bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Massive Iatrogenic Temporal Lobe Meningoencephalocele and Bacterial Meningitis Following Pediatric Cochlear Implant Surgery
Authors: Shave Samantha M. , Saber Camelia N. , David Abel P. , Lee Daniel J. 
Published: November 2024

Objective
To review the management of meningitis, large lateral skull base defect, and meningoencephalocele following pediatric cochlear implant (CI) surgery.

Study Design
Case report.

Methods
Patient demographics, medical and surgical history, computed tomography (CT).

Results
An 8-year-old male with congenital severe to profound sensorineural hearing loss underwent uncomplicated right CI surgery at 18 months of age. He returned to his home country and received a bilateral sequential left ear CI at age 2. Five years following his second CI surgery, he presented to his local emergency room with worsening fever, headache, back pain, and vomiting. Lumbar puncture confirmed bacterial meningitis, and he was managed with intravenous antibiotics. The hospital course was complicated by a right-sided facial nerve paresis, prompting a temporal bone CT. Imaging demonstrated a tegmen defect measuring 15 mm × 10 mm with soft tissue opacification involving the entire mastoid and CI harness. He was then referred by family back to our institution. Intraoperatively, we identified a massive temporal lobe meningoencephalocele involving the entire mastoid cavity and engulfing the entire proximal electrode harness. Following middle cranial fossa craniotomy and revision mastoidectomy, proximal and distal array were separated, encephalocele transected, and remaining temporal lobe reduced. The lateral skull base was reconstructed with calvarial bone, temporalis fascia, and bovine collagen graft. The remnant electrode array was removed, a new CI receiver stimulator was fixed postero-superiorly to the cranial defect, and a new multichannel array inserted. A titanium cranioplasty completed the repair. A lumbar drain was placed for 3 days. Recovery and CI activation occurred uneventfully.

Conclusion
Risk of encephalocele and meningitis underscores the importance of early identification, adequate repair, and long-term radiologic follow-up of iatrogenic tegmen defects during pediatric CI surgery.
Sensitivity and Costs of Intraoperative Trans-Impedance Matrix Recordings, Spread of Excitation Functions, and X-ray Imaging in Detecting Cochlear Implant Tip Foldovers
Authors: Tejani Viral , Piper Robin , Murray Gail , Manzoor Nauman F. , Mowry Sarah , Semaan Maroun , Rivas Alejandro 
Published: November 2024

Objective
Evaluate the sensitivity and financial costs of Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays in detecting cochlear implant tip foldovers

Setting
Tertiary academic medical center

Patients
113 ears of 108 patients

Interventions
Following cochlear implantation and before concluding surgery, intraoperative Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays were conducted to evaluate presence of tip foldover.

Main Outcome Measures
Presence of tip foldover; recording time necessary for and costs of Trans-Impedance Matrix, spread of excitation, and x-rays.

Results
There were six tip foldovers. Trans-Impedance Matrix showed 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predicative value in detecting tip foldovers. Spread of excitation showed 29% sensitivity, 99% specificity, 67% positive predictive value, and 95% negative predicative value. Trans-Impedance Matrix recordings were completed significantly faster than spread of excitation and x-rays. Elimination of x-rays from our intraoperative workflow results in a twofold cost reduction.

Conclusion
Trans-Impedance Matrix recordings have potential great clinical utility in evaluating proper CI placement intraoperatively and reducing costs of surgery while not compromising patient care. Given the low tip foldover rate, a multicenter study is in progress to evaluate the sensitivity, specificity, positive predictive value, and negative predicative value of Trans-Impedance Matrix in a larger dataset. This can provide better guidance to cochlear implant clinics interested in evaluating the impact of using Trans-Impedance Matrix on patient care as well as the economics of reducing use of intraoperative imaging.
Morphometric Measurements of the Incomplete Partition Type II (IP-II) Cochlea and Implications on Cochlear Implantation
Authors: Xiao Adam Y. , Saad Miryam , Fujiwara Rance J.T. , Wong Emily C. , Korte Grant O. , Sennaroglu Levent , Lopez Ivan A. , Ishiyama Gail , Ishiyama Akira 
Published: November 2024

Hypothesis
The objective of this study is to obtain comprehensive morphometric measurements of the incomplete partition type II (IP-II) cochlea to provide a better understanding of intracochlear anatomy and important considerations for electrode selection and insertion.

Background
IP-II is the most common bony inner ear malformation that often requires cochlear implantation. Currently, there is significant controversy on electrode selection due to a lack of research that can provide reliable, high-resolution measurements.

Methods
Three-dimensional reconstructions of the cochlea were made from hematoxylin and eosin–stained slides from 11 archival human temporal bones from 8 adult IP-II patients (one paired) and 2 fetuses. Detailed measurements of the angular and linear length of the spiral ganglion neurons and cochlear duct at the modiolar and lateral wall of the scala tympani as well as cross-sectional areas and vertical height measurements of the scala tympani at 90-degree intervals were measured.

Results
The spiral ganglia neurons terminated at 540.5 ± 45.4 degrees, which corresponded to the beginning of the interscalar septal defect. The corresponding Rosenthal's canal length was 12.75 ± 0.82 mm, and the lateral wall length was 23.95 ± 1.04. The average cochlear duct length was 32.44 mm ± 1.58 mm, corresponding to an average angular distance of 951.6 ± 80 degrees. The modiolar height demonstrated less variation within the scala tympani but was significantly smaller at 0 and 90 degrees compared with the normal cochlea. The lateral wall height was also significantly smaller at 0, 180, and 540 degrees. There was a drastic decrease in lateral wall height at 540 degrees to 0.4 mm, which is smaller than the apical dimension of many electrodes.

Conclusion
This is the first study to provide detailed morphometric measurements of the IP-II cochlea including spiral ganglion neuron length and scala tympani height. These measurements directly relate to electrode selection for cochlear implantation.
Perioperative nutrition in older patients: what are the priorities?
Authors: Gumuskaya Oya , Skendri Sahnoun , Birkenhead Karen , Sarkies Mitchell N. 
Published: November 2024

Purpose of review
This review aimed to synthesize recent literature on perioperative nutritional interventions for older patients.

Recent findings
This review underscores the role of comprehensive preoperative optimization, strategic use of nutritional supplements focusing on calorie, protein, and fluid intake, and active involvement of health consumers in co-designing solutions. Tools like the Geriatric Nutritional Risk Index offer a prediction value for nutrition-related complications in preoperative patients, guiding management strategies. Oral nutritional supplements, particularly those rich in protein and carbohydrates, prevent weight loss and improve functional outcomes postsurgery. However, patient satisfaction with these interventions is inconsistent and often unmeasured. Evidence suggests that prolonged fluid deprivation is harmful and preoperative hydration protocols reduce surgical stress and improve recovery outcomes. Yet, the benefit of preoperative hydration remains under-researched. Multimodal interventions for frail older adults are increasingly considered more effective than single-aspect interventions, which involve combining prehabilitation programs targeting malnutrition with smoking cessation and stabilization of preexisting conditions.

Summary
Comprehensive preoperative nutritional assessment, evidence-based interventions, and health consumer involvement are crucial for improving perioperative care for elderly patients. Implementing multimodal interventions, including nutritional support and proper hydration, can enhance recovery, reduce complications, and improve the quality of life for older surgical patients.
Competency-based medical education in interventional pulmonology: current state and future opportunities
Authors: Hostetter Logan J. , Nelson Darlene R. 
Published: November 2024

Purpose of review
This chapter examines the evolution and current status of competency-based medical education (CBME) in interventional pulmonology, focusing on procedural skills assessment and training.

Recent findings
Traditionally, interventional pulmonology training has used an apprenticeship model with case logs and director attestation, leading to inconsistent outcomes due to a lack of standardized curricula. CBME, established to address these issues, relies on outcome-based assessments to ensure trainees achieve necessary competencies. The chapter reviews various assessment tools, including global rating scales, checklists, and simulation-based methods, and their effectiveness in skill acquisition and clinical evaluation. It also covers specific procedures such as EBUS-TBNA, electromagnetic navigation bronchoscopy, and rigid bronchoscopy, discussing their assessment tools and learning curves. The chapter emphasizes the need for standardized assessment tools and suggests using entrustable professional activities (EPAs) to improve competency evaluation. Future directions include integrating real-time artificial intelligence feedback, addressing high-risk low-volume procedures, and enhancing workplace-based assessments to improve interventional pulmonology training and patient care quality.

Summary
This chapter reviews the transition from traditional apprenticeship models to CBME in interventional pulmonology, highlighting advancements in procedural skills assessment, the effectiveness of various assessment tools, and future directions for improving training and patient care.
Sarcopenia is associated with new-onset acute biliary infection within 1 year in patients with hepatitis B virus-related decompensated cirrhosis
Authors: Zhang Shuangshuang , Zhou Tian , Wu Mingbo , Xiong Xuanxuan 
Published: November 2024

Backgrounds:
Malnutrition and sarcopenia are prevalent complications in cirrhosis. The relationship between sarcopenia and biliary infection in cirrhotic patients is not well understood. Our study aims to clarify this association.

Methods:
In this study, we leveraged data from a tertiary care hospital, enrolling patients with hepatitis B virus (HBV)-induced cirrhosis from 2022. An acute biliary tract infection was defined as the onset of acute cholecystitis or cholangitis within a year. Sarcopenia was identified based on established criteria and assessed using the L3 skeletal muscle index (SMI). A multivariate logistic regression model was constructed to analyze the relationship between sarcopenia and acute biliary tract infection. Receiver operating characteristic (ROC) curve analysis and smooth curve fitting were also conducted.

Results:
This study enrolled a total of 262 patients with HBV-related cirrhosis, with an average age of 60 years and including 173 males. The primary causes for hospital admission were ascites and hepatic encephalopathy. Within the group with biliary infection, patients typically presented with higher white blood cell counts, lower platelet levels, and poorer indicators of liver and kidney function. In the multivariate analysis, after adjusting for various confounding factors, sarcopenia was associated with an odds ratio of 1.55 (P = 0.002) for acute biliary infection. Smooth curve fitting revealed an approximately linear positive relationship between L3 SMI and acute biliary infection, with the area under the ROC curve for L3 SMI reaching 0.89, indicating a strong predictive value.

Conclusion:
Sarcopenia is associated with acute biliary infection in patients with HBV-related cirrhosis.
Evaluating the Impact of a Peer Support Program on Participants’ Well-Being
Authors: Galovski Tara E. , Street Amy E. , Cooney Caroline C. , Winters Michael R. 
Published: November 2024

Background:
Loss of belongingness may be particularly pronounced for women veterans, representing a threat to long-term well-being. Improvements in social support through engagement in a structured peer support program may mitigate the negative effects of loss of belongingness on well-being.

Objective:
We assessed the impact of participation in a peer-led, structured, social support group-based network on outcomes related to well-being [i.e., belongingness, social support, quality of life, posttraumatic stress disorder (PTSD), depression]. Subgroup analyses examined relative impact among those who completed the intervention and those reporting clinical levels of PTSD and depression symptoms.

Methods:
We analyzed survey data consisting of reliable and valid measures collected at baseline, postgroup and 3-month follow-up among 393 participants in the Woven Veterans Network’s (WoVeN) group program.

Results:
We observed improvements in posttraumatic stress disorder (PTSD) symptoms over time. We observed additional benefits among those who received an adequate dose of the intervention (significant improvements on PTSD, belongingness) and those with clinical levels of mental health symptoms (significant improvements on PTSD, depression, belongingness, quality of life).

Conclusions:
Impacts on social support may have been masked due to ceiling effects given wide dispersion baseline social support in this sample. This social support network had particularly profound impacts on well-being for those veterans who suffered from conditions for which isolation and loneliness are particularly salient.
Measuring Patient Well-Being During Whole-Person Clinical Care
Authors: Etingen Bella , Cohen-Bearak Adena , Adjognon Omonyele L. , Vogt Dawne , Hogan Timothy P. , Gaj Lauren , Orner Michelle B. , Barker Anna M. , Bokhour Barbara G. 
Published: November 2024

Background:Measuring patient well-being during clinical care may enhance patient-centered communication and treatment planning. The Veterans Health Administration (VHA) piloted the use of the Well-Being Signs (WBS), a self-report measure of psychosocial well-being, in clinical care.Objective:To understand early WBS implementation and health care team member experiences with its use before developing detailed support materials and finalizing the measure.Methods:We conducted a mixed-methods evaluation of the WBS implementation pilot at 4 VHA facilities, including surveys of (n=4) Whole Health (WH) leaders/clinical leads, and semi-structured interviews with (n=11) clinical leads and team members. Survey data were characterized using descriptive statistics; interview data were analyzed using rapid qualitative analysis.Results:Facilities supported WBS implementation by disseminating information to clinical team members, primarily during staff meetings (3/4 facilities), individual discussions (3/4), and email (3/4); only half provided training sessions. In interviews, some care team members expressed the need for more training on using the WBS in clinical care. Some interviewees also provided suggestions for changes to the draft measure, including response option format and question look-back period.Conclusions:Although there have been growing calls for attention to patient well-being in clinical care, our results suggest barriers to the implementation of well-being measures in this context. Findings were used to inform the development of enhanced training materials and make modifications to enhance the acceptability of the WBS to providers. Other identified barriers will need to be addressed in future implementation efforts, including bolstering leadership support and easing the added time and burden of administration.
Veterans’ Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care
Authors: Weber Marcela C. , Jendro Ashlyn M. , Fischer Ellen P. , Drummond Karen L. , Haltom Trenton M. , Hundt Natalie E. , Cucciare Michael A. , Pyne Jeffrey M. 
Published: November 2024

Background:
Up to 50% of veterans drop out of trauma-focused evidence-based psychotherapies (TF-EBP) without completing treatment or recovering; evidence suggests this is in part because their posttraumatic stress disorder (PTSD) care is insufficiently patient-centered. There is also evidence that measurement-based care (MBC) for mental health should be personalized to the patient, yet this is not common practice in VA PTSD care.

Objectives:
To explore veterans’ experiences and preferences for aligning measurement-based PTSD care with their own treatment goals.

Method:
Qualitative interviews were conducted with veterans (n=15) with PTSD who had received at least 2 sessions of a TF-EBP.

Measures:
Survey on the administration of outcomes questionnaires and demographics and an interview about their most recent TF-EBP episode.

Results:
Half of veterans had symptom-focused goals and half did not; all had at least one treatment goal that was not symptom-focused. They typically met their goals about functioning and coping skills but not their symptom reduction goals. We found veterans overall were receptive to MBC but preferred patient-reported outcomes measures about functioning, wellbeing, coping skills, and understanding their trauma more than the commonly used PTSD symptom scale (the PCL-5).

Conclusions:
Many veterans in this sample disliked the PCL-5 because it reinforced their maladaptive cognitions. Such veterans might be more receptive to MBC if offered patient-report outcomes measures that better align with their functional and wellbeing goals. For many goal/outcome areas, psychometrically sound measures exist and require better implementation in PTSD care. For some areas, scale development is needed.
Updated diagnostic and therapeutic management for membranous nephropathy
Authors: Caravaca-Fontán Fernando , Yandian Federico , Fervenza Fernando C. 
Published: November 2024

Purpose of review
Pioneering contributions in membranous nephropathy over the last decade have greatly enhanced our comprehension of its pathogenesis, diagnosis, and treatments, igniting renewed interest in this entity. This review provides an updated perspective on the diagnosis and therapeutic management of membranous nephropathy.

Recent findings
The identification of antiphospholipase A2 receptor (PLA2R) antibodies in 50–80% of membranous nephropathy patients was a key breakthrough. High or increasing PLA2R antibody levels are linked to persistent nephrotic syndrome and the need for targeted treatment. Given the high specificity of PLA2R antibodies, a kidney biopsy may not be required for pure nephrotic syndrome cases with no comorbidities. Over the years, various target antigens and associated conditions have been identified in membranous nephropathy patients, leading to a reclassification of membranous nephropathy. Treatment approaches vary based on baseline characteristics and changes in proteinuria and PLA2R titers. Rituximab has emerged as the first-line therapy for most patients without severe risk factors, with other emerging therapies under development.

Summary
Advances in the diagnosis and treatment of membranous nephropathy have moved the management towards a more precision-based approach, though further studies and new therapies are needed for a comprehensive management strategy.
Efficacy of additional lateral pinhole and SPECT/CT imaging in dual-phase Tc-99m MIBI parathyroid scintigraphy for localising parathyroid pathologies in patients with primary hyperparathyroidism: a single-institution experience
Authors: Kesim Selin , Turoglu Halil Turgut , Kotan Tuncay , Balaban Genc Zeynep Ceren , Niftaliyeva Khanim , Toper Hasan , Gogas Yavuz Dilek , Ozguven Salih , Kaya Handan , Dede Fuat , Ugurlu Mustafa Umit , Oksuzoglu Kevser , Cagliyan Feyza , Gulluoglu Bahadir Mahmut , Ones Tunc , Erdil Tanju Yusuf 
Published: November 2024

Purpose
Parathyroid imaging with dual-phase technetium-99m methoxyisobutrylizonitrile (Tc-99m MIBI) scintigraphy serves as an important prerequisite for the identification of hyperfunctioning parathyroid gland(s) in patients with primary hyperparathyroidism (PHPT) for a successful targeted parathyroidectomy. This study aimed to evaluate the clinical value of additional lateral imaging and single-photon emission computed tomography/computed tomography (SPECT/CT) versus conventional planar imaging for locating parathyroid pathologies in patients with PHPT.

Materials and methods
A retrospective review was performed on 105 patients who underwent dual-phase Tc-99m MIBI scintigraphy and were surgically treated by parathyroidectomy. Dual-phase Tc-99m-MIBI planar scintigraphy with additional lateral pinhole views and SPECT/CT imaging was performed on a routine basis, as per departmental protocol. Comparison study between imaging modalities was done by patient-based analysis and scintigraphy results were compared with the clinical findings, biochemical markers, and histopathological findings.

Results
Sensitivity and specificity for anterior planar dual-phase Tc-99m MIBI scintigraphy were 78.8 and 80%, respectively. In comparison, lateral pinhole scan and SPECT/CT alone were found to have sensitivities of 85.9 and 90.9%, respectively, with the same specificity. Sensitivity decreased in patients with normocalcaemia and multiglandular disease. The mean adenoma weight and size for true-positive studies were significantly higher than those for false-negative or false-positive studies.

Conclusion
SPECT/CT provided the highest diagnostic accuracy for preoperative identification of parathyroid lesions in PHPT patients. Lateral pinhole imaging offers comparable sensitivity and aids in adenoma localisation when SPECT/CT is unavailable.
Comparison of surgical effectiveness: kidney sparing surgery for upper tract urothelial carcinoma
Authors: Schuil Hugo W. , Figaroa Orlane J.A. , Baard Joyce , Lifshitz David A. , Jamaludin Faridi S. , Kamphuis Guido M. 
Published: November 2024

Purpose of review
This review provides an overview of the recent publications on kidney-sparing-surgery (KSS) for upper tract urothelial carcinoma (UTUC), an alternative to radical nephroureterectomy (RNU) for an increasing number of indications

Recent findings
Recent studies highlight comparable survival outcomes between KSS [ureterorenoscopy with tumour ablation (URS) or segmental ureteral resection (SUR)] and RNU, even in high-risk UTUC patients. KSS has shown to preserve renal function without significantly compromising oncologic control in appropriately selected patients. Included literature also researched surgical complications, surveillance strategies, such as second-look ureteroscopy, and comparative cost analyses.

Summary
Over the past two and a half years, studies have emphasized the growing usage of URS and SUR in treating selected UTUC patients. Recent literature has remarkably included relatively large numbers of typically high-risk patients with features such as high-grade tumours, stage >Ta, multifocality, and hydronephrosis with acceptable results. Further research should expand on the different indications for KSS, its postoperative surveillance and comparative economic analyses.