bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of low-dose Histamine Therapy in Otolaryngology
Authors: King William P. 
Published: May 2019

Low-dose histamine therapy has been prescribed by otolaryngologists primarily to treat Bell's palsy, vestibular disorders, vascular headache, Ménière's attacks, and urticaria vasculitis. The scientific explanations for the usefulness of this once-empiric treatment are becoming more apparent. Two methods of establishing the appropriate dosages have emerged: the empiric, optimum-dosage approach and the objective, endpoint-titration approach. In this article, the author describes and recommends the latter approach. The author also reports on a 100-patient retrospective clinical study that revealed that the objective, endpoint-titration approach was effective in treating 80% of patients. In light of such success and the ease and economy of this treatment, low-dose histamine therapy appears to be a valuable clinical tool.
Phonosurgery in the Elderly: A Review
Authors: Slavit David H. 
Published: May 2019

Surgery in the elderly requires a knowledge of the changes in the larynx that take place with aging. In the elderly larynx, there are changes in the elastin and collagen fibers within the lamina propria. There is also thinning and atrophy of the mucous membranes and atrophy of the mucous glands. Common disorders are vocal fold atrophy, sulcus vocalis, glottic incompetence, and vocal fold edema. A reduction in the number of lymphatic channels is responsible for the vocal fold edema. Vocal fold atrophy is responsible for the increase in pitch that is frequently heard in elderly men. Other common conditions in the elderly include vocal fold nodules, polyps, and Reinke's edema. The most common phonosurgical procedures performed in the elderly are vocal fold surgery for benign pathology and laryngeal structure surgery for glottic incompetence. Microsurgical techniques on benign vocal fold lesions aim to avoid injury to the transitional layer, which is rich in fibroblasts. Although the superficial layer of the lamina propria involves less fibroblastic activity, any surgical manipulation of the lamina propria can influence the vibratory properties of the vocal folds, particularly when the basement membrane zone is manipulated. The alterations in phonosurgical techniques used in the elderly are the result of histologic changes in the vocal folds and altered wound healing. Functional voice disorders often develop to compensate for the structural changes in the larynx. Correction of hyperfunctional or abnormal functional technique is as important as phonosurgical correction of vocal fold pathology.
RinoFlow™ Nasal Wash and Sinus System as a Mechanism to Deliver Medications to the Paranasal Sinuses: Results of a Radiolabeled Pilot Study
Authors: Negley Judith E. , Krause Helen , Pawar Surendra , Reeves-Hoché Mary Kathryn 
Published: May 2019

Direct delivery of medication to the sinuses with standard nebulizers is difficult to achieve. The nasal inhalation of aerosolized medications is dependent on the size of the particles and the pressure with which they are delivered; when the particles are too small or the pressure is too low, the drug cannot reach the sinuses. The ability of topical medications to treat sinus disorders can be improved if the medication could be delivered directly to the sinuses. We tested the ability of the RinoFlow™ nasal aerosol delivery device to deposit aerosol directly to the paranasal sinuses. Five normal, healthy subjects used the device to administer technetium Tc 99m nasally. Nuclear scanning was used to detect deposition in the frontal and maxillary sinuses. Three subjects underwent additional testing after administration of a nasal decongestant. Three of the five subjects showed some evidence of direct delivery to the sinuses, although deposition was not uniform or complete. Pretreatment with a decongestant had no apparent effect on subsequent technetium delivery. We conclude that the results of this study are promising and that further study is warranted.
Antileukotriene Therapy for the Relief of Sinus Symptoms in Aspirin Triad Disease
Authors: Ulualp Seckin O. , Sterman Bruce M. , Toohill Robert J. 
Published: May 2019

We studied the effect of antileukotriene therapy for the relief of sinus symptoms in patients with aspirin triad disease (ATD). We reviewed the charts of 18 ATD patients who had received antileukotriene therapy. All patients had undergone previous sinus surgery. We then designed a questionnaire to determine the level of each patient's symptoms of chronic rhino sinusitis before and after antileukotriene therapy. Responses were converted to symptom scores. For each patient, the role of therapy in the relief of sinus symptoms was evaluated in three ways: by total symptom scores, by self-reports of overall benefit, and by findings on endoscopic nasal examination. Fifteen of the 18 patients completed the questionnaire. Symptom scores for both major and minor symptoms indicated that nine patients had improved following antileukotriene therapy; three other patients reported some overall benefit from therapy, despite no improvement in their symptom scores. Endoscopic nasal examination findings were consistent with the reports of overall benefit. We conclude that antileukotriene therapy is an effective treatment for most patients whose symptoms of chronic rhino sinusitis persist following sinus surgery.
Thrombosed native hemodialysis fistulas: Technical and clinical outcomes of endovascular recanalization and factors influencing patency
Authors: So Young Ho , Choi Young Ho , Oh Sohee , Jung In Mok , Chung Jung Kee , Lucatelli Pierleone 
Published: May 2019

Purpose: To evaluate the technical and clinical results of endovascular recanalization of thrombosed native hemodialysis fistula and the factors influencing patency. Methods: A retrospective study was conducted with 73 patients who had thrombosed arteriovenous fistulas and were treated with endovascular methods. Patient characteristics, arteriovenous fistula-related characteristics, and endovascular procedures were analyzed. Technical and clinical results and patency rates were evaluated. The factors influencing patency were analyzed using a univariate and multivariate Cox proportional hazards model. Results: Technical and clinical success rates were 93% (68/73) and 85% (62/73), respectively. At 3, 6, and 12 months, the primary patency rates were 87.9%, 73.3%, and 64.8%; assisted primary patency rates were 89.2%, 78.6%, and 70.7%; and secondary patency rates were 90.8%, 87.2%, and 83.1%, respectively. Previous intervention and cephalic arch stenosis were risk factors for lower primary and assisted primary patency ( p < 0.05 for all). Cephalic arch stenosis was the only risk factor for lower secondary patency ( p < 0.05). No major complications associated with the procedures were noticed. Conclusion: Endovascular treatment was effective for the immediate recanalization of thrombosed arteriovenous fistula. In addition, previous intervention and cephalic arch stenosis were significantly related to lower arteriovenous fistula patency.
Undergraduate Dermatology Medical Education: Results of a Large-Scale Patient Viewing Program
Authors: Waller Brittany A. M. , Liu Annie , Fleming Patrick , Lansang Perla 
Published: May 2019

Background: Delivering quality dermatologic instruction to medical students can be difficult; time constraints, limited clinical teachers, and a lack of standardization pose challenges. The literature suggests that many trainees and primary care physicians could benefit from increased clinical dermatology teaching. Objective: We sought to deliver and analyze the results of a large-scale patient-viewing undergraduate dermatology education program. Methods: A total of 250 third-year medical students participated in a 32-station patient-viewing program. Voluntary pre- and posttest surveys were administered to evaluate knowledge and self-perceived abilities in dermatology. The identical tests were composed of 20 multiple-choice and 5 self-perception questions. Results: The response rate for completion of pre- and posttests was 24% (N = 59). Pre- and postknowledge test score means were 69.0% and 93.20%, respectively. Pre- and post–self-perception test score means were 3.95/10 and 7.25/10, respectively. Positive student feedback was received on the patient-viewing educational experience. Conclusion: Improvements in knowledge scores and self-assessment scores support the potential integration of structured patient-viewing teaching into undergraduate dermatology medical education curricula.
Low-density lipoprotein cholesterol lowering for the prevention of cardiovascular outcomes in patients with ischemic stroke
Authors: Ntaios George , Milionis Haralampos 
Published: May 2019

Background Low-density lipoprotein (LDL) cholesterol has been long associated with the risk for ischemic stroke, myocardial infarction, and cardiovascular death. For more than a decade, the main pharmacological option to prevent stroke and myocardial infarction through LDL-cholesterol lowering was the use of statins. During the recent years, two novel classes of drugs have proven their efficacy and safety to reduce LDL-cholesterol and prevent cardiovascular events in large, well-conducted randomized controlled trials: ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Aims The present review summarizes the evidence arising from the latest trials of lipid-lowering treatment for cardiovascular outcomes prevention and discusses their implications for secondary prevention strategies in patients with ischemic stroke. Summary of review There is strong evidence which confirms the hypothesis that the lower the LDL-cholesterol, the less frequent the cardiovascular events are and underlines the importance of treating our ischemic stroke patients with intensive statin treatment aiming at low LDL-cholesterol levels. The very low levels of LDL cholesterol seem to be safe, even in the mid/long term but longer follow-up data are needed. Currently there are no tools to reliably predict cardiovascular outcomes in the specific population of ischemic stroke patients. Conclusions Stroke physicians should aim for low LDL-cholesterol levels by intensive statin treatment in all ischemic stroke patients. For those patients who are at the highest risk for recurrent stroke or another cardiovascular event and have unacceptable LDL-cholesterol levels despite intensive statin treatment, PCSK9 inhibitors should be considered.
Brain and spine melanotic schwannoma: A rare occurrence and diagnostic dilemma
Authors: Alamer Ali , Tampieri Donatella 
Published: May 2019

Purpose Melanotic schwannoma (MS) was formerly known as a rare variant of schwannoma. The behavior of MS is unpredictable, with a tendency for recurrence and metastasis. The purpose of this study was to illustrate the imaging characteristics of these rare and misdiagnosed tumors. The prognosis of MS is discussed, along with the importance of follow-up exams to assess for recurrence and metastasis. Furthermore, we compare our results with those previously published on MS in order to have a better understanding of this rare entity. Methods Three MS cases were encountered between 2008 and 2015 at our institute. All available data were reviewed, including the clinical history, imaging findings, operative notes, and the histopathology results. A follow-up magnetic resonance imaging (MRI) scan was also reviewed up to 23 months post surgery to assess for recurrence. Results Three cases of MS are included: one in the brain and two in the spine. The brain lesion was in the occipital region. The spine lesions were thoracic intramedullary and sacral intradural. All cases were hypointense on T2-weighted imaging. Gross total resection was achieved for all lesions without adjuvant therapy. To date, the brain lesion recurred 15 months after surgery. Conclusions MS is a rare and distinct entity rather than a variant of schwannoma, and it poses both diagnostic and management dilemmas. Although MS has characteristic MRI features, including T1 and T2 shortening, the preoperative diagnosis is always challenging. Accurate diagnosis is crucial for management planning, including long-term follow-up exams to assess for recurrence and metastasis.
Polypoid gallbladder tumors with a deep hypoechoic area and a conically thickened outermost hyperechoic layer suggest shallow T2 carcinoma
Authors: Fujimoto Taketoshi , Kato Yo 
Published: May 2019

Background Ultrasound findings of shallow T2 gallbladder carcinoma (GBC) with a favorable prognosis are not known. Purpose To confirm the criteria for ultrasound diagnosis of shallow T2 GBC. Material and Methods A detailed analysis of ultrasound and pathological correlation was conducted in two patients with pT1 GBC and seven with shallow pT2 GBC (subserosal-invasion depth ≤ 2 mm) at our institution from January 1988 to December 2017. Results A polypoid gallbladder tumor with a deep hypoechoic area represented a papillary adenocarcinoma invading the subserosa accompanied by abundant fibrosis and lymphocytic infiltration. Two cases of pT1 GBC did not present a deep hypoechoic area, whereas all seven cases of shallow pT2 GBC did. One case of pT1b GBC and four cases of pT2 GBC showed conical thickening of the outermost hyperechoic layer, whereas one case of pT1a GBC and three cases of pT2 GBC presented no change of the layer thickness. All shallow T2 GBCs showing a conically thickened outermost hyperechoic layer provided good postoperative prognoses. Conclusion Ultrasound images of shallow T2 GBC show a deep hypoechoic area with conical thickening or unchanging of an outermost hyperechoic layer. The former demonstrates pulling up the top of the layer at first and then thinning later as carcinoma invades with enlargement of the hypoechoic area, whereas the latter thinning of the layer from the beginning. Polypoid gallbladder tumors with a deep hypoechoic area and a conically thickened outermost hyperechoic layer suggest shallow T2 GBC and may provide good postoperative prognoses.
Do Clinical Outcomes and Sagittal Parameters Differ Between Diabetics and Nondiabetics for Degenerative Spondylolisthesis Undergoing Lumbar Fusion?
Authors: Khan Jannat M. , Michalski Joseph , Basques Bryce A. , Louie Philip K. , Chen Oscar , Hayani Zayd , Kalish Chaim , Elboghdady Islam , Colman Matthew , An Howard 
Published: May 2019

Study Design: Retrospective cohort study. Objective: To assess the effect of diabetes mellitus (DM) on clinical and radiographic outcomes in patient with degenerative spondylolisthesis undergoing posterior lumbar spinal fusion. Methods: Analysis of patients who underwent open posterior lumbar spinal fusion from 2011 to 2018. Patients being medically treated for DM were identified and separated from nondiabetic patients. Visual analogue scale Back/Leg pain and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were also collected. Results: A total of 850 patients were included; 78 (9.20%) diabetic patients and 772 (90.80%) nondiabetic patients. Final PI-LL difference was significantly larger ( P = .032) for patients with diabetes compared to no diabetes, but there were no other significant differences between radiographic measurements, operative time, or postoperative length of stay. There were no differences in clinical outcomes between the 2 groups. Diabetic patients were found to have a higher rate of discharge to a facility following surgery ( P = .018). No differences were observed in reoperation or postoperative complication. Conclusions: While diabetic patients had more associated comorbidities compared with nondiabetic patients, they had similar patient-reported and radiographic outcomes. Similarly, there are no differences in rates of reoperation or postoperative complications. This study indicates that diabetic patients who have undergone thorough preoperative screening of related comorbidities and appropriate selection should be considered for lumbar spinal fusion.
Development and external validation of 1- and 2-year mortality prediction models in cystic fibrosis
Authors: Stanojevic Sanja , Sykes Jenna , Stephenson Anne L. , Aaron Shawn D. , Whitmore George A. 
Published: May 2019

IntroductionWe aimed to develop a clinical tool for predicting 1- and 2-year risk of death for patients with cystic fibrosis (CF). The model considers patients' overall health status as well as risk of intermittent shock events in calculating the risk of death.MethodsCanadian CF Registry data from 1982 to 2015 were used to develop a predictive risk model using threshold regression. A 2-year risk of death estimated conditional probability of surviving the second year given survival for the first year. UK CF Registry data from 2007 to 2013 were used to externally validate the model.ResultsThe combined effect of CF chronic health status and CF intermittent shock risk provided a simple clinical scoring tool for assessing 1-year and 2-year risk of death for an individual CF patient. At a threshold risk of death of ≥20%, the 1-year model had a sensitivity of 74% and specificity of 96%. The area under the receiver operating curve (AUC) for the 2-year mortality model was significantly greater than the AUC for a model that predicted survival based on forced expiratory volume in 1 s <30% predicted (AUC 0.95versus0.68 respectively, p<0.001). The Canadian-derived model validated well with the UK data and correctly identified 79% of deaths and 95% of survivors in a single year in the UK.ConclusionsThe prediction models provide an accurate risk of death over a 1- and 2-year time horizon. The models performed equally well when validated in an independent UK CF population.
Cost-effectiveness of intrapleural use of tissue plasminogen activator and DNase in pleural infection: evidence from the MIST2 randomised controlled trial
Authors: Luengo-Fernandez Ramon , Penz Erika , Dobson Melissa , Psallidas Ioannis , Nunn Andrew J. , Maskell Nick A. , Rahman Najib M. 
Published: May 2019

The MIST2 (Second Multicentre Intrapleural Sepsis Trial) trial showed that combined intrapleural use of tissue plasminogen activator (t-PA) and recombinant human DNase was effective when compared with single agents or placebo. However, the treatment costs are significant and overall cost-effectiveness of combined therapy remains unclear.An economic evaluation of the MIST2 trial was performed to assess the cost-effectiveness of combined therapy. Costs included were those related to study medications, initial hospital stay and subsequent hospitalisations. Outcomes were measured in terms of life-years gained. All costs were reported in euro and in 2016 prices.Mean annual costs were lowest in the t-PA–DNase group (EUR 10 605 for t-PA, EUR 17 856 for DNase, EUR 13 483 for placebo and EUR 7248 for t-PA–DNase; p=0.209). Mean 1-year life expectancy was 0.988 for t-PA, 0.923 for DNase, and 0.969 for both placebo and t-PA–DNase (p=0.296). Both DNase and placebo were less effective, in terms of life-years gained, and more costly than t-PA. When placebo was compared with t-PA–DNase, the incremental cost per life-year gained of placebo was EUR 1.6 billion, with a probability of 0.85 of t-PA–DNase being cost-effective.This study demonstrates that combined t-PA–DNase is likely to be highly cost-effective. In light of this evidence, a definitive trial designed to facilitate a thorough economic evaluation is warranted to provide further evidence on the cost-effectiveness of this promising combined intervention.
Molecular pattern of lncRNAs in hepatocellular carcinoma
Authors: Mai Haoming , Zhou Bin , Liu Li , Yang Fu , Conran Carly , Ji Yuan , Hou Jinlin , Jiang Deke 
Published: May 2019

AbstractHepatocellular carcinoma (HCC) is one of the most notable lethal malignancies worldwide. However, the molecular mechanisms involved in the initiation and progression of this disease remain poorly understood. Over the past decade, many studies have demonstrated the important regulatory roles of long non-coding RNAs (lncRNAs) in HCC. Here, we comprehensively review recent discoveries regarding HCC-associated lncRNA functions, which we have classified and described according to their mechanism models.
Unsupervised physics-based neural networks for seismic migration
Authors: Vamaraju Janaki , Sen Mrinal K. 
Published: May 2019

We have developed a novel framework for combining physics-based forward models and neural networks to advance seismic processing and inversion algorithms. Migration is an effective tool in seismic data processing and imaging. Over the years, the scope of these algorithms has broadened; today, migration is a central step in the seismic data processing workflow. However, no single migration technique is suitable for all kinds of data and all styles of acquisition. There is always a compromise on the accuracy, cost, and flexibility of these algorithms. On the other hand, machine-learning algorithms and artificial intelligence methods have been found immensely successful in applications in which big data are available. The applicability of these algorithms is being extensively investigated in scientific disciplines such as exploration geophysics with the goal of reducing exploration and development costs. In this context, we have used a special kind of unsupervised recurrent neural network and its variants, Hopfield neural networks and the Boltzmann machine, to solve the problems of Kirchhoff and reverse time migrations. We use the network to migrate seismic data in a least-squares sense using simulated annealing to globally optimize the cost function of the neural network. The weights and biases of the neural network are derived from the physics-based forward models that are used to generate seismic data. The optimal configuration of the neural network after training corresponds to the minimum energy of the network and thus gives the reflectivity solution of the migration problem. Using synthetic examples, we determine that (1) Hopfield neural networks are fast and efficient and (2) they provide reflectivity images with mitigated migration artifacts and improved spatial resolution. Specifically, the presented approach minimizes the artifacts that arise from limited aperture, low subsurface illumination, coarse sampling, and gaps in the data.