists, a child may be referred to a plastic surgeon for reconstruction of what is thought to be an isolated cosmetic or local functional issue. Plastic surgeons should be aware of the complex nature of preaxial polydactyly of the foot and potential syndromic presentation.
Characterization of Inflammatory and Fibrotic Aspects of Tissue Remodeling of Acellular Dermal Matrix in a Nonhuman Primate Model
Authors: Ji HaYeun , Sukarto Abby , Deegan Daniel , Fan Frank 
Published: February 2021

Background:
Human acellular dermal matrices (hADMs) are applied in various soft tissue reconstructive surgeries as scaffolds to support tissue remodeling and regeneration. To evaluate the clinical efficacy of hADM implants, it is integral that the hADM does not induce a host chronic inflammatory response leading to fibrotic encapsulation of the implant. In this study, we characterized the inflammatory and fibrosis-related tissue remodeling response of 2 commercial hADM products (SimpliDerm and AlloDerm RTU) in a nonhuman primate model using histology and gene expression profiling.

Methods:
Eighteen African green monkeys with abdominal wall defects were applied to evaluate the performance of SimpliDerm and AlloDerm RTU implants (N = 3) at 2, 4, and 12-weeks post-implantation. Using histology and gene expression profiling, tissue responses such as implant integration, degradation, cell infiltration, immune response, neovascularization, and pro-fibrotic responses over time were evaluated.

Results:
SimpliDerm showed a lower initial inflammatory response and slower implant degradation rate than AlloDerm RTU evidenced by histomorphological analysis. These factors led to a more anti-inflammatory and pro-remodeling microenvironment within SimpliDerm, demonstrated by lower TNFα levels and lower expression levels of pro-fibrotic markers, and promoted tissue repair and regeneration by 3-months post-implantation.

Conclusions:
Overall, histology and gene expression profiling analyses shown in this study demonstrated an effective model for analyzing hADM performance in terms of host inflammatory and fibrotic response. Further studies are warranted to fully evaluate the utility of this novel hADM in the clinical setting and verify the prognosis of our pre-clinical analysis model.
Analysis of Environmental Data to Support Quantification of Historical Releases from a Former Uranium Processing Facility in Apollo, Pennsylvania
Authors: Mohler H. Justin , Rood Arthur S. , Grogan Helen A. , Caffrey Emily A. , Till John E. 
Published: February 2021

Abstract
This paper describes how environmental measurement data were used to help quantify the spatial impact and behavior of uranium released to the environment from a uranium manufacturing facility in Apollo, PA. The Apollo facility released enriched uranium to the environment while it operated between 1957 and 1983. Historical monitoring data generated by the site, along with other independent data sources, provided a long-term record documenting the presence and behavior of uranium in the local environment. This record of evidence, together with reconstructed estimates of facility releases, has been used to estimate environmental concentrations during facility operations and potential exposures to members of the public. Historical environmental measurement data were also used to confirm predictions of deposition and concentrations in air. The data are used here to derive atmospheric deposition velocities for the uranium emissions. Based on the spatial pattern of measurements and calculated deposition velocities around the facility, the released material contained larger particles that deposited close to the facility, and the released material remains largely in the surface layers of the soil, indicating limited downward mobility. Evidence of measurable impacts was determined to extend a relatively short distance (<500 m) from the facility. The soil data collected around Apollo are also compared to findings related to uranium mobility at another facility where uranium was released to the environment, and similar behavior was observed at both sites.
Radiation Safety for Yttrium-90-polymer Composites (RadioGel™) in Therapy of Solid Tumors
Authors: Fisher Darrell R. 
Published: February 2021

Abstract
Yttrium-90 (90Y)-polymer composite (RadioGel™) is a new cancer therapeutic agent for treating solid tumors by direct interstitial injection. The 90Y-composite comprises insoluble, microscopic yttrium-phosphate particles carried by a sterile, injectable water-polymer (hydrogel) solution that can be placed directly by needle injection into solid tumors. The yttrium-90-RadioGel™ agent was designed to provide a safe, effective, localized, high-dose beta radiation for treating solid tumors. The properties of 90Y-RadioGel™ also make it a relatively safe agent for health care personnel who prepare, handle, and administer the material. The purpose of this work was to demonstrate and characterize radiation safety of the injectable 90Y-RadioGel™ therapeutic agent. Safety in the patient is defined by its ability to target precisely and remain confined within tumor tissue so that radiation doses are imparted to the tumor and not to normal organs and tissues. Radiation safety for health care personnel is defined by the low radiation doses received by persons who prepare and administer the agent. These safety features were demonstrated during experiments, first involving laboratory rabbits and second in cat and dog animal patients that were treated clinically for sarcoma tumors. This paper focuses mainly on the rabbit tissue biodistribution study; follow-on clinical application in cat and dog subjects confirmed the rabbit results. Implanted VX2 liver tumors in the hind limbs of 26 New Zealand White rabbits were treated using tracer amounts of either (a) 90Y-RadioGel™ or (b) 90Y-microparticles in phosphate-buffered saline (PBS) without the gel carrier. Tumor and margin injections were interstitial. Rabbits were euthanized at 48 h or 10 d following injection. Blood and tissues (tumor or tumor margins, liver, lymph nodes, rib bone, kidney, spleen) were collected for liquid scintillation counting using wet-ash procedures. Biodistribution was also analyzed at 10 d post-injection using micro-computed tomography. Thirteen cat and dog subjects were also treated clinically for sarcomas. Liquid scintillation counting at 48 h post-injection of tumors or margins with 90Y-RadioGel™ showed that significant radioactivity was measurable only at the site of administration and that radioactivity above detector background was not found in blood or peripheral organs and tissues. At 10 d post-injection, microCT showed that yttrium phosphate microparticles were confined to the injection site. Yttrium-90 remained where placed and did not migrate away in significant amounts from the injection site. Radiation doses were confined mainly to tumors and margin tissues. During preparation and administration, radiation doses to hands and body of study personnel were negligible. This work showed that 90Y-RadioGel™ can be safely prepared and administered and that radiation doses to cancer patients are confined to tumor and margin tissues rather than to critical normal organs and tissues.
Dose Estimation of Landfill Disposal of Removed Soil Generated Outside Fukushima Prefecture
Authors: Shimada Asako , Sawaguchi Takuma , Takeda Seiji 
Published: February 2021

Abstract
Dose estimation was conducted by assuming landfill disposal of removed soil generated outside the Fukushima Prefecture by each local town and in a lump sum. Because the radioactivity of removed soil is lower than that of specified waste that was generated at Fukushima Prefecture and the radioactivity concentration is 100,000 Bq kg−1 or less, simple landfill covered with 30 cm of non-contaminated soil was used. The exposure doses of loading/unloading, transportation, and landfill workers and the public residing near the repository site were estimated. Furthermore, migration of cesium into groundwater because of precipitation and using the contaminated groundwater for drinking and agricultural water was evaluated, and exposure doses regarding farmers and the ingestion of agricultural products were estimated. It was confirmed that estimated exposure doses during landfill were less than 1 mSv y−1, and those for after landfill were 0.01 mSv y−1.