bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Best Practices for Managing Internal Carotid Artery Injury During Endoscopic Endonasal Surgery by Consensus of Expert Opinion
Authors: Kassir Zachary M. , Gardner Paul A. , Wang Eric W. , Zenonos Georgios A. , Snyderman Carl H. 
Published: July 2021

Background Injury to the internal carotid artery (ICA) is a potentially devastating complication of endoscopic endonasal surgery (EES) that as many as 20% of skull base surgeons will experience at least once during their careers. Managing these injuries is difficult given the small operative field and poor visibility created by high-flow hemorrhage, and, at present, there is no consensus regarding best practices. Objective This study seeks to consolidate the practices and opinions of experienced skull base surgeons from high-volume tertiary care centers into a single consensus statement regarding the best practices for managing ICA injuries during EES. Methods A panel of 23 skull base surgeons (15 neurosurgeons and 8 otolaryngologists) completed a 3-round Delphi survey that assessed experiences and opinions regarding various aspects of ICA injury management. Mean (SD) years since fellowship completion was 15.6 (8.1) and all but 3 surgeons had experienced an ICA injury at least once. Results The final consensus statement included 36 guidelines all of which were grouped under 1 of 4 categories: 11 statements concerned preoperative management and equipment for high-risk patients; 14 statements concerned hemorrhage control; 4 statements concerned definitive management; 7 statements concerned pharmacologic treatment, blood pressure, and neurophysiologic monitoring. Conclusions There are numerous decisions that a surgeon must make when facing a carotid artery injury. In our estimation, many questions can be grouped under 1 of the 4 categories outlined in our consensus statement and can be addressed by these findings.
Safety of Endoscopic Sinus Surgery in the Elderly—Are Octogenarian Patients at a Higher Risk?
Authors: Levi Lirit , Reuven Yonatan , Ben-Ner Daniel , Koch Noam , Gunders-Peleg Mor , Nachalon Yuval , Koren Ilan , Hazan Alain , Nakache Gabriel , Reifen Ella , Soudry Ethan 
Published: July 2021

Background Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. Objective To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. Methods Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. Results We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. Conclusions Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.
17,18-Epoxyeicosatetraenoic Acid Inhibits TNF-α-Induced Inflammation in Cultured Human Airway Epithelium and LPS-Induced Murine Airway Inflammation
Authors: Hara Shiori , Tojima Ichiro , Shimizu Shino , Kouzaki Hideaki , Shimizu Takeshi 
Published: July 2021

Background 17,18-Epoxyeicosatetraenoic acid (17,18-EpETE), an eicosapentaenoic acid metabolite, is generated from dietary oil in the gut, and antiinflammatory activity of 17,18-EpETE was recently reported. Objective To evaluate the inhibitory effects of 17,18-EpETE in airway inflammation, we examined in vitro and in vivo effects on mucus production, neutrophil infiltration, and cytokine/chemokine production in airway epithelium. Methods Nasal tissue localization of G protein-coupled receptor 40 (GPR40), a receptor of 17,18-EpETE, was determined by immunohistochemical staining. Expression of GPR40 mRNA in nasal mucosa of chronic rhinosinusitis (CRS) patients and control subjects was determined by reverse transcription-polymerase chain reaction (RT-PCR). The in vitro effects on airway epithelial cells were examined using normal human bronchial epithelial cells and NCI-H292 cells. To examine the in vivo effects of 17,18-EpETE on airway inflammation, we induced goblet cell metaplasia, mucus production, and neutrophil infiltration in mouse nasal epithelium by intranasal lipopolysaccharide (LPS) instillation. Results GPR40 is mainly expressed in human nasal epithelial cells and submucosal gland cells. RT-PCR analysis revealed that the expression of GPR40 mRNA was increased in nasal tissues from CRS patients compared with those from control subjects. 17,18-EpETE significantly inhibited tumor necrosis factor (TNF)-α-induced production of interleukin (IL)-6 , IL-8, and mucin from cultured human airway epithelial cells dose dependently, and these antiinflammatory effects on cytokine production were abolished by GW1100, a selective GPR40 antagonist. Intraperitoneal injection or intranasal instillation of 17,18-EpETE significantly attenuated LPS-induced mucus production and neutrophil infiltration in mouse nasal epithelium. Inflammatory cytokine/chemokine production in lung tissues and bronchoalveolar lavage fluids was also inhibited. Conclusion These results indicate that 17,18-EpETE plays a regulatory role in mucus hypersecretion and neutrophil infiltration in nasal inflammation. Local or systemic administration may provide a new therapeutic approach for the treatment of intractable airway disease such as CRS.
Prevalence of Maxillary Sinus Hypoplasia and Silent Sinus Syndrome: A Radiological Cross-Sectional Retrospective Cohort Study
Authors: Fiorenza Umberto D’Agostino , Spoldi Chiara , Nekrasova Liudmila , Pipolo Carlotta , Lozza Paolo , Scotti Alberto , Maccari Alberto , Felisati Giovanni , Saibene Alberto Maria 
Published: July 2021

Background Maxillary sinus hypoplasia (MSH), associated with enophthalmos and hypoglobus in the silent sinus syndrome (SSS), is a poorly studied condition. The real incidence of MSH and SSS in the adult population is not known. Our study aims at estimating the radiological prevalence of MSH and identifying undiagnosed cases of SSS in a retrospective cohort. Methods A cross-sectional retrospective cohort study was performed in adults, without a history of maxillofacial surgery or trauma, undergoing head CT scans. A radiological database of 1012 consecutive scans was reviewed independently by two authors to identify patients with signs of MSH and SSS and associated findings (septal deviation, uncinate deviation, concha bullosa, sinus opacification, bony rarefaction, and pterygopalatine fossa enlargement). The findings of MSH and SSS were compared with radiological reports. Results 891 eligible CT scans were analyzed. MSH and SSS prevalences were 6.17% (n = 55) and 0,56% (n = 5), respectively. The maxillary sinus was normally or partially ventilated in 96.36% of MSH patients. Lateralization of the uncinate process was detected in about 50% of MSH patients, while a septal deviation towards the affected sinus was detected in 21.82%. In 20% of MSH scans, a concha bullosa was identified. Radiological reports identified a single MSH case. Conclusions Our study confirmed the literature data on MSH prevalence, while it determined a precedently unknown prevalence for SSS, underestimated in the radiology reports. This prevalence needs further confirmation but suggests a routine accurate comparison of both maxillary sinuses in CT scans.
Acute Cartilage Injury Induced by Trans-Articular Sutures
Authors: Ciglič Matic , Marš Tomaž , Maružin Mitja , Alibegović Armin , Vesel Miha , Drobnič Matej 
Published: July 2021

Objective To determine the extent of acute cartilage injury by using trans-articular sutures. Methods Five different absorbable sutures, monofilament polydioxanone (PDS) and braided polyglactin (Vicryl), were compared on viable human osteochondral explants. An atraumatic needle with 30 cm of thread was advanced through the cartilage with the final thread left in the tissue. A representative 300 μm transversal slice from the cartilage midportion was stained with Live/Dead probes, scanned under the confocal laser microscope, and analyzed for the diameters of (a) central “Black zone” without any cells, representing in situ thread thickness and (b) “Green zone,” including the closest Live cells, representing the maximum injury to the tissue. The exact diameters of suture needles and threads were separately measured under an optical microscope. Results The diameters of the Black (from 144 to 219 µm) and the Green zones (from 282 to 487 µm) varied between the different sutures ( P < 0.001). The Green/Black zone ratio remained relatively constant (from 1.9 to 2.2; P = 0.767). A positive correlation between thread diameters and PDS suturing material, toward the Black and Green zone, was established, but needle diameters did not reveal any influence on the zones. Conclusions The width of acute cartilage injury induced by the trans-articular sutures is about twice the thread thickness inside of the tissue. Less compressible monofilament PDS induced wider tissue injury in comparison to a softer braided Vicryl. Needle diameter did not correlate to the extent of acute cartilage injury.
Is There a Difference in Screw Accuracy, Robot Time Per Screw, Robot Abandonment, and Radiation Exposure Between the Mazor X and the Renaissance? A Propensity-Matched Analysis of 1179 Robot-Assisted Screws
Authors: Lee Nathan J. , Zuckerman Scott L. , Buchanan Ian A. , Boddapati Venkat , Mathew Justin , Marciano Gerard , Robertson Djani , Lakomkin Nikita , Park Paul J. , Leung Eric , Lombardi Joseph M. , Lehman Ronald A. 
Published: July 2021

Study Design: Prospective single-cohort analysis. Objectives: To compare the outcomes/complications of 2 robotic systems for spine surgery. Methods: Adult patients (≥18-years-old) who underwent robot-assisted spine surgery from 2016-2019 were assessed. A propensity score matching (PSM) algorithm was used to match Mazor X to Renaissance cases. Preoperative CT scan for planning and an intraoperative O-arm for screw evaluation were preformed. Outcomes included screw accuracy, robot time/screw, robot abandonment, and radiation. Screw accuracy was measured using Vitrea Core software by 2 orthopedic surgeons. Screw breach was measured according to the Gertzbein/Robbins classification. Results: After PSA, a total of 65 patients (Renaissance: 22 vs. X: 43) were included. Patient/operative factors were similar between robot systems ( P > .05). The pedicle screw accuracy was similar between robots (Renaissance: 1.1%% vs. X: 1.3%, P = .786); however, the S2AI screw breach rate was significantly lower for the X (Renaissance: 9.5% vs. X: 1.2%, P = .025). Robot time per screw was not statistically different (Renaissance: 4.6 minutes vs. X: 3.9 minutes, P = .246). The X was more reliable with an abandonment rate of 2.3% vs. Renaissance:22.7%, P = .007. Radiation exposure were not different between robot systems. Non-robot related complications including dural tear, loss of motor/sensory function, and blood transfusion were similar between robot systems. Conclusion: This is the first comparative analyses of screw accuracy, robot time/screw, robot abandonment, and radiation exposure between the Mazor X and Renaissance systems. There are substantial improvements in the X robot, particularly in the perioperative planning processes, which likely contribute to the X’s superiority in S2AI screw accuracy by nearly 8-fold and robot reliability by nearly 10-fold.
Lower Extremity Biomechanics Predicts Major League Baseball Player Performance
Authors: Teske Lucas G. , Beck Edward C. , Bullock Garrett S. , Nicholson Kristen F. , Waterman Brian R. 
Published: July 2021

Background: Although lower extremity biomechanics has been correlated with traditional metrics among baseball players, its association with advanced statistical metrics has not been evaluated. Purpose: To establish normative biomechanical parameters during the countermovement jump (CMJ) among Major League Baseball (MLB) players and evaluate the relationship between CMJ-developed algorithms and advanced statistical metrics. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players in 2 professional organizations performed the CMJ at the beginning of each baseball season from 2013 to 2017. We collected ground-reaction force data including the eccentric rate of force development (“load”), concentric vertical force (“explode”), and concentric vertical impulse (“drive”) as well as the Sparta Score. The advanced statistical metrics from each baseball season (eg, fielding independent pitching [FIP], weighted stolen base runs [wSB], and weighted on-base average) were also gathered for the study participants. The minimal detectable change (MDC) was calculated for each CMJ variable to establish normative parameters. Pearson coefficient analysis and regression trees were used to evaluate associations between CMJ data and advanced statistical metrics for the players. Results: A total of 151 pitchers and 138 batters were included in the final analysis. The MDC for “load,” “explode,” “drive,” and the Sparta Score was 10.3, 8.1, 8.7, and 4.6, respectively, and all demonstrated good reliability (intraclass correlation coefficient > 0.75). There was a weak but statistically significant correlation between the Sparta Score and wSB ( r = 0.23; P = .007); however, there were no significant correlations with any other advanced metrics. Regression trees demonstrated superior FIP with higher Sparta Scores in older pitchers compared with younger pitchers. Conclusion: There was a positive but weak correlation between the Sparta Score and base-stealing performance among professional baseball players. Additionally, older pitchers with a higher Sparta Score had statistically superior FIP compared with younger pitchers with a similar Sparta Score after adjusting for age.
Prenatal tobacco exposure and risk of asthma and allergy outcomes in childhood
Authors: Sunde Rikke Bjersand , Thorsen Jonathan , Pedersen Casper-Emil Tingskov , Stokholm Jakob , Bønnelykke Klaus , Chawes Bo , Bisgaard Hans 
Published: July 2021

BackgroundHarmful effects of prenatal tobacco exposure and possible interaction with 17q12-21 genetic variants have been shown for some asthma outcomes in childhood, whereas findings related to allergy outcomes are more inconsistent. This study aimed to examine the effect of prenatal tobacco exposure and relation to 17q12-21 genotype on a wide array of asthma and allergy-related outcomes in early childhood.MethodsPrenatal tobacco exposure was determined by maternal smoking during the third trimester (yes/no) in 411 children from the phenotyped Copenhagen Prospective Studies on Asthma in Childhood 2000 (COPSAC2000) birth cohort with clinical follow-up to age 7 years. The rs7216389 single nucleotide polymorphism was used as main representative of the 17q12-21 locus. Asthma end-points included asthma diagnosis, exacerbations, episodes with troublesome lung symptoms and lower respiratory tract infections, spirometry, plethysmography, bronchial responsiveness to methacholine, exercise and cold dry air. Allergy-related endpoints included aeroallergen sensitisation, allergic rhinitis, fractional exhaled nitric oxide, blood eosinophil count and urine eosinophil protein X levels. Statistical analyses were done using Cox regression, linear regression, logistic regression and quasi-Poisson regression.ResultsPrenatal tobacco exposure increased the risk of asthma (adjusted hazard ratio (aHR) 2.05, 95% CI 1.13–3.73; p=0.02), exacerbations (aHR 3.76, 95% CI 2.05–6.91; p<0.001), number of LRTIs (adjusted incidence rate ratio 1.87, 95% CI 1.34–2.55; p<0.001), and was associated with decreased spirometry indices (forced expiratory volume in 1 s (FEV1) adjusted mean difference (aMD) −0.07 L, 95% CI −0.13– −0.005 L, p=0.03; maximal mid-expiratory flow aMD −0.19 L·s−1, −0.34– −0.04 L·s−1, p=0.01) and increased bronchial responsiveness to methacholine (provocative dose of methacholine causing a 20% drop in FEV1adjusted geometric mean ratio 0.55, 95% CI 0.31–0.96; p=0.04). In contrast, there was no association with any allergy-related end-points. The effect on asthma depended on 17q12-21 genotype with an increased risk only among children without risk alleles.ConclusionPrenatal tobacco exposure was associated with asthma dependent on 17q12-21 genotype and with exacerbations, lung function and bronchial responsiveness, but not with any allergy-related outcomes. This suggests that tobacco exposurein uteroleads to adverse lung developmental/structural effects rather than susceptibility to develop allergy and type 2 inflammation.
Health and functional status of tiotropium/olodaterol-treated patients with COPD: results from the AERIAL® non-interventional study
Authors: Gillissen Adrian , Marseille Andrea , Skowasch Dirk , Ritz John , Mattiucci-Guehlke Muriel , Pabst Stefan , Greulich Timm , Koczulla Rembert 
Published: July 2021

Patients with COPD often have reduced physical activity, which can impair health status. Real-world data can provide valuable information on the health and functional status of patients with COPD treated with tiotropium/olodaterol. AERIAL®(ClinicalTrials.govNCT03165045) was a German, non-interventional study of patients with COPD receiving treatment with tiotropium/olodaterol under real-world conditions for ∼6 weeks. The primary end-point was the proportion of patients achieving a decrease of ≥0.4 points in Clinical COPD Questionnaire (CCQ) score. The CCQ-4 subdomain was used to assess functional status, and the Physician's Global Evaluation (PGE) scale was used to assess the patients’ general condition. Safety was assessed, as well as patient satisfaction and willingness to continue treatment. Out of 1351 screened patients, 1322 were treated and 1140 comprised the full analysis set. The primary end-point was met: 66.3% of patients achieved a ≥0.4-point decrease in overall CCQ score (mean±sddecrease 0.78±0.95). Mean±sddecreases in CCQ symptoms and functional state subdomains were 0.84±1.06 and 0.75±1.05 points, respectively. PGE scores improved. One fatality (not treatment-related) and 23 drug-related adverse events were recorded, most commonly nausea and vertigo. >85% of patients were satisfied/very satisfied with tiotropium/olodaterol overall and with the Respimat®device, both in terms of inhalation and handling. Most patients (95.2%) expressed willingness to continue treatment. Patients with COPD treated with tiotropium/olodaterolviaRespimat®in routine clinical practice had clinically relevant improvements in health and functional status compared with baseline.
Prevalence of asymptomatic bronchiectasis and associations among the health screening population in South Korea
Authors: Kim Soo Han , Jung Young Ju , Ko Myung-Su , Lee Sei Won , Lee Jae Seung , Oh Yeon-Mok 
Published: July 2021

Despite the burden of bronchiectasis, there is little data from South Korea regarding asymptomatic bronchiectasis. We aimed to investigate the prevalence of bronchiectasis based on computed tomography (CT) findings, with emphasis on asymptomatic bronchiectasis (CT-proven) and its related factors.We analysed data of individuals who underwent chest CT at a South Korean health screening centre from 2016 to 2017. The prevalence of bronchiectasis was evaluated and adjusted by sex, age, and corresponding year for the Korean general population. Logistic regression analysis was performed to identify factors related to asymptomatic bronchiectasis by comparison between a group without bronchiectasis and a group with symptomatic bronchiectasis.Among the 27 617 subjects screened, 1005 were diagnosed with bronchiectasis based on CT findings, representing an adjusted prevalence of 2329 out of 100 000. The adjusted prevalence of asymptomatic bronchiectasis was 1235 out of 100 000, and that of symptomatic bronchiectasis was 1094 out of 100 000. Compared with the non-bronchiectasis group, the factors related to asymptomatic bronchiectasis were female sex (OR 1.41; 95% CI 1.18–1.70), older age (OR 1.06; 95% CI 1.05–1.07), comorbid liver disease (OR 1.32; 95% CI 1.07–1.63) or COPD (OR 4.99; 95% CI 2.88–8.64), history of tuberculosis (OR 1.98; 95% CI 1.46–2.68) and low forced expiratory volume in 1 s (FEV1; OR 0.99; 95% CI 0.98–0.998).In South Korea, the prevalence of asymptomatic bronchiectasis appeared higher than that of symptomatic bronchiectasis. Female sex, older age, liver disease, COPD, history of tuberculosis and low FEV1may be the factors related to asymptomatic bronchiectasis.
Utility of fractional exhaled nitric oxide suppression as a prediction tool for progression to biologic therapy
Authors: Butler Claire A. , McMichael Alan J. , Honeyford Kirsty , Wright Louise , Logan Jayne , Holmes Joshua , Busby John , Hanratty Catherine E. , Yang Freda , Smith Steven J. , Murray Kirsty , Chaudhuri Rekha , Heaney Liam G. 
Published: July 2021

Rationale:The utility of fractional exhaled nitric oxide (FENO) suppression (FeNOSuppT) to identify non-adherence to inhaled corticosteroid (ICS) treatment has previously been reported, but whether it can predict clinical outcome remains unclear.Objectives:We examined the utility of FeNOSuppT in prediction of progression to biologic agents or discharge from specialist care.Methods:FeNOSuppT was measured at home using remote monitoring technology of inhaler use alongside dailyFENOmeasurement over 7 days. Long-term clinical outcomes in terms of progression to biologic agent or discharge from specialist care were compared for non-suppressors and suppressors.Measurements and main results:Of the 162 subjects, 135 successfully completed the test with 81 (60%) positiveFENOsuppression tests. Subjects with a negative FeNOSuppT were more likely to proceed to biologic therapy (39 of 54 patients, 72%) compared to those with a positive FeNOSuppT (35 of 81 patients, 43%, p=0.001). In subjects with a positive FeNOSuppT, predictors of progression to biologic therapy included higher dose of maintenance steroid at initial assessment and prior intensive care unit admission. These subjects had a significant rise inFENObetween post-suppression test and follow-up (median, 33 (IQR 25–55)versus71 (IQR 24–114); p=0.009), which was not explained by altered corticosteroid dose.Conclusions:A negative FeNOSuppT correlates with progression to biologic therapy. A positive FeNOSuppT, with subsequent maintenance of “optimised”FENO, predicts a subgroup of patients in whom asthma control is preserved with adherence to high-dose ICS/long-acting β2 agonist and who can be discharged from specialist care.