bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usage Patterns of CT and MRI in the Evaluation of Otologic Disease
Authors: Moroco Annie E. , Saadi Robert A. , Baker Aaron R. , Zhu Junjia , Isildak Huseyin 
Published: February 2021

Objective:
To evaluate the current trends and usage patterns of radiographic imaging for otologic disease by specialty, length of practice, practice setting, geographic region, and pediatric volume.

Study Design:
Cross-sectional study.

Setting:
Survey of physicians.

Subjects:
General Otolaryngologists and Otologists/Neurotologists (O/N) of the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS).

Methods and Outcome Measures:
An electronic questionnaire was distributed to AAO-HNS members. Respondents were separated into groups by specialty, length of practice, practice setting, region, and pediatric exposure. Chi-square tests were performed for the determination of significance.

Results:
The survey was sent to 5,168 members of AAO-HNS. The response rate was 10.6% (n = 546) and 18.1% for only O/N (n = 143). Most respondents were generalists (74%), in practice >20 years (51%), with a primarily adult practice (95%). O/N were more often academics (44 versus 17% combined, 40% private; p < 0.001) and saw fewer children (80 fewer than 25%; p < 0.001). Compared with generalists, O/N were more likely to respond with more frequent and earlier magnetic resonance imaging (MRI) utilization in the workup of the majority of otologic diseases. Significant differences in usage patterns for various conditions were demonstrated across all categories, but specialty training was the most common. Generalists (34 versus 12% of O/N; p < 0.001), physicians practicing >20 years (32 versus 18% of < 5 yrs; p = 0.006), and private practice physicians (34 versus 14–20% of others; p < 0.001) relied more heavily on the radiology report to interpret MRI scans.

Conclusion:
Subspecialty training seems to be the main variable correlating with significant differences in the use of MRI and computed tomography imaging in patients with otologic disease.
Rising Resonance Frequency Is the Sole Sign of Early Middle Ear Disease in Children With Adenoid Hypertrophy
Authors: Kourelis Konstantinos , Avgeri Aikaterini , Kourelis Theodoros 
Published: February 2021

Objective:
The present study seeks to estimate the potential of multifrequency tympanometry in the diagnosis of primal otologic disorder in children with adenoid hypertrophy (AH).

Study Design:
Prospective observational study.

Setting:
Tertiary pediatric institution.

Patients:
One hundred thirty-one children presenting consecutively at the otolaryngology clinic were divided on the basis of AH into 98 patients and 33 controls.

Interventions:
Middle ear status was assessed using pneumatic otoscopy, standard, and wide band tympanometry.

Main Outcome Measures:
Tympanogram type/intratympanic pressure, and resonance frequency (RF) were correlated with each other as well as with a set of clinical parameters. Receiver operating characteristic analysis was employed to reveal the diagnostic value of RF.

Results:
Mean RF declined in chronic otitis media with effusion by 43.25% (p < 0.001). In our entire cohort, children with AH under the age of 7 years presented with a relative risk = 2.43 of producing “B” tympanogram (p = 0.016) than their older peers. In patients’ ears with normal, type “A,” tympanogram, RF was the sole tympanometric marker of AH, being elevated by 28.26% in mean value (p = 0.010). On receiver operating characteristic analysis of RF's discriminating capability, the area under the curve was equal to 0.647 (p = 0.010). The optimal cut-off value of RF was set at 899 Hz.

Conclusion:
AH may induce middle ear stiffening, as RF's increase indicates. Wide band tympanometry output could be a warning sign of ongoing compliance reduction to the sound transmission apparatus, at a time point when physical examination and 226 Hz tympanometry are still unremarkable.
Audiometric Pattern in Moderate and Severe Tympanic Membrane Retraction
Authors: Canali Inesângela , Rosito Letícia Petersen Schmidt , Longo Vittoria Dreher , da Costa Sady Selaimen 
Published: February 2021

Objective:
To evaluate the audiometric pattern in moderate/severe retractions of the tympanic membrane and correlate it with the severity of the otoscopy findings.

Study Design:
Cross-sectional study.

Setting:
Tertiary hospital.

Patients:
Consecutive patients with moderate or severe tympanic membrane retraction in at least one ear (451 ears) between August 2000 and January 2019, and no surgical history or effusion (mean [standard deviation] age, 32.8 [20.2] yr; 54% female and 42.4% children).

Intervention:
Pure-tone audiometry.

Main Outcome Measures:
Air conduction (AC) and bone conduction thresholds, and air-bone gap (ABG) measured at the four-frequency pure-tone average.

Results:
The median in decibel hearing level (dB HL) (minimum–maximum) of the AC, BC, and ABG were 25 dB HL (0–120 dB HL), 10 dB HL (0–75 dB HL), and 12.5 dB HL (0–55 dB HL), respectively. Seventy-two percent of the ears had an ABG ≤ 20 dB HL. For severity of the retraction of pars flaccida (PF), the AC, bone conduction, and ABG were similar across groups, with a weak correlation. For the pars tensa (PT), there was a global difference in the medians of AC and ABG in terms of the degree of severity, with a moderate correlation. Retraction in PF and PT at the same time was observed in 6 4% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05).

Conclusion:
The ABG pure-tone average median was higher when PT was involved. We found a significant correlation between the retraction severity and worsening of AC and ABG thresholds, only for PT.
Efficacy and Safety of Statin for Hepatocellular Carcinoma Prevention Among Chronic Liver Disease Patients
Authors: Wong Yu-Jun , Qiu Tian-Yu , Ng Gin-Kee , Zheng Qishi , Teo Eng Kiong 
Published: February 2021

Introduction and Aim:
Hepatocellular carcinoma (HCC) is a deadly complication among patients with chronic liver disease (CLD). Controversies on the efficacy and safety of statin to prevent HCC among patients with CLD remain despite the growing evidences. We aim to investigate the efficacy and safety of using statin for HCC prevention among adult with CLD.

Methods:
We performed a systematic search of 4 electronic databases (PubMed/MEDLINE, EMBASE, Cochrane library, and ClinicalTrial.gov) up to April 15, 2020. We selected all types of studies evaluating the statin use and the risk of HCC among CLD patients, regardless of language, region, publication date, or status. The primary endpoint was the pooled risk of HCC. The secondary endpoint was the risk of statin-associated myopathy.

Result:
From 583 citations, we included a total of 13 studies (1,742,260 subjects, 7 types of statins), fulfilling the inclusion criteria, evaluating efficacy and safety of statin in CLD patients for HCC prevention. All studies were observational (2 nested case-control studies, 11 cohort studies), and no randomised trial was identified. We found that statin user has a lower pooled risk of HCC development (hazard ratio=0.57, 95% confidence interval: 0.52-0.62, I
2=42%). HCC reduction was consistent among statin users in cirrhosis, hepatitis B virus, and hepatitis C virus infections. The risk of statin-associated myopathy was similar between statin user and nonuser (hazard ratio=1.07, 95% confidence interval=0.91-1.27).

Conclusion:
Statin use was safe and associated with a lower pooled risk of HCC development among adults with CLD. Given the bias with observation studies, prospective randomised trial is needed to confirm this finding.
Large-scale food fortification has great potential to improve child health and nutrition
Authors: Keats Emily C. , Charbonneau Kimberly D. , Das Jai K. , Bhutta Zulfiqar A. 
Published: February 2021

Purpose of review
Undernutrition, including micronutrient deficiencies, continues to plague children across the world, particularly in low and middle-income countries (LMICs). The situation has worsened alongside the SARS-CoV-2 pandemic because of major systemic disruptions to food supply, healthcare, and employment. Large-scale food fortification (LSFF) is a potential strategy for improving micronutrient intakes through the addition of vitamins and minerals to staple foods and improving the nutritional status of populations at large.

Recent findings
Current evidence unquestionably supports the use of LSFF to improve micronutrient status. Evidence syntheses have also demonstrated impact on some functional outcomes, including anemia, wasting, underweight, and neural tube defects, that underpin poor health and development. Importantly, many of these effects have also been reflected in effectiveness studies that examine LSFF in real-world situations as opposed to under-controlled environments. However, programmatic challenges must be addressed in LMICs in order for LSFF efforts to reach their full potential.

Summary
LSFF is an important strategy that has the potential to improve the health and nutrition of entire populations of vulnerable children. Now more than ever, existing programs should be strengthened and new programs implemented in areas with widespread undernutrition and micronutrient deficiencies.
Fibrosis-4 index and mortality in coronavirus disease 2019: a meta-analysis
Authors: Pranata Raymond , Yonas Emir , Huang Ian , Lim Michael Anthonius , Nasution Sally Aman , Kuswardhani Raden Ayu Tuty 
Published: February 2021

Background/aims
In this meta-analysis, we aimed to evaluate the prognostic value of fibrosis-4 index (FIB-4) in COVID-19.

Methods
We performed a comprehensive literature search of PubMed, Embase, and Scopus databases on 26 November 2020. FIB-4 was calculated by [age (years) × AST (IU/L)]/[platelet count (109/L) × √ALT (U/L)]. A value above cutoff point was considered high and a value below cutoff point was considered low. The main outcome was mortality, the association between high FIB-4 and mortality was reported in odds ratio (OR). Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic OR (DOR), area under the curve (AUC) were generated.

Results
There were 963 patients from five studies included in this systematic review and meta-analysis. Meta-analysis showed that high FIB-4 was associated with increased mortality [OR 3.96 (2.16–7.27), P < 0.001; I2: 41.3%]. High FIB-4 was associated mortality with a sensitivity of 0.56 (0.40–0.70), specificity of 0.80 (0.72–0.86), PLR 2.8 (1.8–4.2), NLR 0.55 (0.39–0.78), DOR 5 (2–10), and AUC of 0.77 (0.73–0.81). Fagan’s nomogram indicated that for a pre-test probability (mortality) of 30%, a high FIB-4 was associated with 54% post-test probability and a low FIB-4 was associated with 19%, respectively. The funnel-plot analysis was asymmetrical, trim-and-fill analysis by imputation of a study on the left side using linear estimator resulted in an OR of 3.48 (1.97–6.14). Egger’s test showed no indication of small-study effects (P = 0.881).

Conclusion
High FIB-4 was associated with mortality in patients with COVID-19.
Population-based incidence and prevalence of inflammatory bowel diseases in Milan (Northern Italy), and estimates for Italy
Authors: Crocetti Emanuele , Bergamaschi Walter , Russo Antonio Giampiero 
Published: February 2021

Objective
A reliable measure of the burden of inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn’s disease, are essential to monitor their epidemiology and plan appropriate health services.

Methods
This is a population-based study carried out in the Milan Agency for Health Protection. Incident and prevalent cases were identified according to specific codes in hospital discharges and copayment exemptions. Age-standardized incidence rates were computed for 2015–2018 and yearly rates from 2010 to 2018, as well as annual prevalence and prevalence on 31 December 2018. Incidence and prevalence estimates for Italy were also produced.

Results
During 2015–2018, 3434 citizens had an IBD diagnosis, 2154 (62.7%) ulcerative colitis and 1.280 (37.3%) Crohn’s disease. Age-adjusted incidence rates were 15.3 [95% confidence interval (CI), 14.7–16.0] for ulcerative colitis and 9.4 (8.9–9.9) for Crohn’s disease. Incidence was stable during 2010–2018 for both diseases. On 31 December 2018, there were 15 141 prevalent patients, corresponding to a proportion of 442.3 every 100 000 inhabitants/year (95% CI, 435.6–449.8). Prevalence proportion has increased to around +10% per year from 2010 to 2018. Projections for Italy assessed the burden of IBD in more than 15 000 new cases/year (55% ulcerative colitis) and around 260 000 prevalent cases (62% ulcerative colitis).

Conclusions
The exploitation of administrative data provides reliable and up-to-date measures of the burden of disease. Incidence of IBDs is stable while prevalence notably grows. The burden of IBDs and the consequent need for care and follow-up is going to increase in the future.
Advantages of gravity-assisted diuretic renogram: F + 10 (seated position) method
Authors: Tartaglione Girolamo , Foschi Nazario , Recupero Salvatore M. , Ieria Francesco P. , Tarantino Giulio , Bassi Pierfrancesco 
Published: February 2021

Introduction
In 1978, O’Reilly introduced the diuretic renogram using the F + 20 method. Initially, the patient was examined in the seated position. A dose of 40 mg furosemide was injected intravenously 20 min following tracer injection and dynamic acquisition was prolonged for 15–20 min. In 1992, the guidelines suggested to study patients in the supine position to avoid risk of diuretic-induced hypotension and reduce patient movement. Unfortunately, equivocal findings were reported in 15–30% of cases. Side effects such as bladder fullness and disruption because of voiding were reported. Several methods had been proposed in the supine position, such as the well-tempered diuretic renogram F + 20, F − 15, F0 and F + 2, with different time in minute of diuretic administration in relation to tracer injection. However, as confirmed by many studies, there was no clear evidence suggesting superiority among these methods. We suggest using the diuretic renogram with the F ± 10(sp) method for the diagnosis of obstruction in adult patients with hydronephrosis and for the follow-up in patients who underwent a surgical treatment of the urinary tract.

Methods
We searched all international guidelines and articles of most influential authors published from 1978 to October 2020 on diuretic renogram.

Results
We selected 60 articles.

Discussion
F + 10(sp) method improves patient compliance avoiding bladder fullness-related problems, without need of catheterization. It allows for a more reliable quantification of the renal output, thanks to outflow indices that are favored by gravity effects.
Differences in diagnostic impact of dual-tracer PET/computed tomography according to the extrahepatic metastatic site in patients with hepatocellular carcinoma
Authors: Yoo Su Woong , Kim Dong-Yeon , Pyo Ayoung , Jeon Subin , Kim Jahae , Kang Sae-Ryung , Cho Sang-Geon , Lee Changho , Kim Geun-Joong , Song Ho-Chun , Bom Hee-Seung , Min Jung-Joon , Kwon Seong Young 
Published: February 2021

Objectives
We compared the diagnostic performance of C-11 acetate and F-18 fluorodeoxyglucose (FDG) PET/computed tomography (CT) for the detection of extrahepatic metastasis in patients with hepatocellular carcinoma (HCC) and evaluated whether the improvement in the diagnostic performance of dual tracer PET/CT differs by the metastatic site.

Methods
Fifty-eight patients who had extrahepatic metastasis on either C-11 acetate or F-18 FDG PET/CT were enrolled, and 193 metastatic lesions were analyzed in this retrospective study. The metastatic lesions were categorized based on six sites of involvement. According to each involved site, the tracer avidity of the metastatic lesions was compared using the maximum standardized uptake value (SUVmax).

Results
Bone was the most frequent categorized metastatic site (44.8%), followed by lymph node (39.7%), lung (34.5%), soft tissue (27.6%), adrenal gland (6.9%), and vascular category (3.4%). C-11 acetate PET/CT showed a higher SUVmax than F-18 FDG PET/CT in metastatic bone lesions (P = 0.003). F-18 FDG uptake was significantly higher than C-11 acetate uptake in metastatic lymph node lesions (P < 0.001). The detection rate of dual tracer PET/CT was significantly higher in the metastatic lung (93.6%) and soft tissue (100%) lesions. However, the diagnostic performance of dual tracer PET/CT was limited in the metastatic bone and lymph node lesions because each tracer’s detection rate was very high (bone: 94.6% in C-11 acetate, lymph node: 94.1% in F-18 FDG).

Conclusions
The tracer avidity of metastatic lesions differed according to the involved site. This difference affected the complementary role of dual tracer PET/CT in the diagnosis of extrahepatic metastases in patients with HCC.
Infectious diseases affecting the small bowel – what not to miss
Authors: Keuchel Martin , Bota Marc , Baltes Peter 
Published: February 2021

Purpose of review
This review summarizes infectious diseases involving the small bowel (SB) with a focus on recent literature related to diagnosis and pathophysiology.

Recent findings
Typical symptom for SB infections is diarrhea, mostly self-limiting. Pathogens include bacteria, viruses, fungi, protozoan parasites, and helminths. Host–pathogen interaction is of special interest in infections with potentially severe or prolonged course. Research uses increasingly enterocyte cell culture systems. SARS-CoV2 can also infect enterocytes via angiotensin converting enzyme 2 (ACE2) receptor and causes gastrointestinal complaints in some patients. Chronic SB infections as tuberculosis, Cytomegalovirus, or Epstein–Barr virus have to be differentiated from Crohn's and other diseases. Severe rare fungal and protozoan parasitic infections can cause relevant morbidity in immunocompromised patients. Soil-transmitted helminthic infections are a special issue in endemic areas.

Summary
Many infections involve the SB, typically causing mild and self-limiting diarrhea. Symptomatic therapy, hygiene, and isolation are the mainstay of management. However, some patients develop severe or chronic disease. Immunosuppression is a major cause for severe, but also for rare opportunistic systemic infections that can also affect the SB.
Acute-on-chronic liver failure: update on pathogenesis, therapeutic targets, predictive models, and liver transplantation
Authors: Shah Shivani , Goldberg David S. 
Published: February 2021

Purpose of review
Acute-on-chronic liver failure (ACLF) is a clinical syndrome in patients with chronic liver disease that is associated with multiple organ failures and a high short-term mortality. Systemic inflammation is suggested to play a key role in its pathogenesis, although the precise causative mechanism is unknown. The purpose of this review is to present and discuss new findings related to: mechanisms underlying ACLF, therapeutic targets, risk prediction models for developing ACLF, and liver transplantation for ACLF.

Recent findings
Recent studies of ACLF pathophysiology classified the immunosuppressive phenotype in monocytes. Investigation of therapeutic strategies identified inhibition of toll-like receptor-4 (TLR-4) and glutamine synthetase (GLUL) as potential targets. Recent studies identified novel risk prediction models for developing ACLF and enhanced our understanding of liver transplantation for ACLF to guide clinicians in determining that patients will benefit from transplantation.

Summary
Improved knowledge on the pathogenesis of ACLF and identification of TLR-4 and GLUL may lead to clinical trials to study the efficacy of these novel therapeutic targets for patients with ACLF. Liver transplantation is the only current treatment for ACLF. Given the limited availability of donor organs, recent studies have identified ACLF patients who may merit the highest waitlist priority.
Heterogeneity of fetal hemoglobin production in adult red blood cells
Authors: Khandros Eugene , Blobel Gerd A. 
Published: February 2021

Purpose of review
Small amounts of fetal hemoglobin can be expressed in a subset of adult red blood cells called F-cells. This review examines the potential mechanisms and clinical implications of the heterogeneity of fetal hemoglobin expression.

Recent findings
Although the heterocellular nature of fetal hemoglobin expression in adult red blood cells has been noted for over 70 years, the molecular basis of this phenomenon has been unclear. Recent discoveries of novel regulators of fetal hemoglobin as well as technological advances have shed new light on these cells.

Summary
Fetal hemoglobin reactivation in adult red blood cells through genetic or pharmacological approaches can involve both increasing the number of F-cells and cellular fetal hemoglobin content. New technologies enable the study and eventually the improvement of these parameters in patients with sickle cell disease and β-thalassemia.
Ineffective erythropoiesis in sickle cell disease: new insights and future implications
Authors: El Nemer Wassim , Godard Auria , El Hoss Sara 
Published: February 2021

Purpose of review
Sickle cell disease (SCD) is a hemolytic anemia caused by a point mutation in the β globin gene leading to the expression of an abnormal hemoglobin (HbS) that polymerizes under hypoxic conditions driving red cell sickling. Circulating red cells have been extensively characterized in SCD, as their destruction and removal from peripheral blood are the major contributors to anemia. However, few reports showed cellular abnormalities during erythropoiesis in SCD, suggesting that anemia could also be influenced by defects of central origin.

Recent findings
El Hoss et al. demonstrated ineffective erythropoiesis (IE) in SCD and deciphered the molecular mechanism underlying cell death during the hemoglobin synthesis phase of terminal differentiation. They showed that HbS polymerization induces apoptosis of differentiating erythroblasts and that fetal hemoglobin rescues these cells through its antipolymerization function.

Summary
IE is the major cause of anemia in β-thalassemia patients, and it is generally surmised that it contributes little to anemia of SCD. Recent reports demonstrate the occurrence of IE in SCD patients and show important alterations in the hematopoietic and erythroid niches, both in SCD patients and in the humanized Townes SCD mouse model. This implies that therapeutic strategies initially designed to improve red cell survival in the circulation of SCD patients would also positively impact erythropoiesis and bone marrow cellularity.
Evaluation and fetal intervention in severe fetal hydronephrosis
Authors: Safdar Adnan , Singh Kristianna , Sun Raphael C. , Nassr Ahmed A. 
Published: February 2021

Purpose of review
Fetal hydronephrosis secondary to congenital anomalies of the kidney and urinary tract (CAKUT) can adversely affect neonates in the postnatal period with long-term consequences. A prenatal diagnosis of CAKUT can have an early fetal intervention to minimize these consequences. This review aims to provide an overview of the possible fetal intervention with severe hydronephrosis.

Recent findings
Clinical course and outcomes of CAKUT are predicted based on biochemical markers and radiological findings. In spite of advancements and accurately diagnosing the severity of hydronephrosis, there are many controversies surround on selection of cases with antenatal hydronephrosis (ANH) that will benefit from fetal intervention. Despite better diagnosis and techniques fetal intervention is limited to mainly lower urinary tract obstruction patients to improve amniotic fluid volume and assist in lung development.

Summary
ANH can potentially detect the severity of congenital renal anomalies but unable to recognize a specific disease. A multidisciplinary approach is required to diagnose and properly stage cases of severe CAKUT and potential surgical intervention can be considered.