bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis, Surgical Management, and Postoperative Care for the Neonate With Sacrococcygeal Teratoma
Authors: Miller Lori , Dunn Stefanie 
Published: August 2018

Background Neonatal sacrococcygeal teratoma is rare occurring in approximately one in 35,000 live births with a female predominance (3:1–4:1 ratio). It is an unusual tumor that develops before birth and arises from embryologically multipotent cells from the Hensen node, which is located in the coccyx. Sacrococcygeal teratomas generally present in two distinct fashions: newborns with large predominately external masses, which are noted in utero or at the time of delivery and are rarely malignant, and older infants and young children presenting with tumors predominately confined to the pelvis with a much higher rate of malignancy. Most sacrococcygeal teratomas are now diagnosed prenatally because of the routine obstetric ultrasonagraphy. An abnormally sized uterus is typically the first sign that a sacrococcygeal teratoma may be present. The increased-sized uterus can be due to a massive tumor or polyhydramnios. Less common presentations include maternal preeclampsia. Newborns generally present with the mass protruding from the sacral region. If detected prenatally, the neonate should be considered for abdominal delivery if the mass is greater than 5 cm in size. In addition, some develop in utero high-output cardiac failure resulting in fetal hydrops and may be candidates for in utero resection. When a prenatally diagnosed sacrococcygeal teratoma is associated with fetal hydrops, the tumor can become life-threatening to both mother and baby. A classification system has been devised by Altman et al. in 1974 and is still used today. Sacrococcygeal teratomas are categorized according to their location and severity. Type I tumors are predominately external. Type II tumors present with both internal and external components. Type III tumors are predominately hidden in the pelvis with a very small external portion. Type IV tumors are entirely hidden within the pelvis. The recommended treatment of a sacrococcygeal teratoma is complete removal of the tumor by surgery performed soon after the birth. Unfortunately, there is a significant recurrence rate of 10%–20% even with complete resection. Long-term follow-up is needed, as there is a risk of malignancy and reoccurrence. Postoperative follow-up is needed during the first several years of life as bowel and bladder functions can be affected. Children should be followed through potty training to ensure that bowel and bladder functions are normal.
Concussion in Adolescents Impairs Heart Rate Response to Brief Handgrip Exercise
Authors: Woehrle Emilie , Harriss Alexandra B. , Abbott Kolten C. , Moir Marcy Erin , Balestrini Christopher S. , Fischer Lisa K. , Fraser Douglas D. , Shoemaker Joel Kevin 
Published: August 2018

Objective:
Test the hypotheses that (1) concussion in adolescents impairs autonomic neural control of heart rate (HR), and (2) HR reactivity improves with symptom resolution.

Design:
Observational, case–control.

Participants:
Nineteen concussed adolescents (8 female adolescents; age 15 ± 2 years) and 16 healthy controls (6 female adolescents, age 15 ± 2 years).

Intervention:
All participants performed an isometric handgrip (IHG) at 30% maximum voluntary contraction lasting 30 seconds. Heart rate (electrocardiogram) and hemodynamic responses (photoplethysmographic Finometer) were recorded from 30 seconds of baseline and the last 10 seconds of handgrip.

Main Outcome Measures:
The HR response (ΔHR) at the onset of moderate-intensity IHG using a mixed 1-way analysis of variance.

Results:
A group × time interaction (P < 0.005) indicated that handgrip evoked a greater ΔHR among control participants (13 ± 10 beats/min) compared with concussed (6.4 ± 6.3 beats/min; group P = 0.63; time P < 0.001; d = 0.77).

Conclusion:
These preliminary results suggest that a concussion impairs the ability to elevate HR at the exercise onset and, given the nature of the task, this could be interpreted to reflect reduced ability to withdraw cardiovagal control. Therefore, the data support the hypothesis of neural cardiac dysregulation in adolescents diagnosed with concussion.

Clinical Relevance:
The IHG test could aid concussion diagnosis and support return-to-play decisions.
Evolving Trends in Cochlear Implantation: A Critical Look at the Older Population
Authors: Agabigum Bora , Mir Ahsan , Arianpour Khashayar , Svider Peter F. , Walsh Erika M. , Hong Robert S. 
Published: August 2018

Objectives/Hypothesis:
Cochlear implantation (CI) is a well-accepted surgical option for the treatment of moderate to profound deafness. The purpose of this study was to evaluate the temporal and geographic trends of this procedure nationwide in the Medicare population in an attempt to explore the impact of evolving technologies and changes in healthcare policy.

Methods:
Medicare Part B national summary procedural datasets from 2007 to 2016 were obtained. Current Procedural Terminology codes for CI as well as auditory osseointegrated implantation were obtained. Centers for Medicare and Medicaid Services (CMS) datasets were evaluated to determine temporal trends. For geographic trends, specific carrier datasets from 2007 and 2016 were used.

Results:
From 2007 through 2016, the number of CI procedures increased annually from 1603 to 3600 (124.6%). Other procedures to treat hearing loss including bone-anchored implantation exhibited comparatively modest increases (23%, 90%). CI procedures increased every year in contrast to bone-anchored implants. Controlling for Medicare population, the greatest number of CI procedures performed per capita in the United States was in the West North Central, with an average 1.05 CIs per 10,000 beneficiaries.

Conclusion:
The number of CI procedures performed in the elderly population has increased markedly over the past 10 years, far outpacing growth in other hearing surgeries. Potential reasons may relate to changes in criteria for CI candidacy over the past decade, although significant regional variability demonstrated suggests a lack of consensus. Further studies would be necessary to ascertain the true reason for geographic disparities.
Novel Computed Tomography Findings Suggestive of Perilymph Gusher
Authors: Varadarajan Varun V. , DeJesus Reordan O. , Antonelli Patrick J. 
Published: August 2018

Objectives:
Perilymphatic gusher (PLG) is an uncommon complication of stapedectomy and cochlear implant placement. Computerized tomography (CT) may reveal congenital dysplasia responsible for PLG but may also be (incorrectly) interpreted as normal. The aim of this study was to review CT findings in patients with PLG reported to have normal temporal bones.

Patients:
Patients in which a PLG was encountered and preoperative CT imaging had been interpreted as normal.

Intervention:
Collaborative review of temporal bone computed tomography by neurotologist and neuroradiologist.

Main Outcome Measure:
Identification of undetected inner ear anomalies that may predispose to PLG.

Results:
Unanticipated PLG was encountered during stapes surgery in two patients and cochlear implantation in one. A focal bony dehiscence between the basal turn of the cochlea and internal auditory canal (IAC) was identified on a few oblique reformatted images in all patients.

Conclusions:
High resolution CT with oblique image reformatting is essential to identify focal communication between the IAC and basal turn of the cochlea in ears with PLG.
Prevention of Chlorhexidine Ototoxicity With Poloxamer in Rats
Authors: Dirain Carolyn O. , Vasquez Taylor K. , Antonelli Patrick J. 
Published: August 2018

Objective:
Skin preparations, like chlorhexidine, are toxic to the inner ear, preventing their use as a preoperative skin disinfectant in the presence of a nonintact eardrum (e.g., perforation or tube). We aimed to determine if a poloxamer gel applied over perforated eardrums could prevent chlorhexidine ototoxicity.

Study Design:
Controlled, in vivo.

Setting:
Academic research laboratory.

Subjects and Methods:
Bilateral myringotomies were performed on 20 Sprague-Dawley rats. Half had poloxamer placed over both eardrums before treatment. All rats had chlorhexidine instilled in one ear and saline in the other. Auditory brainstem response thresholds were measured before and 2- and 4-weeks posttreatment. Cochlear hair cell damage was assessed using scanning electron microscopy.

Results:
Ears with chlorhexidine without poloxamer had significant hearing loss, 37 to 50 dB worse than the other three ear treatments at 2 and 4 weeks posttreatment, at all tested frequencies (4, 18, 16, and 24 kHz; all p < 0.0001). No significant hearing loss was observed in ears that were treated with poloxamer and chlorhexidine (−2 to 8 dB) and the results were not different from the ears that received saline, with or without poloxamer (−2.5 to 8 dB and 5–17 dB; p > 0.05). Electron microscopy showed far more outer hair cell damage in the no poloxamer + chlorhexidine ears compared with the other three treatments.

Conclusion:
The use of a poloxamer barrier may be an effective approach to prevent ototoxicity before chlorhexidine disinfection of the ear with a nonintact tympanic membrane.
Augmented Reality of the Middle Ear Combining Otoendoscopy and Temporal Bone Computed Tomography
Authors: Marroquin Roberto , Lalande Alain , Hussain Raabid , Guigou Caroline , Grayeli Alexis Bozorg 
Published: August 2018

Hypothesis:
Augmented reality (AR) may enhance otologic procedures by providing sub-millimetric accuracy and allowing the unification of information in a single screen.

Background:
Several issues related to otologic procedures can be addressed through an AR system by providing sub-millimetric precision, supplying a global view of the middle ear cleft, and advantageously unifying the information in a single screen. The AR system is obtained by combining otoendoscopy with temporal bone computer tomography (CT).

Methods:
Four human temporal bone specimens were explored by high-resolution CT-scan and dynamic otoendoscopy with video recordings. The initialization of the system consisted of a semi-automatic registration between the otoendoscopic video and the 3D CT-scan reconstruction of the middle ear. Endoscope movements were estimated by several computer vision techniques (feature detectors/descriptors and optical flow) and used to warp the CT-scan to keep the correspondence with the otoendoscopic video.

Results:
The system maintained synchronization between the CT-scan image and the otoendoscopic video in all experiments during slow and rapid (5–10 mm/s) endoscope movements. Among tested algorithms, two feature-based methods, scale-invariant feature transform (SIFT); and speeded up robust features (SURF), provided sub-millimeter mean tracking errors (0.38 ± 0.53 mm and 0.20 ± 0.16 mm, respectively) and an adequate image refresh rate (11 and 17 frames per second, respectively) after 2 minutes of procedure with continuous endoscope movements.

Conclusion:
A precise augmented reality combining video and 3D CT-scan data can be applied to otoendoscopy without the use of conventional neuronavigation tracking thanks to computer vision algorithms.
Complications in Endoscopic Ear Surgery
Authors: Marchioni Daniele , Rubini Alessia , Gazzini Luca , Alicandri-Ciufelli Matteo , Molinari Giulia , Reale Marella , Presutti Livio 
Published: August 2018

Objective:
The aim of this study was to examine the premise that endoscopic ear surgery (EES) is associated with a low rate of complications (intraoperative and postoperative).

Study Design:
Retrospective review at two institutions.

Setting:
Tertiary referral center.

Patients:
The study included 825 patients who underwent exclusive EES between 2008 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Modena University Hospital, and between 2014 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Verona University Hospital.

Interventions:
Exclusive endoscopic ear surgery between 2008 and 2016 (tympanoplasties, second look or revision tympanoplasties, myringoplasties, stapedoplasties, canalplasties, ossiculoplasties, and exploratory tympanotomies). All surgical procedures were performed by two experienced surgeons.

Main Outcome Measure:
For each procedure, intraoperative, and early and delayed postoperative complications were evaluated.

Results:
The most common ear pathologies for which patients were sent for EES were cholesteatoma (33.6%), chronic otitis media (36.3%) and otosclerosis (26.8%). There was no case of major intraoperative complications such as injury to the dura or vascular structures. We observed minor intraoperative complications in 4.1% of the cases. Only 1.3% of patients experienced early postoperative complications. Delayed complications affected less than 1% of the cohort.

Conclusions:
Data from this study confirm the safety of the endoscopic technique, with very low complication rates, indicating that EES is a reliable therapeutic option, in particular, for tympanoplasties, myringoplasties, and stapedoplasties, as well as second look procedures. We have reported our experience with EES morbidity so that it can be compared with data from other centers using the same surgical technique.
‘Massive transfusion protocols and the use of tranexamic acid’
Authors: Godbey Elizabeth A. , Schwartz Joseph 
Published: August 2018

Purpose of review
We review recent articles pertaining to the use of tranexamic acid (TXA) in populations at risk for massive transfusion. Although there are no recent studies that specifically examine the use of TXA in massive transfusion protocols (MTPs), there are a few studies with subgroups of massive transfusion patients.

Recent findings
In recent years, many publications have discussed outcomes and safety associated with the addition of TXA to treatment plans for bleeding pediatric, trauma, and postpartum hemorrhage patients. In general, TXA appears to decrease mortality and transfusion requirements.

Summary
TXA was shown to decrease mortality in several bleeding populations. It is now a common addition to MTPs. There is conflicting evidence regarding the potential of TXA as a risk factor for thrombotic events. Ongoing studies should provide additional evidence regarding the thrombotic risk of TXA in massive transfusion.
Delayed haemolytic and serologic transfusion reactions: pathophysiology, treatment and prevention
Authors: Siddon Alexa J. , Kenney Barton C. , Hendrickson Jeanne E. , Tormey Christopher A. 
Published: August 2018

Purpose of reviewThe aim of this study was to summarize the basic epidemiology, pathophysiology and management of delayed serologic and delayed haemolytic transfusion reactions (DHTRs), as well as recent developments in our understanding of these adverse events.Recent findingsSeveral studies have identified risk factors for DHTRs, including high alloantibody evanescence rates among both general patient groups and those with sickle cell disease (SCD). Antibody detection is also hampered by the phenomenon of transfusion record fragmentation. There have also been enhancements in understanding of what may contribute to the more severe, hyperhaemolytic nature of DHTRs in SCD, including data regarding ‘suicidal red blood cell death’ and immune dysregulation amongst transfusion recipients with SCD. With growing recognition and study of hyperhaemolytic DHTRs, there have been improvements in management strategies for this entity, including a multitude of reports on using novel immunosuppressive agents for preventing or treating such reactions.SummaryDelayed serologic and haemolytic reactions remain important and highly relevant transfusion-associated adverse events. Future directions include further unravelling the basic mechanisms, which underlie DHTRs and developing evidence-based approaches for treating these reactions. Implementing practical preventive strategies is also a priority.
Age-related clonal hematopoiesis: implications for hematopoietic stem cell transplantation
Authors: Abelson Sagi , Wang Jean C.Y. 
Published: August 2018

Purpose of review
Over the past decade, advances in hematopoietic stem cell transplantation (HSCT) have enabled older individuals to undergo the procedure as well as to serve as donors. Recently, aging has been linked with the development of age-related clonal hematopoiesis (ARCH), defined as the gradual clonal expansion of hematopoietic stem and progenitor cells (HSPC) carrying recurrent disruptive genetic variants in individuals without a diagnosis of hematologic malignancy. Here we will review the implications of ARCH in the context of HSCT.

Recent findings
ARCH is highly prevalent in the general population and commonly involves genes that are recurrently mutated in hematologic malignancies. Nevertheless, the vast majority of individuals with ARCH will not develop overt hematologic disease in their lifetime. The presence of ARCH may increase the risk of therapy-related myeloid neoplasms (t-MN) in individuals undergoing autologous HSCT. In the setting of allogeneic HSCT, ARCH present in the donor may contribute to adverse outcomes such as unexplained cytopenias posttransplant and donor cell leukemia.

Summary
A better understanding of the hematopoietic milieu of HSCT recipients and of the importance of ARCH in the context of the replicative pressures imposed on transplanted HSPCs is needed in order to optimize conditioning regimens, donor selection and clinical outcomes post-HSCT.
Preexisting Diabetes Elevates Risk of Local and Systemic Complications in Acute Pancreatitis
Authors: Mikó Alexandra , Farkas Nelli , Garami András , Szabó Imre , Vincze Áron , Veres Gábor , Bajor Judit , Alizadeh Hussain , Rakonczay Zoltán , Vigh Éva , Márta Katalin , Kiss Zoltán , Hegyi Péter , Czakó László 
Published: August 2018

Abstract
The prevalence of diabetes mellitus (DM) and acute pancreatitis (AP) increases continuously, therefore, to understand the effects of preexisting diabetes on AP is crucially needed. Here, we performed a systematic review and meta-analysis in which AP patients including DM and non-DM groups were sorted. Several outcome parameters were analyzed, and the odds ratio (OR) and standardized mean difference with 95% confidence intervals (CIs) were calculated.
We found 1417 articles, of which 9 articles involving 354,880 patients were analyzed. More complications were seen in diabetic patients than in non-DM patients (OR, 1.553 [95% CI, 1.266–1.904]; P < 0.001). Intensive care unit admission (OR, 1.799 [95% CI, 1.442–2.243]; P < 0.001) and renal failure (OR, 1.585 [95% CI, 1.278–1.966]; P < 0.001) were more frequent in DM patients. There was a tendency of higher mortality and local complications (OR, 1.276 [95% CI, 0.991–1.643]; P = 0.059; and OR, 1.267 [95% CI, 0.964–1.659]; P = 0.090, respectively) in preexisting DM. Length of hospitalization was longer in DM patients (standardized mean difference, 0.217 [95% CI, 0.075–0.360]; P = 0.003). Preexisting DM negatively influences the outcome of AP and increases the risk of renal failure, local complications, and mortality.
Physical Activity, the Childhood Cancer Symptom Cluster–Leukemia, and Cognitive Function
Authors: Hooke Mary C. , Rodgers Cheryl , Taylor Olga , Koerner Kari M. , Mitby Pauline , Moore Ida , Scheurer Michael E. , Hockenberry Marilyn J. , Pan Wei 
Published: August 2018

Background
Children undergoing leukemia treatment report co-occurring symptoms of fatigue, sleep disturbances, pain, nausea, and depression as a symptom cluster. Physical activity (PA) is essential for development and may influence symptom severity. Children with leukemia are at risk of cognitive impairments from central nervous system therapies. Using a longitudinal parallel-process model, relationships among function and symptom clusters were explored.

Objective
This study examined the longitudinal mediation effects of PA on cognition via a symptom cluster during leukemia treatment.

Methods
Symptoms, PA, and cognitive function of 327 children aged 3 to 18 years were measured over 4 intervals during the first year of leukemia treatment. Children 7 years or older self-reported and parents reported for younger children. Parents completed cognitive function measurements for all children. The influence of the first time point and the subsequent change between all 4 time points of PA on the symptom cluster were explored. Analysis determined whether the symptom cluster mediated the effect of cognition over the treatment period.

Results
Patients with a higher PA at time 1 reduced their symptom cluster severity over the measurements. However, when PA increased over the measurements, symptom cluster severity also increased. When the symptom cluster was more severe at time 1, cognitive function was lower at time 1, and cognitive function decreased over time. When symptoms became more severe over time, cognitive function declined.

Conclusions
The symptom cluster acted as a mediator between PA and cognition.

Implications for Practice
Symptom management during treatment may be an additional strategy for protecting cognitive function.
The Relationships Between Weight Bias, Perceived Weight Stigma, Eating Behavior, and Psychological Distress Among Undergraduate Students in Hong Kong
Authors: Cheng Man Yan , Wang Shu-Mei , Lam Yin Ying , Luk Hiu Tung , Man Yuk Ching , Lin Chung-Ying 
Published: August 2018

Abstract
Weight bias issues are rarely discussed in Asia. Therefore, we examined the relationships between weight bias, perceived weight stigma (PWS), eating behavior, and psychological distress among Hong Kong people. Using cross-sectional design, 400 undergraduate students (175 men) completed questionnaires and were assigned into a self-reported overweight (n = 61) or nonoverweight group (n = 339) using body mass index, and a self-perceived overweight (n = 84) or nonoverweight group (n = 316) based on self-perception. For self-reported and self-perceived overweight groups, more weight bias was related to higher depression (β = −0.403; p = 0.004). Self-perceived group additionally showed that weight bias was related to PWS and inappropriate eating behaviors; PWS related to inappropriate eating behaviors. For self-reported and self-perceived nonoverweight groups, weight bias was related to PWS, inappropriate eating behaviors, anxiety, and depression (β = −0.228 to −0.148; p's < 0.05); PWS was associated with inappropriate eating behaviors, anxiety, and depression. Thus, weight bias issues should not be ignored for both overweight and nonoverweight people.
A Cross-Sectional Study on the Prevalence and Risk Correlates of Mental Disorders: The GRANADΣP Study
Authors: Cervilla Jorge A. , Gutiérrez Blanca , Rodríguez-Barranco Miguel , Ibanez-Casas Inmaculada , Pérez-García Miguel , Valmisa Eulalio , Carmona José , Molina Esther , Moreno-Kustner Berta , Rivera Margarita , Lozano Vanessa , Muñoz-Negro José Eduardo , Ching Ana , Guerrero Margarita , Porras-Segovia Alejandro , Ruiz-Pérez Isabel 
Published: August 2018

Abstract
This is a cross-sectional study of participants from a population census living in the province of Granada (Spain). A total of 1176 persons were contacted, 367 (31%) refused and 54 (6.7%) needed substitution. A final sample of 809 participants (response rate, 69.3%) were screened for mental disorder (MD) using the MINI International Neuropsychiatric Interview, a comprehensive interview validated to generate diagnoses compatible with ICD-10/DSM-4 criteria. Current (1-month) prevalence for any MD was 11.3% (95% confidence interval [CI], 9.7%–13.4%; affective 8.2%, anxiety 9.6%, psychotic 2.1%, addiction 1.8%, personality disorder 3.6%). Lifetime MD prevalence was 24.6% (95% CI, 21.6–27.6; affective 14.9%, anxiety 15.5%, psychotic 3.4%, addiction 4.4%, personality disorder 3.6%). Female sex was associated with MD, but this appeared partially due to higher levels of neuroticism among women. MD also correlated significantly with cannabis use, family history of MD, higher social adversity, higher suicide risk, poorer physical health, poorer cognitive performance, and personality problems.