bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audiological Features in 63 Patients With Cochlear Nerve Deficiency
Authors: Matsuura Kazuki , Yoshimura Hidekane , Shinagawa Jun , Kurozumi Masahiro , Takumi Yutaka 
Published: September 2021

Objective:
We aimed to investigate the clinical features of cochlear nerve deficiency (CND), and in particular, the long-term course of hearing disability and audiogram shapes.

Study Design:
Retrospective observational nonrandomized group study.

Setting:
Academic medical center.

Patients/Interventions:
The subjects were 63 children with congenital hearing loss who visited our hospital between 2009 and 2019 and underwent MRI, based on which they were diagnosed with CND. There were 61 cases of unilateral CND and two cases of bilateral CND.

Main Outcome Measures:
Imaging tests by MRI and CT and audiometric assessments by pure-tone audiometry and distortion product otoacoustic emission were performed.

Results:
Among the cases of CND diagnosed by assessing the cochlear nerve on MRI, approximately 20% of the bony cochlear nerve canals that could be assessed on CT were normal. Of the 61 cases diagnosed with unilateral CND, 55 cases had cochlear nerve aplasia (90.2%), and six had cochlear nerve hypoplasia (9.8%), with a mean hearing ability of 92.2 and 94.6 dB HL, respectively. Thus, the majority of cases had severe-to-profound hearing loss. The overall audiometric patterns were 78.7% flat, 9.8% cookie-bite, and 9.8% high-frequency. Six of 61 cases (9.8%) had a distortion product otoacoustic emission (DPOAE) response based on the affected side, and none of the cases lost the response during follow-up.

Conclusions:
Herein, we report the largest study on CND and performed CND image and audiometric assessments. Accurately in diagnosing CND requires not only CT but also MRI assessment. Hearing loss is often severe to profound; however, various audiometric patterns have been observed. CND includes a small number of cases that respond to DPOAE, indicating that some CND cases are clinically diagnosed with auditory neuropathy spectrum disorder (ANSD). A sustained DPOAE response might help in differentiating CND from other ANSDs. Children with congenital deafness who have passed the newborn hearing screening by DPOAE should be examined by MRI to rule out CND.
Patient Safety Culture in 2 Public Hospitals in Vietnam
Authors: Tran Ha Thi Nhi , Pham Thanh Quoc , Tran Huong Lien , Nguyen Hung Dinh , Nguyen Tu Minh , Bui Ha Thi Thu 
Published: September 2021

Background:
Patient safety culture is an important measure in assessing the quality of care. There is a growing need to establish a patient safety culture in hospitals. This study explored the perception of health professionals on patient safety culture in 2 public hospitals in Hanoi, Vietnam.

Method:
A mixed-methods study with an online Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative data collection was conducted in Hanoi. The HSOPSC was validated in Vietnam before using it.

Results:
A total of 626 health professionals, including physicians and nurses, were involved in the survey, and 49 of them participated in in-depth interviews and focus group discussions. The average positive response of patient safety culture composites was high at 85.2% and varied from 49.4% to 97.9%. The strongest areas were teamwork within units (91.3%) and organizational learning/continuous improvement (88.4%), and the areas that needed improvement were staffing (49.4%) and nonpunitive response to error (53.1%).

Conclusion:
The centralized incident reporting, management with peer involvement on event reporting, and continuous quality improvement should be routinely embedded by hospital leaders down to unit managers and all staff.
General estimates of the energy cost of walking in people with different levels and causes of lower-limb amputation: a systematic review and meta-analysis
Authors: Ettema Sanne , Kal Elmar , Houdijk Han 
Published: September 2021

Background:
Energy cost of walking (ECw) is an important determinant of walking ability in people with a lower-limb amputation. Large variety in estimates of ECw has been reported, likely because of the heterogeneity of this population in terms of level and cause of amputation and walking speed.

Objectives:
To assess (1) differences in ECw between people with and without a lower-limb amputation, and between people with different levels and causes of amputation, and (2) the association between ECw and walking speed.

Study design:
Systematic review and meta-analysis.

Methods:
We included studies that compared ECw in people with and without a lower-limb amputation. A meta-analysis was done to compare ECw between both groups, and between different levels and causes of amputation. A second analysis investigated the association between self-selected walking speed and ECw in people with an amputation.

Results:
Out of 526 identified articles, 25 were included in the meta-analysis and an additional 30 in the walking speed analysis. Overall, people with a lower-limb amputation have significantly higher ECw compared to people without an amputation. People with vascular transfemoral amputations showed the greatest difference (+102%) in ECw. The smallest difference (+12%) was found for people with nonvascular transtibial amputations. Slower self-selected walking speed was associated with substantial increases in ECw.

Conclusion:
This study provides general estimates on the ECw in people with a lower-limb amputation, quantifying the differences as a function of level and cause of amputation, as well as the relationship with walking speed.
Exploring the interaction of knee and ankle component use on mobility test performance in people with unilateral transfemoral amputation
Authors: Barnett Cleveland T. , Hughes Liam D. , Sullivan Amy E. , Strutzenberger Gerda , Levick Jodie L. , Bisele Maria , De Asha Alan R. 
Published: September 2021

Background:
Ankle-foot and knee components are important determinants of mobility for individuals with transfemoral amputation. Individually, advanced ankle-foot and knee components have been shown to benefit mobility in this group of people. However, it is not clear what effect a variety of combinations of ankle-foot and knee components have on mobility test performance.

Objectives:
To assess whether outcomes from mobility tests in people with unilateral transfemoral amputation are influenced by varying combinations of ankle-foot and knee components.

Study Designs:
Repeated measures.

Methods:
Nine adults with unilateral transfemoral amputation completed the two-minute walk test, the timed up-and-go test, the L-test, and a custom locomotion course in four randomized prosthetic conditions. These conditions were each a combination of an ankle-foot component (rigid, nonarticulating [RIG] or hydraulically articulating [HYD]) and a knee component (non–microprocessor-controlled [NMPK] or microprocessor-controlled [MPK]). The test-retest reliability and concurrent validity of the custom locomotion course were also established.

Results:
The best performance in all mobility tests was associated with the MPK + HYD combination, followed by the MPK + RIG, NMPK + HYD, and NMPK + RIG combinations. This effect was statistically significant for the two-minute walk test (P = 0.01,

= 0.36) and on threshold for the L-test (P = 0.05,

= 0.36), but not statistically significant for the locomotion course (P = 0.07,

= 0.38) or the timed up-and-go test (P = 0.12,

= 0.22). Locomotion course performance had good to excellent test-retest reliability and strong concurrent validity.

Conclusion:
Using a combination of a HYD ankle-foot and a MPK knee resulted in the highest performance in mobility tests. This was observed in contrast to combinations of prosthetic components that included a rigid ankle-foot component and/or a NMPK knee component.
Functional outcomes and user preferences of individuals with transfemoral amputations using two types of knee joints in under-resourced settings
Authors: Andrysek Jan , Michelini Alexandria , Eshraghi Arezoo , Kheng Sisary , Heang Thearith , Thor Phearsa 
Published: September 2021

Background:
Information relating to prosthetic performance can inform clinical practice and improve patient outcomes in under-resourced countries.

Objectives:
The main goal of this study was to compare functional outcomes and user preferences of individuals with transfemoral amputations using common types of knee joints in an under-resourced country.

Study design:
Prospective, longitudinal, before and after trial.

Methods:
Twenty individuals with unilateral transfemoral amputations from a center in Cambodia transitioned from a commonly used single-axis manually locking knee International Committee of the Red Cross (ICRC) to a more advanced multiaxis knee joint with stance control All-Terrain Knee (ATK). Data were collected for the ICRC knee joint and the ATK immediately after fitting, after acclimation, and as part of a long-term follow-up. A timed walk test assessed walking distance and efficiency. Mobility and user-preferences were evaluated through questionnaires.

Results:
Distance during the timed walk test was significantly higher for the ATK compared with ICRC (P < 0.001), with functional gains retained at follow-up. No differences were found for gait efficiency and the mobility questionnaires. All participants, except one, preferred the ATK prosthesis. Benefits included greater knee stability and fewer perceived knee collapses; however, some disliked the appearance of the ATK.

Conclusions:
The findings suggest positive outcomes with prosthetic services in under-resourced regions and the ICRC system, as well as the potential for improved functional outcomes with more advanced multiaxis knee components.
Computed Tomography Findings Suggestive of Connective Tissue Disease in the Setting of Usual Interstitial Pneumonia
Authors: Chung Jonathan H. , Montner Steven M. , Thirkateh Prahasit , Cannon Brenna , Barnett Scott D. , Nathan Steven D. 
Published: September 2021

Purpose
A usual interstitial pneumonia (UIP) pattern is common in idiopathic pulmonary fibrosis (IPF) and connective tissue disease–related interstitial lung disease (CTD-ILD). The purpose of the study was to validate imaging findings differentiating CTD-ILD from IPF in UIP.

Methods
Patients with a multidisciplinary diagnosis of CTD-ILD or IPF and a UIP pattern on computed tomography and/or pathology were included in this study. Prevalence of 3 computed tomography findings shown to be associated with CTD-ILD (the straight edge sign [SES], the exuberant honeycombing sign, and the anterior upper lobe sign [AULS]) were tabulated in CTD-ILD and IPF subjects. The ability of each of these signs to discriminate between CTD-ILD and IPF was evaluated. Survival analysis was also performed using log-rank analysis.

Results
The study cohort included 50 CTD-ILD and 100 IPF subjects with UIP. The SES and the AULS were more common in CTD-ILD than IPF (prevalence, 36.0% and 34.9% in CTD-ILD vs 8.3% and 17.2% in IPF, respectively [P = 0.0105 − <0.001]). The highest specificity (95.7%) of CTD-ILD diagnosis was seen with bilateral SES. Moreover, the SES was associated with improved survival (P = 0.0383), which appeared to be largely because of improvement in survival in IPF subjects. The presence of AULS was associated with pulmonary functional abnormalities.

Conclusions
A radiographic UIP pattern with evidence of SES or the AULS should raise suspicion for CTD-ILD rather than IPF. Patients with IPF and SES have an attenuated disease course and might represent a different phenotype than those without the SES.
Emissary Foramina of the External Occipital Protuberance: A Magnetic Resonance Imaging Study
Authors: Tsutsumi Satoshi , Ono Hideo , Ishii Hisato 
Published: September 2021

Objective
The posterior interparietal region is known to be a distinct area of the skull, predisposing to a variety of bony variants and congenital anomalies. The bony canals in this region have not yet been explored in detail. This study aimed to characterize them.

Patients and Methods
Overall, 82 patients underwent thin-slice contrast magnetic resonance imaging. Coronal and sagittal images were used for the analysis.

Results
At the rostral limit of the posterior interparietal region, the parietal foramen (PF) and transmitting emissary vessels were identified in 84% of cases, mostly delineated as single channels. They were located in the left parasagittal region (PS) in 26%, lateral to the left PS in 33%, right PS in 40%, lateral to the right PS in 12%, and midline in 16% of the cases. In 4% of the cases, the PF presented an obstruction around the outer opening. In the more caudal part of the posterior interparietal region, 51% of the patients presented with fine bony canals and transmitting emissary vessels, lying in the midline and parasagittal levels.

Conclusions
The frequency of PFs may be underestimated for superficially hidden outer openings of the canals. The midline posterior interparietal region may present fine bony canals for transmitting emissary vessels that function complementarily with PFs.
Hourglass-Like Constriction Neuropathy of the Upper Limb Nerve: Diffusion-Weighted Magnetic Resonance Neurography Imaging Findings
Authors: Wu Chao , Bao Hongjing , Xu Qiang 
Published: September 2021

Objective
The purposes of this study were to determine reliable diffusion-weighted magnetic resonance neurography (DW-MRN) features of hourglass-like constriction of the upper limb nerve and to evaluate the application value of DW-MRN compared with ultrasonography (US).

Methods
We retrospectively reviewed MRN studies of 13 patients. Qualitative and quantitative image analyses were carried out. The number of constrictions based on DW-MRN and US findings was compared.

Results
Of the 13 cases, there were 7 cases with radial nerve abnormalities, 4 with median nerve abnormalities, and 2 with radial and median nerve abnormalities. Diffusion-weighted MRN showed a single-segmental constriction in 7 of 13 cases and multisegmental constrictions in 6 of 13 cases; the hourglass-like constriction appeared in all cases (13 of 13). Thirty-three nerve constrictions were found in DW-MRN, and 29 nerve constrictions were found in US.

Conclusions
Diffusion-weighted MRN is a noninvasive and helpful diagnostic for hourglass-like constriction of the upper limb nerve.
MRI and Sonography of the Knee in Acute Reactive Arthritis
Authors: Thomas Koshy Nithin , Jain Neeraj , Mohindra Namita , Misra Durga , Agarwal Vikas , Gupta Latika 
Published: September 2021

Introduction
Reactive arthritis (ReA) is a unique subgroup of spondyloarthritis with acute presentation and tendency to develop chronicity. Magnetic resonance imaging (MRI) has enabled identification of sensitive markers of response to therapy.

Methods
A longitudinal pilot study of acute ReA with knee joint involvement satisfying the Braun's criteria was undertaken. Magnetic resonance imaging of the knee was assessed at baseline, and agreement with ultrasonography was assessed. Clinical details were recorded using a detailed and structured case record form. Patients were followed up, and MRI predictors of transition to chronic arthritis were looked for.

Results
In 25 patients with ReA, synovial thickening was the most common feature. Enthesitis was observed on MRI in 20%. Urethritis-related and HLA-B27–positive ReA had higher synovial thickening scores (p = 0.007). Agreement was poor between MRI and ultrasonography (synovial hypertrophy: k = 0.04). On follow-up, 34% (n = 7/21 for >12 months) continued to have active disease. None of the clinical or radiological features were predictive of chronicity.

Conclusions
Posturethritis and B27-positive ReA was more severe than postenteritis ReA and RA on MRI. One third develop chronic disease on follow-up. Magnetic resonance imaging is superior to sonography, although baseline imaging is not predictive of chronicity. The results of this pilot exploratory study argue for larger studies on MRI in ReA.
Precision Pharyngeal Flap: An Individualized, Patient-Specific Surgery for the Treatment of Velopharyngeal Insufficiency
Authors: Baek Rong-Min , Kim Ji-Young , Kwon Heeyeon , Ahn Taeseon , Kim Baek-Kyu , Myung Yujin 
Published: September 2021

Background:
The pharyngeal flap is one of the most common secondary surgeries for the correction of velopharyngeal insufficiency (VPI) for patients with cleft palate and/or cleft lip and palate. This study aimed to demonstrate the effectiveness of the precision pharyngeal flap surgery performed by the senior author.

Materials and Methods:
Children with VPI, who underwent precision pharyngeal flap, were retrospectively examined. All surgical procedures were performed by the senior author. The flap size was individually configured based on the patients’ preoperative nasopharyngoscopic analysis and speech function evaluation. Pre- and post-operative velopharyngeal functions were assessed using perceptual speech evaluation and nasometric analysis; factors affecting surgical outcomes were determined.

Results:
Of 138 patients, 112 (women: 53, men: 59) were included in analyses, according to the inclusion and exclusion criteria. The median follow-up period was 21 months (range: 9–120). Postoperative perceptual speech evaluation revealed improved velopharyngeal function in 108 (96.4%). There were no reports of postoperative hyponasality (preoperative, 1.8% versus postoperative, 0%; P = 0.053). Other parameters of perceptual speech evaluation (hypernasality, nasal emission, articulation error, and intelligibility) showed significant improvement postoperatively (P < 0.01). Postoperative nasalance scores revealed sufficient postoperative resonance rating in 96% of patients. No patients experienced postoperative complications (bleeding, airway obstruction, and surgical wound dehiscence).

Conclusions:
Individually configured pharyngeal flaps designed based on preoperative nasopharyngoscopic examination coupled with precise surgical techniques led to the high surgery success rate for VPI treatment.
Using Active-Phonation Cone-Beam Computed Tomography to Evaluate Pediatric Patients With Suspected Velopharyngeal Dysfunction, a Pilot Study
Authors: Tessler Karen , Wiegmann Aaron Lee , Esmaeeli Shooka , Skertich Nicholas J. , Jeffe Jill S. , Figueroa Alvaro , Tragos Christina 
Published: September 2021

Abstract
Velopharyngeal dysfunction (VPD) is described as the incomplete closure of the velopharyngeal port during a speech production. Nasopharyngoscopy and/or multiplanar videofluoroscopy have been utilized for decades to assess the degree and nature of the dysfunction. Cone-beam computed tomography (CBCT) is presented as an additional diagnostic tool, allowing for clear visualization of the affected structures and the ability to obtain accurate measurements (within 100 microns) of the involved anatomy and defect. This prospective pilot study aims to test the feasibility of using “active-phonation” CBCT to assess suspected VPD in the pediatric and young adult populations and compare the results to nasopharyngoscopy; the current standards of care.
Six patients, ages 6 to 26 years, with suspected VPD, defined as the inability to completely close off the nasal airway during an oral speech, seen at an urban medical outpatient craniofacial care center, served as subjects for this pilot study. Each patient received a comprehensive speech evaluation and participated in both active-phonation CBCT and nasopharyngoscopy.
Both active-phonation CBCT and nasopharyngoscopy revealed incomplete closure of the velopharyngeal port during a speech in all 6 patients (100%). Two patients (33%) were unable to tolerate a complete nasendoscopic examination. There was no difference between CBCT or nasopharyngoscopy in determining the presence of VPD and noting the severity on a 3-point scale, (P = 0.61) as judged by 4 experienced clinicians.
As a functional imaging modality, active-phonation CBCT is a useful adjunct tool for accurate diagnosis of VPD and may be more easily tolerated during a thorough VPD assessment than nasopharyngoscopy. It also provides quantitative data that is useful to augment treatment optimization and surgical planning in this population. Further studies are needed to validate these results.
A Volumetric and Morphological Analysis of Recurrent Odontogenic Keratocysts by Semiautomatic Segmentation
Authors: Lentzen Max-Philipp , Riekert Maximilian , Zirk Matthias , Nickenig Hans-Joachim , Zoller Joachim E. , Kreppel Matthias 
Published: September 2021

Purpose:
The authors conducted this study to provide morphological and volumetric data of recurrent odontogenic keratocysts of the upper and lower jaw to emphasize risk factors in accordance with their radiological appearance and guide clinical decisions for jeopardized patients.

Methods:
By applying the open-source software “ITK-Snap” on cone-beam computed tomography images, volumetric measurements of histopathologically diagnosed recurrent odontogenic keratocysts could be performed. For statistical investigations, descriptive statistics and independent Student t test were performed. The intraclass correlation coefficient was used to assess intra- and inter-rater reliabilities. P values P
< 0.05 were considered significant.

Results:
Forty patients (24 male and 16 female) were included in this study. Recurrent odontogenic keratocysts had a mean maximum diameter of 28.91 mm ± 12.00 mm and a mean volume of 4.48 cm3 ± 4.29 cm3. According to morphology, irregular shape (P = 0.001; P = 0.005), unclear margin (P = 0.001; P = 0.001), multilocular morphology (P = 0.001; P = 0.001), and cortical bone exceedance (P = 0.001; P = 0.007) are statistically significantly associated with a larger cyst diameter and volume. Furthermore, significant differences by diameter and volume could be shown between patients with and without iliac crest graft reconstruction (P = 0.001; P = 0.001).

Conclusions:
Volumetric analysis reveals that recurrent odontogenic keratocysts show large diametric and volumetric extension that leads to complex reconstruction by iliac crest grafts, adding an argument that special attention should be paid to this entity and its recurrence. in case of difficult histopathological examination, lesions with irregular shape and margin, multilocular morphology, cortical bone exceedance, and clinically visible symptoms should be considered for close morphological and volumetric clinico- radiological follow-up.
Effect of the “Time to Surgery” on Civil Cranial Gunshot Injuries: Syria War
Authors: Cingoz Ilker Deniz , Kaya Ismail , Sahin Meryem Cansu , Ozyoruk Safak , Goksu Ethem Taner 
Published: September 2021

Abstract
Studies on cranial gunshot injuries in the Syrian war are present in the literature. However, the effect of surgical timing on the clinical outcomes of patients undergoing surgical treatment has not been discussed extensively. In this study, the time from injury to surgery is called “time to surgery.” Kilis, a city close to Aleppo, Afrin, and Azez, where the conflicts in Syria are intense, is one of the cities where the first emergency treatments were administered. This study aimed to evaluate patients who underwent surgery in Kilis State Hospital due to cranial gunshot injury in the Syrian war and to investigate the effect of surgical timing on mortality and Glasgow Outcome Score.
Surgical treatment was applied to 42 (32.8%) patients in the first 4 hours, 64 (50%) patients within 4 to 24 hours, and 22 (17.2%) patients between 24 hours and 3 days. As the time to surgery decreased, the good Glasgow Outcome Score (GOS) (4-5) outcome rates increased. The differences in surgical timing and GOS results of patients with Glasgow Coma Score (GCS) <8 and >8 were found to be significant for good GOS results. As the time to surgery decreased for patients with a GCS <8 and >8, mortality rates decreased equally. This result was statistically significant.
Our study showed that surgical timing is as important as early intubation, aggressive resuscitation, and admission GCS for both survey and GOS.