bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra-Cochlear Electrocochleography During Cochear Implant Electrode Insertion Is Predictive of Final Scalar Location
Authors: Koka Kanthaiah , Riggs William Jason , Dwyer Robert , Holder Jourdan Taylor , Noble Jack H. , Dawant Benoit M. , Ortmann Amanda , Valenzuela Carla V. , Mattingly Jameson K. , Harris Michael M. , O’Connell Brendan P. , Litvak Leonid M. , Adunka Oliver F. , Buchman Craig Alan , Labadie Robert F. 
Published: August 2018

Hypothesis:
Electrocochleography (ECochG) patterns observed during cochlear implant (CI) electrode insertion may provide information about scalar location of the electrode array.

Background:
Conventional CI surgery is performed without actively monitoring auditory function and potential damage to intracochlear structures. The central hypothesis of this study was that ECochG obtained directly through the CI may be used to estimate intracochlear electrode position and, ultimately, residual hearing preservation.

Methods:
Intracochlear ECochG was performed on 32 patients across 3 different implant centers. During electrode insertion, a 50-ms tone burst stimulus (500 Hz) was delivered at 110 dB SPL. The ECochG response was monitored from the apical-most electrode. The amplitude and phase changes of the first harmonic were imported into an algorithm in an attempt to predict the intracochlear electrode location (scala tympani [ST], translocation from ST to scala vestibuli [SV], or interaction with basilar membrane). Anatomic electrode position was verified using postoperative computed tomography (CT) with image processing.

Results:
CT analysis confirmed 25 electrodes with ST position and 7 electrode arrays translocating from ST into SV. The ECochG algorithm correctly estimated electrode position in 26 (82%) of 32 subjects while 6 (18%) electrodes were wrongly identified as translocated (sensitivity = 100%, specificity = 77%, positive predictive value = 54%, and a negative predictive value = 100%). Greater hearing loss was observed postoperatively in participants with translocated electrode arrays (36 ± 15 dB) when compared with isolated ST insertions (28 ± 20 dB HL). This result, however, was not significant (p = 0.789).

Conclusion:
Intracochlear ECochG may provide information about CI electrode location and hearing preservation.
No Squelch Effect After Sequential Bilateral Cochlear Implantation in Postlingually Deafened Adults: Is There a First Ear Advantage?
Authors: Kraaijenga Véronique J. C. , Smit Adriana L. , Ramakers Geerte G. J. , Stokroos Robert J. , van Zanten Gijsbert A. 
Published: August 2018

Objectives:
To investigate whether a squelch effect develops in postlingually deafened adults after sequential bilateral cochlear implantation.

Study Design:
Prospective study as part of a randomized controlled trial on the difference between simultaneous versus sequential bilateral cochlear implantation.

Setting:
Tertiary referral center.

Participants:
Sixteen postlingually deafened adults.

Intervention:
Sequential bilateral cochlear implantation with a 2-year interimplant interval.

Main Outcome Measure:
A squelch effect was defined as a better bilateral score than unilateral score on a speech-intelligibility-in-noise test with spatially separated sources. The squelch effect was evaluated for the participants’ best performing cochlear implant (CI) ear, the left CI in the condition with speech from −60 degrees azimuth and noise from +60 degrees azimuth (S-60 N+60), the right CI (N-60 S+60), CI1 and CI2. Evaluations took place 1, 2 and median 4 years after sequential implantation.

Results:
No significant squelch effect was found, except for the right CI (N-60 S+60) after 2 years. No differences in speech perception-in-noise from straight ahead were seen between CI1 and CI2. Comparing performance of participants whose better or worse ear was implanted first did not reveal differences either. For the best performing situation, 7/16, 6/16, and 3/12 participants exhibited a squelch effect after 1, 2, and 4 years of follow-up.

Conclusions:
Participants who underwent sequential bilateral cochlear implantation with a 2-year interimplant interval did not develop an evident squelch effect on group level after a median follow-up of 4 years. Individual participants were able to make use of the squelch effect. The less evident squelch effect is at odds with our group of simultaneously implanted bilateral cochlear implant users. Neither a difference between CI1 and CI2, nor implanting the better or worse ear first could explain the less evident squelch effect in these patients.

Trial Registration:
Dutch Trial Register NTR1722.
Evolution of Acquired Middle Ear Cholesteatoma in Patients With Ectrodactyly, Ectodermal Dysplasia, Cleft Lip/Palate (EEC) Syndrome
Authors: Lourencone Luiz Fernando Manzoni , Koga Fernanda Dias Toshiaki , Oliveira Eduardo Boaventura , Jorge Jose Carlos , de Brito Rubens 
Published: August 2018

Objective:
To review an institutional experience with the surgical and clinical management of acquired middle ear cholesteatoma in patients with ectrodactyly, ectodermal dysplasia, cleft lip/palate (EEC) syndrome.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
Eight patients with medical history significant for EEC syndrome who underwent surgery for acquired middle ear cholesteatoma between 1996 and 2016.

Intervention(s):
Appropriate surgical interventions at the time of admission.

Main Outcome Measure(s):
History of ventilation tube insertion, status of the contralateral ear, surgical technique, cholesteatoma recidivism, presence of postoperative external auditory canal stenosis, pre and postoperative audiograms.

Results:
Cholesteatoma was diagnosed in all patients, 3 (37.5%) unilateral and 5 (62.5%) bilateral, totalizing 13 ears. Six ears (46.2%) underwent a canal wall up mastoidectomy but required conversion to a canal wall down technique in a second procedure due to recurrent cholesteatoma. In the remaining seven ears (53.8%) a canal wall down mastoidectomy was performed. Of all meatoplasty performed, seven (53.8%) evolved with stenosis of the external auditory canal.

Conclusions:
Our results suggest that most patients with EEC syndrome and middle ear cholesteatoma should be considered for a canal wall down mastoidectomy due to extensive disease and a high rate of recidivism. In addition, a high percentage of postoperative stenosis of the external auditory canal was found in this group.
Reducing Radiation Dose for High-resolution Flat-panel CT Imaging of Superior Semicircular Canal Dehiscence
Authors: Mekabaty Amgad El , Pross Seth E. , Martinez Mesha , Carey John P. , Pearl Monica S. 
Published: August 2018

Objective:
High-resolution flat panel computed tomography (FPCT) is useful for the evaluation of temporal bone pathologies. While radiation exposure remains a concern, efforts have been devoted to reduce dose, while maintaining image quality. We hypothesize that removing the antiscatter grid (ASG) results in decreased radiation exposure, while maintaining diagnostic image quality for the evaluation of superior semicircular canal dehiscence (SSCD).

Methods:
Ten patients with clinical suspicion for SSCD participated in this prospective study. Two sequential collimated 20-second FPCT acquisitions were performed (first: grid in; second: grid removed) in all patients. Secondary reconstructions were created by manually generating the volume of interest to include the middle ear using a voxel size of 0.1 mm and 512 × 512 matrix. Radiation dose parameters (air kerma (Ka,r) in mGy and dose area product (DAP) in μGym2) were recorded. Three reviewers analyzed images for the ability to diagnose SSCD, to identify the stapes crurae, and to determine if an ASG was present.

Results:
The average Ka,r and DAP for the grid-in acquisitions were 246.7 mGy (SD 47.9) and 2838.0 μGym2 (SD 862.8), versus 160.2 mGy (SD 33.2) and 2026.3 μGym2 (SD 644.8) for the grid-out acquisitions, respectively (p<0.001 for both Ka,r and DAP). Radiation exposure was reduced by approximately 30% solely by removing the ASG. All reviewers correctly identified all patients with SSCD (confirmed at surgery), with mean AUC of 0.99 (κ = 0.90).

Conclusion:
Removing the antiscatter grid during FPCT imaging of the temporal bones is a simple and effective way to reduce radiation exposure while maintaining diagnostic image quality for the evaluation of SSCD.
Further Beneficial Effect of Hearing Aids on Speech Recognition Performance Besides Amplification: Importance of the Restoration of Symmetric Hearing
Authors: Kwak Min Young , Kang Yong Kyung , Kim Dong Hyun , An Yong-Hwi , Shim Hyun Joon 
Published: August 2018

Objective:
To identify the improvement in auditory spectral resolution, temporal resolution, and speech recognition conferred with various hearing-aid (HA) technologies when the amplification effect of the HA is excluded, and to compare the beneficial effects depending on the restoration of symmetric hearing with different amplification settings in various hearing impairment conditions.

Study Design:
Prospective study.

Setting:
Tertiary referral center.

Subjects:
Sixty-two subjects who had used HAs for more than 3 months were divided into four groups: group 1, bilateral HAs (n = 28); group 2, unilateral HA in the better ear (n = 12); group 3, unilateral HA in the worse ear (n = 12); group 4, unilateral HA with symmetric hearing thresholds (n = 10).

Methods:
Aided performance and unaided performance were compared in each group. Four different psychoacoustic measurements were made: 1) spectral ripple discrimination; 2) temporal modulation detection; 3) speech recognition threshold in white noise; and 4) speech discrimination score (SDS) under quiet conditions. All test signals were presented by a loudspeaker located 1 m in front of the subject in a sound-attenuating booth, at their most comfortable levels, with or without HAs.

Results:
In group 1, the use of HAs significantly improved both SDS under quiet conditions and speech recognition in noise compared with the unaided condition. Group 2 showed better SDS under quiet conditions with HAs, and group 3 showed improved speech recognition in noise with HAs. In contrast, in group 4, no measurements differed with or without HAs.

Conclusions:
These results demonstrate the benefits of HAs on speech perception in noise, in addition to their amplification effect, but only when HA restores symmetric hearing.
Weight Gain Trajectory Predicts Long‐term Overweight and Obesity After Pediatric Liver Transplant
Authors: Swenson Sonja Marie , Perito Emily Rothbaum 
Published: August 2018

ABSTRACTObjective:The aim of the study is to identify early predictors of long‐term overweight and obesity in pediatric liver transplant recipients.Methods:Single‐center, retrospective review of children who underwent liver transplant before age 6 years. Body mass index (BMI), weight, and height percentiles at transplant and post‐transplant were calculated. BMI, weight gain trajectories, and failure‐to‐thrive (FTT) were examined as predictors of overweight/obesity at 3 and 5 years post‐transplant.Results:Children (n = 70) were median 0.9 years at transplant. Median BMI percentile increased from 37 (interquartile range (IQR) 12–73) at transplant to 83 (IQR 64–97) at 12 months, with median weight percentile 47 (IQR 26–67) and height percentile 9 (IQR 2–32). Overweight/obesity prevalence peaked at 3 years post‐transplant (44%). Children who were overweight/obese at 3 years post‐transplant were more likely to be overweight/obese at transplant, and at 6 and 12 months post‐transplant (odds ratio (OR): 9.4, P = 0.02; OR: 6.7, P = 0.013, OR: 6.4, P = 0.007, respectively). The prevalence of overweight/obesity decreased to 26% at 5 years. Rapid weight gain post‐transplant did not predict overweight/obesity at 3 or 5 years. Over one‐third of children who were FTT at transplant were overweight/obese at 3 or 5 years, but FTT at transplant did not increase later obesity risk.Conclusions:Most children gain weight rapidly after liver transplant. Nearly half of transplant recipients are overweight/obese at 3 years, but the prevalence decreases by 5 years. Those who become overweight/obese tend to do so within 1 year post‐transplant, making this an important time to identify high‐risk children and provide counseling.
Nationwide Survey of Hospitalization Due to Pediatric Food-Induced Anaphylaxis in the United States
Authors: Okubo Yusuke , Nochioka Kotaro , Testa Marcia A. 
Published: August 2018

Objective
Anaphylaxis is a common, serious, systemic allergic reaction. In the United States, the change of annual hospitalization rates by anaphylaxis-trigger foods and risk factors associated with severity remain unclear.

Methods
Hospital discharge records of food-induced anaphylactic reactions of individuals younger than 20 years were obtained from Kids' Inpatient Database in 2006, 2009, and 2012 and were weighted to estimate the number of hospitalizations in the United States. We identified annual hospitalization rates by patients' characteristics and anaphylaxis-trigger foods and investigated factors associated with severity and use of mechanical ventilation with multivariable logistic regression.

Results
A total of 3427 hospitalizations were obtained, and annual hospitalization rates showed a significantly increasing trend from 1.2 per 100,000 children in 2006 to 1.5 per 100,000 children in 2012 (P < 0.001). The leading causes of hospitalizations due to food-induced anaphylaxis were peanuts (0.35–0.48 per 100,000 children), tree nuts and seeds (0.20–0.32 per 100,000 children), and milk products (0.09–0.13 per 100,000 children), with significantly increasing trends during 2006–2012. Milk products were significantly associated with severity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3–2.9). Ages between 13 and 20 years (OR, 2.7; 95% CI, 1.4–5.1) and comorbidity of asthma (OR, 2.1; 95% CI, 1.3–3.4) were significantly associated with the use of mechanical ventilation.

Conclusions
The annual hospitalization rates in the entire United States showed an increasing trend during 2006–2012. The rates of peanuts, tree nuts and seeds, and milk products demonstrated upward trends. Milk products, ages between 13 and 20 years, and comorbidities of asthma were related to severity and morbidity.
A Review of Validated Quality-of-Life Patient-Reported Outcome Measures in Pediatric Plastic Surgery
Authors: Roller Janine M. , Courtemanche Rebecca J. M. , Courtemanche Douglas J. 
Published: August 2018

Background:
There has been an exponential increase in the number of patient-reported outcome measures in plastic surgery. The authors reviewed the reliability, validity, and practicality of the most frequently used patient-reported outcome measures in pediatric plastic surgery research.

Methods:
A review of the literature from January of 2010 to June of 2015 was conducted to identify patient-reported outcome measures in pediatric plastic surgery. Patient-reported measures used in five articles with two validation studies were included for analysis and classified as generic, disease-specific, and mental health. The type of validation used and reliability scores were compared across each class of outcome measure. The practicality of each measure was determined by the frequency of use and the number of items and cost.

Results:
Of the 173 unique patient-reported outcome measures identified, 14 were included for analysis and classified as generic (n = 7), disease-specific (n = 4), and mental health (n = 3). The majority of all measures used construct validity. Disease-specific measures had the highest distribution of domains related to physical functioning, the same domain also found to have the highest reliability scores. A patient-reported outcome measure’s frequency of use was not associated with its number of items or cost.

Conclusions:
This review found that generic patient-reported outcome measures were used most often, construct validity was used most frequently, physical functioning domains had the highest reliability, and the number of items or cost of a patient-reported outcome measure was not related to its frequency of use. Considered together, this information may inform the future development or selection of patient-reported outcome measures in pediatric plastic surgery.
Simultaneous Reconstruction of the Lower Lip with Gracilis Functioning Free Muscle Transplantation for Facial Reanimation: Comparison of Different Techniques
Authors: Lin Jerry Tsung-Kai , Lu Johnny Chuieng-Yi , Chang Tommy Nai-Jen , Chuang David Chwei-Chin 
Published: August 2018

Background:
Functioning free muscle transplantation is currently the gold standard for the reconstruction of facial paralysis, focusing more on the upper lip reconstruction rather than on the lower lip. This study aimed to compare different lower lip reconstructive methods when performing functioning free muscle transplantation for facial reanimation.

Methods:
A retrospective review of functioning free muscle transplantation for facial reanimation from 2007 to 2015 was performed. Patients were divided into three groups: in group 1 (n = 15), a free plantaris tendon graft anchored to the gracilis muscle was passed into the lower lip to create a loop within; in group 2 (n = 12), an aponeurosis tail of the gracilis muscle was attached to the lower lip; and in group 3 (n = 18), no suspension of the lower lip was performed. All patients had at least 2 years of follow-up. Outcomes were assessed by photographs and videos, including subjective evaluation of midline deviation and horizontal tilt and objective analysis of smile dimensions and area.

Results:
A total of 45 patients were included. Results from the subjective evaluation demonstrate group 1 patients having the best improvement (overall score: p = 0.004 and p = 0.005, Fisher’s exact test). The objective evaluation showed group 1 and 2 patients with better results compared with group 3 (horizontal component, p = 0.009; vertical component, p = 0.004; area distribution, p < 0.001, Kruskal-Wallis test).

Conclusions:
Both plantaris tendon graft and gracilis aponeurosis achieved better improvement in subjective and objective evaluations than those who had no reconstruction of the lower lip. In particular, the plantaris tendon graft can achieve the most lower lip excursion with overall improved symmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Cephalic Rotation of the Nasal Tip
Authors: Afrooz Paul N. , Carboy Jourdan A. , Mendez Bernardino M. , Rohrich Rod J. 
Published: August 2018

Summary:
The position of the nasal tip holds important aesthetic significance. Cephalic rotation of the nasal tip is a frequent motivating factor for patients seeking rhinoplasty. The position of the nasal tip is a complex interplay of the size, morphology, and position of several anatomical components of the lower one-third of the nose. Cephalic rotation can be achieved by means of six different methods. The indirect methods promote passive cephalic rotation and include cephalic trim of the lower lateral cartilages, caudal trim of the upper lateral cartilages, and caudal septal trim. Direct methods involve precise repositioning of the domes and include shortening the lateral crura, lateral domal relocation, and the tip rotation suture. Used alone or in combination, these techniques and their subtle variations represent comprehensive and effective methods to achieve cephalic rotation of the nasal tip.
Mechanical Loading Improves Engineered Tendon Formation with Muscle-Derived Cells: An In Vivo Analysis
Authors: Chen Bo , Ding Jinping , Zhao Zhenxia , Jin Ji , Zhu Shan , Zang Mengqing , Xue Bingjian , Liu Yuanbo 
Published: August 2018

Background:
The authors’ previous study showed that muscle-derived cells could regenerate strong engineered tendon with better tissue structure. However, little was known about the mechanism of neotendon built by muscle-derived cells, and the development and maturation of the cells. The authors hypothesized that mechanical loading modulated this process. The aim of this study was to investigate whether mechanical loading could regulate muscle-derived cell–based engineered tendon formation and maturation.

Methods:
Muscle-derived cells were isolated, expanded, and seeded onto polyglycolic acid fibers that formed a cell-scaffold complex. After in vitro culture for 2 weeks, half of them were implanted without loading and the other half were sutured to mouse fascia that could provide a natural dynamic loading. At 12 and 24 weeks after implantation, histologic examinations, ultrastructure, and biomechanical characteristics were evaluated.

Results:
Gross observation results showed that under mechanical loading, neotendon tissue could be generated with muscle-derived cells and the tissue structure became more mature with the increase of culture time. Well-organized aligned collagen fibers and elongated morphologic cells were observed on histologic examination under mechanical loading. In contrast, the nonload group failed to form neotendon, but formed disorganized fibrous tissue with significantly worse mechanical properties and poor collagen fibril structure.

Conclusions:
This study demonstrates that mechanical loading is indispensable in tendon tissue engineering with muscle-derived cells. Although muscle-derived cells have a potential advantage in neotendon regeneration, stress deprivation resulted in a distinctly inferior maturity level of engineered tendon.
Protocol Duodenal Graft Biopsies Aid Pancreas Graft Surveillance
Authors: Gunther Brockmann Jens , Butt Amir , AlHussaini Hussa F. , AlMana Hadeel , AlSaad Khaled , Al-Awwami Moheeb , Clemens Broering Dieter , Ali Tariq 
Published: August 2018

Background.
Histological evaluation of the pancreas graft is usually done on demand resulting in significant delays. This analysis reports on endoscopic protocol duodenal graft biopsies at regular intervals to determine feasibility, safety, and monitoring benefits.

Methods.
Protocol duodenal graft biopsies in 27 consecutive pancreas transplants (10 simultaneous pancreas kidney [SPK], 17 pancreas after kidney [PAK]) with a follow-up of a minimum of 12 months were performed at days 14, 30, 90, 180, 360, 430. University of Pittsburgh Medical Center classification for intestinal rejection was used. C4d staining was performed when antibody-mediated rejection was suspected.

Results.
Overall patient and pancreas graft survival was 100% and 93% at a mean follow-up of 2.8 years. One hundred sixty-seven endoscopic biopsy procedures were performed in 27 grafts without any complication. Biopsies revealed rejection in 3 (30%) SPK recipients and in 15 (82%) of PAK recipients as early as 14 days posttransplant. Two patients underwent PAK retransplantation diagnosed with acute rejection at day 180. All except 1 recipient being treated for rejection, showed histological improvement following antirejection treatment. Following transient treatment success, a total of 3 pancreas grafts were lost for immunological reason. One loss was immediate despite antirejection treatment, 1 secondary to nonresolving rejection at 7 months and the third due to recurrent rejection 15 months posttransplantation. Additionally, biopsies detected vascular (venous thrombosis) and overimmunosuppression (cytomegalovirus infection) complications.

Conclusions.
Protocol graft duodenal biopsies detect complications after whole-organ pancreas transplantation, are useful in guiding therapy, and carry potential for improving outcome.