bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physiological correlates of the Epworth Sleepiness Scale reveal different dimensions of daytime sleepiness
Authors: Lok Renske , Zeitzer Jamie M 
Published: May 2021

AbstractThe Epworth Sleepiness Scale is commonly used to examine self-reported daytime sleepiness in clinical populations; the physiologic correlates of this scale, however, are not well understood. Furthermore, how well this scale correlates with parallel objective and self-reported concepts of daytime sleepiness is not well described. As such, we used machine learning algorithms to examine the association between Epworth Sleepiness Scale scores and 55 sleep and medical variables in the Sleep Heart Health Study (N = 2105). Secondary analyses examined data stratified by age and gender and the relationship between the Epworth and other measures of daytime sleepiness. Analyses of the main data set resulted in low explained variance (7.15%–10.0%), with self-reported frequency of not getting enough sleep as most important predictor (10.3%–13.9% of the model variance). Stratification by neither age nor gender significantly improved explained variance. Cross-correlational analysis revealed low correlation of other daytime sleepiness measures to Epworth scores. We find that Epworth scores are not well explained by habitual or polysomnographic sleep values, or other biomedical characteristics. These analyses indicate that there are different, potentially orthogonal dimensions of the concept of “daytime sleepiness” that may be driven by different aspects of sleep physiology. As the physiologic correlates of the Epworth Sleepiness Scale remain to be elucidated, interpretation of the clinical meaning of these scores should be done with caution.
Endothelial Dysfunction as a Component of Severe Acute Respiratory Syndrome Coronavirus 2–Related Multisystem Inflammatory Syndrome in Children With Shock
Authors: Borgel Delphine , Chocron Richard , Grimaud Marion , Philippe Aurélien , Chareyre Judith , Brakta Charlyne , Lasne Dominique , Bonnet Damien , Toubiana Julie , Angoulvant François , Desvages Maximilien , Renolleau Sylvain , Smadja David M. , Oualha Mehdi 
Published: May 2021

TRIAL REGISTRATION:
NCT04420468.

OBJECTIVES:
Severe acute respiratory syndrome coronavirus 2–related multisystem inflammatory syndrome in children is frequently associated with shock; endothelial involvement may be one of the underlying mechanisms. We sought to describe endothelial dysfunction during multisystem inflammatory syndrome in children with shock and then assess the relationship between the degree of endothelial involvement and the severity of shock.

DESIGN:
Observational study.

SETTING:
A PICU in a tertiary hospital.

PATIENTS:
Patients aged under 18 (n = 28) with severe acute respiratory syndrome coronavirus 2–related multisystem inflammatory syndrome in children and shock, according to the Centers for Disease Control and Prevention criteria.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Correlations between endothelial marker levels and shock severity were assessed using Spearman coefficient. The median (interquartile range) age was 9 years (7.5–11.2 yr). Sixteen children presented with cardiogenic and distributive shock, 10 presented with cardiogenic shock only, and two presented with distributive shock only. The median left ventricular ejection fraction, troponin level, and lactate level were, respectively, 40% (35–45%), 261 ng/mL (131–390 ng/mL), and 3.2 mmol/L (2–4.2 mmol/L). Twenty-five children received inotropes and/or vasopressors; the median Vasoactive and Inotropic Score was 8 (5–28). Plasma levels of angiopoietin-2 (6,426 pg/mL [2,814–11,836 pg/mL]), sE-selectin (130,405 pg/mL [92,987–192,499 pg/mL]), von Willebrand factor antigen (344% [288–378%]), and the angiopoietin-2/angiopoietin-1 ratio (1.111 [0.472–1.524]) were elevated and significantly correlated with the Vasoactive and Inotropic Score (r = 0.45, p = 0.016; r = 0.53, p = 0.04; r = 0.46, p = 0.013; and r = 0.46, p = 0.012, respectively).

CONCLUSIONS:
Endothelial dysfunction is associated with severe acute respiratory syndrome coronavirus 2–related multisystem inflammatory syndrome in children with shock and may constitute one of the underlying mechanisms.
Conjunctival Infiltration in a Child as a Rare Manifestation of IgG4-Related Disease
Authors: Qi Susan Ruyu , Hébert Mélanie , You Eunice , Proulx-Gauthier Jean-Philippe , Légaré Marie Eve 
Published: May 2021

Purpose:
Ocular manifestations of immunoglobulin G4 (IgG4)-related disease are common in children although remain ill-defined because of the disease's rarity. We describe a pediatric case of IgG4-related orbital disease (IgG4-ROD) who presented with persistent conjunctival infiltration before developing lacrimal gland enlargement 3 years later.

Methods:
This was a case report.

Results:
An 8-year-old girl developed forniceal salmon-patch-like conjunctival lesions in her left eye that were refractory to topical corticosteroids. Investigations, including an orbital MRI and 2 conjunctival biopsies, were negative for lymphoma. She was treated with topical corticosteroids and then nonsteroidal antiinflammatory drops. The lesions decreased mildly, and no new lesion emerged. After 3 years, the patient developed a ptosis, new salmon-patch conjunctival lesions, and papillae. Vision deteriorated to 20/80 because of severe punctate epithelial erosions in the left eye, and the Schirmer test was significantly reduced. A repeat MRI revealed an enlarged left lacrimal gland. A biopsy was performed and was compatible with IgG4-ROD. An elevated IgG4 level of 4.61 g/L was also found. The patient was successfully treated with oral prednisone but flared on tapering the dosage. Rituximab was therefore initiated with excellent clinical response, and prednisone was discontinued. Vision returned to 20/20 after aggressive lubrification, punctal plugs, and autologous serum eye drops. Tear function came back to normal, and local treatments were stopped.

Conclusions:
This case describes a pediatric case of IgG4-ROD presenting initially with conjunctival follicular reaction, later developing lacrimal gland involvement. Therefore, it is important to consider IgG4-ROD in chronic atypical follicular conjunctival lesions in children, even in the absence of orbital disease.
Long-term Outcomes of Cataract Surgery in Patients With Chronic Ocular Graft-Versus-Host Disease
Authors: Bae Steven S. , Iovieno Alfonso , Yeung Sonia N. 
Published: May 2021

Purpose:
The aim of this study was to evaluate the outcomes of cataract surgery in patients with chronic ocular graft-versus-host disease (GVHD).

Methods:
A retrospective review was performed on 77 eyes of 42 patients with chronic ocular GVHD that underwent cataract surgery between January 2014 and February 2020 in a tertiary institution.

Results:
Posterior subcapsular cataract was seen in 53 (68.8%) of 77 eyes, with a mean preoperative corrected distance visual acuity (CDVA) of 0.61 ± 0.49 logarithm of the minimum angle of resolution (logMAR). Postoperatively, with a mean follow-up of 21 months, CDVA improved to 0.17 ± 0.22 logMAR at the latest visit (P < 0.0001). With latest available refraction, 42 (57.5%) of 73 eyes were within 0.5 diopters of target refraction, and 59 eyes (80.8%) were within 1.0 diopter. Postoperative complications included superficial punctate keratopathy within 1 month postoperatively (19 eyes, 24.7%), posterior capsular opacification requiring yttrium-aluminum-garnet (YAG) laser capsulotomy (36 eyes, 46.8%), corneal epithelial defect (7 eyes, 9.1%), filamentary keratopathy (5 eyes, 6.5%), cystoid macular edema (3 eyes, 3.9%), and infectious crystalline keratopathy (1 eye, 1.3%). Lower preoperative National Institutes of Health ocular GVHD severity scores were associated with a better postoperative CDVA (grade 1, 0.13 ± 0.16 logMAR; grade 2, 0.16 ± 0.23 logMAR; and grade 3, 0.36 ± 0.21 logMAR; P = 0.004).

Conclusions:
Cataract surgery improves visual acuity long term in most patients with chronic ocular GVHD. Close postoperative monitoring is important to detect ocular surface inflammation secondary to chronic ocular GVHD, particularly in severe ocular GVHD.
Comparison of the Incidence of Urinary Tract Infection by Replacement Time of the Urinary Drainage System
Authors: CHEN Yin-Yin , CHEN Chii-Shya , CHEN Ian-Horng , LIN Chu-Chun 
Published: May 2021

ABSTRACT

Background
Urinary catheters (UCs) with a closed urinary drainage system have been widely used in patients for many years. However, the frequency of replacing and operating these devices may be associated with catheter-associated urinary tract infection (CAUTI).

Purpose
This study was designed to compare the incidence of CAUTI by replacement time (every 14 or ≥ 15 days) of the urinary drainage system.

Methods
This 1-year prospective, nonrandomized controlled study was conducted in a major teaching hospital. The Transparent Reporting of Evaluations with Nonrandomized Designs Statement checklist was used. All of the patients with UCs were divided into two groups based on each patient's preference with regard to replacement time of the urinary drainage system.

Results
Five hundred sixty-two patients were evaluated, and 341 patients with UCs were enrolled as participants in the study. In the per-protocol analysis, 16 patients (22.2%; 9.3 episodes/1,000 catheter-days) in the 14-day group and 15 patients (17.9%; relative risk = 1.24, 95% confidence interval [0.66, 2.34]) in the ≥ 15-day group (7.7 episodes/1,000 catheter-days; incidence density ratio 1.20, 95% confidence interval [0.60, 2.43]) had CAUTIs. A comparison of cleanliness within urinary bags showed no significant intergroup difference (p > .05). In the intention-to-treat analysis, the incidence of CAUTI between the two groups was also not significantly different (p > .05).

Conclusions
No statistically significant difference in the incidence of CAUTI was identified between patients who used the 14-day replacement interval and those who used the ≥ 15-day replacement interval for their urinary drainage system.
Transmastoid Superior Semicircular Canal Plugging: A Prospective Analysis of Surgical Outcomes
Authors: Kontorinis Georgios , Gaggini Margaret 
Published: May 2021

Objectives:
To assess the outcomes of the transmastoid superior semicircular canal plugging in patients with superior semicircular canal dehiscence (SSCD).

Study design:
Prospective cohort study.

Setting:
Tertiary, university center.

Patients:
Patients with SSCD undergoing transmastoid superior semicircular canal plugging within a 30-month period.

Interventions:
Transmastoid superior semicircular canal occlusion.

Main outcome measures:
We documented the surgical technique, pre- and postoperative (3-month review) dizziness handicap inventory scores, average hearing thresholds, low-frequency air-bone gap, six-canal video head-impulse-test responses, improvement of the auditory symptoms and complications.

Results:
Out of 30 patients with SSCD, 11 patients (12 ears) were enrolled with an average age 41.17 years (range 32–65 years). Oscillopsia resolved in all patients; DHI score improved from 56.7 (range 22–84) preoperatively to 25.83 (10–46) postoperatively (p = 0.001), while out of the nine patients with troublesome auditory symptoms, five patients noticed an improvement. The average pre- and postoperative hearing thresholds were 15.2 dB (range 3–32.5 dB) and 14.17 dB (range 5–30 dB) (p = 0.73), respectively. The average pre- and postoperative low-frequency air bone gap was 12.3 dB (range 5–20 dB) and 9.4 dB (range 0–20 dB), respectively (p = 0.24) (Table 1). There were no major complications; two patients developed postoperative benign paroxysmal positional vertigo.

Conclusion:
Transmastoid plugging of the superior semicircular canal can safely and significantly improve the vestibular symptoms of the patients with SCDS, as well as the auditory symptoms in a substantial number of patients in a hearing-preservation way.
Effects of Moringa Extract on Aminoglycoside-Induced Hair Cell Death and Organ of Corti Damage
Authors: Broderick Michael T. , Prince Andrew D. P. , Dhukhwa Asmita , Mukherjea Debashree , Jiang Peng , Campbell Kathleen C. M. , Rybak Leonard P. , Brenner Michael J. 
Published: May 2021

Hypothesis:
Moringa extract, a naturally occurring anti-oxidant, protects against aminoglycoside-induced hair cell death and hearing loss within the organ of Corti.

Background:
Reactive oxygen species (ROS) arise primarily in the mitochondria and have been implicated in aminoglycoside-induced ototoxicity. Mitochondrial dysfunction results in loss of membrane potential, release of caspases, and cell apoptosis. Moringa extract has not previously been examined as a protective agent for aminoglycoside-induced ototoxicity.

Methods:
Putative otoprotective effects of moringa extract were investigated in an organotypic model using murine organ of Corti explants subjected to gentamicin-induced ototoxicity. Assays evaluated hair cell loss, cytochrome oxidase expression, mitochondrial membrane potential integrity, and caspase activity.

Results:
In vitro application of moringa conferred significant protection from gentamicin-induced hair cell loss at dosages from 25 to 300 μg/mL, with dosages above 100 μg/mL conferring near complete protection. Assays demonstrated moringa extract suppression of ROS, preservation of cytochrome oxidase activity, and reduction in caspase production.

Conclusion:
Moringa extract demonstrated potent antioxidant properties with significant protection against gentamicin ototoxicity in cochlear explants.
Cochlear Implantation in the Setting of Menière's Disease After Labyrinthectomy: A Meta-Analysis
Authors: Selleck Anne Morgan , Dillon Margaret , Perkins Elizabeth , Brown Kevin D. 
Published: May 2021

Objective:
Characterize the speech recognition and sound source localization of patients with unilateral Menière's disease who undergo labyrinthectomy for vertigo control with simultaneous or sequential cochlear implantation.

Databases Reviewed:
PubMed, Embase, and Cochrane databases.

Methods:
The search was performed on May 6, 2020. The keywords utilized included: “Menière's disease AND cochlear implant;” “cochlear implant AND single sided deafness;” “cochlear implant AND vestibular;” and “labyrinthectomy AND cochlear implant.” Manuscripts published in English with a publication date after 1995 that assessed adult subjects (≥18 years of age) were included for review. Subjects must have been diagnosed with Menière's disease unilaterally and underwent labyrinthectomy with simultaneous or sequential cochlear implantation. Reported outcomes with cochlear implant (CI) use included speech recognition as measured with the consonant-nucleus-consonant (CNC) word test and/or sound source localization reported in root-mean squared (RMS) error. The method of data collection and study type were recorded to assess level of evidence. Statistical analysis was performed with Wilcoxon signed ranks test.

Results:
Data from 14 CI recipients met the criteria for inclusion. Word recognition comparisons between the preoperative interval and a postactivation interval demonstrated a significant improvement with the CI (p = 0.014), with an average improvement of 23% (range −16 to 50%). Sound source localization postoperatively with the CI demonstrated an average RMS error of 26° (SD 6.8, range 18.7–43.1°) compared to the 42° (SD 19.1, range 18–85°) in the preoperative or CI off condition, these two conditions were not statistically different (p = 0.148).

Conclusion:
Cochlear implantation and labyrinthectomy in adult patients with Menière's disease can support improvements in speech recognition and sound source localization for some CI users, though observed performance may be poorer than traditional CI candidates.
Impacts of the COVID-19 Pandemic on Communication and Healthcare Access for Adults With Hearing Loss
Authors: Wilson Harper L. , Crouch Jacob , Schuh Marissa , Shinn Jennifer , Bush Matthew L. 
Published: May 2021

Objective:
Adults with hearing loss are at risk of negative impacts of the pandemic. Specific factors, such as hearing loss severity and location of residence, may disproportionately impact patients during the pandemic. The objective of this study was to assess the relative impact of the COVID-19 pandemic on hearing loss patients, based on hearing device type and location of residence.

Study Design:
Prospective cross-sectional questionnaire study.

Setting:
Tertiary referral center.

Patients:
Adults with hearing loss.

Main Outcome Measures:
Data included sociodemographic data, communication challenges, pandemic preparedness, access to healthcare, and mental and emotional health.

Results:
A total of 614 patients responded (27.8% response rate). Compared with hearing aid users, cochlear implant users reported more difficulty communicating with family/friends (53% versus 41%, p = 0.017), obtaining pandemic information (10% versus 3%, p = 0.002), and understanding live broadcasts (47% versus 17%, p = 0.001) during the pandemic. CI users were less likely than hearing aid users to seek general (52% versus 69%, p = 0.001) and hearing healthcare services (20% versus 34%, p = 0.002). Rural residents reported greater difficulty than urban residents communicating with friends/family (53% versus 39%, p = 0.001), obtaining food/supplies (41% versus 20%, p = 0.004), understanding live broadcasts (31% versus 20%, p = 0.001) during the pandemic. Compared with urban residents, rural residents reported greater difficulty accessing general (57% versus 42%, p = 0.004) and hearing healthcare (49% versus 34%, p = 0.043). Rural residents reported poorer mental/emotional health than urban residents.

Conclusions:
Among adults with hearing loss, cochlear implant users and rural residents experience greater challenges in communication, pandemic preparedness, and access to healthcare during the COVID-19 pandemic.
Effect of Surgical Start Time on Stapedotomy Outcomes
Authors: Conway Robert M. , Babu Seilesh C. , Sioshansi Pedrom C. , Howard Anthony L. , Tu Nathan C. , Minutello Katrina , Schettino Amy E. , Bojrab Dennis I. , Schutt Christopher A. 
Published: May 2021

Objective:
To examine if performing stapedotomy as the first case of the day provides improved outcomes compared with those performed later in the day.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
Adult patients undergoing stapedotomy for otosclerosis.

Main Outcome Measure(s):
Patients were separated into either a first case group or a later case group based on surgical start time. Audiologic outcomes and complications were compared between the two groups.

Results:
The first case group had a smaller postoperative air-bone gap (ABG) compared with the later case group of 9.81 dB HL compared with 11.73dB HL and 3.79 dB HL compared with 6.29 dB HL at 1000 and 2000 Hz, respectively (p = 0.03, p < 0.01). The mean postoperative ABG was 10.63 dB HL for the first start group compared with 12.12 dB HL for the later start group, which was statistically significant (p = 0.05).

Conclusions:
First start stapedotomy is associated with slightly improved audiologic outcomes compared with those starting later in the day, although both groups had significantly improved postoperative outcomes overall. There was no significant difference in complications when comparing stapedotomy by case start time.
Quality Indicators for the Diagnosis and Management of Sudden Sensorineural Hearing Loss
Authors: Cottrell Justin , Zahr Siraj K. , Yip Jonathan , Agrawal Sumit , Archibald Jason , Chau Justin , Lea Jane , Lin Vincent , Mick Paul , Morris David , Parnes Lorne , Schramm David , Chan Yvonne , de Almeida John , Eskander Antoine , Witterick Ian J. , Monteiro Eric 
Published: May 2021

Objective:
Sudden sensorineural hearing loss (SSNHL) is an ideal entity for quality indicator (QI) development, providing treatment challenges resulting in variable or substandard care. The American Academy of Otolaryngology—Head and Neck Surgery recently updated their SSNHL guidelines. With SSNHL demonstrating a large burden of illness, this study sought to leverage the updated guidelines and develop QIs that support quality improvement initiatives at an individual, institutional, and systems level.

Methods:
Candidate indicators (CIs) were extracted from high-quality SSNHL guidelines that were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Each CI and its supporting evidence were summarized and reviewed by a nine-member expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs using the modified RAND Corporation-University of California, Los Angeles appropriateness methodology.

Results:
Fifteen CIs were identified after literature review. After the first round of evaluations, the panel agreed on 11 candidate indicators as appropriate QIs with 2 additional CIs suggested for consideration. An expert panel meeting provided a platform to discuss areas of disagreement before final evaluations. The expert panel subsequently agreed upon 11 final QIs as appropriate measures of high-quality care for SSNHL.

Conclusion:
The 11 proposed QIs from this study are supported by evidence and expert consensus, facilitating measurement across a wide breadth of quality domains. With the recently updated SSNHL guidelines, and a greater focus on quality improvement opportunities, these QIs may be used by healthcare providers for targeted quality improvement initiatives.
Prodromal Signs and Symptoms of Chronic Pancreatitis
Authors: Thompson Bridie S. , Philcox Stephen , Devereaux Benedict , Metz Andrew J. , Croagh Daniel , Gray Andrew , Hamarneh Zaki , Windsor John A. , Neale Rachel E. 
Published: May 2021

Goal:
We aimed to extract the percent of signs and symptoms at the time of diagnosis from published studies and to pool these using meta-analytic techniques.

Background:
Delayed or misdiagnosis of chronic pancreatitis may occur because the signs and symptoms are nonspecific and varied.

Study:
We performed a systematic review of studies reporting the signs and symptoms of chronic pancreatitis at diagnosis. The percentage of patients with each sign and symptom was extracted and random-effects meta-analyses used to calculate pooled percentages.

Results:
In total, 22 observational studies were included. Across 14 studies, 55% of chronic pancreatitis patients were classified as having alcoholic etiology. Abdominal pain was the most common symptom (76%), and weight loss was reported in 22% of patients. Jaundice occurred in 11% of patients and steatorrhoea in 3%. Half of the patients had a history of acute pancreatitis, and 28% had diabetes mellitus at diagnosis. Heterogeneity between the studies was high for all signs and symptoms.

Conclusions:
This research has identified some common features of patients with chronic pancreatitis, but the high heterogeneity makes it difficult to draw solid conclusions. Carefully designed studies to examine the signs and symptoms leading up to a diagnosis of chronic pancreatitis, and common combinations, are required. These would enable the development of a tool to aid in the early identification of chronic pancreatitis in the primary care setting, with potential for improved short-term and long-term outcomes for patients.