bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-Fidelity Surgical Middle Ear Simulator: A Pilot Study
Authors: Shim Timothy , Chillakuru Yeshwant , Darwish Christina , Sparks Andrew , Kim Sunny , Wiedermann Joshua , Monfared Ashkan 
Published: June 2021

Objectives:
To assess a middle ear simulator as a surgical training tool among a cohort of novice trainees.

Study Design:
Prospective pilot study.

Setting:
The George Washington University Hospital (tertiary care academic hospital).

Participants:
Twenty one medical students and physician assistant students completed the protocol. Each student produced four recordings over 10 attempts. The two raters were attending surgeons from the George Washington University Hospital.

Interventions:
Stapedotomies performed on a high-fidelity middle ear simulator. Participants were assessed at baseline with a Purdue pegboard test and trained with video and a low fidelity middle ear simulator.

Main Outcome Measures:
Two experts rated recordings on scales based upon a validated objective skills assessment test (OSAT) format.

Results:
Inter-rater reliability was strong across all stapedotomy skills scores and global rating scores. Participants demonstrated statistically significant improvement up to the third recording (seventh attempt), but the scores on the fourth recording (tenth attempt) were not significantly different from the third. One participant failed to improve in score over 10 attempts. Pegboard test performance was not correlated with score improvement. Low-fidelity trial time was significantly correlated to stapedotomy and global rating scores.

Conclusions:
This pilot study serves as the first investigation of this middle ear simulator amongst a cohort of trainees. A high-fidelity middle ear simulator may serve as a measurement tool to select future surgical trainees, customize training pathways, and assess surgical capacity before graduation.
Comparing Transcanal Endoscopic Ear Surgery to Post-Auricular Microscope-Guided Surgery in Pediatric Ossiculoplasty: Hearing Outcomes and Post-Operative Pain
Authors: Kwinter Adam , Purcell Patricia L. , Leonard Colin G. , James Adrian L. 
Published: June 2021

Objective:
This study compares post-operative hearing outcomes and morbidity after pediatric total ossicular replacement prosthesis (TORP) ossiculoplasty with transcanal totally endoscopic ear surgery (TEES) versus a post-auricular microscope-guided (PAM) approach.

Patients:
Forty-four children who underwent ossiculoplasty with titanium TORP after previous cholesteatoma surgery

Intervention:
Ossiculoplasty using TEES or PAM approach.

Main outcome measures:
Hearing outcome after ossiculoplasty was determined by post-operative air-bone gap (ABG) on audiogram nearest to 1 year after surgery. Post-operative morbidity was measured by total number of opiate doses the child received during hospital stay, along with the highest documented post-operative pain score. Comparisons were made with Mann–Whitney U test.

Results:
Hearing data were available for 41 patients: 21 had undergone TEES (median preoperative ABG 39 dB) and 20 had PAM surgery (median preoperative ABG 39 dB). Post-operatively at 1 year, ABG closed significantly in each group (TEES 21 dB, p = 0.003; PAM 23 dB, p = 0.01), and there was no difference between groups (p = 0.6). 57% who underwent TEES and 50% who underwent PAM surgery experienced serviceable hearing post-operatively, defined as air conduction pure-tone average (PTA) ≤ 30 dB HL. Visual analogue pain scores from 0 (no pain) to 10 (worst pain imaginable) were available for 13 who underwent TEES and 18 who underwent PAM surgery. In children undergoing TEES, only two reported pain above 0, with the highest pain score being 4. Children undergoing PAM surgery had a median pain score of 3 (median difference = 3, p < 0.001). Children undergoing TEES required fewer weight appropriate doses of opiate analgesic (median = 0) than children who underwent PAM surgery (median = 1) (median difference = 1, p = 0.003). Children undergoing TEES had a significantly shorter surgical time (median 135 min) than those who underwent PAM surgery (median 168 min) (median difference = 33 min, p = <0.006).

Conclusion:
Hearing outcomes in TORP ossiculoplasty are similar in TEES and PAM surgery, and TEES may decrease post-operative pain.
The Influence of Ciprofloxacin–Dexamethasone Ear Drops on Perforation Closure Rates After Endoscopic Tympanoplasty
Authors: Sharma Sunil D. , James Adrian L. 
Published: June 2021

Objective:
Topical ciprofloxacin and dexamethasone have both been shown to disrupt healing of tympanic membrane perforations in animal models. There have been no clinical studies evaluating the effect of ciprofloxacin–dexamethasone (CD) ear drops on success of tympanoplasty. We compare perforation closure rates in pediatric endoscopic tympanoplasty with and without use of postoperative CD.

Study design:
Retrospective comparative cohort study.

Setting:
Tertiary referral centre.

Patients:
One hundred sixty-two totally endoscopic tympanoplasties with porcine-derived collagen graft in children, mean age 12.0 years (range 2.3–17.9 yrs).

Intervention:
Prescription of CD versus no ear drops in the immediate postoperative period.

Main outcome measure:
Perforation closure rate 2 months after totally endoscopic tympanoplasty.

Results:
Postoperative CD was given to 65 (40%) ears and no drops given to the remainder. Overall, successful closure of tympanic membrane perforation was achieved in 140 (86%) of ears. The closure rate was not significantly different in those ears given CD postoperatively than those not given CD (54/65 [83%] vs 86/97 [89%], Fisher's p = 0.35). Multiple logistical regression revealed no confounding effect of other variables on outcome including age, revision surgery, graft position, or type of postoperative packing material.

Conclusions:
Our results reveal no harm or benefit with prescription of drops containing ciprofloxacin and dexamethasone on success of perforation closure after tympanoplasty. Allocation to treatment in this retrospective study was nonrandomized and was predominantly based on a change in practice. No other variables are known to have influenced this finding but a randomized prospective study could be justified for more reliable evidence.
Hearing Outcomes for an Underwater Endoscopic Technique for Transmastoid Repair of Superior Semicircular Canal Dehiscence
Authors: Creighton Francis X. , Zhang Lisa , Ward Bryan , Carey John P. 
Published: June 2021

Objectives:
To compare hearing outcomes between traditional microsurgical transmastoid repairs and underwater, endoscopic transmastoid repairs of superior semicircular canal dehiscence syndrome (SCDS).

Methods:
A retrospective review of 14 patients undergoing transmastoid repair of SCDS between 2013 and 2017. Preoperative, immediate (7–10 d) postoperative, and long-term (>6 wk) postoperative speech discrimination scores, pure-tone averages, as well as pure-tone air conduction and bone conduction thresholds were obtained at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz. Hearing threshold changes were all calculated as preoperative thresholds subtracted from postoperative threshold at each frequency. Wilcoxon rank-sum tests were conducted to assess changes in postoperative hearing thresholds at both the immediate and long-term postoperative period between those undergoing the traditional transmastoid technique and the underwater, endoscopic transmastoid technique.

Results:
Our results demonstrate patients who underwent underwater transmastoid repairs had significantly less increase in their high-frequency bone conduction thresholds at both time periods, indicating less sensorineural hearing loss, compared to the traditional microscopic repair (p = 0.02 [effect size, r = 0.4], p = 0.006 [r = 0.6]). At long-term follow-up, there was also significantly improved pure-tone averages in the patients in the underwater repair cohort compared to the traditional group (p = 0.004 [r = 0.6]). There were no differences in air-bone gaps at any frequency or any time period between the two cohorts.

Conclusions:
Preliminary findings show that the underwater endoscopic technique may prevent sensorineural hearing loss during transmastoid repair of SCDS.
Underwater Endoscopic Ear Surgery for Closure of Cholesteatomatous Labyrinthine Fistula With Preservation of Auditory Function
Authors: Yamauchi Daisuke , Honkura Yohei , Kawamura Yoshinobu , Shimizu Yuichi , Sunose Tomoki , Hara Yosuke , Ohta Jun , Suzuki Jun , Kawase Tetsuaki , Katori Yukio 
Published: June 2021

Objective:
To analyze the outcomes of the underwater endoscopic ear surgery (UWEES) technique for closure of cholesteatomatous labyrinthine fistula (LF) with preservation of auditory function.

Study Design:
Retrospective case review study.

Setting:
Tertiary referral center.

Patients:
A total of 12 patients with cholesteatomatous LF.

Intervention:
Surgical method of closure using UWEES for cholesteatomatous LF to minimize inner ear damage. Artificial cerebrospinal fluid (CSF) was used as the perfusate, except for earlier cases when saline was employed.

Main Outcome Measures:
Comparison of bone conductance hearing level (BCHL) before and after surgery. A change of BCHL less than 10 dB was defined as successful preservation of bone conductance hearing.

Results:
All cases of LF were treated successfully by closure using the UWEES technique. Seven cases were type I, one was type IIa, and four were type III according to the Milewski and Dornhoffer classification of LF. The average LF size was 3.1 mm (1–7 mm). Eleven patients were evaluated and their bone conductance hearing was well preserved in all of them (11/11). One patient was too young for preoperative evaluation of BCHL, but hearing preservation was verified 2 years later at the age of 6 years. Remarkably, none of the patients complained of vertigo, except for only a slight manifestation on postoperative day 1.

Conclusion:
The UWEES technique was effective for closure of cholesteatomatous LF with preservation of auditory function.
Congenital Unilateral Hearing Loss: Characteristics and Etiological Analysis in 121 Patients
Authors: Acke Frederic R. E. , Van Hoecke Helen , De Leenheer Els M. R. 
Published: June 2021

Objective:
To describe the characteristics and etiological analysis in patients with congenital unilateral hearing loss.

Study design:
Retrospective cohort analysis.

Setting:
Tertiary referral center.

Patients:
Children with permanent congenital unilateral hearing loss born between 2007 and 2018. Patients were referred after universal newborn hearing screening or by a colleague to confirm the diagnosis and perform etiological examinations.

Main outcome measures:
Hearing loss type, severity, and evolution linked with the results of etiological testing.

Results:
In the 121 included children, aural atresia is the leading cause of congenital unilateral hearing loss (32%), followed by structural anomalies (19%) and cCMV (13%), whereas 24% remained idiopathic after etiological work-up. Severity is mainly moderately severe (33% with 56–70 dB hearing loss, majority aural atresia) or profound (31% with > 90 dB hearing loss, predominantly cochlear nerve deficiency). Syndromic features were present in 26%. Although discussed with all parents, only 26% of the children regularly used hearing amplification.

Conclusions:
Congenital conductive unilateral hearing loss is mainly caused by aural atresia, which proportion in congenital unilateral hearing loss proved higher than previously reported. Cochlear nerve deficiency and cCMV are the predominant etiologies of congenital unilateral sensorineural hearing loss. Etiological work-up in affected patients is mandatory as it might impact the approach, and syndromic features should be actively searched for.
Magnetic Resonance Imaging in Patients With Hearing Implants – Follow-up on Prevalence and Complications
Authors: Loth Andreas G. , Fischer Kathrin , Hey Anna Katharina , Weiß Roxanne , Leinung Martin , Burck Iris , Linke Albrecht , Kramer Sabine , Stöver Timo , Helbig Silke 
Published: June 2021

Objective:
To examine the number of magnetic resonance imaging (MRI) examinations performed in patients with hearing implants and to quantify side effects or complications related to this procedure.

Study Design:
Questionnaire.

Setting:
Tertiary referral center, academic hospital.

Patients:
One thousand four hundred sixty-onepatients with an implanted hearing system.

Intervention:
Patients were asked to complete a questionnaire either during a visit to the clinic (304) or by mail contact (1,157) between February 2018 and March 2019.

Main Outcome Measures:
Number of examinations by means of MRI per patient and number of side effects or complications.

Results:
A total of 711 questionnaires were returned. After excluding nonvalid information on the questionnaire, 12.8% of patients were identified who had undergone an MRI after having received their hearing implant. Within this group of 91 patients, the most common precaution undertaken was a head bandage (69%). Side effects were mainly pain (37%), followed by anxiety (15%) and tinnitus (9%). The MRI had to be aborted in 14% and dislocation of the magnet occurred in 7% of examinations.

Conclusions:
Our data indicate that patients undergoing hearing implant surgery need better information about the limitations and requirements of MRI. The occurrence of side effects is likely as only half of the patients in our study group were completely free of symptoms. Dislocation of the implant magnet was observed in several cases, hence patients and physicians need to be educated about this potential complication.
Cortical Auditory Plasticity Following Cochlear Implantation in Children With Auditory Neuropathy Spectrum Disorder: A Prospective Study
Authors: Saki Nader , Nikakhlagh Soheila , Moridi Babak , Karimi Majid , Aghayi Azam , Bayat Arash 
Published: June 2021

Objectives:
The cortical auditory evoked potential (CAEP) can provide an insight into the maturation of the central auditory nervous system by recording the auditory cortex responses to speech stimuli. This study aimed to explore the central auditory system development in children with auditory neuropathy spectrum disorder (ANSD) using cochlear implants (CIs) and to find the correlation of CAEP biomarkers with speech perception.

Methods:
This study was performed on 23 children with prelingual deafness, diagnosed with ANSD, as well as 23 children with prelingual deafness, without ANSD as the control group. All children underwent unilateral CI before the age of 3 years. Children with ANSD were classified into two groups, based on their CAEP results prior to implantation: children with a clear CAEP response (ANSD-I) and children without an identifiable CAEP (ANSD-II). The P1 component of CAEPs and speech intelligibility rating (SIR) were recorded before the initial device activation (baseline) and at 6, 12, and 24 months postimplantation.

Results:
The P1 CAEP responses were present in all children in the control group, while they were recorded in only 52% of ANSD children before the CI surgery. The longitudinal analysis revealed a significant reduction in the P1 latency and a significant improvement in the P1 amplitude across different time points in all study groups. However, the P1 latency and P1 amplitude were significantly shorter and larger in the control group than the ANSD group, respectively. Also, children in the ANSD-I group exhibited a slightly shorter P1 latency, a larger P1 amplitude, and a higher SIR score than the ANSD-II group after 2 years of follow-up. The P1 CAEP latency was significantly correlated with the SIR score.

Conclusion:
The CAEP can be used as an objective indicator of auditory cortical maturation and a predictor of speech perception performance in implanted children with ANSD.
Unclassifiable, or simply unclassified interstitial lung disease?
Authors: O’Callaghan Marissa , Bonella Francesco , McCarthy Cormac 
Published: June 2021

Purpose of review
Unclassifiable interstitial lung disease (ILD) comprises a subset of ILDs which cannot be classified according to the current diagnostic framework. This is a likely a heterogeneous group of diseases rather than a single entity and it is poorly defined and hence problematic for prognosis and therapy.

Recent findings
With increased treatment options for progressive fibrosing ILD it is increasingly relevant to correctly categorise ILD.

Summary
This review article will summarise the definition and reasons for a diagnosis of unclassifiable ILD, the current management options and possible future approaches to improve diagnosis and differentiation within this broad subset. Finally, we will describe the implications of the labelling of unclassifiable ILD in clinical practice and research and whether the term ‘unclassified’ should be used, implying a less definitive diagnosis.
Patient perception of receiving a thyroid cancer diagnosis
Authors: Jensen Catherine B. , Pitt Susan C. 
Published: June 2021

Purpose of review
This review describes the current state of the literature on patients’ perceptions of receiving a diagnosis of thyroid cancer. The evaluation progresses from people's understanding about thyroid cancer in general to the lived experiences of those receiving an initial diagnosis or one of recurrence. The implications on patients’ quality of life and treatment decisions are also discussed.

Recent findings
Receiving a diagnosis of thyroid cancer often elicits intense and immediate emotions of shock and fear evoked by the word ‘cancer,’ which may be related to lack of knowledge about thyroid cancer specifically. Describing thyroid cancer as the ‘good cancer’ in an attempt to reassure patients is not necessarily reassuring and can inadvertently minimize the impact of a patient's diagnosis. Fear and worry about cancer in general and the possibility for recurrence contribute to lasting psychological distress and decreased quality of life. Patients’ perceptions of their diagnosis and resulting emotional reactions influence treatment decision-making and have the potential to contribute to decisions that may over-treat a low-risk thyroid cancer.

Summary
Understanding patients’ experience of receiving a thyroid cancer diagnosis is critical because their emotional reactions can have a profound impact on treatment decision-making and quality of life.
Painful chronic pancreatitis - new approaches for evaluation and management
Authors: Yadav Dhiraj , Palermo Tonya M. , Phillips Anna E. , Bellin Melena D. , Conwell Darwin L. 
Published: June 2021

Purpose of review
Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis.

Recent findings
Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy.

Summary
Several lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
Manuscript Review at the Journal of Pediatric Gastroenterology and Nutrition
Authors: Kumar Prerna , Ravindra Aditya , Wang Yanzhi , Belli Dominique C. , Heyman Melvin B. , Gupta Sandeep K. 
Published: June 2021

ABSTRACTObjective:Given the importance of scholarly work in academic medicine, better understanding of the manuscript review process (MRP) is useful for authors, reviewers, and editorial boards. We aim to describe the MRP at the Journal of Pediatric Gastroenterology and Nutrition (JPGN), assess the correlation between editor decisions and reviewer recommendations, and provide transparency to this process.Methods:All manuscripts submitted in 2018 to JPGN were included in this analysis. Data included reviewers’ manuscript scores and recommendations, time spent on each review by reviewers, the editor's rating of the reviewers’ reviews, the editor's first decision, and final outcome. Data were collated using the JPGN manuscript submission website, Editorial Manager.Results:1023 manuscripts were submitted to JPGN in 2018 and included in this analysis. Of these, 486 manuscripts had at least two peer reviewers. The recommendations of the two reviewers were in agreement 43% of the time. Intra‐class correlation (ICC) between the two reviewers suggests moderate agreement (ICC = 0.40). When both reviewers agreed to Not Reject (289/486), the editor agreed in 93% of cases (269/289). When both reviewers agreed to Reject (55/486), the editor agreed 100% of the time (55/55). The reviewers disagreed in about one‐third of submissions (142/486), and the editor recommended to Reject in two‐thirds of these cases (95/142). Overall, inter‐reviewer agreement strongly correlated with the editor's initial decision (P < 0.001).Conclusions:The editor most often agreed with reviewers’ assessments when there was concordance between the two reviewers’ recommendations. About a third of peer reviews result in discordant recommendations between the two reviewers.
Pediatric Collagenous Gastritis: Clinical and Histologic Outcomes in a Large Pediatric Cohort
Authors: Beinvogl Beate C. , Goldsmith Jeffrey D. , Verhave Menno 
Published: June 2021

ABSTRACT

Objective:
The aim of the study was to present the clinical characteristics, treatment, and outcomes of pediatric collagenous gastritis (CG).

Method:
This is a retrospective cohort study. Patients were identified via query of the institutional pathology database. Clinical data was obtained by review of medical records.

Results:
Forty patients (57.5% female) were identified, mean age 11.3 ± 3.7 years (2–16years). Isolated CG was present in 66.7%, coexisting collagenous duodenitis (CD) in 17.5%, collagenous colitis (CC) in 7.5%, and collagenous ileitis in 2.5%. Atopic comorbidities were found in 25%, autoimmune comorbidities in 12.5%.

Presenting Symptoms:
Abdominal pain (77.5%), vomiting (65%), anemia (57.5%), nausea (55.5%), diarrhea (32.5%), anorexia (25.0%), weight loss (25%), gastrointestinal bleed (22.5%), poor growth (20%), poor weight gain (12.5%).

Endoscopic Findings:
All had abnormal endoscopic findings on esophago-gastro-duodenoscopy (EGD), most commonly gastric nodularity (77.5%), visible blood (20%), erosions/superficial ulcerations (10%), ulcers (7.5%). Histologically, all patients had increased subepithelial collagen deposition.

Treatment:
A variety of medications aimed towards inflammation and symptomatic treatment were used. Patients with anemia received iron supplementation and responded. Otherwise, there was no significant association of clinical or histologic improvement with specific treatments.

Clinical and Histologic Outcomes:
87.5% reported improvement or resolution of symptoms at the last follow-up (34.8 ± 27.0 months). Persistent sub-epithelial collagen was noted in 73.1% on the last EGD.

Conclusions:
Despite persistent findings of increased sub-epithelial collagen deposition during the follow-up period, most patients with CG show remission or resolution of clinical symptoms. Anemia responds to iron supplementation in all patients.