bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnetic resonance imaging findings in idiopathic sudden sensorineural hearing loss
Authors: Clyde Joseph W , Patel Vijay A , Kanekar Sangam , Isildak Huseyin 
Published: January 2019

Background The unpredictability in presenting signs and symptoms of idiopathic sudden sensorineural hearing loss (SSNHL) presents a notable diagnostic challenge for clinicians. Previous studies have confirmed the potentially important role of magnetic resonance imaging (MRI) in the diagnosis and prognostication of idiopathic SSNHL to guide definitive medical therapy, but correlations of these findings with outcomes remain controversial. Purpose To evaluate and identify magnetic resonance imaging (MRI) findings associated with idiopathic sudden sensorineural hearing loss (SSNHL). Material and Methods Sixty-eight patients with a documented diagnosis of idiopathic SSNHL and 20 controls underwent 1.5-T or 3-T MRI of the brain. Age, gender, ethnicity, associated co-morbidities, and audiometry findings were also recorded. Statistical analysis was performed to compare outcome measures between idiopathic SSNHL and control groups. Results The mean age of the cohort was 57 ± 17 years, with a male-to-female ratio of 1:1.1. MRI findings include 25.0% ( P = 1.000) with chronic microangiopathic disease, 14.7% ( P = 0.165) with temporal bone aberrations, 13.2% ( P = 0.165) with facial and/or vestibulocochlear nerve complex changes, 11.8% ( P = 1.000) with venous malformations, 8.8% ( P = 0.104) with arterial malformations, and 8.8% ( P = 0.184) with cerebral and/or brainstem parenchymal disease. Conclusion Arteriovenous malformations and central neurologic disease are not directly associated with idiopathic SSNHL on MRI. However, visualized signal changes of inner ear structures and facial/vestibulocochlear nerve complex support previously postulated theories, which include viral as well as inflammatory processes in the development of idiopathic SSNHL.
Meta-analysis of the efficacy of sexual intercourse for distal ureteric stones
Authors: Xu Bin , Yan Huilei , Zhang Xuebao , Cui Yuanshan 
Published: January 2019

Objective This meta-analysis was performed to evaluate the efficacy of sexual intercourse for treatment of distal ureteral stones. Methods Randomized controlled trials (RCTs) of sexual intercourse for treatment of distal ureteral stones were searched using PubMed, EMBASE, and the Cochrane Controlled Trials Register. Results Three RCTs comprising 240 patients were included in the meta-analysis, which showed that sexual intercourse was effective in treating distal ureteral stones. The expulsion rate of distal ureteral stones at the second week (odds ratio [OR] = 6.61, 95% confidence interval [CI]: 3.66 to 11.94), expulsion rate of distal ureteral stones at the fourth week (OR = 4.00, 95% CI: 2.09 to 7.64), and number of analgesic injections (mean difference [MD] = −0.79, 95% CI: −1.51 to −0.08) indicated that sexual intercourse was more effective than placebo. However, the mean expulsion time of distal ureteral stones (MD = −3.98, 95% CI: −8.77 to 0.81) showed no difference between sexual intercourse and placebo. Conclusions Compared with placebo, sexual intercourse exhibited greater efficacy for the treatment of distal ureteral stones, whilst potentially alleviating pain.
Biomechanical Comparison of 3 Novel Repair Techniques for Radial Tears of the Medial Meniscus: The 2-Tunnel Transtibial Technique, a “Hybrid” Horizontal and Vertical Mattress Suture Configuration, and a Combined “Hybrid Tunnel” Technique
Authors: Buckley Patrick S. , Kemler Bryson R. , Robbins Colin M. , Aman Zachary S. , Storaci Hunter W. , Dornan Grant J. , LaPrade Robert F. 
Published: January 2019

Background: Historically, radial meniscal tears were treated with partial or near-total meniscectomy, which usually resulted in poor outcomes. Radial meniscal tears function similar to a total meniscectomy and are challenging to treat. Repair of radial meniscal tears should be performed to prevent joint deterioration and the need for salvage procedures in the future. Purpose/Hypothesis: The purpose was to compare 3 repair techniques for radial tears of the medial meniscus: the 2-tunnel, hybrid, and hybrid tunnel techniques. It was hypothesized that there would be no differences among the 3 groups in regard to gapping and ultimate failure strength. Study Design: Controlled laboratory study. Methods: Thirty human male cadaver knees (10 matched pairs, n = 20; 10 unpaired, n = 10) were used to compare the 2-tunnel, hybrid, and hybrid tunnel repairs. A complete radial tear was made at the midbody of the medial meniscus. Repairs were performed according to the described techniques. Specimens were potted and mounted on a universal material testing machine where each specimen was cyclically loaded for 1000 cycles before experiencing a pull to failure. Gap distances at the tear site, ultimate failure load, and failure location were measured and recorded. Results: After 1000 cycles of cyclic loading, there were no significant differences in displacement among the 2-tunnel repair (3.0 ± 1.7 mm), hybrid repair (3.0 ± 0.9 mm), and hybrid tunnel repair (2.3 ± 1.0 mm; P = .4042). On pull-to-failure testing, there were also no significant differences in ultimate failure strength among the 2-tunnel repair (259 ± 103 N), hybrid repair (349 ± 149 N), and hybrid tunnel repair (365 ± 146 N; P = .26). However, the addition of vertical mattress sutures to act as a “rip stop” significantly reduced the likelihood of the sutures pulling through the meniscus during pull-to-failure testing for the hybrid and hybrid tunnel repairs (4 of 16, 25%) as compared with the 2-tunnel repair (7 of 9, 78%; P = .017). Conclusion: The results showed equivalent biomechanical testing with regard to gap distance and pull-to-failure strength among the 3 repairs. The addition of the vertical mattress sutures to act as a rip stop was effective in preventing meniscal cutout through the meniscus. Clinical Relevance: Effective healing of radial meniscal tears after repair is paramount to prevent joint deterioration and symptom development. Each tested repair showed a biomechanically equivalent and stable construct to use to repair radial meniscal tears. The authors recommend that rip stop vertical mattress sutures be used, especially in poor-quality meniscal tissue, to prevent suture cutout.
Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study
Authors: Burmann Sven Niklas , Neukirchen Martin , Ostgathe Christoph , Beckmann Mingo , Schwartz Jacqueline , Scheer Karin , Klco-Brosius Stephanie , Hense Joerg , Teufel Martin , Tewes Mitra 
Published: January 2019

Background: In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties. Objective: This pilot study aimed to evaluate feasibility of assessing palliative care knowledge (PCK) and palliative care self-efficacy (PCSE) using a paper-based questionnaire. Methods: Palliative care knowledge and PCSE were assessed by introducing a score, followed by a descriptive analysis (determination of frequency, mean, median, and range) using nonparametric tests (χ2 test, Mann–Whitney U test). Results: We assessed 17 RPs following SPC rotation and 16 board-certified specialists (BCSs) who had no experience in SPC from 3 German comprehensive cancer centers. Resident physicians were predominantly enrolled in residency programs of hematology and oncology (n = 6), anesthesiology (n = 6), and psychosomatic medicine (n = 3). Resident physicians rotated between year 1 and 8 of residency. Fifteen RPs (88%) had elected this rotation and 72% preferred 12-month duration. The total PCK score of PCK was 27 (RPs) and 24 (BCSs; P = .002). Mean PCSE scores were 46 (RPs) and 39 (BCSs; P = .016). Of 71% of RPs, only 27% of BCSs knew how support of hospice service was initiated ( P = .004). Participants rated the items as comprehensible (n = 24; 73%), relevant (n = 25; 76%) and the questionnaire as adequately long (n = 23; 70%). Conclusion: An improved PCK and PCSE were observed in physicians who rotated through an SPC unit; this resulted in an increased tangibility of local palliative care and hospice services. The questionnaire was comprehensible, relevant in terms of content, and adequate in length for a prospective multicenter survey.
Comparative Outcomes of Block and Cancellous Iliac Bone Grafting in Older Unilateral Alveolar Cleft Patients
Authors: Zhou Wei-Na , Pan Yong-Chu , Tang Yan-Chi , Hou Wei , Wu Da-Ming , Yuan Hua , Wan Lin-Zhong , Du Yi-Fei , Jiang Hong-Bing 
Published: January 2019

Objective: To compare osseous outcomes of block and cancellous iliac bone grafting in older unilateral alveolar cleft patients. Design: Retrospective and observational follow-up study. Setting: Cleft Lip and Palate Centre, Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, China. Patients: Forty-five nonsyndromic patients with unilateral complete alveolar cleft were enrolled in this study (25 patients in block bone graft group and 20 patients in cancellous bone graft group). Interventions: In cancellous bone graft group, the alveolar cleft was filled with iliac cancellous bone particulate. In group of block bone graft, the harvested bone block was trimmed and fixed in alveolar defect. Main Outcome Measures: A novel method was proposed to investigate the volume and density of residual bone graft at 1-week, 3- and 6-month, 1- and 2-year postoperatively based on cone beam computed tomography scans. Results: No difference in bone graft volume was found between 2 groups at 1-week and 3-month postoperatively; however, the residual volume of block bone graft group was significantly larger than that of cancellous bone graft group at 6-month, 1- and 2-year postoperatively. The bone density of block bone graft group was lower at 1-week and 3-month postoperatively but was comparable at 6-month, 1- and 2-year postoperatively. Our method was reliable and accurate to identify the range of residual bone graft when the boundary of grafted bone could not be identified clearly. Conclusion: Block bone graft could achieve comparable bone density and retain a greater amount of residual bone comparing to cancellous bone graft.
Ex-PRESS mini-shunt implanted in a pregnant patient with iridocorneal endothelial syndrome
Authors: Colás-Tomás Teresa , López Tizón Elena 
Published: January 2019

Introduction: The failure rate of both filtration surgery and of aqueous shunt implantation is higher for iridocorneal endothelial syndrome than in other scenarios, due to the continuous proliferation of abnormal endothelial cells over the trabecular meshwork and the filtration area and also due to the more pronounced cicatrizing response shown by these young patients. We present the first case ever described in the literature of a pregnant patient with iridocorneal endothelial syndrome and uncontrolled ocular hypertension who was implanted an Ex-PRESS mini-shunt. Clinical case: A 35-year-old female presented with diminution of vision in the left eye for 2 months. She was 20 weeks pregnant. Her visual acuity was 20/20 in right eye and 20/25 in left eye, and intraocular pressure was 11 mmHg in right eye and 34 mmHg in left eye. Slit lamp biomicroscopic examination revealed no alterations in right eye, whereas left eye showed corectopia and uveal ectropion, stroma of iris’ sectoral atrophy and moderate corneal epithelial edema. Gonioscopy showed some anterior iris synechiae in left eye. Fundus evaluation was normal. Based on clinical features and examination, the diagnosis of left eye iridocorneal endothelial syndrome with decompensated intraocular pressure was made. She was prescribed topical timolol (0.5%) and dorzolamide. As a result of uncontrolled intraocular pressure and the impossibility to prescribe other hypotensive treatment available due to her being pregnant, it was decided to perform surgery in left eye using an Ex-PRESS mini-shunt and Ologen®; 6 months post surgery, intraocular pressure was 9 mmHg with no need for hypotensive treatment. The cornea was transparent, and the patient maintained her left eye visual acuity. Conclusions: Ex-PRESS mini-shunt can be considered a surgical option for iridocorneal endothelial syndrome. Its composition allows the ostium to remain open and the device triggers a milder postoperative inflammatory response. In our particular case, taking into account that the subject was a young, phakic, pregnant woman, whose intraocular pressure had to be closely controlled and we had to ensure that her postoperative care included as few drugs and as few reoperations as possible, we thought that using this device was the most appropriate option.
Two weeks post-operative ultrasound examination of radio-cephalic arteriovenous fistulae to predict maturity in a Chinese population
Authors: Guo-Cun Hou , Yong-Hong Yan , Xiu-Li Sun , Yi Hou , Na Yin , Guo-Zhen Feng , Ai-Zhen Chen 
Published: January 2019

Aim: The aim of this study was to assess the accuracy of post-operative ultrasound examination for predicting wrist radio-cephalic arteriovenous fistula maturity. Methods: All radio-cephalic arteriovenous fistulas performed in our hospital between October 2015 and December 2017 were included in this study. Ultrasound examination of radio-cephalic arteriovenous fistulas was performed 2 weeks post-surgery. Radio-cephalic arteriovenous fistula maturation was defined as successful cannulation of a fistula with two needles, delivery of blood via the access route at a flow rate ⩾200 mL/min for 4 h, and dialysis via fistulae in at least six consecutive sessions. Results: Eighty-two wrist radio-cephalic arteriovenous fistulas were analyzed, of which 13 failed. Cephalic vein diameter >4.285 mm and brachial artery peak systolic velocity >134.75 cm/s were the best post-operative ultrasound predictors of radio-cephalic arteriovenous fistula maturity ( p < 0.001 and p = 0.011, respectively). Receiver-operating characteristic curve analysis showed that the sensitivity and specificity of predicting radio-cephalic arteriovenous fistula maturation were 88.4% and 92.3% for cephalic vein diameter (area under the curve = 0.939), respectively, and 82.9% and 76.9% for brachial artery peak systolic velocity (area under the curve = 0.830), respectively. All assessments predicted radio-cephalic arteriovenous fistula maturity (post-operative positive predictive values: cephalic vein diameter = 98.4%, brachial artery peak systolic velocity = 95%) much better than radio-cephalic arteriovenous fistula failure (post-operative negative predictive values: cephalic vein diameter = 60%, brachial artery peak systolic velocity = 45.5%). Conclusion: Two weeks after surgery, a new wrist radio-cephalic arteriovenous fistula with a cephalic vein diameter >4.285 mm was considered suitable for dialysis. A high-risk arteriovenous fistula failure would benefit from early intervention.
Buformin increases radiosensitivity in cervical cancer cells via cell-cycle arrest and delayed DNA-damage repair
Authors: Chen Ling , Zhang Ting , Liu Qiuli , Tang Mei , Yang Yu’e , Wang Yuan , Qiu Haifeng , Yu Jinjin 
Published: January 2019

Buformin is a commonly used hypoglycemic agent, and numerous studies have shown that buformin has potent antitumor effects in several malignancies. In this study, we aimed to assess the cytotoxic effect of buformin combined with ionizing radiation (IR) on two human cervical cancer cell lines (Hela and Siha). Cytotoxicity was detected by colony formation assays; impacts on the cell cycle and apoptosis were detected by flow cytometric analyses. Changes in histone H2AX (γ-H2AX) phosphorylation and impacts on the AMPK/S6 pathway were also explored. Our data show that the combination of buformin and IR had a much stronger antiproliferative effect and resulted in more apoptosis than did buformin or IR alone. Combination treatment with a low dose of buformin (10 µM) and IR (4 Gy) caused G2/M-phase cell cycle arrest. Consistent with these findings, Western blotting showed that the combination of buformin and IR activated AMPK and suppressed S6. In addition, delayed disappearance of γ-H2AX was detected by immunofluorescence in cervical cancer cells treated with buformin plus IR. Taken together, the data indicate that the combination of a low concentration of buformin and IR increases the radiosensitivity of cervical cancer cells via cell cycle arrest and inhibition of DNA repair. Based on these results, we strongly support the use of buformin as an effective agent for improving IR treatment efficiency in the context of cervical cancer. Impact statement Our idea originated in the thought of discovering new effects of old drugs. Although this study is a basic research, it is very close to clinical treatment. Flow cytometry and immunofluorescence were used to verify that buformin increases radiosensitivity. We aimed to address one of the thorniest problems in treatment process. Based on discovering new effects of old drugs, it is feasible to use buformin as an anticancer drug in clinical application. This will provide new ideas for clinical treatment.
Six-Month Freedom From Amputation Rates and Quality of Life Following Tibial and Pedal Endovascular Revascularization for Critical Limb Ischemia
Authors: Dua Anahita , Rothenberg Kara A. , Lee Jisun J. , Gologorsky Rebecca , Desai Sapan S. 
Published: January 2019

Objective: Patients with critical limb ischemia (CLI) and gangrene have a 10% to 38% rate of major amputation at 6 months. The purpose of this study is to report short- and mid-term major and minor amputation rates for patients who underwent tibial and pedal revascularization in addition to quality-of-life (QoL) scores. Methods: All patients who presented to a single institution with CLI (defined as rest pain or nonhealing wounds) and underwent antegrade or retrograde tibial access, atherectomy and angioplasty of the tibial circulation, and angioplasty of pedal circulation (antegrade or retrograde) from June 2016 to September 2017 were included. The Stark QoL questionnaire was used at each visit. Patients were scored at 1, 3, and 6 months postprocedure. Amputation rates were recorded. Results: Forty-two patients with CLI and gangrene underwent 57 peripheral interventions for limb salvage between June 2016 and September 2017. Thirty-two limbs had dry gangrene along the dorsalis pedis angiosome, 14 limbs had dry gangrene along the posterior tibial angiogram, and 11 limbs had a combined disease pattern. Twelve limbs underwent angioplasty of the superficial femoral artery (SFA), 18 limbs underwent angioplasty and stenting of the SFA, and 14 limbs underwent atherectomy, angioplasty, and stenting of the SFA. All patients had 1 or 2 tibial vessel runoff and high-grade stenosis of the pedal circulation. Immediate technical success defined as 3-vessel outflow to the foot occurred in 49 limbs (86%) with zero 30-day complications (30-day readmission, major amputation, or sepsis). Major amputation rate at 1, 3, and 6 months was 0%, 2%, and 4%, respectively. Patient satisfaction in terms of QoL increased over the 6-month follow-up period. Conclusion: Aggressive tibial and pedal revascularization may improve freedom from minor and major amputation at 6 months and may be associated with a short- and mid-term higher QoL.
Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis
Authors: Arslan M , Dedic A , Boersma E , Dubois EA 
Published: January 2019

Aims: The purpose of this study was to determine (a) the ability of serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and (b) the ability of a single high baseline high-sensitivity cardiac troponin T measurement to rule in acute myocardial infarction in patients presenting to the emergency department with acute chest pain. Methods and results: Embase, Medline, Cochrane, Web of Science and Google scholar were searched for prospective cohort studies that evaluated parameters of diagnostic accuracy of serial high-sensitivity cardiac troponin T to rule out acute myocardial infarction and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction. The search yielded 21 studies for the systematic review, of which 14 were included in the meta-analysis, with a total of 11,929 patients and an overall prevalence of acute myocardial infarction of 13.0%. For rule-out, six studies presented the sensitivity of serial measurements <14 ng/l. This cut-off classified 60.1% of patients as rule-out and the summary sensitivity was 96.7% (95% confidence interval: 92.3–99.3). Three studies presented the sensitivity of a one-hour algorithm with a baseline high-sensitivity cardiac troponin T value<12 ng/l and delta 1 hour <3 ng/l. This algorithm classified 60.2% of patients as rule-out and the summary sensitivity was 98.9% (96.4–100). For rule-in, six studies reported the specificity of baseline high-sensitivity cardiac troponin T value>50 ng/l. The summary specificity was 94.6% (91.5–97.1). Conclusion: Serial high-sensitivity cardiac troponin T measurement strategies to rule out acute myocardial infarction perform well, and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction has a high specificity.
Outcomes of Single Ventricle Patients Undergoing the Kawashima Procedure: Can We Do Better?
Authors: Alsoufi Bahaaldin , Rosenblum Joshua , Travers Curtis , Kanter Kirk , Trusty Philip M. , Yoganathan Ajit P. , Slesnick Timothy P. 
Published: January 2019

Objectives: Current technology advances in virtual surgery modeling and computational flow dynamics allow preoperative individualized computer-based design of Fontan operation. To determine potential role of those innovations in patients undergoing hepatic vein incorporation (HVI) following Kawashima operation, we retrospectively examined historic cohort of patients who underwent HVI following Kawashima with focus on regression of pulmonary arteriovenous malformations (PAVMs). Methods: Twenty-two children with single ventricle and interrupted inferior vena cava underwent Kawashima operation (2002-12). Twenty-one (96%) patients had left atrial isomerism and 21 (96%) had undergone prior first-stage palliation. Clinical outcomes were examined. Results: Mean O2 saturation (SaO2) increased from 77% ± 8% to 85% ± 6% ( P = .002) after Kawashima. Fifteen (68%) patients developed PAVMs. Eighteen patients underwent HVI (median age and interval from Kawashima: 4.4 and 3.7 years, respectively). Mean SaO2 prior to HVI was 77% ± 8% and increased to 81% ± 10% at the time of hospital discharge ( P = .250), with five patients requiring home oxygen. On follow-up, mean SaO2 increased to 95% ± 4% ( P < .001). Overall ten-year survival following Kawashima was 94%. Conclusions: A large number of patients develop PAVMs and subsequent cyanosis after Kawashima operation. Early following HVI, SaO2 is commonly low and insignificantly different from that prior to HVI. Although SaO2 will improve on follow-up in most patients, a number of patients continue to have low saturations, indicating incomplete resolution of PAVMs. Given the heterogeneity of those patients and lack of preoperative predictors for complete PAVM regression, our findings suggest a role for virtual surgery to determine optimal individual procedure design that would provide even distribution of hepatic blood flow to both pulmonary arteries.